“I Am the One That Needs Help”: The Theory of Help-Seeking Behavior for Survivors of Intimate Partner Violence

Abstract

African American women survivors of intimate partner violence disproportionately experience homicide due, in part, to the racism and racial discrimination they experience during their help-seeking process. Yet, existing scholarship neglects to examine how this multiply-marginalized population of women navigate sociocultural barriers to obtain crisis services and supports from the domestic violence service provision system. Fundamental to developing culturally-salient interventions is more fully understanding their help-seeking behavior. We conducted 30 in-depth, semi-structured interviews with women who self-identified as African American. Constructivist grounded theory methodology was employed. Sensitizing concepts from the Transtheoretical Model of Change and Intersectionality theories, along with Agency framework were conceptually bound. The Theory of Help-Seeking Behavior emerged from the data. This nascent theory provides practitioners and researchers with a theoretical model to examine African American women’s nuanced help-seeking efforts.

Keywords

battered women disclosure of domestic violence domestic violence domestic violence and cultural contexts sexual assault support seeking

Introduction

Intimate partner violence (IPV) is the leading cause of premature death among African American women due, in part, to the barriers they experience during help-seeking (Petrosky et al., 2017). The average age that an African American woman is murdered by her intimate partner is 35 years old, which is 6 years younger than the overall national average (Violence Policy Center, 2021). Survivors typically experience societal stigma and internalized shame because of IPV victimization (Overstreet & Quinn, 2013). African American women additionally contend with barriers resulting from racial discrimination and systemic racism (Poleshuck et al., 2013; Waller et al., 2021; Ward et al., 2009). As a result, they generally defer help-seeking, further increasing their likelihood of femicide (Bent-Goodley, 2013; Petrosky et al., 2017). IPV help-seeking includes survivors securing assistance from informal networks, formal providers within the domestic violence service provision system, and the Black church. This study will focus on African American survivors’ help-seeking from formal providers within the domestic violence service provision system. The system is designed to provide immediate, coordinated care for IPV survivors and is inclusive of the criminal justice, shelter, and healthcare systems. Fundamental to more fully supporting their nuanced needs while help-seeking from formal providers is understanding how survivors navigate sociocultural barriers to secure crisis aid. Consequently, this study employed constructivist grounded theory methodology to develop an emergent theory that explains African American women’s IPV help-seeking. Specifically, how do African American women survivors’ social context and beliefs about formal providers influence how they employ their contextualized sense of agency to secure immediate, life-saving interventions during help-seeking.

Help-Seeking

Help-seeking is a means of women disclosing partner abuse to their family and friends and often escalating the victimization to formal providers before terminating the relationship and ultimately leaving their abusive partner. Lelaurain et al. (2017) conducted a systematic review of the literature and found that IPV help-seeking generally occurs within three phases: 1. problem identification; 2. decision to secure assistance; and 3. determining who to engage to secure urgent aid. Although service providers typically view terminating the abusive relationship as ideal, a more recent analysis of women living in marginalized and oppressed conditions challenges this presupposition and includes help-seeking as a means of garnering strength from others through sharing their stories of victimization (Campbell & Mannell, 2016; Logie & Daniel, 2016; Mannell et al., 2016). In contexts where IPV survivors experience more dire economic conditions, women tend to use more creative ways to counteract their abuse while remaining with the perpetrator (Mannell et al., 2016). This perspective provides a foundation for understanding the limitations that African American women experience during help-seeking (Monterrosa, 2021).

Help-Seeking Barriers

Barriers that survivors encounter during help-seeking depend upon their sociocultural context and whether they opt to secure aid from formal providers. These barriers range from shame and stigma to denial that the abuse occurred and siding with the perpetrator (Cho et al., 2020; Monterrosa, 2021). African American women also contend with multiple, overlapping, and reinforcing barriers unique to their sociohistorical context that often inhibits them from attaining urgent aid (Monterrosa, 2021). They have limited access to culturally congruent services, misconceptions of available services, and diminished access to financial resources (Monterrosa, 2021). Racial discrimination is often evidenced throughout survivors’ interactions with formal providers. Waller et al. (2021) conducted a systematic review of the literature and found that African American survivors would rather forgo engaging formal providers because of the ways providers routinely mistreated them, denied or delayed crisis interventions. In one of the more egregious examples, a survivor shared that responding officers waited outside her home for 30 min while her partner continued to physically abuse her. They intervened only after she crawled her battered body outside of the house (Waller et al., 2021). As a result of primary and secondary exposure to these adverse encounters, many African American women survivors would generally rather forgo engaging the domestic violence service provision system (Waller et al., 2021).

