Intimate Partner Violence - Research Proposal Example

? Research Proposal-Intimate Partner Violence      Intimate partner violence (IPV) is a form of violence that occurs between intimate people in a relationship. IPV may affect people from all ages, gender and ethnicity, but it is notably predominant among women in relationships, with most of the perpetrators being their intimate male counterparts. Health sectors are cognizant of the dangers of IPV and they indeed note that it is a major threat to women and children’s health. IPV concerns have recently heightened with the realization that IPV is also prevalent during pregnancy. Research has shown that approximate cases of IPV during pregnancy range between1% to 20%. This situation raises further concern because some hospital and clinic-based research bids have also shown that there is an association between increased IPV risk and pregnancy. As such, it becomes necessary for the obstetric-gynecologic nursing department to make rigorous screening so as to handle the health threat posed by IPV. Research has therefore been focused on the significance, completeness, acceptability and accuracy of different screening instruments and methods. Better screening methods and approaches have been identified, but the exercise of screening has not yet attained perfection due to non-disclosure. The problem is disproportionately high among immigrant minorities and this affects implementation of intervention measures to curb IPV. In order to enhance screening there is a need to find out factors that cause non-disclosure, which in turn, affects results obtained and used in decision-making and policy formulation. The determination of these factors will be a helpful step towards finding countermeasures that will help improve the screening process. This paper proposes an approach towards solving the non-disclosure challenge and its underlying causes as well as countermeasures. Key words: Intimate Partner Violence (IPV), Immigrants, Minorities. Research Proposal-Intimate Partner Violence In the past several decades research in obstetric-gynecologic nursing has been focused on Intimate Partner Violence (IPV) screening within mainstream society as well as among immigrants from minority groups. Questions about the significance, completeness, acceptability and accuracy of different screening instruments and methods have, either indirectly or directly been the focus of obstetric research. These questions have increased awareness on IPV prevalence, accuracy of screening among various groups and optimal approaches and tools to screening of IPV in the obstetric-gynecologic field (Liebschutz & Chuang, 2002). The results from research bids elicited by such questions have informed the formulation of effective screening of IPV among various groups and appropriateness of methods applied. In spite of improving effectiveness in screening and approaches to screening, nursing practitioners in obstetric-gynecologic nursing have become cognizant of the fact that there are still many cases of ineffective screening. This occurs due to non-disclosure, which is elicited by multiple factors. Cases of ineffective screening are prevalent within immigrant and minority groups and occur to a lesser extent within mainstream populations (Kaguyutan & Shetty, 2002; Pendleton, 2003). Specific factors that influence revelation of information during screening are prominently cited in most pieces of literature on IPV. However, there is a lack of a substantial body of research into the component factors and their relative influence on information revelation during screening and the outcomes of screening. Additionally, there is no comprehensive body of research in to how the factors that influence information revelation and screening can be positively influenced to favor screening. Indeed, effectively ascertaining the significance, completeness, acceptability and accuracy of different screening instruments, is not sufficient in helping improve the screening process (Marks et al., 1998). This is because no matter how effective a certain tool or approach is to screening, there is still the human element that affects how effective the screening will be. This has not been well addressed. Problem Statement On the basis of the discussion above a two-fold problem is identifiable, and which will serve as the basis for the proposed research. As noted above and will be highlighted in the literature review, there is significant non-disclosure of truthful information on IPV. This tendency is prevalent among immigrant minorities, and it significantly affects any evidence-based assumptions inferred from IPV screening statistics (Mark et al., 1996). It also affects measures adopted thereafter in countering IPV because there is no true information. The inability to acquire truthful revelation brings about aberrations about the actual status of IPV. This eventually affects the