A Qualitative Assessment of Social Norms Related to Seeking Help for Intimate Partner Violence in Honduras

Abstract

Intimate partner violence (IPV) is a major public health issue in Honduras and other low- and middle-income countries, with few victims seeking help. While structural factors, such as lack of services and economic barriers, are often cited as reasons for not seeking help, social and cultural factors may also play a role. This study aims to describe the normative social environment that may hinder women’s help-seeking behaviors for IPV. Thematic analysis was conducted on data from four focus group discussions with 30 women at a busy health center in urban Tegucigalpa, Honduras. Data were coded inductively and themes were identified deductively using the theory of normative social behavior and its components (descriptive and injunctive social norms, expected outcomes, and groups of reference). Four themes emerged: social norms and expected outcomes that discourage IPV help-seeking; factors that determine the direction of a social norm, either discouraging or encouraging help-seeking; groups of reference for IPV victims; and society sets women up for failure. Social norms, expected outcomes, and groups of reference hinder women’s help-seeking behavior after IPV. These findings have significant implications for designing effective interventions and policies to support women and their families affected by IPV.

Keywords

intimate partner violence help-seeking behavior social norms qualitative research

Introduction

Intimate partner violence (IPV) against women is a worldwide issue that can negatively impact the physical and mental well-being of women, both in the short- and long-term. When experiencing IPV, women respond in a myriad of ways, such as defending themselves, avoiding the abuser, or seeking help from informal or formal sources (Hamby, 2014). Seeking help from informal (e.g., family members, friends, neighbors, religious leaders) or formal sources (e.g., police, health centers, social service organizations, nongovernmental organizations) has the potential to provide a sense of security (Matos et al., 2014), reduce levels of distress (Fortin et al., 2012), reduce repeated victimizations (Bybee & Sullivan, 2002), and improve victims’ health outcomes (Coker et al., 2002).

In Honduras, 15.6% of women who are 15 to 49 years of age have experienced emotional, physical, or sexual violence in the past year by their romantic partner (Instituto Nacional de Estadística, & Secretaria de Salud de Honduras, 2021). Nonetheless, the majority of women physically or sexually victimized by their partners do not seek help (64.2%) (Instituto Nacional de Estadística, & Secretaria de Salud de Honduras, 2021). As a result, Honduras is one of the countries with the lowest proportion of women seeking any type of help for an IPV episode, both in Latin America (Bott et al., 2012) and worldwide (Palermo et al., 2014).

To date, most studies on women’s use of IPV help-seeking strategies have focused on structural models, which posit that behavioral differences across individuals are primarily determined by socioeconomic deprivation or uneven resource distribution (Ackerman & Love, 2014). However, structural factors fail to explain all differences in help-seeking behaviors between groups. For example, a study in Kenya found that demographic characteristics such as age, marital status, education, parity, and employment status were not significantly associated with women’s IPV help-seeking behaviors (Maticka-Tyndale et al., 2020). Furthermore, seeking help for IPV is a complex process that even victims themselves cannot clearly explain. In Honduras, data from the 2011 to 2012 Demographic Health Survey revealed that 24% of women who did not seek help for IPV provided an explanation coded as “other reasons”, rather than citing the standard options - (i.e., fear of the partner, thinking it was not necessary/useful, shame, didn’t know where to go, don’t know) (Instituto Nacional de Estadística, & Macro International, 2013). Furthermore, a different study shows that nearly half of the women were simply unwilling to respond to that question (49.7%) (Zavala & Montoya-Reales, 2017).

The decision to seek help for IPV is also influenced by cultural and attitudinal differences in women’s social environment. For example, Latinas’ help-seeking behaviors can be influenced by cultural constructs such us familyism (i.e., prioritizing the family over the individual), marianism (i.e., women’s responsibility for chastity), and simpatia (i.e., emphasis on the avoidance of conflict) (Ahrens et al., 2010). Additionally, beliefs held by the victims’ social context can also affect their likelihood of seeking help. Social norms (informal rules that spur and guide behaviors within a society) have been widely studied as influential factors in shaping behavior. However, different theoretical perspectives have been used to analyze them (Young, 2015), leading to unclear conclusions about the mechanisms of their influence on behavior. Notably, there is no evidence about the role of social norms in shaping help-seeking behaviors for IPV.

The current study has a twofold purpose. First, to identify and describe social norms associated with women’s decision to seek help for an IPV episode in an urban area in Honduras. Second, to identify and describe components that influence, reinforce, or modify existing social norms associated with women’s decision to seek help. By taking into account the impact of societal expectations on women’s decision-making, we will greatly advance our understanding of the determinants of IPV help-seeking behaviors among women in low- and middle-income countries.

Conceptual Framework

The theory of normative social behavior (TNSB) (Rimal & Real, 2005) elucidates how cultural and social constructs shape behavior when these are conceived as informal norms of society. However, the strength and direction of this association may vary depending on how these norms are defined, which requires distinguishing between descriptive and injunctive norms, as well as analyzing all the conditions surrounding these norms (Cialdini et al., 1990). The TNSB posits that the association between descriptive social norms and the behavior of interest is moderated by injunctive social norms, expected outcomes, and group identity (Rimal & Real, 2005). Figure 1 provides a graphic representation of the components and associations described by the TNSB, using IPV help-seeking as the behavior of interest.

Figure 1.

Components of the theory of normative social behavior.

Descriptive and Injunctive Norms

Descriptive norms are the beliefs about what behaviors are prevalent in a society or group (e.g., the belief that most women in Honduras do not seek help). Because descriptive norms signal typical behaviors within a group, they are considered a good prudential response to do something similar to what others would do (Bicchieri, 2005). Conformity to a descriptive norm might be especially relevant under situations of uncertainty or ambiguity (Bicchieri, 2005). For example, if a woman must make a quick decision about how to respond to her partner’s violence without information about the environment or her available options, she will likely follow the existing descriptive norm of how to cope with the abuse.

