Addressing and identifying barriers : intimate partner violence

PLEASE NOTE: This work is protected by copyright. Downloading is restricted to the BU community: please click Download and log in with a valid BU account to access. If you are the author of this work and would like to make it publicly available, please contact open-help@bu.edu.Thesis (DScD) --Boston University, Henry M. Goldman School of Dental Medicine, 2011 (Department of Health Policy and Health Services Research).Includes bibliographic references: leaves 129-134.BACKGROUND: Intimate partner violence (IPV) is an important public health issue which has serious mental and physical health effects on victims. Identifying and addressing barriers to seeking help will minimize these devastating consequences. OBJECTIVES: 1) To pilot test the effect of a motivational interviewing (MI) intervention on increasing safety behavior and reducing risky behaviors of IPV victims in a dental setting. 2) To estimate IPV prevalence, test the knowledge, and determine barriers for Muslim women seeking help from services in Massachusetts. METHODOLOGY: The first objective used a randomized controlled trial pilot study to test Ml in a dental setting. Twenty-two women were randomized (intervention (N=12), control (N=10)). Both groups were screened for lPV and eligible, consenting women completed a survey at baseline and another at one month follow-up. The intervention group received a 45-minute intervention and both groups received $85 dollar remuneration. To achieve the second objective, an exploratory mixed-methods study assessed the need for Muslim-specific IPV services in Massachusetts. Convenience and snowball sampling techniques were used to collect the data at Muslim gatherings and locations using a paper-based survey, and through email using a Web-based survey. RESULTS: The MI pilot study resulted in fewer sad days in the intervention group (mean-diff[plus or minus]SD=-1.4[plus or minus]6.9) compared to the control group (mean-diff[plus or minus]SD=7.3[plus or minus]4.04). At one month, the intervention group were more likely to increase their grab bag safety behavior compared to the control group. The intervention group experienced less abuse at one month post-baseline (baseline=92%, follow-up=67%), whiIe the control group’s abuse experience increased (baseline=50%, follow-up=70%). The Muslim women’s needs assessment study revealed an abuse prevalence of 44.3%, with 26.1% reporting severe abuse. Multivariate modeling predicting agreement with killing the wife when suspecting adultery showed that for every year increase in time lived in the US, women were 30% more likely to identify this statement as abuse (OR=1.3, p-value=0.004). The multivariate model predicting agreement with seeking outside help as last option showed that religiously observant women had a 20% increase in agreement with this statement compared to less observant women (OR=1.2, p-value=0.02), and Arabs were almost 22 times more likely to agree compared to non-Arabs (OR=21.9, p-value=0.002). The model predicting abuse score showed that for every unit increase in religious observance, abuse score increased by 20%. Muslim specific barriers included not feeling that the shelter would understand their religious background, and that shelter personnel wouldn’t understand the complexity of the Muslim situation. CONCLUSIONS: Positive patterns were noticed after the MI intervention such as reductions in depression frequency, increased safety behavior, and decreased abuse experience. The prevalence of abuse in the MA Muslim women population is lower than in other studies, but it is still high. Religious observance was a statistically significant, but not a strong predictor of preferences for services used, and abuse score. A team approach of social, legal, and healthcare services is needed to minimize the devastating effects of IPV