Rural Primary Health Care Providers' Response to Intimate Partner Violence and Survivors' Perceptions of Helpfulness.

摘要

Intimate partner violence (IPV) affects the health and mental health of many women in the United States, with some estimates projecting that one in three women will experience physical, sexual, and/or psychological abuse from a current or former partner during their lifetimes (National Intimate Partner and Sexual Violence Survey [NISVS], 2011). The problems many survivors of IPV face as they attempt to secure help and establish a life free from violence are numerous and include housing, legal, employment, medical, and other domains. Such problems are frequently compounded for survivors residing in rural areas of the U.S., where access to social services, including domestic violence shelters, is notably scarce (Iyengar & Sabik, 2009). Although many rural areas are also medically under-served, rural health care providers represent one of the front lines of helping professionals with whom abused women have semi-regular contact. Rural health care providers may thus play an important role in the identification of IPV and the assistance or referral of survivors to additional helping services. However, the ways that rural health care providers identify and respond to IPV in their resource-poor communities is not known. This dissertation research was undertaken to address a gap in the social work and public health literature regarding the management of IPV by primary health care providers, specifically rural primary health care providers, in addition to collecting information on the perceptions of helpfulness by survivors who received care from a rural provider. A mixed-methods study was conducted across rural Missouri and included surveys and interviews of rural providers and interviews with rural survivors of IPV. Overall, data indicated that rural providers are aware of IPV and view it as a problem in their communities, yet have low levels of knowledge regarding its dynamics and correlates with other problems, such as substance misuse. The lack of social, mental, and behavioral health services in many rural parts of the state also made it difficult for providers to respond effectively to the presenting concerns of their patients experiencing IPV. The majority of survivors interviewed stated they had never been asked about IPV by a primary health care provider and did not characterize their overall experience in the health care setting as helpful or effective in resolving issues related to their abuse. These and additional research findings indicate an urgent need for social workers to take an active role in health care, and that this role that may be especially meaningful for rural survivors of IPV.