Creating comfort: a grounded theory of intimate partner abuse survivors' perspective of primary health care visits
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Grounded theory methodology was used to develop an understanding of the experience of primary health care appointments from the perspective of survivors of intimate partner violence. English-speaking females above the age of 18, who by self-report were survivors of domestic violence, were recruited via flyers distributed at sites selected to elicit a natural variation in socioeconomic levels, ages, ethnicities, and current status of abuse. In semi-structured interviews, the 18 participants (5 African American, 9 Caucasian, 3 Hispanic, 1 Nigerian) revealed that routine health care visits, rather than being therapeutic, frequently added to their stress. These women struggled with anxiety before the appointment, disappointment with the caregiver's interaction, and frustration with the aftermath. Through constant comparative analysis of the data, “creating their own comfort” emerged as the process used by the participants to cope with primary care visits that frequently ignored or denied the violence from their partners. Fears that the abuse would be reported to authorities or that they would be negatively judged caused most participants to choose silence as their best protection. Patients who did decide to risk exposure of the violence at home were often dismissed without support. When care providers offered validation and resource information, women were often moved to take action. Many patients grieved that failure to provide information in the primary care setting contributed to the continuation of abuse, simply because they did not know their rights and options. The participants urged care providers to practice sensitive communication skills, screen all patients for intimate partner violence, and distribute written information regarding reporting laws, the impact of domestic violence on children, and local resource referrals. The proposed theory yielded many implications for change in practice, most notably that routine provision of written information may be at least as important as routine screening in breaking the cycle of abuse. This research also underscored the need for pediatricians to serve as another screening and information distribution point for intimate partner violence. Because this theory is grounded in the shared experiences of survivors of intimate partner violence, it is relevant from their point of view.