implementation of interventions on IPV, because there is a lack of exact and true information on IPV from screening exercises. The challenge is even greater because some IPV manifestations may be hidden and not easily detectable by practitioners (Liebschutz & Chuang, 2002). Additionally, since the factors influencing non-disclosure are not well understood, it becomes challenging to make appropriate evidence-based measures to counter non-disclosure (Marks et al., 1998). This research challenge results from a lack of accuracy in evidence used in the decision-making phase, and therefore negatively impacting the assumptions made (Burns & Grove, 2009). Problem Description and How it Affects Nursing Lack of research into the factors which influence revelation of information during screening hinders the attainment of effective screening. Effectiveness in screening may only be attainable if the negative influence that the identified factors have can be countered (Liebschutz & Chuang, 2002). A number of the factors are widely mentioned in various forms of literature, but the specificity in relative influence of various factors in screening is not well researched. As such, research in to how to effectively counter their influence is also not effectively covered. This information is especially lacking when the issue of IPV is narrowly focused on immigrants in minority groups. Secondly, there is a clear lack of information on how the effect of these factors may be countered so as to facilitate better information revelation at screening. The later forms the second problem, which needs intervention after the factors influencing revelation have been identified. In essence, the effectiveness of screening can only be achieved if the screened individuals can be appropriately influenced to reveal truthful information about their lives in relation to IPV. However, before this is possible there is a need to address the gap in research on identifying the influential factors and their relative influence as well as how to counter their negative influence. IPV is recognized as a global health problem for all genders and age groups, but more so for women (Pottie et al., 2011; Montgomery et al., 2004; Webb et al., 2006). IPV significantly influences women’s health especially during their periods of pregnancy. Severe cases of IPV, which involve physical and sexual violence, are more lethal than verbal, economic, psychological or emotional abuse. These pose a threat to both the health of the expectant mother as well as the fetus (Henderson et al., 2003). Research has shown that approximate cases of IPV during pregnancy range between1% to 20%. Most of the reported cases range between 4% and 8% (Goodwin et al. 2003; Marks et al., 1996). These rates of IPV among pregnant women are worrying considering that ideally pregnant women should be cared for rather than abused or mistreated. This situation raises further concern because some hospital and clinic-based research bids have also shown that there is an association between increased IPV risk and pregnancy (Goodwin et al., 2003; Marks et al., 1996). This puts pregnant women in a state of risk, and without addressing IPV causes there is bound to be a higher rate of health complications related to IPV during pregnancy. However, addressing IPV issues is a challenge when victims are unwilling to openly confess and reveal the details about the abuse. This becomes even more challenging because some cases of IPV may not be physically evident or easily detectable through medical examinations. In fact, most cases are revealed or detected when they get out of hand. Therefore, screening loses meaning if victims cannot openly reveal IPV. Similarly, community-based interventions and policies formulated to counter IPV’s prevalence may not be effectively implemented if truthful revelation of IPV information is not attained. The interventions and policies are formulated based on data from IPV screening. However, since the supposedly high rates of non-revelation skew the true picture, interventions may not be appropriately formulated and implemented. This would eventually translate to more health complications within obstetric-gynecologic departments. There is also a high likelihood that most of these complications will be difficult to handle because they emerge when it is too late. This will most probably occur when IPV becomes physically evident and serious. Notably, in some cases IPV may persist unreported for a very long time if the perpetrator prevents the victim from seeking help. Significance of Problem/Purpose of Study The fact that IPV is a global health challenge implies that it needs to be effectively screened and prevented and treated (Montgomery et al., 2004). This can in turn, help in reducing complications associated with IPV as well as mortality among immigrant minorities. However, before this is attainable there is a need to have actual