1. Health Care Providers and Intimate Partner Violence: Attitudes, Beliefs, and Education A Quantitative Study Ingrid Adams and Linda Stonecipher Email: iradams@comcast.net AAHPERD National Convention Baltimore, Maryland March 2007 Free Communication

2. Disclaimer While abuse is perpetrated by both genders this research concentrates on issues that affect abused women. No prejudice is intended. While abuse is perpetrated by both genders this research concentrates on issues that affect abused women. No prejudice is intended.

3. Overview of Presentation Definition of Intimate Partner Violence Definition of Intimate Partner Violence CDC CDC One women’s voice One women’s voice Purpose of study Purpose of study National Statistics (Oregon, and Local Domestic Abuse Statistics - hand outs only. Demographics of victims - prejudice & myth busters) National Statistics (Oregon, and Local Domestic Abuse Statistics - hand outs only. Demographics of victims - prejudice & myth busters) Rationale Rationale Methods Methods Results Results Questions Questions

4. 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).

5. “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

6. 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.

7. 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

8. 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).

9. 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.

10. Study Design Quantitative Study Convenience sample

11. 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

12. 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.

13. 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.

14. Results - Demographic Characteristics of Sample

15. Results - Age of Participants Gender was almost evenly distributed. No correlation between age and education

16. Results - Education Characteristics of Sample

17. Results % of Sample with at least “Little” (4 point scale) IPV Education little = brief introduction

18. Results Correlation Coefficients between Attitude Measures and Education Categories (using Pearson r for continuous data)

19. “involuntary”“voluntary”“environment” Results

20. Statistical Reliability Reliability was determined by Cronbach’s alpha. attitude reliability.83 beliefs about resources reliability.89

21. 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.

22. 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

23. 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

24. 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

25. 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!

26. 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.

27. Thesis Advisors Dr. M. Gatium Education Dr. L. Stonecipher Health & Physical Education Dr. V. Savicki Psychology Dr. Braza Health (Program Advisor)

28. 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