Involving the Health Care System in Domestic Violence: What Women Want

This study is an important addition to our understanding of the receptivity of women in Arab countries to screening for intimate partner violence in healthcare settings and validating the HITS cross-culturally, a critical component to building the psychometric properties of screening tools. The results indicate a strong potential for intimate partner violence screening in the primary care setting if important cultural and resource barriers can be overcome. The United States' experience of how to effectively involve the healthcare system in intimate partner violence screening offers important lessons for moving this agenda forward in Arab countries notwithstanding cultural differences between the two settings. Implementation of routine screening in the healthcare setting remains elusive in the United States despite more than four decades of national level recognition of intimate partner violence as a social ill, dedicated federal legislation to protect women in abusive relationships, endorsement of the practice by multiple health professional organizations, and the growing body of literature on the health impacts of intimate partner violence. Further, as noted by the authors, screening for intimate partner violence is not sufficient. As in the United States, evaluation of service availability and interventions to establish safety remain essential next steps. It is important to consider however, that screening tools while readily accessible and enable providers to navigate difficult questions, may not be as effective as direct questioning about abuse. Given the sub- populations cultural differences noted by authors in their study sample, it may be necessary to develop alternative screening methods rather than adapting tools developed in the United States. This may be true internationally, but also locally as we work with immigrant communities seeking care in the United States.

As identified by the women in this study, Lebanon, and other Arab countries will likely need to first raise awareness of intimate partner violence as an important public health issue, and garner support from governing bodies to create protective laws and dedicate funding for intimate partner violence-related services. This study serves as a platform for developing the culturally appropriate approach needed to deal with intimate partner violence in Lebanon and countries with similar societal structures and cultural norms. Perhaps leveraging on existing research in western literature and western approaches to screening and prevention of intimate partner violence is not applicable and even disastrous if applied in other contexts due to variations in the constructions of individualism and discrepancies in social structures. The need to identify a new approach/model to screening, prevention and treatment of intimate partner violence that is culturally appropriate and effective might be what is called for. Most successful intimate partner violence interventions are multi-disciplinary. It would be helpful to develop a deeper understanding of the key stakeholders and their roles in responding to and preventing intimate partner violence in Arab communities. Efforts to identify the key modifiable drivers of the normative underpinnings of intimate partner violence may reveal specific points of entry to address the social control at root of most violence against women. In the United States, the burden of much of this work was based in the grass-roots efforts of the women's movement, empowered by policy efforts, to ensure the rights of voting, education and financial independence for women. Arab women are the experts of their cultural strengths and limitations. We will need to leverage on the knowledge we have gained in our experiences to work closely with and help advocate for the voice of women to be heard internationally in addressing the impact of intimate partner violence and creating a universal culture of safety and prevention.

Competing interests:   None declared