Partnering with Black Intimate Partner Violence Survivors to Identify Barriers to Help-Seeking in the Healthcare and Mental Healthcare Systems

Background and Purpose: United States (US) Black women experience the poorest outcomes resulting from intimate partner violence (IPV) victimization. They are not only disproportionately murdered, but they also experience a myriad of chronic and acute physical health consequences, including a loss of consciousness, cardiovascular disease, circulatory and respiratory problems, and enduring pain. Victimization also puts Black women at elevated risk of adverse proximal and distal mental health outcomes, specifically depression, PTSD, anxiety, substance use, and suicidal ideation. Immediate engagement with formal systems of support can improve their overall wellbeing. However, Black survivors remain reticent about connecting with providers. This study employs a community partnered participatory research (CPPR) approach to examining gaps in the healthcare and mental healthcare systems for Black survivors.

Methods: Thirty in-depth, semi-structured interviews were conducted with women who have experienced a violent episode within the previous year. This study was part of a larger formative study that utilized CPPR to identify the psychosocial processes of help-seeking among US Black women IPV survivors. Purposive and snowball sampling methods were employed. Survivors who were seeking assistance from the domestic violence service provision system and/or domestic violence ministries at their church participated in the study. Data was collected during one 60-120-minute, face-to-face interview. Interviews were conducted in a private office where participants could speak freely. To further ensure survivors’ confidentiality, a Certificate of Confidentiality (CoC) was obtained from the NIH. To avoid the risk of coercion, audio recordings commenced upon obtaining participants’ approval. We used a grounded approach and constructs from the theory of help-seeking behavior for thematic analysis. Atlas.ti was utilized for data management.

Results: Findings reveal the ways that Black women believe that their interactions with providers within the healthcare and mental healthcare systems have influenced their IPV help-seeking process. Importantly, women identified the ways that their intersecting identities have influenced provider interactions. Specifically, survivors noted the ways that a confluence of structural racism and racial discrimination, along with their historical knowledge of and community’s experiences with these formal systems of support informed their sense of self-efficacy and willingness to obtain assistance during their IPV help-seeking.

Conclusions and Implications: Structural and individual-level barriers continue to preclude Black IPV survivors’ immediate help-seeking efforts. Black survivors’ negative interactions with providers and the harmful effects thereof underscore the need for continued progress toward identifying and eliminating the enduring and harmful ways that societal infrastructures continue to unduly prevent this underserved and underresourced population of survivors from more immediately obtaining crisis care. Study findings have implications for systemic reform that will improve the mental health and overall wellbeing of Black women IPV survivors.