Injunctive norms refer to beliefs about what behaviors are usually approved or disapproved of within a society or group (e.g., belief that most women in Honduras should not seek help). They direct individuals towards the concern of what others previously approved or disapproved of, rather than how others behaved in a particular setting (Reno et al., 1993). Conforming to an injunctive social norm is usually accompanied by the belief that defying these norms will lead to a social sanction. Distinguishing between injunctive and descriptive norms is crucial for the understanding of behavior, given that both types can exist simultaneously in a setting and can have either congruent or contradictory implications for behavior.

Outcome Expectations

Outcome expectations, also called sanctions, can be positive or negative and are defined as an individual’s expected outcomes of performing a behavior or following a social norm (Rimal & Real, 2005; Bicchieri, 2005). Sanctions for violating social norms are less severe than those for legal rules and can include responses such as gossip, open censure, ostracism, or dishonor (Bicchieri, 2005). A literature review of stigma-related barriers to IPV help-seeking behaviors in the United States documents that victims, especially those who stay with their partner, have strong expectations about potential negative consequences of seeking help from formal and informal sources, such as judgmental attitudes, gestures, actions that provoke embarrassment and shame, being looked down upon, or being ridiculed (Overstreet & Quinn, 2013).

Group Identity or Perceived Identity With Groups of Reference

We define group identity, following Rimal and Real (2005), as the degree to which individuals perceive similarities between themselves and their community, social networks, or groups of reference. “Groups of reference” refers to the groups of people that influence an individual’s behavior, either because they aspire to become one of them or because they need or desire to be similar to them. As an individual’s identity with their groups of reference grows stronger, there is an implicit understanding that their “compliance with the group behavior will be observable to other group members” (Rimal & Real, 2005). Thus, the proximity to the group of reference and the nature of these relationships will influence conformity to the norm (Yang, 2018).

Methods

Study Design

This qualitative study employs focus group discussions with women in Tegucigalpa to examine social norms related to women’s help-seeking decisions and the components that influence these norms and subsequently impact their behavior.

Study Setting

The study population consists of women attending a populous primary health center (PHC) in the city of Tegucigalpa (in the Department of Francisco Morazán) between September and October of 2018. Tegucigalpa is the capital of Honduras and it is located in Distrito Central, the municipality with the second-highest rate of IPV in Honduras (Instituto Nacional de Estadística, & Secretaria de Salud de Honduras, 2021). The selected PHC receives around 600 patients per day, and it is classified as a health center with physician and dentistry, one of 436 in the country (Carmenate-Milián et al., 2017).

Participants

Eligible participants were women attending or visiting the selected PHC. Eligibility requirements included being between the ages of 18 and 49 years at the time of screening and having access to a phone to schedule the discussion. Neither experiencing nor having witnessed IPV was a requirement to participate in the study. This study aimed to describe societal beliefs; therefore, any woman could provide information about the beliefs and perceptions that were prevalent in her community. Given that IPV is a prevalent phenomenon in urban Honduras, it was expected that most women would have beliefs and perceptions about this topic. Not all participants who were invited to participate enrolled in the study, those who declined cited time constraints as the main reason. From all participants who agreed to participate, two did not show up.

Sampling Strategy

Convenience sampling was used to select participants. Specifically, we focused on selecting cases that were “most available and easiest to recruit” (Green & Thorogood, 2018). The sample size was determined using sampling to code saturation. This means that we kept sampling and analyzing data until no new codes were generated. Although this is a very flexible approach, the experience of qualitative researchers is that most prevalent themes are identified with only three to four focus groups (Guest, Namey & McKenna, 2017; Hennink et al., 2019).

Recruitment

Screening of eligible participants took place in the main waiting room of the PHC, where they were approached and invited to participate if they were either alone or in the company of other females. Recruitment was conducted by two female researchers (the principal investigator and an experienced collaborator). Participants in the study received the local equivalent of 5 U.S. dollars to compensate for their transportation costs when attending the focus group discussion. Complete lunch with snacks was provided on the day of the discussion. In total, 30 women participated in one of the four focus group discussions. All participants provided informed consent.

Participants shared similar sociodemographic characteristics (Table 1). The majority were housewives, with an average age of 28.5 years (with 47% of the sample being in their 20s and 40% in their 30s). Most participants had at least one child (only one woman did not have any children), with the average number of children being two and with 23.3% of the sample being currently pregnant. Only one woman in the sample completed secondary education, and the majority of women were living together with a partner (66.7%). Only two women reported consuming alcohol, and only 23.3% of participants declared not having a religion.

Table 1.

Descriptive Information of all Women Participating in any of the Four Focus Groups (n = 30).

Age (mean)	28.5
Parity (mean)	2.1
Education attainment
None/primary incomplete	8
Primary complete/secondary incomplete	21
Secondary complete	1
Occupation
Housewife	24
Other (cleaning, sales, nurse, nanny)	6
Marital status
Married	5
Separated	5
In a union	20
Currently pregnant	7
Participant consumes alcohol	2
Religion
Evangelic	13
Catholic	4
Other	6
None	7

Data Collection

Focus groups were conducted in Spanish and in a private room inside the PHC facility. All windows were blinded in the room so no outside person could see that the discussion was taking place. Two experienced female researchers facilitated all discussions. Participants had only met the researchers when being recruited. Each session began with participants individually completing a brief questionnaire about their demographic characteristics. Once the group was complete, the discussions started with a general introduction and an overview of the confidential and anonymous nature of the discussion.

The discussions were conducted using a semi-structured interview guide. The guide was developed based on the study’s research questions and on recommendations from existing guidelines for measuring social norms (Alexander-Scott & Women, 2016; Cislaghi & Heise, 2018). The guide was pilot tested by conducting individual and group interviews with four women from the target population and refined accordingly. The open-ended questions covered the following domains: understanding a woman’s group of reference when facing problems with a romantic partner, women’s definitions of IPV, perceived social norms related to help-seeking behaviors for IPV, and expected outcomes of different IPV help-seeking strategies. The discussions ended with an overview of available services for IPV victims. Sessions lasted between 60 and 100 min.