IPV Help Seeking Theories

IPV help-seeking theories emerged to explicate IPV survivors’ process of securing aid. Liang et al. (2005) developed a theory that explains women’s overall nonlinear, cognitive help-seeking processes, which they note begin with problem recognition and definition. While this model provided a framework for understanding women’s cognitive stages of help-seeking, it fell short of capturing the action-oriented steps women employ to secure urgent aid (Chang et al., 2006). Theoretical development then shifted to identify South Asian and Latina women’s help-seeking (Raj & Silverman, 2007; Randell et al., 2012). Raj & Silverman (2007) employed grounded theory methodology to identify women’s preference for family and community-based options; however, authors neglected to include theoretical constructs. Randall et al. (2012) explicated the internal and external factors that motivate Latina women to commence help-seeking. Despite these advancements, there is a dearth of theories that identify how help-seeking manifests among African American survivors. This study aims to fill this gap. The goal of this study is to understand how African American women navigate their psychosocial barriers to secure crisis interventions and support. We specifically want to identify the ways that survivors’ social context and beliefs about formal providers influence how they employ their contextualized sense of agency to secure urgent aid. To ensure we centered survivors’ voices during theory development, we employed constructivist grounded theory methodology to explicate their nuanced help-seeking process.

Methods

Design

This cross-sectional qualitative study employed constructivist grounded theory methodology developed by Kathy Charmaz (2014). Constructivist grounded theory (CGT) allows the researcher to use participants’ standpoint to examine socially situated knowledge claims, moving their voices to the center of inquiry (Harding, 1992). This is critical when conducting research with African American women IPV survivors, because their voices are often overlooked in the literature (Collins, 2000). CGT acknowledges the interaction between participants’ social contexts and the researcher’s interpretive understandings. Two of the authors are licensed clinicians who have worked with IPV survivors in various capacities and were able to use this knowledge to help situate respondents’ experiences. Two of the authors are African American women scholars who were able to incorporate their positionality into this project. Charmaz (2014) contends that CGT is a means of examining, comparing, and contrasting qualitative data across participants, situations, and hypotheses. This data-driven theory allows for the development of a general explanation of African American women IPV survivors’ psychosocial processes of help-seeking (Charmaz, 2014; Creswell & Poth, 2018).

Sensitizing Concepts

We utilized constructs from the Transtheoretical Model of Change (TTM) and Intersectionality theories, as well as the Agency framework as sensitizing concepts for theoretical development. TTM is a phase-oriented model that identifies women’s cognitive and behavioral phases of change (Prochaska & DiClemente, 1982). TTM captures the cyclical ways that survivors advance and/or relapse through the various phases of change. Yet, it falls short of identifying women’s cultural nuances that influenced their help-seeking process because it offers a value-free perspective. We employed Intersectionality to capture the overlapping barriers of race-class-gender politics that African American women encounter and navigate during their interactions with providers (Crenshaw, 1991). However, this failed to incorporate women’s strengths. To account for the creative and often incremental ways that this marginalized group of women use their power while navigating the barriers they experience, we employed the Agency framework (Mahmood, 2001; Mannell et al., 2016). These theories were conceptually bound and used as sensitizing concepts for theory development.

Sampling

The study was conducted in a large northeastern, metropolitan area where the rates of IPV-related homicide are higher than the national rates and African American women mostly reside (Mayor’s Office to Combat Domestic Violence, 2020; Violence Policy Center, 2021). A theoretical sampling strategy—purposeful sampling based on theoretical interests—was used to recruit African American women IPV survivors during their help-seeking process (Charmaz, 2014). Three mechanisms were employed to recruit respondents: (1) active and intentional engagement with service providers, (2) announcements at partner agencies and churches, and (3) flyer postings in areas where African American women are known to frequent (Anyikwa, 2015; Johnson et al., 2010; Lucea et al., 2013; Woods-Giscombé, 2010).

