Intimate partner violence among African American and African Caribbean women: prevalence, risk factors, and the influence of cultural attitudes.

BackgroundWomen of African descent are disproportionately affected by intimate partner abuse; yet, limited data exist on whether the prevalence varies for women of African descent in the United States and those in the US territories.ObjectiveIn this multisite study, we estimated lifetime and 2-year prevalence of physical, sexual, and psychological intimate partner abuse (IPA) among 1,545 women of African descent in the United States and US Virgin Islands (USVI). We also examined how cultural tolerance of physical and/or sexual intimate partner violence (IPV) influences abuse.DesignBetween 2009 and 2011, we recruited African American and African Caribbean women aged 18-55 from health clinics in Baltimore, MD, and St. Thomas and St. Croix, USVI, into a comparative case-control study. Screened and enrolled women completed an audio computer-assisted self-interview. Screening-based prevalence of IPA and IPV were stratified by study site and associations between tolerance of IPV and abuse experiences were examined by multivariate logistic regression analysis.ResultsMost of the 1,545 screened women were young, of low-income, and in a current intimate relationship. Lifetime prevalence of IPA was 45% in St. Thomas, 38% in St. Croix, and 37% in Baltimore. Lifetime prevalence of IPV was 38% in St. Thomas, 28% in St. Croix, and 30% in Baltimore. Past 2-year prevalence of IPV was 32% in St. Thomas, 22% in St. Croix, and 26% in Baltimore. Risk and protective factors for IPV varied by site. Community and personal acceptance of IPV were independently associated with lifetime IPA in Baltimore and St. Thomas.ConclusionsVariance across sites for risk and protective factors emphasizes cultural considerations in sub-populations of women of African descent when addressing IPA and IPV in given settings. Individual-based interventions should be coupled with community/societal interventions to shape attitudes about use of violence in relationships and to promote healthy relationships

"It Doesn't Freak Us Out the Way It Used to": An Evaluation of the Domestic Violence Enhanced Home Visitation Program to Inform Practice and Policy Screening for IPV.

The Domestic Violence Enhanced Home Visitation (DOVE) intervention used in the Perinatal Nurse Home Visiting Intervention Enhanced With mHealth Technology (RCT: R01HD071771) is a nurse-lead evidenced-based intervention that has been shown to decrease violence overtime. This summative mixed-methods impact evaluation is intended to provide insight to enhance the DOVE IPV protocol for screening and intervention by (a) identifying which core aspects of DOVE facilitated or inhibited its success and what was most critical to optimal IPV (intimate partner violence) screening and intervention practices, (b) informing how DOVE IPV screening and intervention were influenced by the experiences of home visitor (HV), and (c) identifying policy considerations and best practice recommendations for the DOVE protocol. Participants were HVs and managers (N = 13) in rural/urban home visiting programs delivering DOVE across three states. The sample had a mean age of 48.76. Three fourths were baccalaureate-prepared nurses with an average of 10.5 years of home visiting experience. The method used in this study was one-to-one qualitative in-depth interviews with HVs. Data were interpretively analyzed using Nvivo 10 to generate three themes. Participants endorsed screening women for IPV with DOVE being the approach of choice to facilitate IPV screening and intervening with women. HVs found DOVE helped enhance their IPV knowledge, screening, and intervening capabilities while filling an existing void in this type of preparation of HV nurses. Establishing a relationship with the women before initiating screening was an important aspect in delivering DOVE as was the training, support, and increased comfort level in addressing IPV. The evidence offers an understanding of which core aspects of DOVE contributed to its success and what was most critical to optimal IPV screening and intervention practices. Furthermore, this evaluation provided multilevel insights into how best to advance home visiting practices and policies when screening and intervening with perinatal women exposed to IPV

Infusing Technology Into Perinatal Home Visitation in the United States for Women Experiencing Intimate Partner Violence: Exploring the Interpretive Flexibility of an mHealth Intervention.

