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: iradams@comcast.netEmail: iradams@comcast.net

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