Sample

The sample included 30 women in heterosexual relationships, who self-identified as African American, between the ages of 19 and 64 years old who experienced at least one violent IPV episode by their most recent heterosexual partner within the previous 12 months. African American women were included because they are the largest group of Black women residing in the United States (U.S.) and have a unique sociocultural history dating back to slavery which may impact their help-seeking efforts (Brondolo, E., Ver Halen, N. B., Pencille, M., Beatty, D., & Contrada, R. J., 2009; Johnson, 2008). Black women additionally include African, Afro Caribbean, Black Latina, Black European and women, as well as African American lesbian and transgender women (Brondolo, E., Ver Halen, N. B., Pencille, M., Beatty, D., & Contrada, R. J., 2009; Gillum, 2021; Johnson, 2008). Including the experiences of all these subpopulations of Black women omits the nuanced differences between them. In this study, IPV included any physical, psychological, sexual, or financial abuse, as well as stalking, and/or controlling behaviors that occurred within a violent IPV episode (Breiding et al., 2015). According to the Centers for Disease Control and Prevention Intimate Partner (2015), a violent IPV episode is a single act or series of acts of violence that an intimate partner perceives are connected and includes one or more forms of IPV. The duration of the episode may span from several minutes to several days (Breiding et al., 2015).

Sample Characteristics

Study participants largely (96%) resided in an urban area. The average age was 40 years old. Most of the women were single (57%) or separated (17%). The average duration of their relationship was 9.38 years and a standard deviation of 8.63 years. Most of the participants attained an associate degree (n = 11). Most of the women (67%) were employed outside of the home. They either worked part-time (n = 11) or per diem or as needed (n = 7). Just over one in four (27%) respondents were homemakers, caring for their children.

Data Collection and Analysis

Data was collected during one in-depth semi-structured interview for each study respondent (N = 30). Prior to commencing interviews, the first author pilot tested the instrument with one provider and two survivors who mirrored the sample (Castillo-Montoya, 2016). The tool was modified based on the feedback and an updated version of the guide was used during the study. Prospective participants were initially screened via the telephone to ensure they met study eligibility. The primary care PTSD screen for the DSM-5 (PC-PTSD-5) was administered. The five-item self-report scale screens for PTSD symptomology. Two women disclosed that they were previously diagnosed with PTSD and two other women screened for elevated levels of PTSD. All four women opted to participate. To ensure there was no paperwork connecting them to the study, respondents provided a verbal consent (Btoush & Campbell, 2009). To avoid coercion, audio recording commenced after respondents provided approval. To further protect confidentiality, participants’ responses are reported via a pseudonym.

In line with CGT and the overall goal of the study, we analyzed individual interviews and field notes data using a progressive coding process. This progressive process consisted of (a) open coding, followed by (b) focused and axial coding that, ultimately, led to (c) theoretical coding (Charmaz, 2014). Open coding encouraged scrutiny of each line of data to begin conceptualizing ideas. Focused coding entailed separating, sorting, and synthesizing large chunks of data to synthesize and elucidate larger portions of data. Axial coding included reconstructing the data after focused coding (Charmaz, 2014). Finally, theoretical coding entailed coding the array of possible relationships among categories created by focused coding, making theoretical codes integrative and generating the model or theories that grounded theory methodology produces. The first author also conducted coding reliability checks by using team members as additional coders. Methodological dilemmas, decisions and subsequent directions were documented via a journal. Dilemmas were resolved via a discussion with the first and second authors. The methodological journal assisted with the memo-writing process and included other items for follow-up.

Rigor

Methodological rigor was achieved by employing trustworthiness. Trustworthiness ensures that the findings reflect the voices of participants and includes truth value, applicability, consistency, and neutrality (Lietz et al., 2006; Lincoln & Guba, 1985). Trustworthiness includes eight strategies and this project included all of them. These strategies include (i) prolonged engagement at the location where data was collected and persistent observation by attending task force and domestic violence ministry meetings; (ii) participant-observation and immersion into the environment where data was collected; (iii) triangulation via the demographic interview, semi-structured interview, and field notes, along with a transparent audit trail; (iv) transparent audit trail with a methodological journal that documented decisions, along with process notes and subsequent rationales; (v) member checking occurred immediately after concluding each interview since IPV is the leading cause of housing instability among women, (Baker et al., 2010) and peer debriefing by reviewing findings with two community-based domestic violence advocates; (vi) reflexive journaling of thoughts and insights after all contacts with key informants and agency personnel and after each interview; (vii) authors conducted a negative case analysis intentionally searching for elements of the data that appeared to contradict the findings as a means of broadening or confirming the expanded theoretical model; and (viii) memo-writing to add rigor to the analytic process (Charmaz, 2014).