statistics on IPV prevalence and causes among these groups. This will help tailor interventions during treatment of IPV cases and preventive measures to curb IPV among these groups. Acquisition of such information relies on the effectiveness of screening (Liebschutz & Chuang, 2002). Therefore, screening methods and instruments have to be effective, and ideally the screened individuals are expected to truly reveal information about their lives. However, since this is not the case due to non-disclosure, the true statistics about IPV among immigrant minorities are not yet captured. As such, there is a need to solve the non-revelation problem so as to not only to determine the causes of non-disclosure among these groups, but also to tailor appropriate measures to enhance revelation. This will in turn help in formulating appropriate measures to enhance truthful revelation of IPV related information among women in immigrant minorities. The enhancement of revelation will ensure that the data captured during screening is true and can be reliably used in handling IPV both in preventive terms and during treatment of IPV cases (Liebschutz & Chuang, 2002). This will eventually contribute to a better handling of IPV cases, which may lead to an eventual reduction of IPV among the target population. Operational Definitions of Key Terms Intimate Partner Violence (IPV)-IPV denotes any form of violence against close or intimate family members. However, in this proposal the definition will be strictly restricted to violence against the female gender (Acosta, 2011). Violence-Violence in this case is defined as any act or threat of sexual or physical assault against women and perpetrated by their former or current intimate partners and spouses. Minorities- These are sociological groups of people within a demographic region. The groups are defined by the social majority within society and the differentiation characteristic is specifically based on ethnicity in this proposal. Immigrants- Immigrants are people who come to live in a foreign nation on a permanent basis either legally or illegally. Statement of Purpose/Aims and Objectives The purpose of the proposed study shall be the identification of factors that prevent full disclosure of IPV related information during screening. This will be aimed at determining an evidence-based approach to the formulation of interventions that can enhance full disclosure. Specifically, focus will be on two primary objectives: To determine causes of non-disclosure by type among the selected population. To determine the relative influence of various factors implicated in non-disclosure. In addition, simple knowledge on causal relations is not sufficient in solely solving the challenge; there will be a need for a third, secondary objective. This secondary objective will make the research complete and valuable by linking to the development of a solution to non-disclosure. To determine possible ways and means to counter the effect of factors that lead to non-disclosure. Literature Review Intimate Partner Violence denotes violence perpetrated among people with intimate relations. Under general circumstances IPV encompasses domestic violence, family violence and even elder abuse. In most cases IPV is used interchangeably with domestic violence. In the United States, an estimated 1 million cases of domestic violence are reported in a year. However, estimates place the actual number of IPV cases at about 4 million. The disparity between the actual numbers of IPV cases and the reported cases result from the fact that a large number of these cases go unreported. IPV affects all genders and ages, but women make up an estimated 85% of the victims. An estimated 10% to15% of the total victims are male, but most of them are from gay relationships. Women exposed to IPV encounter many negative consequences including physical injury, emotional and psychological problems as well as depression and suicidal ideation (Kim & Cho, 2012). A number of women also die due to injuries that result from IPV. IPV presents a significant challenge at pregnancy among women because of the precarious nature of their state. Research shows that an estimated 15% of females experience intimate partner violence (Webb et al., 2006). Estimates on research also show that 1% to 20% of pregnant women experience intimate partner violence. A large number of the research bids conducted reported rates ranging between 4% and 8% (Goodwin et al., 2003; Marks et al., 1996). These findings imply that there is significant number of pregnant women that suffer from physical, emotional and psychological trauma, which is detrimental to their health and that of their expected children (Campbell, 2002). As such, it becomes necessary to conduct screening during regular clinic visits for expectant women. Screening helps nurses in obstetrics in detecting cases of IPV in women and in implementing treatment for