BACKGROUND: Intimate partner violence (IPV) is common during pregnancy and the postpartum. Perinatal home visitation provides favorable conditions in which to identify and support women affected by IPV. However, the use of mHealth for delivering IPV interventions in perinatal home visiting has not been explored. OBJECTIVE: Our objective was to conduct a nested qualitative interpretive study to explore perinatal home visitors' and women's perceptions and experiences of the Domestic Violence Enhanced Home Visitation Program (DOVE) using mHealth technology (ie, a computer tablet) or a home visitor-administered, paper-based method. METHODS: We used purposive sampling, using maximum variation, to select women enrolled in a US-based randomized controlled trial of the DOVE intervention for semistructured interviews. Selection criteria were discussed with the trial research team and 32 women were invited to participate. We invited 45 home visitors at the 8 study sites to participate in an interview, along with the 2 DOVE program designers. Nonparticipant observations of home visits with trial participants who chose not to participate in semistructured interviews were undertaken. RESULTS: We conducted 51 interviews with 26 women, 23 home visiting staff at rural and urban sites, and the 2 DOVE program designers. We conducted 4 nonparticipant observations. Among 18 IPV-positive women, 7 used the computer tablet and 11 used the home visitor method. Among 8 IPV-negative women, 7 used the home visitor method. The computer tablet was viewed as a safe and confidential way for abused women to disclose their experiences without fear of being judged. The meanings that the DOVE technology held for home visitors and women led to its construction as either an impersonal artifact that was an impediment to discussion of IPV or a conduit through which interpersonal connection could be deepened, thereby facilitating discussion about IPV. Women's and home visitors' comfort with either method of screening was positively influenced by factors such as having established trust and rapport, as well as good interpersonal communication. The technology helped reduce the anticipated stigma associated with disclosing abuse. The didactic intervention video was a limiting feature, as the content could not be tailored to accommodate the fluidity of women's circumstances. CONCLUSIONS: Users and developers of technology-based IPV interventions need to consider the context in which they are being embedded and the importance of the patient-provider relationship in promoting behavior change in order to realize the full benefits. An mHealth approach can and should be used as a tool for initiating discussion about IPV, assisting women in enhancing their safety and exploring help-seeking options. However, training for home visitors is required to ensure that a computer tablet is used to complement and enhance the therapeutic relationship. CLINICALTRIAL: Clinicaltrials.gov NCT01688427; https://clinicaltrials.gov/ct2/show/NCT01688427 (Archived by WebCite at http://www.webcitation.org/6limSWdZP)

Transforming the Healthcare Response to Intimate Partner Violence and Taking Best Practices to Scale

BACKGROUND: Intimate partner violence (IPV) is prevalent among adolescent and adult women, with significant physical, sexual, and mental health consequences. In 2011, the Institute of Medicine\u27s Clinical Preventive Services for Women consensus report recommended universal screening for violence as a component of women\u27s preventive services; this policy has been adopted by the Health Resources and Services Administration (HRSA). These policy developments require that effective clinic-based interventions be identified, easily implemented, and taken to scale. METHODS: To foster dialogue about implementing effective interventions, we convened a symposium entitled Responding to Violence Against Women: Emerging Evidence, Implementation Science, and Innovative Interventions, on May 21, 2012. Drawing on multidisciplinary expertise, the agenda integrated data on the prevalence and health impact of IPV violence, with an overview of the implementation science framework, and a panel of innovative IPV screening interventions. Recommendations were generated for developing, testing, and implementing clinic-based interventions to reduce violence and mitigate its health impact. RESULTS: The strength of evidence supporting specific IPV screening interventions has improved, but the optimal implementation and dissemination strategies are not clear. Implementation science, which seeks to close the evidence to program gap, is a useful framework for improving screening and intervention uptake and ensuring the translation of research findings into routine practice. CONCLUSIONS: Findings have substantial relevance to the broader research, clinical, and practitioner community. Our conference proceedings fill a timely gap in knowledge by informing practitioners as they strive to implement universal IPV screening and guiding researchers as they evaluate the success of implementing IPV interventions to improve women\u27s health and well-being