Participant and researcher bias were potential threats to validity. To control for participant bias, the team engaged in prolonged engagement at the location where data was collected. Data was triangulated via the demographic and semi-structured interviews, and field notes (Lietz et al., 2006). An audit trail, peer debriefing with a senior domestic violence researcher and a colleague, data triangulation, reflexive journaling, and member checking, which allows participants to review the findings to ensure accuracy of analysis were utilized to limit researcher bias.

Results

The Theory of Help-Seeking Behavior emerged from the data. The Theory of Help-Seeking Behavior accounts for survivors’ sociocultural context, intersectionality, and beliefs, as well as the ways in which these factors may influence survivors’ nature and level of help-seeking. The Theory of Help-Seeking Behavior (THSB) postulates that women’s beliefs about and experiences with available supports, as well as their individual agency affects how and when they obtain crisis aid. THSB includes the following three constructs (See Figure 1: Theory of Help-Seeking Behavior): (1) social context, which explicates the ways that survivors’ sociocultural context influences their help-seeking efforts; (2) beliefs, specifically their lived experiences and reflections about available services and supports; and (3) agency, which includes the strength or power they employ to secure assistance.

Figure 1.

Theory of help-seeking behavior.

Social Context

Survivors shared the ways that their social context informed their perspectives about which supports were actually available to them. Many of the women detailed how providers disbelieved and disregarded them largely because of the intersectional nature of their sociocultural context, specifically the ways that their race, class, and gender intersected and influenced providers’ nature and level of helpfulness. Several survivors alluded to the ways they believed providers offered diminished levels of support because of the neighborhood where they lived. In a few instances, women shared that instead of receiving an immediate response to their urgent calls for intervention, they experienced significant delays. To that end, Sherry described her harrowing experience of waiting for law enforcement to respond to her multiple urgent calls to 9-1-1 one evening. This respondent tearfully shared that she feared her husband was going to murder her in front of their eight-year-old daughter. She noted that her husband was yelling, smashing glass, and trying to break down the couple’s bedroom door. She shared that she used bedroom furniture to fortify the locked door and barricade herself behind it for additional protection. Sherry said:

When I called the police, I called them like around 6 o’clock and they never come ‘till probably after 7 o’clock. But I am saying if he were supposed to kill me, I would have died because I called over and over and over. They said, “They are coming, they’re coming.” I do not understand that because I live close to the precinct. The precinct is like two blocks from me.

This respondent noted that she feared her death was imminent on that day but felt like officers disregarded her urgent cries for help because, like many of the respondents, she resided in a neighborhood where Black people largely reside. Survivors with young children shared their adverse encounters with providers from the Administration for Children’s Services (ACS). These women noted that they felt like the people working within child protective services blamed them for being abused. Women noted that their children were always with them and questioned how helpful the system was really being when they removed the children and provided financial assistance to foster parents to care for them while simultaneously making it difficult for them to receive similar assistance. Many of the respondents noted that child protective services workers were very disrespectful toward them. A few survivors noted that workers sometimes made house visits at inappropriate times of day, either extremely early in the morning or very late at night. Jada said, “They sent ACS to my house at 10:30 at night.” At the time, she said she was preparing for bed and her child was already asleep when the worker arrived. The worker entered her home, checked on the child’s well-being, asked several questions, looked in her refrigerator and cupboards, and left. Notably, survivors shared that their negative experiences with providers impacted their beliefs about which services and supports were readily available to fully assist them as African American women.

Beliefs

Survivors’ beliefs about the resources that are really available to them are fundamental to them determining whether they will engage with formal providers. Respondents noted that although some providers are physically accessible, they may not be the best option to engage because they anticipate that some of them will offer diminished and substandard levels of care. Participants’ beliefs about who they can rely upon during times of crisis underscores their decision-making process. Respondents stated that their decision is either based upon their personal experiences with providers or their understanding of how providers have interacted with other members of their community. To this end, Alecia shared that her history of being racially profiled by police made her reticent to engage with all service providers, despite desperately needing help. Alecia said:

I think some of it is because of the history with the system that depicted us [African American people] in such a way that was not so positive. I think that’s part of it. I think it’s also not trusting the system. I also think it might be not feeling that assurance.

Alecia noted that her negative interactions with the police when she was an adolescent have deteriorated her confidence that they, and other providers, would fully support her during her times of crisis now that she is an adult. This has resulted in her significantly delaying her engagement with all domestic violence service providers. Rather than relying on providers, she instead preferred to take care of things herself or rely upon her family members and friends.

