Article Figures & Data
Tables
Characteristic No. (%) IPV = intimate partner violence. Age (mean), y 32 Race White 16 (50) African American 16 (50) Socioeconomic status below federal poverty level48 24 (75) No health insurance 7 (22) Children Mean number of children 3, range 1–7 Age range children, y 1–26 Current pregnancy 3 Participants whose children heard or saw the abuse 31 (97) Relationship issues Average length of abusive relationship, y 6.7, range 1–28 Abusive relationship ongoing 9 (28) Previous abusive relationship 16 (50) Grew up in home with IPV, child abuse, or sexual abuse 22 (70) Tool, Processes Used to Change* Definition Physician Interventions Illustrative Quotations From Participants Adapted from Prochaska et al.40 The 10 tools or processes of change are consciousness-raising, dramatic relief, self-reevaluation, self-liberation, counter-conditioning, stimulus control, reinforcement management, helping relationships, environmental reevaluation, social liberation. IPV = intimate partner violence. * In this article we focus on the 3 tools used during precontemplation and contemplation by the person trying to change behavior. Definitions and physician’s interventions are interpreted for IPV. Quotations from our data illustrate the 3 tools. Consciousness-raising Increasing information about self and IPV Ask about IPV They (prenatal clinic) hooked me up to a stress monitor because he (abuser) gave me a concussion and they wanted to make sure that my baby was still OK …. I did let them know [about the abuse]. Share observations about the relationship Educate about the impact of stress/injuries on health Dramatic relief Experiencing and expressing emotions about IPV Empathize I had broken my finger. The physician said to me, “You can’t break your finger that way by falling. I understand being afraid.” He was real nice. I remember his name. But, he was like; “I understand fear, being afraid.” He told me his professional opinion as a doctor seeing an abused woman is that “get help, you know, get out.” Identify emotional state Self-reevaluation Assessing how one feels and thinks about the abusive relationship Clarify values I just didn’t, you know, want to have that useless, powerless feeling no more. I needed something to gain, and I knew I had to do something to change that, because where I was at was going to [nowhere] and nothing was going to change. Experiences and feelings - Table 3.
Stages of Change (Precontemplation and Contemplation) for Intimate Partner Violence with Matched Physician Interventions From Study Data and Published Guidelines
Stage of Change Physician Stage-Matched Interventions From Study Data and Rationale Additional Interventions From Published Guidelines19–21,53Interpreted for Appropriate Stage Management IPV = intimate partner violence; ADHD = attention deficit hyperactivity disorder. *Warning symptoms and conditions: injuries (ask about the mechanism of the inquiry, if mechanism does not make sense, consider probing further in a nonjudgmental manner); chronic pain (headache, abdominal pain, including irritable bowel syndrome, pelvic pain, back pain, etc); vague somatic complaints (fatigue, dizziness); mental health issues (depression, anxiety, post-traumatic stress disorder, substance abuse); abuser’s inappropriate behavior in the office.5–12 † Safety assessment: evaluate suicide oe homicide risk (victim and abuser), weapons or threat to use weapons (victim and abuser), drug and alcohol use (victim and abuser), abuse of children, abuse of pets, escalating severity of abuse, threats to life.49,54 ‡ Safety plan: where to go, important documents and items to have ready to take with such as keys, medications, children’s immunizations, money. Precontemplation: the patient-victim does not see the relationship as abusive Ask about IPV when there is an injury; ask how injury occurred Ask about IPV at the annual examination Ask during pregnancy Ask during each trimester of pregnancy Ask routinely (annual examination) and when warning symptoms and illnesses are present* Ask when warning symptoms and illnesses are present* Have and make pamphlets available. Do not spend time reviewing them in detail Ask at well-child examination and if abuse is suspected (child abuse, failure to thrive, behavior problems, school problems, ADHD/hyperactivity, depression, teen risk-taking behaviors, worried parent) Educate about the impact of IPV on the physical and mental health of the victim and her children Make pamphlets with safety plan information available in the office. Document suspicions about IPV Assess safety.† If any risk factors are present, share concerns with the patient-victim or follow mandated reporting guidelines Early contemplation: the patient-victim sees the relationship as abusive, but may choose not to share this with the physician Ask about IPV as above despite nondisclosure—women want to be screened Ask as above Listen and watch for clues (hints or evidence of abuse) Victims are observing whether physician is willing to discuss abuse Assess safety.† If any risk factors are present share concerns with the patient-victim or follow mandated reporting guidelines Discuss observations about the abuser’s controlling behavior—if physicians observe abuse, discuss concerns in private with the patient-victim Make pamphlets with safety plan information available in the office Have and make pamphlets available. Do not spend time reviewing them in detail Educate about the impact of IPV on the physical and mental health of the victim and her children Document suspicions about IPV Document subjective and objective findings Late contemplation: the patient-victim sees the relationship as abusive and is weighing the pros and cons of making a change Ask as above Ask as above Affirm abuse is occurring and that no one deserves to be abused Assess safety.† If any risk factors are present share concerns with the patient-victim or follow mandated reporting guidelines Educate about the impact of IPV on the physical and mental health of the victim and her children Consider reviewing safety plan‡ with the patient-victim, educate staff about IPV and have them review safety plan, or refer the patient to IPV agency Review local IPV crisis numbers with the patient-victim Offer to have the patient telephone the crisis number from a private room in the office Make referrals for counseling to a counselor knowledgeable about IPV for the patient or her children Document subjective and objective findings
Additional Files
Supplemental Appendix
Interview Questions
Files in this Data Supplement:
- Supplemental data: Appendix - PDF file, 1 page, .58 MB.
The Article in Brief
Physicians can assist women who experience physical abuse but are not yet ready for help by inquiring about violence, looking for clues that the patient might provide, and having resources available when the woman is ready for help.
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