Public Release: 

Abused Immigrant Women Suffer When Health Professionals Communicate Indirectly

University of California - San Francisco

Health care providers can encourage the well-being of immigrant women whom they suspect are victims of domestic abuse through supportive and direct communication, according to a University of California San Francisco specialist in violence prevention. "Domestic violence is a painful subject, and we've found that many health professionals shy away from it or try to discuss it indirectly. For immigrant women, in particular, this approach often discourages their interest in seeking adequate medical care and social support," said Michael A. Rodriguez, MD, MPH, a UCSF assistant professor of family and community medicine at San Francisco General Hospital Medical Center.

In an effort to bridge the gap, Rodriguez and his colleagues conducted a research study to identify the factors that affect patient-physician communication among abused Latina and Asian women now living in the United States. Their project is believed to be the first to explore this topic from the perspective of abused immigrant women. Research results are published in the October issue of the Journal of Family Practice.

Study participants said provider behaviors that instill trust and demonstrate compassion and understanding improve patient-provider interaction. Participants also said they wanted providers to initiate discussions about partner abuse. "As a group, the women in our research study face special barriers--cultural background and often limited English--that make the subject of abuse even more difficult to discuss. We were interested in their experiences, perceptions, and expectations when communicating with health care providers," said Rodriguez, who also is research director of the Pacific Center for Violence Prevention, an organization that designs and promotes public policies to reduce youth violence using a public health approach.

The study involved 28 immigrant women who have lived in the U.S. from 1-22 years. There were 14 Latinas from Mexico, El Salvador, and Guatemala and 14 Asians from China, Viet Nam, Korea, the Philippines, and Taiwan. Ranging in age from 18-64, all had experienced abuse within the previous two years.

Participants were organized into small discussion groups according to ethnic identity, and each group had two moderators, one of whom was female and matched the ethnicity.

Research findings include:

    * Latina participants often used the Spanish word "confianza" to describe the constellation of trust, confidentiality, support, comfort, and safety that they deemed essential for discussing domestic violence.

    * Participants noted "listening to me as if he were a brother" and providing information on shelters, support groups, and other community resources as behaviors that medical providers had used to facilitate communication and demonstrate support.

    * One woman noted that a provider who doesn't convey a caring attitude makes one feel "that he/she is laughing at you ...and maybe your situation is not worth attention."

    * Participants in both ethnic groups expressed the difficulty of disclosing abuse and asking for help. One woman commented: "I didn't tell him about the violence because he didn't ask."

    * Some participants reported losing confidence in their health care providers because they focused on the physical injury and medication, with no reference to psychological and social issues.

    * Several Asian women said multiple interactions with the same provider were needed in order to establish the trust and rapport for disclosing abuse.

One limitation of the study was the small sample, according to Rodriguez, and he hopes to expand the research in the future to include other groups of women. "Given the growing immigrant population in the U.S., we need to give greater consideration to the interaction of culture and ethnicity in effectively addressing domestic violence," he said.

"We do know from this project that medical providers have a vital role in facilitating or undermining communication about domestic violence through their understanding, sensitivity, and willingness to initiate discussion in the context of a supportive relationship," he added.

Study co-investigators were Heidi M. Bauer, MD, MPH, UCSF Department of Family and Community Medicine; Seline Szkupinski-Quiroga, BA, UCSF Department of Epidemiology and Biostatistics; and Yvette Flores-Ortiz, Ph.D., UC-Davis Department of Chicano Studies.

The research was supported by grants from the Robert Wood Johnson Foundation and The California Wellness Foundation.

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