She was not alone in her assessment of providers’ disregard for her. Many of the survivors also noted that judges were calloused and uncaring about the specifics of their case. Terri is 32-year-old, stay-at-home mother of a 3-year-old daughter who became very frustrated during her interactions with several judges within the court system. She said:

I feel like they do not give a f—. They have large caseloads. In the beginning they want what’s best, but in the end it’s like you could tell they’re burned out. But it just seemed like everything was being standoffish. So, it is like a procedure.

Several participants identified justices by name, noting social media groups that were formed as support groups for other African American survivors experiencing difficulties. Other respondents noted they were more likely to get the “runaround” from providers rather than the same level of compassionate care and interventions that White women more readily receive. To that end, Jada said:

I feel like it’s been hell. Domestic violence is serious. It’s not just abuse. It’s your whole life. It changes your whole life from mental, emotional, verbal, health, homeless…it changes everything. I feel like being a Black woman you need more help. We need more resources. We don’t get enough. We don’t get enough leniency. We [are] the ones that are tormented and get all the bull—. It’s just too much in one.

Several other survivors shared that the shelters where they were relegated to reside were situated in impoverished neighborhoods, with substandard schools. These women stated that their units were roach- and mold-infested, lacked heating in the winter months, and non-working stoves. Their complaints to management were met with threats that they would be reported to the Administration for Children’s Services (ACS) and have their children removed. As a result, most of the women noted that they do not trust formal providers. In fact, several respondents noted that they would rather forgo engaging the entire domestic violence service provision system until they believed their death was imminent.

A few of the survivors shared the ways they were mishandled while interacting with medical staff within the healthcare system. Imani shared the ways she was disbelieved by medical staff members who engaged with her following her sexual assault. After she was sexually assaulted by her then-boyfriend, she said that her deep feelings of shame and disgust compelled her to wash her body and panties before formally reporting her victimization. As a result, the forensic nurse had difficulty securing enough of his DNA to support her accusation. Imani said:

They gave me a lot of side eyes and a lot of, what’s the word, like they did not believe what I was saying. A lot of attitudes, they did not really cooperate with me. It was just a lot of back and forth. It is just been really hard.

Imani described the hurtful ways the emergency room staff treated her and how it harmed her psychological well-being. She says that she overheard the medical team saying that she was likely lying about the victimization. She says the way they treated her made her feel like she had been sexually violated twice. The first time she was raped by the perpetrator, and the second time she was violated by the providers who disbelieved her.

Most of the survivors shared the ways their experiences with providers shaped their beliefs about which ones were available to fully support them. These women noted that their encounters were harmful and deteriorated their ability to trust other providers within the domestic violence service provision system. Several of the respondents shared that they did not believe that providers were willing to offer the nature and level of support that their victimization required. Their reflections about these interactions influenced women’s willingness to engage with other formal providers. The women shared that these experiences were particularly at issue when they were in the midst of an IPV episode.

Agency

Another factor in women’s help-seeking is their individual agency. Survivors’ sense of individual agency was an essential to determining their ability to successfully act upon their beliefs and persist in their help-seeking efforts despite contending with and navigating a series of barriers. Most of the respondents shared that they became resolute in their determination to help themselves even when they were unable to rely upon anyone else for assistance. These women shared their frustrations with providers in the domestic violence service provision system who they believe gave them the runaround prior to providing essential services. The survivors noted that they became frustrated seeking help across multiple departments and entities rather than receiving immediate crisis assistance from their initial point of contact. These women stated, “you have to help yourself” because they did not believe they were able to rely upon providers within the system that was designed to provide immediate aid. To that end, Keisha declared that she was determined to get the kind of assistance she desperately needed. She said:

My focus is getting my own place and it is what it is. I got to reach out to people. Like I will go. And I’ll try to talk and advocate for myself if I can, because it’s better than sitting home and being on the phone or writing the email. I actually show up and speak on my behalf about my situation.

Keisha also shared that IPV survivors must remain determined to navigate the barriers that the systems erect. She believed the multiplicity of rules were designed to create some form of accountability. However, providers were unaware that these mechanisms of accountability were actually discouraging the very people they were designed to help. The result was women returning to their abusive partner. To that end, Brianna said, “I feel like a lot of people just get burnt out and go back to their former situation because they do not have any help in this.”