Analytical Strategy

All focus groups were audiotaped and transcribed verbatim. Field notes were collected during each session. Transcripts and field notes were analyzed in Spanish using thematic analysis. Thematic analysis focuses on “identifying and describing both implicit and explicit ideas within the data, that is, themes” (Guest et al., 2011). Themes were identified following the six-step approach suggested by Braun and Clarke (2006) and combining inductive and deductive approaches. These steps consisted of becoming familiar with the data and noting down initial ideas, generating initial codes (using an inductive approach), searching for themes, reviewing themes (using a deductive approach and testing them against the TNSB), defining and naming themes, and producing the report. Subthemes were defined for each theme and representative quotes were directly translated from Spanish to English, and supplemented with additional clarifications. To ensure rigor and credibility, the principal investigator coded the data using NVivo 12 Plus (QSR International, 2018) at two different points in time. This approach helped correct any bias in the analytical process, as the researcher could reflect on the objectivity of the analysis.

Ethics Approval

The study was reviewed and approved by Tulane University’s Internal Review Board ethics review committee (IRB reference number: 2018-1512) in the United States and by the Instituto Hondureño de la Seguridad Social ethics review committee in Honduras (Approval number: ACTA 045-CB-HE 01 de Octubre del 2018).

Results

The thematic analysis applied to the focus groups identified four main themes: (a) social norms and expected outcomes that discourage IPV help-seeking; (b) factors that change the direction of a norm from discouraging to encouraging help-seeking; (c) groups of reference for IPV victims; and (d) society sets women up for failure.

Theme 1: Social Norms and Excepted Outcomes That Discourage IPV Help-Seeking

In general, narratives from the focus group discussions revealed a context in which different components of the TNSB interact to discourage help-seeking from informal and formal sources. First, we identified a descriptive norm that most women in Tegucigalpa stay silent about the experienced violence and endure it. Second, this inertia is supported by injunctive norms that suggest that women should keep marital matters private and prioritize their family over themselves. Third, expected outcomes of talking with informal and formal sources about the violence include gossip, ignoring, blaming, and mocking the victim.

Descriptive Norms

Under uncertainty, beliefs about what most women do after experiencing violence are often considered as a good prudential strategy for other women to follow. Study participants believed that the majority of women in Tegucigalpa do not seek any type of help after an IPV episode. Violence is seen as a normal phenomenon in the lives of women; therefore, most women endure it and continue with their regular activities:

I’m just saying, there are women who first receive a blow with a fist and from there they will go and make dinner. (FGD = 2, P = 7)

Injunctive Norms

Although some participants suggested that help-seeking strategies can be helpful (to be discussed further in this publication), the deep-rooted belief that women should keep marital problems private was consistently mentioned across groups, representing an important injunctive norm in Tegucigalpa:

Problems between a couple are only between a couple, the problem is that you don’t have to tell everyone, it is only the couple, not even his family because one [the woman] is the donkey that ignores [or does not obey] him [by telling others]. (FGD = 4, P = 3)

Furthermore, participants talked about the idea that women should keep their families united and stay with only one man at all costs. This injunctive norm discourages help-seeking behavior as seeking help often leads to separation from the perpetrator.

You made that decision [to be with that partner], therefore, you need to endure, and we want you to be woman of only one man [woman repeating what was told by her parents after a victimization]. (FGD = 3, P = 7)

Expected Outcomes or Sanctions

The overwhelming majority of stories shared during the focus group discussions listed negative consequences or sanctions that resulted from seeking help for an IPV episode, or even from discussing the episode with others. Specifically, when talking about informal sources of help, women across groups recognized that the outcome of talking with someone or venting about the abuse would have negative consequences for them, either because the person may divulge the information, ignore, blame, and/or make fun of the victim:

I’ve talked with family members and it didn’t work out for me because they start telling, [you tell them] with trust and they divulge after. (FGD = 4, P = 4)

The neighbors made fun of me after [a violence episode], and they would tell me [mock me], instead of giving me advice, instead of telling me to seek support from someone. (FGD = 3, P = 7)

Informal sources may also minimize the victim’s situation and give oversimplistic advice. For example, participants consistently identified different challenges victims face when ending a violent relationship (e.g., safety concerns, economic challenges). Family members and friends may provide advice that fails to recognize these challenges:

And then a person [will tell you] “oh leave him!” instead of giving you good advice, they want you to decide something that one [a victim] sometimes cannot. (FGD = 1, P = 8)

“Go kill him” that is what you are being told [the advice you receive from friends]. (FGD = 1, P = 4)

When seeking help from the police (the main formal source of help identified by participants), the expectation was that the victim would be ignored, blamed, and/or humiliated. Participants referred to the police mostly with dismay, as depicted in the following quote:

If one goes [to the police] because the husband hit you, the policeman says, “this one is because of flirtatious for sure, you cheated on your husband.” (FGD = 3, P = 7)

Theme 2: Factors That Determine the Direction of a Norm, Either Discouraging or Encouraging Help-Seeking

In the previous section, it was noted how descriptive norms, injunctive norms, and expected outcomes disincentivize help-seeking behaviors among IPV victims. However, there are situations in which the narrative shifts, and seeking help becomes a social normative behavior. These situations include: (a) when facing violence of high severity; (b) when children are exposed to the violence; and (c) when a source of help that respects the privacy of the victim becomes available.

Severity of the Violence

Women will perceive the need to seek help when the severity of the violence reaches a certain level (this level varies among women). Stories of women seeking help for IPV almost always included a scene of severe violence that triggered the decision to act. In Honduras, the severity of the violence plays a crucial role in women’s decision-making due to the increasingly brutal and sexualized nature of IPV. In fact, cases of men killing their partners are a daily problem in the country. In this context, seeking help after facing severe violence becomes a survival strategy.