Strategies Pregnant Rural Women Employ to Deal with Intimate Partner Violence

This study explored strategies from the Intimate Partner Violence Strategy Index (IPVSI) that a sub-set of 20 rural, low-income, abused women of a larger, multi-site, mixed-method study employed to deal with Intimate Partner Violence (IPV) during the perinatal period. We conducted 32 in-depth interviews with women who were pregnant (N = 12) and/or three months postpartum (N = 8). We then conducted content analysis of the IPVSI strategies employed by these women to halt, escape, or avoid the violence. We found that the women used the entire IPVSI range of safety planning, resisting, placating, and formal and informal support networks to deal with abuse in their lives. The urge to protect the unborn fetus and be a good mother seemed to be the impetus for halting, avoiding, or escaping the violence

Town and gown parntnerships : improving pregnant women's safety [abstract]

In an effort to move research related to women and children experiencing violence from the university setting to the field, the DOVE study has been implemented to test the effectiveness of a structured intervention for pregnant women experiencing IPV. Using existing home health professionals, the DOVE program is directed at empowering new mothers in order to prevent their children's exposure to IPV. A town (community) and gown (academic institution) partnership was developed to assist prenatal home visiting nurses to intervene with pregnant women experiencing IPV but barriers to working together were noted. Methods and Design: Quantitative and qualitative data from surveys and focus group discussions were gathered from the home visitors during a two-day workshop. Results: Thirty-five percent of the home visitors had or were experiencing abuse. Correlation results show that HVs reports of self- or friend-experienced IPV was moderately associated with working with more abused women in their career (r=.45, p<.05) and having attended more professional trainings about IPV (r=.47, p<.05). Regression analysis was conducted to examine whether HVs practices were predicted by their experiences of IPV. Qualitative data analysis indicates that fear and stress of intervening with women experiencing IPV are the greatest barriers for the HVs intervening in the community. Conclusion: This study suggests some potential barriers for nurses working with women experiencing IPV. A town/gown partnership can facilitate a reciprocal exchange of information and bring evidence based interventions from the gown partners to practice by working with town partners

Strategies Pregnant Rural Women Employ to Deal with Intimate Partner Violence

This study explored strategies from the Intimate Partner Violence Strategy Index (IPVSI) that a sub-set of 20 rural, low-income, abused women of a larger, multi-site, mixed-method study employed to deal with Intimate Partner Violence (IPV) during the perinatal period. We conducted 32 in-depth interviews with women who were pregnant (N = 12) and/or three months postpartum (N = 8). We then conducted content analysis of the IPVSI strategies employed by these women to halt, escape, or avoid the violence. We found that the women used the entire IPVSI range of safety planning, resisting, placating, and formal and informal support networks to deal with abuse in their lives. The urge to protect the unborn fetus and be a good mother seemed to be the impetus for halting, avoiding, or escaping the violence

Town and Gown Partnerships: Improving Pregnant Women’s Safety

In an effort to move research related to women and children experiencing violence from the university setting to the field, the DOVE study has been implemented to test the effectiveness of a structured intervention for pregnant women experiencing IPV. Using existing home health professionals, the DOVE program is directed at empowering new mothers in order to prevent their children’s exposure to IPV. A town (community) and gown (academic institution) partnership was developed to assist prenatal home visiting nurses to intervene with pregnant women experiencing IPV but barriers to working together were noted. Methods and Design: Quantitative and qualitative data from surveys and focus group discussions were gathered from the home visitors during a two-day workshop. Results: Thirty-five percent of the home visitors had or were experiencing abuse. Correlation results show that HVs reports of self- or friend-experienced IPV was moderately associated with working with more abused women in their career (r=.45, p\u3c.05) and having attended more professional trainings about IPV (r=.47, p\u3c.05). Regression analysis was conducted to examine whether HVs practices were predicted by their experiences of IPV. Qualitative data analysis indicates that fear and stress of intervening with women experiencing IPV are the greatest barriers for the HVs intervening in the community. Conclusion: This study suggests some potential barriers for nurses working with women experiencing IPV. A town/gown partnership can facilitate a reciprocal exchange of information and bring evidence based interventions from the gown partners to practice by working with town partners