Several of the participants stated they were bereft of social supports and knew they needed to be self-reliant, rather than fully depend upon providers for resources and support. These women stated they did not trust law enforcement to provide the interventions they believed were necessary to discourage their abusive partners’ tactics nor the criminal justice system to exact justice they believed was due. One woman’s story epitomizes several respondents’ experiences. Tanisha said:

You’re not going to sit there and let them slay you. You’re not just going to wallow in self-pity and dwell. You’re not going to do that. You’re going to go do what the f— you got to do.

This respondent shared that she was raised by her devout maternal grandmother who provided her with a healthy sense of self when she was a child. Tanisha noted that she felt empowered and believed she had limitless capabilities. She credited her grandmother’s Bible-based teachings with forming and fortifying her with a strong, healthy sense of self when she was a child. As a result, she felt empowered to terminate her abusive relationship although she did not receive the nature and level of assistance that she believed she should have received from the criminal justice system.

Discussion

To our knowledge, this is the first theory that explains African American women IPV survivors’ help-seeking process. This emergent theory explicates the ways that these survivors navigate barriers resulting from racism, racial discrimination, and systemic racism to secure crisis aid. THSB illuminates the ways that survivors’ sociocultural context, beliefs about providers and sense of individual agency impact their help-seeking efforts. There is an urgent need to understand African American women survivors’ help-seeking because they are more likely than women of other racial and ethnic groups to experience intimate partner homicide (Petrosky et al., 2017). Yet, the literature neglects to explain how their intersectional experiences, specifically racism, racial discrimination, and systemic racism shapes their help seeking process. This omission has long had dire consequences upon this vulnerable population of women (Petrosky et al., 2017; Violence Policy Center, 2021).

Existing theories that explain African American women’s lived experiences fall short of providing a comprehensive understanding of their experiences related to IPV help-seeking (Crenshaw, 1991; Collins, 2000; Delgado & Stefancic, 2007). Theories that explain IPV help-seeking in general and among populations of color neglect to account for the pernicious ways that racism has shaped African American women’s help-seeking. The seminal IPV help-seeking theory developed by Liang et al. (2005) focuses solely on survivors’ cognitions. While critical, a theory that provides a cognitive understanding while simultaneously omitting contextual factors that influence women’s cognitions during help-seeking could be harmful, leading clinical researchers to develop limited and/or ineffective interventions. Two studies employed grounded theory methodology to develop theories specific to South Asian and Latina women survivors (Raj & Silverman, 2007; Randell et al., 2012). Yet, neither explained the ways that survivors’ social context, beliefs, and individual agency informed their help-seeking process. While Raj & Silverman (2007) neglected to identify constructs which are fundamental for theory development, Randall et al. (2012) focused on explicating factors that motivate Latina women to commence help-seeking. Each of the aforementioned theories provide a substantive contribution to the literature; however, neither provide an understanding of African American women survivors’ help-seeking. Most notably, this is the first IPV help-seeking theory that has been postulated that includes Agency framework as a foundation for theoretical development to explicate experiences of a marginalized population of survivors in the U.S.

THSB provides a theoretical understanding specific to a multiply-marginalized and under studied population of African American women who are often bereft of the nature and level of services and supports that their White counterparts are generally afforded. Rather than focus solely upon survivors’ cognitions (Liang et al., 2005), the THSB posits that survivors’ social context, beliefs, and individual agency result in their action-oriented help-seeking efforts. THSB accounts for the ways that survivors’ social context, specifically the ways that racism, positionality, and community influence, along with their beliefs about formal providers inform and shape their help-seeking process. Rather than understand survivors through a deficit lens, THSB focuses upon the ways that survivors use their individual agency to contend with barriers to their help-seeking and secure critical assistance.

Study findings are consistent with extant literature that examines African American women’s help-seeking experiences. Scholarly literature is replete with studies that analyze the sociocultural implications of African American women’s help-seeking. Specifically, studies reveal the ways that providers fall short of providing African American women the same nature and level of treatment and services afforded to White women (Cho et al., 2020; Few, 2005; Waller et al., 2021). African American women are not always referred to shelters, experience significant delays in police response and are harmed by providers in the healthcare system (Waller, 2021). High-profile instances of police misconduct along with the murders of unarmed African Americans have likely further exacerbated an already tenuous relationship between law enforcement and the African American community (Miller & Vittrup, 2020). This has not only scarred survivors’ perspectives of the criminal justice system, it has likely served as a warning for African American survivors to not trust formal providers. Rather than readily engage providers, these women noted that they would only enlist assistance when they believe that their death is imminent. This finding is consistent with the literature that overwhelmingly reflects African American women survivors’ preference to forgo police intervention (Davies et al., 2007; Leone et al., 2007; West, 2021). Despite these challenges, respondents similarly reflected the individual agency that Black women in non-western populations readily employ to navigate barriers to their IPV help-seeking behavior (Campbell & Mannell, 2016; Logie & Daniel, 2016; Mannell et al., 2016).