I heard that he turned on the stove [to burn my hair] so I pushed him and started strangling him. When I saw he was on the ground [not being able to move] I grabbed my six-month-old baby and ran. (FGD = 3, P = 6)

Similarly, and when talking about the expected outcomes of seeking help from formal sources, it is expected that the police will only respond to a call and provide help if the violence is severe enough or if there is the risk of death:

My mom said “they will come when people are made a chanfaina [a stew made with small pieces of animal organs]” then they move, then you will see that the police move when there is a death. (FGD = 3, P = 6)

Children’s Exposure to IPV

The presence of children triggers beliefs that accept and encourage help-seeking behaviors. If a woman realizes that her children are being affected by IPV she will be more likely to seek help:

My son would tremble, my son would tremble every time he would look at his father, he [the father] left him traumatized, so what I did, I had to jail him and leave him. (FGD = 1, P = 3)

Most of the time, participants blamed IPV victims in their narratives. However, children are seen as true victims. When children are exposed to or witnessed IPV, others feel the need to intervene, as exemplified in the next quote:

If I don’t hear a child screaming, I won’t intervene, you know a child can’t defend against the strength of an adult, but if she [the victim] is screaming, she can stay there and keep screaming. (FGD = 2, P = 1)

Availability of a Place Where Your Privacy is Respected

Another factor that can modify existing injunctive norms regarding what most women should do when facing violence is the availability of individuals or institutions that respect the privacy of the victim, such as a trusted friend, a psychologist, or other health professionals. In this scenario, participants believed that victims should seek help.

Thank god she has been a good friend and does not share the things you tell her. . .if you have someone you trust, yes [tell her/him about the violence]. . .because it is something intimate of the household and you cannot share it with neighbors nor friends. (FGD = 4, P = 5)

[The psychologist] Won’t criticize you, he/she won’t be making a scandal around the neighborhood, but like that, it will be confidential. (FGD = 1, P = 3)

Although social and mental health services were seen as good options for victims, most women did not seek help from these sources, evidencing a contradiction between the injunctive (what is approved of) and the descriptive social norm (what is typical).

Theme 3: Groups of Reference for IPV Victims

This third theme refers to the characteristics of women’s groups of reference and how these groups might influence, reinforce, and/or modify the perceived norms, expected sanctions, and ultimately women’s behaviors. Within this theme, we discuss the relationship between women and four potential groups of reference: neighbors, friends and family, other IPV victims, and church members. In general, women’s narratives depicted isolation where they only discuss family issues with a few family members or friends. Therefore, women’s responses to violence can reflect the indifference of their social networks. Victims may comply with the normative behavior of not seeking help out of fear of the social sanctions established by geographic neighbors, or from perceiving themselves to be similar to friends and family who are in the same situation (e.g., other IPV victims), or from admiration for a group whose beliefs encourage women to endure the violence (e.g., church members).

Geographic Neighbors

Many programs have relied on neighborhoods or geographic communities to conduct and promote community-based IPV prevention campaigns and interventions (Contreras-Urbina et al., 2016). Therefore, this study assessed the potential role of neighbors as a group of reference for IPV victims. Our findings evidence that neighbors strongly influence the perpetuation of pervasive social norms and the perceived negative sanctions of seeking help for IPV. Neighborhoods represent communities in which women feel isolated and insecure. In Tegucigalpa, the high levels of internal and external migration due to gang violence have created a scenario where neighborhoods are constantly shifting, and neighbors do not trust each other.

The majority of people from the neighborhood have emigrated and left their homes rented and they do not investigate the type of people they are renting it to, and they rent to any person, do you get it? (FGD = 2, P = 1)

Geographic neighbors are depicted as betrayers and gossipmongers, implying negative expected outcomes from seeking help. Therefore, it was consistent across focus group discussions that victims would never talk about IPV with their neighbors. This situation might be compounding inequality, as women become afraid to engage in public life.

The neighbors will have you from mouth to mouth [implying that the neighbors will talk about you with everybody]. (FGD = 4, P = 3)

I have advised my kids to never get used to going from house to house [referring to the neighborhood], if we have food, we eat, if we do not, we go to bed. (FGD = 1, P = 6)

Family of Origin and Friends

This subtheme captures mixed feelings about the role of the family of origin and friends as groups of reference for IPV victims. On the one hand, many participants argued that neither families nor friends tend to support victims of violence.

I say there are no friends, friend only God. (FGD = 4, P = 2)

On the other hand, some participants described having good relationships and talking about IPV with their mothers, sisters, or close friends. Explanations for these discrepancies are hypothesized in the next subtheme, when discussing the bond that exists between victims and other women who had also endured violence.

Sometimes in the home there are problems, and instead of me venting with someone else it is better to go to my mom. (FGD = 1, P = 8)

Other Victims of IPV

Participants recounted stories in which the victims almost exclusively discussed abuse with female friends and family who had also experienced violence from an intimate partner. Having experienced violence in similar contexts or time frames can strengthen victims’ bonds with one another and heighten their boundaries with-nonvictims.

I believe that when someone goes through this [violence], then they have more experience, have a different way of seeing life. (FGD = 2, P = 5)

Victims accept and comply with the group’s behavior, given their need to belong and receive support. The participants’ narratives revealed that while relying on other women in similar situations allowed victims to vent or “to take off the load” (as described by participants), it didn’t necessarily lead to healing or ending the violence. Instead, proximity with other victims tends to reinforce existing social norms and sustains practices that disincentivize help-seeking.

Church Members

Among women who belonged to a church, church members represented a strong group of reference for their behavior, as almost all participants considered that the pastor and other members were wise or fair. The primary motivation for joining the church for most women was to seek answers and solutions related to poverty, family issues, or violence:

Thank God, with my husband I have now lived with him for nineteen years, previously, as I told you, there was violence, but from the moment I sought Christ after two and a half years of going to church [it ended]. (FGD = 1, P = 9)

However, the advice offered by church members is rarely associated with seeking legal solutions or accessing social services. Instead, findings evidenced that church members encourage victims to prevent further violence by staying quiet.

