health care providers and intimate partner violence: attitudes, beliefs, and education a...
TRANSCRIPT
Health Care Providers Health Care Providers
and Intimate Partner and Intimate Partner
Violence: Attitudes, Beliefs, Violence: Attitudes, Beliefs,
and Education and Education
A Quantitative StudyA Quantitative Study
Ingrid Adams and Linda StonecipherIngrid Adams and Linda StonecipherEmail: [email protected]: [email protected]
AAHPERD National Convention AAHPERD National Convention
Baltimore, MarylandBaltimore, Maryland
March 2007March 2007
Free CommunicationFree Communication
Disclaimer Disclaimer
While abuse is perpetrated by both While abuse is perpetrated by both genders this research concentrates genders this research concentrates on issues that affect abused women. on issues that affect abused women. No prejudice is intended. No prejudice is intended.
Overview of Overview of PresentationPresentation Definition of Intimate Partner ViolenceDefinition of Intimate Partner Violence
CDCCDC One women’s voiceOne women’s voice
Purpose of studyPurpose of study National Statistics (Oregon, and Local National Statistics (Oregon, and Local
Domestic Abuse Statistics - hand outs only. Domestic Abuse Statistics - hand outs only. Demographics of victims - prejudice & myth Demographics of victims - prejudice & myth busters)busters)
RationaleRationale MethodsMethods Results Results Questions Questions
Definition of Term IPV - CDC
The US Center for Disease Control (CDC) has defined
domestic abuse as Intimate Partner Violence (IPV). Such violence is perpetrated in a relationship between present or past intimate partners. It is the act or the intention to
inflict harm. Abusers seek to control, intimidate, or humiliate their victims. Abuse may be physical, sexual or psychological in nature (Oregon Department of Health and Human Services,
2003).
“Place a frog into a pot of cold water with the heat on low. The frog never makes the connection to danger because the water heats slowly over time. Unable to identify the danger the animal does not jump out. The frog will eventually die, shriveled by the heat carefully managed a fractional degree at a time. That is the work of an effective abuser. Bruises are explained in terms of bumps against a post, headaches from slaps, or pulling of hair become hormone related issues, and so on. If the bubble of abuse is not exploded by a tragic event in life, or slowly punctured over time by compassionate inquiry from friends, family, or medical providers, the woman, like the frog will slowly die. Not necessarily a physical death. Worse, she will die a psychological death. The work of the abuser is now only routine maintenance.”
An abused women’s metaphorical definition
Purpose of Study Investigate the relationship between:
Health care provider’s attitudes about female victims of IPV,
the provider’s attitudes about his or her role in the intimate relationship of patients, and
the provider’s education pertaining to intimate partner violence in defined contexts.
Also measured was the role clinic support plays in providers’ attitudes about female victims of abuse.
Rationale Physical health risks to abused women:
Physical injuries with long term consequences Post traumatic stress disorders Metabolic disorders Pre-natal health problems/risk to fetus
Long term psychological risks to abused women: Shatters self-esteem Shatters self-concept Depression
Health risk to children living with domestic violence: Psychological and physical risks Risk of becoming perpetrator or a victim of abuse as
adult
National Statistics
Intimate Partner Violence (IPV) ended the lives of: 61,593 US individuals between the
years 1976 and 2002. 38,662 were Femicide – murder of
women. (U.S. Department of Justice, 2004).
National Statistics Data from the National Violence Against
Women Survey and the CDC estimates that: 5.3 million IVP victimizations per year in
the US (CDC, 2003). 2.0 million women are injured. 550,000 women require medical attention. 8.0 million paid work days are lost 5.6 million days of domestic productivity are
lost.
Study Design
Quantitative StudyConvenience sample
Study Design - Research Variables
Four Education Categories Pre-service In-service (internship/residency, grand-rounds, current
practice) Continuing Education Self-directed Education
Three Attitude Measures Total Attitude – all attitude questions Non-blaming Active Role of the Provider (in the intimate relationship of
abused patients Additional Data
Attitude about the perceived support providers receive in their clinic of practice
Study Design - Research Variables - Education
Pre-service education data were collected in: University semester hours and quarter system credit hours. Semester hours were later articulated into quarter hours at 1.5 quarter hours equal
to 1 semester hour.
In-service education data and self-directed education data were measured on a 4-point scale and operationalized:
None; little (brief introduction) moderate amount (little plus brief discussion) a great deal (thorough introduction and in-depth discussion)
Continuing education (CEC/CME) were measured on a range from: None; 2-4hrs; 4-6 hrs; 6>hrs.
Methods - Data Collection
I met with 16 clinic administrators. I met with two Women Crisis Shelter
Directors, phoned two others. Ultimately distributed 166 surveys in 16
clinics RR 43%, N=71. Approx. 40% of independent clinics not
associated with major HMO in area. Approx. 80% of independent primary care
clinics in area.
