Health Care Experiences of Rural Survivors of Intimate Partner Violence: Help-Seeking and Perceptions of Providers' Effectiveness

Title: Health Care Experiences of Rural Survivors of Intimate Partner Violence: Help-seeking and Perceptions of Providers’ Effectiveness

Background & Purpose: Primary health care providers have been recognized as an important source of help for battered women, and this potential may be amplified in rural areas where other resources, such as domestic violence shelters and mental health treatment, are scarce. Although national guidelines recommend that all providers screen for intimate partner violence (IPV) among their female patients, few studies have included the perspectives of rural women regarding their experiences disclosing abuse in these settings. Rural survivors of IPV have much to tell researchers and social work practitioners about the help-seeking process in under-resourced communities, whether their provider was a source of assistance during their abusive relationship, and whether their provider’s response to a disclosure of abuse (if any was made) was effective. This study sought to fill a gap in the social and health services literature describing the current rural abuse experience and survivors’ methods of help-seeking, and in so doing, provides important information on the overall quality of health care rural women receive.

Methods: Twenty semi-structured interviews with self-identified survivors of IPV who were patients of rural health clinics and/or rural federally qualified health centers in Missouri were conducted. Survivors described their abuse history and how it had affected their health and health care experiences, including whether they had ever been screened by their primary provider and what the outcome of that encounter had been. Interviews were digitally recorded and transcribed, then analyzed in NVIVO via a coding scheme incorporating major constructs of interest and themes as they emerged from the data.

Results: The majority of the survivors interviewed stated they had never been asked about IPV by their provider while a significant portion of these women believed their provider knew about the abuse but did not initiate a conversation about it. Survivors perceived their providers as not being particularly knowledgeable or helpful about IPV in all but three cases. Substance abuse, poverty, and victim-blaming attitudes were all reasons cited by survivors as to why they thought their provider did not ask about IPV or respond effectively once it had been disclosed. Ultimately, the severity of the abuse that many women reported caused state-sponsored services rather than health care providers, such as law enforcement or child welfare, to intervene.

Conclusions & Implications: Findings from these 20 interviews suggest that rural health care providers may be missing opportunities to ask women about abuse. Social workers in rural areas, particularly those working in settings addressing intimate partner or family violence, could expand their services to train and collaborate with health care providers as well as advocate for their clients seeking health care. Substance abuse and the severity of violence many rural women reported are factors that warrant a closer look by social work researchers, especially since providers were not perceived by these survivors as empathic when IPV occurred in tandem with substance abuse.