If we look at our partners and they are mad, then you stay quiet, you must stay quiet and lay prostrate before God and ask God for direction on how to direct our homes [a woman describing the advice that she received from the pastor]. (FGD = 3, P = 7)

Theme 4: Society Sets Women up for Failure

This final theme describes the general situation of women in Honduras and how it influences their help-seeking behaviors. Specifically, the social and economic exclusion of women and their perceived role in society set them up for failure when seeking any type of help for IPV. Women’s marginalization and lack of economic opportunities make them dependent on a romantic partner or the father of their children to survive, which forces them to endure various forms of violence. There is a societal belief that women are to blame for most problems in the household, including the violence. Believing that you are to blame for experiencing IPV will reduce the likelihood of seeking help, as it increases fear of judgment and retaliation, lack of trust, and feeling hopeless.

Women Have no Economic Opportunities

An important factor that sets women up for failure is their poverty-related vulnerability and lack of economic opportunities. This lack of economic opportunities is rooted in Honduras’s high-unemployment rate and deficient educational system, including high-dropout rates and insufficient alternative educational opportunities.

The hard part is that we cannot find a job to maintain our children because having a job it would be a different thing. (FGD = 2, P = 2)

In many cases, women get together and stay in a violent relationship because of economic needs (as illustrated in the quote below). Therefore, women not only have a higher risk of experiencing violence due to their economic dependency (Dhungel et al., 2017), but they also lack the resources to access or request help (e.g., literacy, transportation, childcare options).

She is a child that lives with a 65-year-old man, because of hunger she got together with that old man. . .he grabs her with a machete, not to cut her but with the back of the machete. (FGD = 3, P = 7)

Finally, the presence of gangs in the country poses a twofold threat to women, encompassing both their physical and emotional well-being as well as their economic stability. Gangs harass those who start a business of any nature.

The gangs are in every corner, at the doors of the houses, if we start a business selling tortillas, they will ask for a tax, if we don’t pay, we are threatened and we die. (FGD = 1, P = 7)

Women are Responsible and Blamed for Everything That Happens in the Household

Women in Honduras are expected to attend to all the needs of their families, including securing food and providing care.

Maybe they [partners] give you a hundred lempiras in the morning and they want you to perform miracles, I tell him [that it’s not enough], sometimes the man wants to eat well. (FGD = 1, P = 3)

Study participants believed that failing to fulfill these needs may lead to violence. Victim blaming was associated with the belief that women provoke the violence, by failing to perform their duty or by demanding more than what the man can offer. It is less likely for sources of help to assist a victim if they perceive her as responsible for the abuse.

I tell my daughter-in-law, “look, learn to do things [cooking and taking care of the child] like that” it’s not like she’s going to be submissive, but to avoid problems she should learn to do things because she’s only sixteen. (FGD = 2, P = 1)

Instead of one reducing the problems, it is like you [the victim] rummage instead, then when you see that the man is mad and about to beat them, then they say it is his fault, but is hers for starting the problem. (FGD = 4, P = 6)

Women are Exposed to Multifaceted Violence

Violence against women is embedded in Honduran society and exacerbated by crime. Despite participants not being asked to talk about their own experiences with violence, participants described experiencing violence throughout their lives, from childhood to adulthood, both inside and outside their own homes, including exposure to crime, gang, and family violence.

We all have different problems [when growing up], in my case, I was raped, my mom never believed me and. . . (silence) when I told her about it she removed my underwear on the street to see if it was true. (FGD = 1, P = 6)

[If someone has problems with the gang] We all die, and the family as a whole, even the dog of the house if it is possible. (FGD = 3, P = 7)

In this context, experiencing multifaceted violence minimizes and normalizes these experiences, which leads to the belief that this is how things are and always will be. Hence, seeking help is considered pointless.

[When you are pregnant] They ask the father “what will you have?” girl, and then they tell you “ah, if it is a girl then it’s meat for dogs” so from there on you know how this world will be for you. (FGD = 3, P = 7)

Discussion

The present study identifies and describes the normative social environment that influences women’s decisions to seek help using the TNSB and focus group discussions with 30 women attending a popular PHC in Tegucigalpa, Honduras. Four themes emerged through the thematic analysis of the collected data. Taken together, our findings depict a situation in which women are constantly exposed to IPV, society disincentivizes help-seeking behaviors, and women are left out alone to endure or end the violence by themselves. While this study provides important insights into the Latin American context, our findings are also consistent with research from other parts of the world that have documented similar societal and cultural norms.

Social Norms and Expected Outcomes That Discourage IPV Help-Seeking

We identified several factors that discourage IPV help-seeking strategies. First, there is a social normative belief that most women do not take action when confronted with IPV (descriptive norm). This finding suggests a congruency between the normative belief and the actual practice, given that only 35.8% of Honduran women who suffered IPV in the past 12 months sought any type of help (Instituto Nacional de Estadística, & Secretaria de Salud de Honduras, 2021). Second, there is a social belief that women should keep household matters private (injunctive norm), a result that is in line with findings from several Hispanic populations (Ahrens et al., 2010; Murdaugh et al., 2004). The perceived need to keep household matters private underscores the shame attached to experiencing IPV and the perception that the needs of the family (e.g., reputation) are more important than the needs of the individual. Third, the expected outcomes or sanctions from seeking help from informal sources are negative, including the expectation that friends and neighbors will blame, mock, ignore, gossip about the victim, or offer oversimplistic advice. A recent study in Uganda also identified humiliation, shame, loss of respect, and negative pressure as expected sanctions from seeking help (Gardsbane et al., 2022).