IPV-related injuries as well as emotional and psychological problems. A number of methods including computerized and printed questionnaires as well as face-to-face interviews have been used in screening. The responsiveness of the screened women has shown variation based on the method used. The findings show that most women prefer self-administered methods, which include computer or printed questionnaires as compared to face-to-face screening. Contrastingly, some women seem to be more responsive when directly asked questions on IPV by a medical practitioner. The differences in responsiveness and disclosure of IPV-related information are, therefore, influenced by the screening tools and methods applied. Research in this area has shown that self-administered approaches to screening are highly likely to increase levels of disclosure or truthfulness in responding to IPV-related questions. Similar research efforts on the same have all been aimed at identifying the best approach towards improving disclosure during screening (Wathen & McMillan, 2003). In essence, the selection of an appropriate screening method is likely to improve disclosure, which will in turn permit better treatment and response to the problem. In spite of understanding the significance, completeness, acceptability and accuracy of different screening instruments and methods the highest level of level of disclosure has not been attainable. Notably, the levels of non-disclosure are highest among immigrant women in minority groups. Although IPV affects all women from different ethnic backgrounds, races and socioeconomic classes, women in the minority populations suffer from IPV at disproportionately high rates. According to the Women of Color Network (WOCN) IPV rates are 35% higher among women of color when compared to white women (Marquand, 2010). Surprisingly, women from these minority groups, especially illegal immigrants are less likely to seek social services or medical care for trauma resulting from IPV (Marquand, 2010; Kim & Cho, 2012). This may be a result of multiple factors including fear, economic dependency, legal status of citizenship, cultural inclinations, language barriers and lack of knowledge on the legal system-just to mention, but a few. Immigrant minorities often fail to disclose IPV-related violence and remain in relationships characterized by various forms of violence because of the status of their citizenship. Immigrant minorities often have no financial security due to lack of jobs. As such, these women are often dependent and fear leaving their abusive male partners because of fear of losing financial support. The dependency also affects disclosure because victims are often less likely to disclose information on IPV if it concerns supportive partner (Campbell & Adames, 2005). Women in the illegal immigrants’ category fear possible deportation. As such, most of them fear disclosing IPV because in the process, their citizenship status may be revealed. Additionally, perpetrators are often aware of such fears and thus exploit the fears by threatening the victims so as to ensure that they stay silent about the violence (Kaguyutan & Shetty, 2002; Pendleton, 2003). The lack of disclosure of information creates a lack of knowledge and a significant challenge in the bid to understand IPV and formulate strategies and policies to curb it. The situation becomes even more challenging considering the fact that at times it is not possible for nursing practitioners to recognize the manifestations of IPV. Unfortunately, various manifestations are not physically visible and may be hidden from the nursing practitioners (Acosta, 2011). Therefore, in spite of making sure that appropriate screening methods and tools are used, it is still not possible to acquire reliable statistics from screening. As long as gaps in disclosure still exist the obtained results are never a true representative of the situation within the screened populations. Therefore, there is a need for measures other than the application of the accurate and appropriate screening methods so as to attain a clearer understanding in tackling IPV. This is when it becomes necessary to look into factors that influence disclosure so as to create better understanding on why most immigrant minorities are unable to disclose information IPV. The research into factors that affect disclosure will not only create a clear understanding of the influencing factors, but also their relative weight of influence within the designated population. Additionally, the research will also be able to seek answers as to what would be done so as to eliminate the negative influence from these factors. For example, if economic dependency and citizenship status were the two most influential factors in non-disclosure, then, what would be done to eliminate or mitigate their negative influence within the population? This would be a question directed at the victims