Understanding abused women’s needs, identifying their goals and using the stages of change to enhance health professionals’ care for women experiencing intimate partner violence

Submission note: A thesis submitted in total fulfilment of the requirements of the degree of Doctor of Philosophy (by published work) to the Judith Lumley Centre, School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Bundoora.

Thesis with publications.

AIM AND BACKGROUND Intimate partner violence (IPV) is a significant contributor to the burden of disease experienced by women, their families and community. Abused women often seek assistance from health care professionals however there is an ongoing mismatch between health care women seek and receive. This research sought to understand women’s experiences of IPV-related health care and with this knowledge explored how health professionals can best support abused women. METHODS This two-part study used mixed methods. It includes situational analysis (Clarke, 2005) for qualitative analysis of interviews with abused women and multinomial logistic regression with data from an RCT (n equals 225) of a clinical intervention in primary care over two years (WEAVE) (Hegarty et al., 2010). RESULTS Qualitative: Women often reported judgmental and damaging health care experiences. Care that enhanced women’s self-esteem and self-efficacy, named experiences as IPV, and allowed women to make decisions at their own pace was reported as being most helpful. Quantitative: Prochaska and DiClemente’s (1986) stages of change can be applied to abused women’s change making behaviours and used by health professionals to evaluate and support women’s readiness and capacity for change in the context of IPV. Additionally, using women centred goals may provide a more realistic means of measuring success of IPV-related health care, especially in the short term. Depression and anxiety persisted in women for up to 2 years after ending abusive relationships, highlighting the need for longer term support. Higher levels of self-efficacy were associated with women being in later (preparation/action or maintenance) stages of change. CONCLUSION Women and their families may be better supported by health care professionals who build women’s self-efficacy and use women-centred goals. Health professionals can use stages of change to work with abused women to plan, implement and measure outcomes of health care for affected women.