Select Journal or Resource JAMA & Archives Home JAMA Archives of   Dermatology   Facial Plastic Surgery   Family Medicine (1992-2000)   General Psychiatry   Internal Medicine   Neurology   Ophthalmology   Otolaryngology—Head & Neck Surgery   Pediatrics & Adolescent Medicine   Surgery JAMA-français JAMA & Archives CME Calendar of Events Physician Jobs For The Media Users’ Guides to the Medical Literature Peer Review Congress Student JAMA (1998-2004)

	Welcome   | My Account | E-mail Alerts | Access Rights | Sign In Vol. 5 No. 3, March 1996   Archives  •  Online Features ARTICLE  This Article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal Breaking the silence. Battered women's perspectives on medical care M. A. Rodriguez, S. S. Quiroga and H. M. Bauer Department of Family and Community Medicine, University of California-San Francisco, USA. OBJECTIVE: To determine the barriers to identification and management of domestic violence from the battered women's perspective. DESIGN: Qualitative research methods using semistructured focus groups. SETTING: Urban and suburban community-based organizations serving women and their families in the San Francisco Bay (Calif) area. PARTICIPANTS: Fifty-one women with histories of domestic violence comprised eight focus groups divided as follows: two groups of Latino (n=14), two groups of white (n=14), Asian (n=14), and two groups of African-American (n=9) women. RESULTS: Participants from all ethnic groups identified major factors that affect identification and management of battered women in the health care setting. Factors that interfere with patient disclosure included threats of violence from the partner, embarrassment, adherence to gender roles, concerns about police involvement and lack of trust in the health care provider. One factor that predisposed a woman to seek help from providers was a need for the providers to exhibit compassion, awareness, and respect for the patient's need to make the final decisions about her situation. Most participants said that providers should take the initiative to ask directly about domestic violence, establish a supportive patient-provider relationship, and refer battered women to available community resources. The major institutional barriers to using the health care system included the high cost of medical care and long waiting periods. CONCLUSIONS: Many battered women experience social, institutional, and provider barriers to obtaining help from the health care system for problems related to domestic violence. Providers as well as institutions can overcome these barriers through an understanding of the social context of domestic violence and the victim's needs. Identification may be improved through a trusting patient-provider relationship and by direct questioning about domestic violence. THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES "You're Not a Victim of Domestic Violence, Are You?" Provider Patient Communication about Domestic Violence Rhodes et al. ANN INTERN MED 2007;147:620-627. ABSTRACT | FULL TEXT   Randomized Comparison of 3 Methods to Screen for Domestic Violence in Family Practice Chen et al. Ann Fam Med 2007;5:430-435. ABSTRACT | FULL TEXT   Screening for Intimate Partner Violence: The Impact of Screener and Screening Environment on Victim Comfort Thackeray et al. J Interpers Violence 2007;22:659-670. ABSTRACT   Evaluating the cultural validity of the stressful life events screening questionnaire. Green et al. Violence Against Women 2006;12:1191-1213. ABSTRACT   Factors influencing help-seeking from informal networks among african american victims of intimate partner violence. Morrison et al. J Interpers Violence 2006;21:1493-1511. ABSTRACT   Toward a more comprehensive understanding of violence against impoverished women. Wenzel et al. J Interpers Violence 2006;21:820-839. ABSTRACT   Lowering the threshold for discussions of domestic violence: a randomized controlled trial of computer screening. Rhodes et al. Arch Intern Med 2006;166:1107-1114. ABSTRACT | FULL TEXT   Women Exposed to Intimate Partner Violence: Expectations and Experiences When They Encounter Health Care Professionals: A Meta-analysis of Qualitative Studies Feder et al. Arch Intern Med 2006;166:22-37. ABSTRACT | FULL TEXT   Screening for domestic violence in a predominantly Hispanic clinical setting Chen et al. Fam Pract 2005;22:617-623. ABSTRACT | FULL TEXT   Experiencing Interpersonal Violence: Perspectives of Sexually Active, Substance-Using Women Living in Shelters and Low-Income Housing Tucker et al. Violence Against Women 2005;11:1319-1340. ABSTRACT   Patients' Advice to Physicians About Intervening in Family Conflict Burge et al. Ann Fam Med 2005;3:248-254. ABSTRACT | FULL TEXT   Intimate Partner Violence and Physical Health Consequences: Policy and Practice Implications Plichta J Interpers Violence 2004;19:1296-1323. ABSTRACT   Screening for Intimate Partner Violence when Children are Present: The Victim's Perspective Zink and Jacobson J Interpers Violence 2003;18:872-890. ABSTRACT   Routine Screening for Intimate Partner Violence in an Obstetrics and Gynecology Clinic Scholle et al. Am. J. Public Health 2003;93:1070-1072. FULL TEXT   Interventions for Intimate Partner Violence Against Women: Clinical Applications Rhodes and Levinson JAMA 2003;289:601-605. ABSTRACT | FULL TEXT   Parental Screening for Intimate Partner Violence by Pediatricians and Family Physicians Borowsky and Ireland Pediatrics 2002;110:509-516. ABSTRACT | FULL TEXT   Traumatic events in a general practice population: the patient's perspective Mol et al. Fam Pract 2002;19:390-396. ABSTRACT | FULL TEXT   Mothers' and Health Care Providers' Perspectives on Screening for Intimate Partner Violence in a Pediatric Emergency Department Dowd et al. Arch Pediatr Adolesc Med 2002;156:794-799. ABSTRACT | FULL TEXT   Intimate Partner Violence Against Chinese Women: The Past, Present, and Future XU et al. Trauma Violence Abuse 2001;2:296-315. ABSTRACT   Women's strategic responses to violence in Nicaragua Ellsberg et al. J. Epidemiol. Community Health 2001;55:547-555. ABSTRACT | FULL TEXT   Dentists' attitudes and behaviors regarding domestic violence: The need for an effective response LOVE et al. Journal of the American Dental Association 2001;132:85-93. ABSTRACT | FULL TEXT   Promise and Perils of Surveillance in Addressing Violence Against Women CAMPBELL Violence Against Women 2000;6:705-727. ABSTRACT   Review Article: Barriers within the health care system to dealing with sexualized violence: a literature review Ronnberg and Hammarstrom Scand J Public Health 2000;28:222-229. ABSTRACT   Exploring Barriers to Utilization of Poison Centers: A Qualitative Study of Mothers Attending an Urban Women, Infants, and Children (WIC) Clinic Kelly and Groff Pediatrics 2000;106:199-204. ABSTRACT | FULL TEXT   A Qualitative Analysis of How Physicians with Expertise in Domestic Violence Approach the Identification of Victims Gerbert et al. ANN INTERN MED 1999;131:578-584. ABSTRACT | FULL TEXT   Integrating Routine Inquiry about Domestic Violence into Daily Practice Warshaw and Alpert ANN INTERN MED 1999;131:619-620. FULL TEXT   Domestic Violence Eisenstat and Bancroft NEJM 1999;341:886-892. FULL TEXT   Screening and Intervention for Intimate Partner Abuse: Practices and Attitudes of Primary Care Physicians Rodriguez et al. JAMA 1999;282:468-474. ABSTRACT | FULL TEXT   Women battering in primary care practice Naumann et al. Fam Pract 1999;16:343-352. ABSTRACT | FULL TEXT   Physician Interaction With Battered Women: The Women's Perspective Hamberger et al. Arch Fam Med 1998;7:575-582. ABSTRACT | FULL TEXT   HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | PHYSICIAN JOBS | HELP CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP   © 1996 American Medical Association. All Rights Reserved.