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

Jinan Usta; Jumana Antoun; Bruce Ambuel; Marwan Khawaja

doi:10.1370/afm.1336

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Figure 1
Recruitment of women from community health centers into focus groups.

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Table 1

The HITS Screening Tool for Domestic Violence in English and Arabic

HITS – English version
Please read each of the following activities and fill in the circle that best indicates the frequency with which your partner acts in the way depicted.
How often does your partner?			Never	Rarely	Sometimes	Fairly often	Frequently

1. Physically hurt you			○	○	○	○	○
2. Insult or talk down to you			○	○	○	○	○
3. Threaten you with harm			○	○	○	○	○
4. Scream or curse at you			○	○	○	○	○
HITS – Arabic version


○	○	○	○
○	○	○	○
○	○	○	○
○	○	○	○

HITS = Hurt, Insult, Threaten, Scream.
Adapted with permission from Sherin et al.³⁶

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Table 2

The Voices of Lebanese Women: Key Topics and Themes

Health care’s role in domestic violence intervention
Encouragement	“I knew I am not the first woman nor going to be the last woman to be assaulted.”
Encouragement	“I felt that I have enough courage to speak out.”
Promise of change	“A step forward to help women”
	“We should start talking about it so that we can start thinking of solutions.”
	“Break the silence.”
Feeling supported/relieved	“I feel that someone is caring.”
	“Psychological satisfaction as I got relieved from a major burden”
	“When the woman victim of violence has the courage to talk openly and frankly about what is happening in her life, she will be relieved.”
	“Her morale and psyche will be better.”
	“She has so many problems on her head and should not face them alone.”
Confidentiality	“They (health care professionals) don’t know me and this makes me feel more comfortable.”
Intrusion	“Interference in private affairs”
	“Outsiders should not get involved in personal issues.”
	“The woman should solve her problems alone.”
Shame	“I felt ashamed.”
Men’s response
Indifference	“It is the last of their worries.”
Indifference	“Even when there is infertility problem in the family, he doesn’t check himself as he thinks his manhood will be affected.”
Encouragement	“Men may look at it positively as there is a professional involvement aiming at improving his relations with his wife.”
Encouragement	“Not all men are bad; there are men who are active in community problems.”
Denial	“Men will not accept that women have started to gain rights.”
Denial	“Men like to look like angels; such a step will destroy this image.”
Increase in violence	“He may forbid her from coming to the health center.”
	“He may beat her anyway; women are not expected to make scandals and expose the house privacy.”
	“He may beat the doctor.”
Inquiry about domestic violence
First establish the physician-patient relationship	“So the woman would feel more confident talking” and “trust is being built”
First establish the physician-patient relationship	“He knows when he is not in a hurry and has enough time to listen.”
Physicians are trusted	“The doctor has seen my naked body so why can’t I talk to him about my problems?”
Physicians are trusted	“I trust my doctor more than I trust my neighbor, I talk to him and he usually guides me to what is best for me to do.”
Social workers are trusted	“She has the right to interfere in family problems.”
Social workers are trusted	”She can get into the house and the brother or husband would not feel she is against him.”
Responding to domestic violence disclosure
Support	“He can provide power and energy.”
Support	“Although he cannot abolish violence and sometimes cannot provide solutions, he can listen to her and provide her with medications that help her.”
Guidance and awareness	“The woman should find out how to solve her issues but she can refer to him for advice.”
	“Unlike other people, the doctor provides advice with care and confidence, he relieves the suffering and makes the woman feel better.”
	“He can make her aware that she is suffering from the violence she is living in because she may not recognize this.”
	“Refer [victimized women] to professional organizations or psychological support team.”
Action	”He can write a report and the aggressor can be punished.”
	“He can talk to the man and ask him why he is doing this [being violent].”
	“Communicate with the police.”
Competence is expected	“My neighbor was beaten by her brother, but in the hospital, the treating doctor did not ask her about the bruises; she was upset with the physician and felt unprotected.”
Cultural and community barriers and suggested solutions
Cultural barriers	“The society forces women to wear a mask.”
	“Culture and tradition forbid us from speaking.”
	“The way women are brought up, they are not allowed to raise their voice.”
	“Ridiculous, we are subject to insults even on the street.”
Fear of scandal	“It is not easy to face the scandal.”
Fear of scandal	“She will be the talk of the town if she speaks.”
Free or low-cost resources	“Women don’t have many resources.”
Community awareness campaign	Highlight “improving family relationships” rather than “fighting against domestic violence.”
Community awareness campaign	“Give lectures on healthy relations within the family and specifically among couples so that the violent man doesn’t feel he is being targeted.”

The Article in Brief

Jumana Antoun , and colleagues

Background Despite increasing interest in addressing domestic violence in the Arab world, research is limited. This study explores Lebanese women's opinions and attitudes about the role of primary health care clinics in addressing domestic violence.

What This Study Found Most participants encourage the health care system's involvement in managing domestic violence and consider it to be a socially acceptable way to break the silence around the issue. Participants do not believe that the health care system alone can reduce or end domestive violence and recommend community interventions, such as public awareness and media campaigns to change knowledge, attitudes, beliefs, and social norms.

Implications

This study breaks new ground by reflecting Arab women's voices about the health care system's role in identifying and intervening with domestic violence.