Deciding to tell: qualitative configurational analysis of decisions to disclose experience of intimate partner violence in antenatal care

Authors

Jo Spangaro, University of New South Wales
Jane Koziol-Mclain, Auckland University of Technology
Anthony Zwi, University of New South Wales
Alison Rutherford, University of New South WalesFollow
Mary-Anne Frail, University of New South Wales
Jennifer Ruane, University of New South Wales

RIS ID

108924

Publication Details

Spangaro, J., Koziol-Mclain, J., Zwi, A., Rutherford, A., Frail, M. & Ruane, J. (2016). Deciding to tell: qualitative configurational analysis of decisions to disclose experience of intimate partner violence in antenatal care. Social Science and Medicine, 154 45-53.

Additional Publication Information

Erratum to the artilce DOI: 10.1016/j.socscimed.2016.05.041

Abstract

Rationale Intimate partner violence (IPV) is a significant global public health risk causing premature death and morbidity that largely remains hidden. Understanding decisions about whether or not to disclose abuse when asked about it in health settings is important to ensuring that those experiencing violence are provided with access to services to support their safety and wellbeing. Objective This study tested a model for women's decisions to disclose IPV in response to routine inquiry as part of antenatal assessment. Methods Qualitative configurational analysis, suited to the study of causal pathways in complex social phenomena, was used to analyse interviews with 32 women who had experienced IPV in the past 12 months and who elected, when asked, to either disclose this to the midwife (n = 24) or not to do so (n = 8). Findings Multiple pathways to disclosure were identified. While no single factor was necessary or sufficient for a decision to disclose, direct asking and care, defined as showing interest and a non-judgemental attitude, were found to be key conditions. The absence of care was also central to decisions not to disclose, as were perceptions of relevance of the abuse at the time of assessment. Conclusion Confirming key elements of the original model, these findings highlight the importance of being asked about abuse in women's decisions to disclose, as well as the relational nature of this process. Trauma-informed practices for identifying and responding to intimate partner violence are needed.