Results - Demographic Characteristics of Sample
Characteristics n %
GenderFemale 34 48Male 37 52
DegreeMD 44 62PA 6 8NP 14 20Other 7 10 (multiple Degrees)
Personally knowing a Victimyes 21 30no 50 70
Results - Age of Participants 25
20
15
10
5
20-30 31-40 41-50 51-60 61 +
Age of Participants
Freq
uenc
y
Std Dev = 10.19
Mean = 47.6
N = 71
Gender was almost evenly distributed. No correlation between age and education
Education Characteristics n %
1) Pre-Service EducationQuarter System Credit Hours
0 57 801 to 5 10 146 to 12 4 6
2) In-Service Education Grandrounds
None 29 41Little 33 46Moderate Amount 5 7Great Deal 0 0
Internship/ResidencyNone 27 38Little 30 42Moderate Amount 9 13Great Deal 0 0
Current Practice SettingNone 37 52Little 23 32Moderate Amount 9 15Great Deal 0 0
3) Continuing Medical Education (CME)None 44 622hrs> 16 224hrs> 6 96hrs> 5 7
4) Self-Directed EducationNone 11 16Little 41 58Moderate Amount 18 26Great Deal 1 1
Results - Education Characteristics of Sample
Results% of Sample with at least “Little” (4 point scale) IPV Education
little = brief introduction
100
60
40
20
0
20%
% o
f sa
mpl
e w
ith a
t lea
st "
little
" ed
ucat
ion
In-service
8084%
Self-directed
51%
Pre-service
38%
CEC/CME
ResultsCorrelation Coefficients between Attitude Measures
and Education Categories (using Pearson r for continuous data)
Attitude Types
Mean SD Total Attitude Non-blaming Active Role of ProviderAttitudes
Attitude Total 88.11 8.96
Non-blaming 28.52 4.49
Active Role 59.59 5.71
Education Categories
Pre-service 0.81 2.07 0.13
In-service 6.27 2.06 .37**
Continuing Education (CEC/CME) 1.66 0.94 .43**
Self-directed 2.13 0.68 .51**
Other Variables of InterestClinic Support 23.46 6.45 .63**
Age 47.61 10.19 -0.16
Gender -0.17
**p <.01, *p <.05
.62**
0
-0.08
0.12
0.18
.26**
.33**
.46**
-.33**
-0.22
0.12
.43**
.48**
.54**
Pears
on
r C
orr
ealt
ion C
oeff
icie
nt
Correlational Coefficients Between Education Categories, Clinic Support and Overall Attitude.
0.43
Pre-service
In-service
Self-directed
0.63
0.51
0.13
0.37
Support
0.35
0.00
CEC/ CME
1.00
0.65
“involuntary” “voluntary” “environment”
Results
Statistical Reliability Reliability was determined by Cronbach’s
alpha. attitude reliability .83 beliefs about resources reliability .89
Discussion Results of the statistically significant relationships suggest:
More education about a phenomena may lead to more positive attitudes.
Positive attitudes inspire more education i.e. - as this study suggest in results of self-directed education.
The possibility might exist that individual curiosity about social phenomena or social consciousness, altruistic attitudes, may influence positive attitudes and inspire education.
Discussion The statistically significant results offer several
avenues where domestic violence crisis shelters may address their lobby for IPV education of Health Care Providers: IPV Education of Clinic Administrators Education of Individual Physicians Continuing Medical Education Institutions Medical Schools
Discussion Results of relationships between pre-service education
and attitudes are not statistically significant. These results open the door of opportunity to critically
explore where this education takes place. Oregon has many regarded higher education
institutions. Attending these are: Future medical care providers Future political governing bodies Future business leaders Future partners in Intimate Relationships Future educators
Recommendations Core curricula in all pre-service and in-service
institutions should include education on: What is spouse abuse Roots of violence in intimate relationships The role of social prejudice in partner violence The role of theology in partner violence How can a victim identify the slide into acceptance Critical self-knowledge of behaviors and mood states Tools for healthy relationships Social consequences of violence present and future
What abused women ask of us? In the Qualitative Study (n=8) for ED534M I learned
Abused Women face many hurdles on their path toward a life without violence.
Abused Women count two major support networks: Formal – Health Care Providers, Legal System,
Judicial System Informal – Friends, Family, Clergy
Abused Women ask to please trust in their decisions however unreasonable they seem.
Abused Women asked for absolute confidentiality and anonymity from both networks.
Their life as well as their children’s life may depend on it!
Limitation of the Study Convenience sample As a quantitative study with close-ended questions, this research
is limited to the extent to which attitudes can be studied. Qualitative study may examine deeper issues of attitudes and
also examine the education physicians feel they may need to assist female victims of spouse abuse.
It is difficult to define the construct of education. While great efforts were made to define education, this limitation is acknowledged.
Thesis Advisors Dr. M. Gatium Education
Dr. L. Stonecipher Health & Physical Education
Dr. V. Savicki Psychology
Dr. Braza Health (Program Advisor)
Our life is the instrument with which we experiment with the truth.
Thich Nhat Hanh
This Thesis is Dedicated To:
Annemarie Gregory and her physician
Frau Dr. Mez. Lindeman