Factors That Determine the Direction of a Social Norm, Either Discouraging or Encouraging Help-Seeking

If a victim is experiencing severe violence, it will be acceptable for her to seek help and she will be encouraged to do so. The positive association between the severity of the violence and help-seeking behaviors has been widely documented in the literature (Ansara & Hindin, 2010; Ellsberg et al., 2001; Henning & Klesges, 2002; Sabina et al., 2012). Realizing that a child is being affected by the violence also encourages victims to seek help and increases the likelihood that others will intervene and/or help the victim. In the available literature, the presence of children has varying effects on women’s responses, with some seeking help to safeguard their children (Acevedo, 2000; Meyer, 2010), while others opt not to seek help to avoid social services from taking their children away from them (Wolf et al., 2003). However, our results confirm that victims are less likely to face negative reactions from family and friends if they have more minors living with them (Goodkind et al., 2003). Finally, our results show that it is socially acceptable to seek help from a source that will respect the privacy of the victim (e.g., a psychologist or a discreet friend), if such a source is available. This finding aligns with evidence from Latin America that highlights the importance IPV victims place on confidentiality (Marta Garnelo et al., 2019).

Groups of Reference for IPV Victims

It is observed that neighbors, family of origin, friends, other IPV victims, and members of the church influence women’s perceptions and behaviors in different ways. First, neighborhoods in Tegucigalpa are communities in which women feel isolated and threatened by judgment and gossip (Pine, 2008). Women’s perceived isolation will discourage them from seeking help, given the positive association that exists between social belonging or stronger network ties and help-seeking and resilience among IPV victims (Barrett et al., 2020; Machisa et al., 2018). Female friends and family members who have experienced IPV represent an important group of reference for IPV victims. Given the overwhelming distrust within Honduran communities, victims have learned to trust only those in the same situation or with the same beliefs. However, this close relationship reinforces existing social norms and sustain practices that discourage seeking help. Members of the church are regarded as a trusted and respected group of reference for women. Women often join the church looking for a sense of community and control, as previously documented in the literature (Pine, 2008). Nevertheless, few women have sought help from church members, and in nearly all cases, they were advised to endure the violence. A study among Hispanics has also described the Catholic church as a setting that promotes staying married at all costs (Adames & Campbell, 2005).

Society Sets Women up for Failure

Honduran women are constantly exposed to violence, have limited economic opportunities, and bear the weight of being held responsible and accountable for all household matters, including acts of violence. These findings are consistent with descriptions of the social and economic exclusion of Honduran women, who are exposed to daily acts of control and humiliation (Menjívar & Walsh, 2017). Economic independence is instrumental in enabling women to seek help, as evidenced by studies that highlight the positive association between employment and formal help-seeking (Hayes & Franklin, 2017; Katiti et al., 2016; Linos et al., 2014). Finally, victim blaming is ingrained in society and stems from the social and institutional endorsement of violence as a way of resolving conflict and asserting power. This blame imposed on women further perpetuates their marginalization within society and reflects the deep-seated gender inequalities and biases that continue to persist.

Recommendations

In light of the results obtained from the study, the following recommendations are put forth. It should be noted that these recommendations are solely based on the research findings and not influenced by external sources. Given that most women do not and will not seek help for IPV, a strategy to be considered is the use of a “routine inquiry” protocol (i.e., asking women about IPV in all healthcare encounters) (World Health Organization, 2013). However, the feasibility of this strategy depends on the ability of the health system to protect women after disclosing the violence. Specifically, IPV assessments should be conducted within the context of other sensitive assessments, such as HIV testing and counseling among pregnant women. Given the enduring impact of IPV on the development of young children (Leyton, 2020), and recognizing that the well-being of children is a priority for battered women, family violence communication campaigns should incorporate information regarding available services for children who have been exposed to violence. Furthermore, services for children can constitute an entry point for women to seek and access help for themselves, by emphasizing that active and responsible motherhood includes taking care of themselves first.

When addressing groups of reference, it is crucial for women to have female role models within their communities who can help break the cycle of violence. Specifically, interventions should feature stories of IPV victims who have successfully overcome violence. Additionally, public offices and community organizations should employ IPV survivors to serve as inspirational figures and and offer nonjudgmental support to other victims. Programs and interventions should further explore the possibility of collaborating with pastors and church members to better help victims and their children. As a specific example, information about available legal, health, and social services could be advertised within church settings.

Changing the social context that sets women up for failure requires a multisectoral approach. As a first step, Honduras must reform social institutions that inadvertently reinforce violence through the neglect and the lack of implementation of the law. Second, the education and social protection sectors need to secure job opportunities for women, particularly for single mothers who bear the responsability of sustaining their households. These policy changes need to take place using a gender transformative approach, which includes addressing gender issues, violence, and nonviolent conflict resolutions in school life-skills programs (Jewkes, 2002).

Finally, a major recommendation is that funds need to be allocated to assess and evaluate current interventions that support IPV victims in Honduras. While various services are offered by different institutions, there is a lack of evidence regarding their effectiveness, the challenges they face when serving women, and the challenges women face when accessing these services. Quantitative and qualitative evaluations of these programs is imperative.

Strengths and Limitations

This study has several strengths, including the collection of primary data about an understudied yet critical problem. Prior work in this field has broadly considered structural factors as determinants of women’s lack of help-seeking behaviors for IPV. The current study expands on this work by analyzing social factors that complement, rather than compete with, previous findings on structural determinants. Studying the determinants of IPV help-seeking behaviors through a qualitative exploration of normative influences is a more nuanced approach to understanding the decision-making process of women experiencing violence. Furthermore, this study uses a strong theoretical background to understand the mechanisms that maintain and reinforce these norms in society.

Like other empirical studies, this study is not without limitations. The first limitation is the possibility of selection bias. It is possible that women who agreed to participate in the study were more willing than others to talk about violence. Therefore, our findings might not be generalizable to women who would not talk with strangers about violence from intimate partners. Second, this study used focus group discussions, which are typically not recommended for collecting sensitive information. However, some researchers argue that focus group discussions are better than individual interviews in eliciting sensitive themes (Guest, Namey, Taylor, et al., 2017). This may seem counterintuitive; however, participants often feel more comfortable disclosing sensitive information when surrounded by other individuals with a similar sociocultural background than when having an intimate one-on-one conversation with a researcher (Guest, Namey, Taylor, et al., 2017). Finally, although we reached code saturation with our sample size, it is possible that enrolling more women in the study could have potentially enhanced the depth, breadth, and nuanced understanding of each code (i.e., meaning saturation).