that identify a particular factor as their impediment to disclosure. Apart from sampling the victims’ information on the factors influencing non-disclosure, they will also get a chance to constructively contribute to suggestions on how to change the situation. After capturing sufficient data from victims of IPV, it would also be prudent to seek information from experts on how to eliminate the negative influence of the identified factors. The professionals may be sampled from the field of social work, law and Obstetrics. Once this information is acquired nursing practitioners in obstetrics will be able to improve their screening by first implementing steps that can counter non-disclosure (Liebschutz & Chuang, 2002). Additionally, they will probably be at a better position to improve the screening tools and methods. The improvements may enable them to capture truthful information on IPV from individuals that may not be willing to disclose information. This will positively influence the efficiency of the screening tools and improve the screening process as well as make the acquired information more reliable and valid (Wathen & McMillan, 2003). Reliable and valid information is very essential in making any clinical policies and decisions, and it improves practice because the decision or policy making is evidence-based (Burns & Grove, 2009). References Acosta, D. (2011). Intimate Partner Violence and Hispanic/Latina Women. Retrieved from http://faculty.washington.edu/dacosta/HHP/module3/ipv.html Burns, N., & Grove, S.K. (2009), The Practice of Nursing Research: Analysis, Synthesis and Generation of Evidence (6th Ed.). St. Louis, MO: Saunders Elsevier. Campbell, J. C. (2002). Health consequences of intimate partner violence. Lancet; 359 (1), 1331–1336. Campbell, R., & Adames, S. B. (2005), Immigrant Latinas’ conceptualization of IPV. Violence against Women Journal, 11(10), 1341-1364. Goodwin, M.M., Gilbert, B. C., Johnson, C. H., & Saltzman, L.E. (2003), Physical abuse around the time of pregnancy: an examination of prevalence and risk factors in 16 states. Maternal and Child Health Journal, 7 (1), 31-43. Henderson, A. D., Critchlow, C. M., Emanuel, I., Sugg, N., K. Holt, V. L., & Janssen, P. A. (2003).Intimate partner violence and adverse pregnancy outcomes: a population-based study. American Journal of Obstetrics & Gynecology; 188(5), 1341–7. Kaguyutan, J., & Shetty, S. (2002). Immigrant victims of domestic violence: Cultural challenges and available legal protections. Retrieved from http://new.vawnet.org/Assoc_Files_VAWnet/AR_immigrant.pdf Kim, J. W., & Cho, H. (2012), Intimate Partner Violence among Asian Americans and Their Use of Mental Health Services: Comparisons with White, Black, and Latino victims. Journal Immigrant Minority Health, 14 (5), 809-15. Liebschutz, J. M., & Chuang, C. H. (2002), Screening for intimate partner violence in the primary care setting: a critical review. Journal Clinical Outcomes Management, 9(10), 565-71. Mark, J. S., Saltzman, L.E., Ballard, T. J., Spitz, A. M., Lazorick, S., & Gazmararian, J. A. (1996). Prevalence of violence against pregnant women. The Journal of the American Medical Association, 275 (24), 1915-1920. Marks, S. J., Lazorick, S., Spitz, A. M., Gazmararian, J. A., Saltzman, L. E., & Ballard, T. J. (1998), Violence during pregnancy: measurement issues. American Journal of Public Health; 88 (2), 274-276. Marquand, B. (2010). Minority Women and Intimate Partner Violence: Nurses can play an important role in developing culturally sensitive interventions to help victims of physical, sexual and emotional abuse. Retrieved from http://www.minoritynurse.com/minority-health/minority-women-and-intimate-partner-violence Montgomery, M. J., & Duran, M. B., & Malcoe, H. L. (2004). Socioeconomic disparities in intimate partner violence against Native American women: a cross-sectional study. BMC Medicine, 2 (20), p. 1-14. Pendleton, G. (2003). Ensuring fairness and justice for noncitizen survivors of domestic violence. Retrieved from http://iwp.legalmomentum.org/reference/additional-materials/family-law-for-immigrants/civil-justice-system/RSRCH_DV_Ensuring_Fairness.pdf/view Pottie, K., Ueffing, E., Feightner, J., Kirmayer, J. L., Rousseau, C., Thombs, D.B., & Hassan, G. (2011). Intimate partner violence: evidence review for newly arriving immigrants and refugees. Retrieved from http://www.cmaj.ca/content/suppl/2010/06/07/cmaj.090313.DC1/imm-ipv-13-at.pdf DOI 10.1503/cmaj.090313. Wathen, C., & McMillan, H. (2003), Violence against women: integrating the evidence into clinical practice. Canadian Medical Association Journal, 169 (6), 570–571. Webb, M., Lent, B., Worster, A., McNutt, L., Boyle, M., Jamieson, E., Wathen, N. C., & McMillan, L. H. (2006). Approaches to Screening for Intimate Partner Violence in Health Care Settings: A Randomized Trial FREE. The Journal of the American Medical Association, 296 (5), 530-536. Read More