BREAKING THE SILENCE - BATTERED WOMENS PERSPECTIVES ON MEDICAL-CARE

Objective: To determine the barriers to identification and management of domestic violence from the battered woman's perspective. Design: Qu alitative research method using semistructured focus groups. Setting: Urban and suburban community-based organizations serving women and the ir families In the San Francisco Bay (Calif) area. Participants: Fifty -one women with histories of domestic violence comprised eight focus g roups divided as follows: two groups of Latino (n=14), two groups of w hite (n-14), Asian (n=14), and two groups of African-American (n=9) wo men. Results: Participants from all ethnic groups identified major fac tors that affect identification and management of battered women in th e health care setting. Factors that interfere with patient disclosure included threats of violence from the partner, embarrassment, adherenc e to gender roles, concerns about police involvement, and lack of trus t in the health care provider. One factor that predisposed a woman to seek help from providers was a need for the providers to exhibit compa ssion, awareness, and respect for the patient's need to make final dec isions about her situation. Most participants said that providers shou ld rake the initiative to ask directly about domestic violence, establ ish a supportive patient-provider relationship, and refer battered wom en to available community resources. The major institutional barriers to using the health care system included the high cost of medical care and long waiting periods. Conclusions: Many battered women experience social, institutional, and provider barriers to obtaining help from t he health care system for problems related to domestic violence. Provi ders as well as institutions can overcome these barriers through an un derstanding of the social context of domestic violence and the victim' s needs. Identification may be improved through a trusting patient-pro vider relationship and by direct questioning about domestic violence.