THSB further accounts for the sociocultural experiences that often result in racialized interactions that underrepresented populations generally contend with during their IPV help-seeking experiences. Although the theory was developed to illuminate the IPV-help seeking experiences specific to African American women, it may also help illuminate the experiences that are related to other marginalized, understudied, and underrepresented groups that have a pervasive mistrust of existing systems of support, including U.S. Indigenous women, and members of the LGBTQ+ community. Indigenous women are disproportionately burdened with IPV victimization and reflect the second highest rates of intimate partner homicide (Petrosky et al., 2017). Yet, they have access to a paucity of culturally salient services and support (Kong et al., 2018). Members of the LGBTQ+ community, particularly Black lesbian and transgender survivors, additionally contend with homophobia, and an abundance of gender normative services and supports that may additionally preclude their help seeking (Guadalupe-Diaz & Jasinski, 2017). THSB provides the lens necessary to more fully examine the ways that contextual factors, beliefs about formal providers and individual agency informs their help-seeking. THSB may also be utilized to examine the experiences of other marginalized populations experiencing discrimination resulting from poverty, disability, criminal history, HIV status, and substance use disorders (SUD).

This study has implications for practice and research. Understanding the barriers with which African American women typically contend may help providers understand help-seeking from the survivors’ unique standpoint. Utilizing this theory could help practitioners create a therapeutic environment that promotes equity and encourages women to employ their individual agency throughout treatment. This is important even if women show resistance in treatment (Quinn & Grumbach, 2015). Scholars suggest that signs of resistance could be seen as unique ways that clients choose to cooperate in treatment, which is also aligned with the agency framework and influences their help-seeking behaviors (de Shazer, 1985).

THSB helps practitioners more fully understand that African American women IPV survivors’ help-seeking process is often fraught with difficulties. African American women have long been stigmatized, marginalized, and rejected by providers within the domestic violence service provision system. Understanding that this group of survivors will likely experience various forms of anticipatory stigma, providers could deliver services in a more supportive environment that is salient to their ways of knowing. For example, it may be helpful to conduct a warm hand-off rather than providing survivors with a document that includes a list of available services and supports. Warm hand-offs foster trust and safety between the prospective client and clinician. Therapists generally call the person to whom she is referring their client to ensure a connection is made before transitioning and terminating the client. While this may be a novel approach within the domestic violence service provision system, warm hand-offs have long been used in therapeutic settings when therapists are concerned about clients who may drop out of treatment during transitions.

Moreover, the THSB provides a framework that researchers can employ to develop client-centered, bottom-up interventions that remove some of the impediments that survivors typically encounter throughout the domestic violence service provision system. This emergent theory could also lay the groundwork for developing interventions that are salient to African American women’s cultural preferences.

Limitations

Despite its significant contribution to the literature, this study is not without limitations. First, there is a lack of research that focuses primarily on theories about African American women’s help-seeking behaviors, processes, and experiences, as well as their unique stressors and circumstances. Second, respondents were recruited while they were help-seeking from either the domestic violence service provision system and/or domestic violence ministries in their church. As a result, participants’ experiences may not account for their more private means of securing aid. This understanding is critical, particularly since African American women IPV survivors are well-known for more private means of help-seeking (Nicolaidis et al., 2010; Sears, 2021). Most striking is the prevalent lack of a theoretical foundation identifying causal factors associated with African American help-seeking in any context. This theoretical dearth reflects potential methodological gaps, which hinders the rigor associated with intervention development and the potential for overall effectiveness with this population. This is noteworthy since scholars have identified the indicators associated with the social structures and community conditions (Snowden, 2001) that comprise obstacles made up of “systematic oppression, institutional inequalities, and structural disparities” when people of color seek (mental) health or other services (Burkett, 2017). Specifically, scholars suggest that cultural experiences (e.g., historical trauma, stigma around mental illness, systemic racism and discrimination, language barriers, and general mistrust of mental health care providers) and social components (e.g., environmental toxicity, a lack of health insurance, and a lack of cultural proficiency/humility on the part of mental health care providers) reinforce these cultural and racial disparities (Betancourt et al., 2016; Lindsey et al., 2013; Quinn, 2018; Williams & Wyatt, 2015).