Footnotes

Declaration of Conflicting Interests

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

Funding

The author(s) received no financial support for the research and/or authorship of this article.

ORCID iDs

Alejandra Leyton

Xiaojin Chen

Author Biographies

Alejandra Leyton, PhD, is a behavioral scientist with expertise in behavioral economics, impact evaluation, and research methodology. Over the last years, her research has focused on Honduras and the determinants and consequences of violence against women.

Dominique Meekers, PhD, is a professor of program evaluation and communication research at Tulane School of Public Health and Tropical Medicine.

Paul Hutchinson, PhD, is an associate professor of advanced research methods at Tulane School of Public Health and Tropical Medicine.

Katherine Andrinopoulos, PhD, is an associate professor of social determinants of health and qualitative data analysis at Tulane School of Public Health and Tropical Medicine.

Xiaojin Chen, PhD, is an associate professor of deviant behavior and research methods at the Department of Sociology in Tulane School of Liberal Arts.

References

Acevedo

M. J.

(2000). Battered immigrant Mexican women’s perspectives regarding abuse and help-seeking. Journal of Multicultural Social Work, 8(3–4), 243–282.

Ackerman

Love

T. P.

(2014). Ethnic group differences in police notification about intimate partner violence. Violence Against Women, 20(2), 162–185.

Adames

S. B.

Campbell

(2005). Immigrant Latinas’ conceptualizations of intimate partner violence. Violence Against Women, 11(10), 1341–1364.

Ahrens

C. E.

Rios-Mandel

L. C.

Isas

del Carmen Lopez

(2010). Talking about interpersonal violence: Cultural influences on Latinas’ identification and disclosure of sexual assault and intimate partner violence. Psychological Trauma Theory Research Practice and Policy, 2(4), 284–295.

Alexander-Scott

Women

V. A.

(2016). DFID Guidance Note: shifting social norms to tackle violence against women and girls (VAWG). Violence Against Women and Girls (VAWG).

Ansara

D. L.

Hindin

M. J.

(2010). Formal and informal help-seeking associated with women’s and men’s experiences of intimate partner violence in Canada. Social Science & Medicine, 70(7), 1011–1018. https://doi.org/10.1016/j.socscimed.2009.12.009

Barrett

B. J.

Peirone

Cheung

C. H.

(2020). Help seeking experiences of survivors of intimate partner violence in Canada: The role of gender, violence severity, and social belonging. Journal of Family Violence, 35(1), 15–28.

Bicchieri

(2005). The grammar of society: The nature and dynamics of social norms. Cambridge University Press.

Bott

Guedes

Goodwin

M. M.

Mendoza

J. A.

(2012). Violence against women in Latin America and the Caribbean: A comparative analysis of population-based data from 12 countries. Pan American Health Organization.

10.

Braun

Clarke

(2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.

11.

Bybee

D. I.

Sullivan

C. M.

(2002). The process through which an advocacy intervention resulted in positive change for battered women over time. American Journal of Community Psychology, 30(1), 103–132.

12.

Carmenate-Milián

Herrera-Ramos

Ramos Caceres

Lagos Ordonez

Ordonez

T. L.

Valladares

C. S.

(2017). Situation of the health system in Honduras and the new proposed health model. Archives of Medicine, 9(4), 1.

13.

Cialdini

R. B.

Reno

R. R.

Kallgren

C. A.

(1990). A focus theory of normative conduct: Recycling the concept of norms to reduce littering in public places. Journal of Personality and Social Psychology, 58(6), 1015–1026.

14.

Cislaghi

Heise

(2018). Theory and practice of social norms interventions: Eight common pitfalls. Globalization and Health, 14(1), 83. https://doi.org/10.1186/s12992-018-0398-x

15.

Coker

A. L.

Smith

P. H.

Thompson

M. P.

McKeown

R. E.

Bethea

Davis

K. E.

(2002). Social support protects against the negative effects of partner violence on mental health. Journal of Women’s Health & Gender-Based Medicine, 11(5), 465–476.

16.

Contreras-Urbina

Heilman

Von Au

A. K.

Hill

Puerto Gómez

Zelaya

Arango

D. J.

(2016). Community-based approaches to intimate partner violence: a review of evidence and essential steps to adaptation. World Bank Group.

17.

Dhungel

Dhital

S. R.

Stock

(2017). Is economic dependence on the husband a risk factor for intimate partner violence against female factory workers in Nepal? BMC Women’s Health, 17(1), 1–9.

18.

Ellsberg

Winkvist

Pena

Stenlund

(2001). Women’s strategic responses to violence in Nicaragua. Journal of Epidemiology and Community Health, 55(8), 547–555.

19.

Fortin

Guay

Lavoie

Boisvert

J.-M.

Beaudry

(2012). Intimate partner violence and psychological distress among young couples: Analysis of the moderating effect of social support. Journal of Family Violence, 27(1), 63–73.

20.

Gardsbane

Bukuluki

Musuya

(2022). Help-seeking within the context of patriarchy for domestic violence in urban Uganda. Violence Against Women, 28(1), 232–254.

21.

Goodkind

J. R.

Gillum

T. L.

Bybee

D. I.

Sullivan

C. M.

(2003). The impact of family and friends’ reactions on the well-being of women with abusive partners. Violence Against Women, 9(3), 347–373.

22.

Green

Thorogood

(2018). Qualitative methods for health research. SAGE.

23.

Guest

MacQueen

K. M.

Namey

E. E.

(2011). Applied thematic analysis. SAGE Publications.

24.