Data was collected prior to the COVID-19 pandemic and may not account for survivors’ prior or current help-seeking experiences. The study was also conducted in a large urban area in the northeastern U.S. where resources could be perceived as generally accessible. Consequently, survivors residing in suburban and rural areas, as well as other regions of the country may have qualitatively different experiences related to service access than study participants.

Future research should build upon this theory by also directly engaging providers and criminal justice personnel to investigate their views and perspectives associated with their (un)intentional responses to African American women who seek help for IPV services. More research is necessary to understand the implications of this theory upon other marginalized and stigmatized populations, including Native American women and members of the LGBTQ+ community. Additional research should encompass other regions of the country, specifically women living in suburban and rural areas where domestic violence services are scant and care between providers may be less coordinated.

Conclusion

In sum, we have presented an emergent grounded theory for understanding the nuanced ways that African American women IPV survivors navigate their psychosocial barriers to secure crisis interventions. THSB postulates that African American IPV survivors’ sociocultural context, beliefs about service providers and their sense of individual agency interact in ways that may promote their IPV help-seeking. The theory includes three constructs: (1) social context, which explicates the ways that survivors’ sociocultural context influences their help-seeking efforts; (2) beliefs, specifically their lived experiences and reflections about available services and supports; and (3) agency, which includes the strength or power they employ to secure assistance. THSB provides an understanding of African American women IPV survivors’ help-seeking that is long overdue. The theory addresses a critical gap in the scholarly literature by explaining help-seeking among a population of survivors that experiences the poorest outcomes resulting from IPV victimization. This nascent theory incorporates the women’s cognitions and action-oriented phases of change, along with their intersectional experiences resulting from the overlapping, multiaxial, and interlocking nature of race-class-gender politics, and the nuanced ways that survivors employ their strengths to navigate barriers to their help seeking. The THSB offers a pathway for scholar-clinicians to develop client centered, culturally salient interventions that more fully support the well-being of African American IPV survivors’ help-seeking via the domestic violence service provision system.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work is supported by National Institute of Mental Health (Grant Nos. R36MH116680 and T32MH096724-10).

ORCID iDs

Bernadine Waller

Camille R. Quinn

Author Biographies

Bernadine Waller, PhD LMHC, is a NIMH T32 postdoctoral fellow in Global Mental Health at Columbia University Irving Medical Center/New York State Psychiatric Institute where she focuses on intervention and implementation science. She is a NYS-licensed clinician whose research examines the intersections of intimate partner violence, help-seeking, service provision and mental health, with a specific focus on African American women survivors. She is also an senior adjunct professor at Adelphi University School of Social Work.

Patricia A. Joyce, DSW is an associate professor at Adelphi University School of Social Work. Her scholarly work includes qualitative research on trauma, child sexual abuse, cultural competence, social work education, and doctoral dissertation advisement.

Camille R. Quinn, PhD, LCSW, LISW-S is an Assistant Professor in the College of Social Work at The Ohio State University. She is a juvenile justice expert and has nearly 20 years’ experience as a clinician and administrator in social and health services. She is a licensed social worker in Illinois and Ohio, which informs her program of research. She conducts mixed methods research with a collaborative spirit to engage community, university and government partners in her work.

Azahah Abu Hassan Shaari, PhD, MSW, is a Lecturer at the Faculty of Language Studies and Human Development, Universiti Malaysia Kelantan, Malaysia. Her research interests are substance use disorder (SUD) with a specific focus on contextual understanding on narrative of people in recovery from SUD, both in the United States and Malaysia. Her scholarship also examines the effectiveness of healthy relationship-focused education interventions to prevent the perpetrations of dating violence among at-risk youth.

Donte T. Boyd, PhD, MSW is an Assistant Professor at the College of Social Work, at The Ohio State University. He also serves as a Visiting Research Faculty member as part of the Research Education Institute for Diverse Scholars (REIDS) at Yale University School of Public Health through the Center for Interdisciplinary Research on AIDS (CIRA). He’s research addresses how socio-contextual factors impact young Black MSM decision-making behaviors.

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