Guest

Namey

McKenna

(2017). How many focus groups are enough? Building an evidence base for nonprobability sample sizes. Field Methods, 29(1), 3–22.

25.

Guest

Namey

Taylor

Eley

McKenna

(2017). Comparing focus groups and individual interviews: Findings from a randomized study. International Journal of Social Research Methodology, 20(6), 693–708.

26.

Hamby

(2014). Battered women’s protective strategies: Stronger than you know. Oxford University Press.

27.

Hayes

B. E.

Franklin

C. A.

(2017). Community effects on women’s help-seeking behaviour for intimate partner violence in India: Gender disparity, feminist theory, and empowerment. International Journal of Comparative and Applied Criminal Justice, 41(1–2), 79–94.

28.

Henning

K. R.

Klesges

L. M.

(2002). Utilization of counseling and supportive services by female victims of domestic abuse. Violence and Victims, 17(5), 623–636.

29.

Hennink

M. M.

Kaiser

B. N.

Weber

M. B.

(2019). What influences saturation? Estimating sample sizes in focus group research. Qualitative Health Research, 29(10), 1483–1496.

30.

Instituto Nacional de Estadística, & Macro International. (2013). Encuesta nacional de demografía y salud: ENDESA 2011–2012. Instituto Nacional de Estadística.

31.

Instituto Nacional de Estadística, & Secretaria de Salud de Honduras. (2021). Encuesta nacional de demografía y salud/Encuesta de Indicadores Multiples por Conglomerados Honduras 2019. Instituto Nacional de Estadística.

32.

Jewkes

(2002). Intimate partner violence: Causes and prevention. Lancet, 359(9315), 1423–1429.

33.

Katiti

Sigalla

G. N.

Rogathi

Manongi

Mushi

(2016). Factors influencing disclosure among women experiencing intimate partner violence during pregnancy in Moshi Municipality, Tanzania. BMC Public Health, 15(1), 715. https://doi.org/10.1186/s12889-016-3345-x

34.

Leyton

(2020). A latent class analysis to identify how patterns of intimate partner violence influence early childhood development outcomes in Honduras. Child Abuse & Neglect, 107, 104609.

35.

Linos

Slopen

Berkman

Subramanian

S. V.

Kawachi

(2014). Predictors of help-seeking behaviour among women exposed to violence in Nigeria: A multilevel analysis to evaluate the impact of contextual and individual factors. Journal of Epidemiology and Community Health, 68(3), 211–217.

36.

Machisa

M. T.

Christofides

Jewkes

(2018). Social support factors associated with psychological resilience among women survivors of intimate partner violence in Gauteng, South Africa. Global Health Action, 11, 1491114.

37.

Marta Garnelo

C. B.

Suzanne

Morrison

(2019). Applying behavioral insights to intimate partner violence: Improving services for survivors in Latin America and the Caribbean. Behavioural Insights Ltd.

38.

Maticka-Tyndale

Barnett

J. P.

Trocaire

(2020). Exploring the relationship between stigma, stigma challenges, and disclosure among slum-dwelling survivors of intimate partner violence in Kenya. Violence Against Women, 26, 1188–1208. https://doi.org/10.1177/1077801219856101

39.

Matos

Conde

Santos

(2014). Multiple victimisation in socially excluded women: From prevalence to meanings. Procedia-Social and Behavioral Sciences, 161, 70–76. https://doi.org/10.1016/j.sbspro.2014.12.012

40.

Menjívar

Walsh

S. D.

(2017). The architecture of feminicide: The state, inequalities, and everyday gender violence in Honduras. Latin American Research Review, 52(2), 221–240.

41.

Meyer

(2010). Seeking help to protect the children?: The influence of children on women’s decisions to seek help when experiencing intimate partner violence. Journal of Family Violence, 25, 713–725.

42.

Murdaugh

Hunt

Sowell

Santana

(2004). Domestic violence in Hispanics in the Southeastern United States: A survey and needs analysis. Journal of Family Violence, 19(2), 107–115.

43.

Overstreet

N. M.

Quinn

D. M.

(2013). The intimate partner violence stigmatization model and barriers to help-seeking. Basic and Applied Social Psychology, 35(1), 109–122.

44.

Palermo

Bleck

Peterman

(2014). Tip of the iceberg: reporting and gender-based violence in developing countries. American Journal of Epidemiology, 179(5), 602–612.

45.

Pine

(2008). Working hard, drinking hard: On violence and survival in. University of California Press.

46.

QSR International. (2018). NVivo 12 (Version 12) [Computer software]. https://www.qsrinternational.com/nvivo-qualitative-data-analysis-software/home

47.

Reno

R. R.

Cialdini

R. B.

Kallgren

C. A.

(1993). The transsituational influence of social norms. Journal of Personality and Social Psychology, 64(1), 104–112.

48.

Rimal

R. N.

Real

(2005). How behaviors are influenced by perceived norms: A test of the theory of normative social behavior. Communication Research, 32(3), 389–414.

49.

Sabina

Cuevas

C. A.

Schally

J. L.

(2012). Help-seeking in a national sample of victimized Latino women: The influence of victimization types. Journal of Interpersonal Violence, 27(1), 40–61.

50.

Wolf

M. E.

Hobart

M. A.

Kernic

M. A.

(2003). Barriers to seeking police help for intimate partner violence. Journal of Family Violence, 18(2), 121–129.

51.

World Health Organization. (2013). Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines.

52.

Yang

(2018). The moderating role of close versus distal peer injunctive norms and interdependent self-construal in the effects of descriptive norms on college drinking. Health Communication, 33(6), 762–770.

53.

Young

H. P.

(2015). The evolution of social norms. Annual Review of Economics, 7(1), 359–387.

54.

Zavala

G. L.

Montoya-Reales

D. A.

(2017). Violencia contra la mujer en la relación de pareja; caracterización en cinco comunidades de Honduras. Rev. fac. cienc. méd.(Impr.), 14(2), 16–27.