Help-Seeking Behaviors and Barriers Among Black Women Exposed to Severe Intimate Partner Violence: Findings From a Nationally Representative Sample

Abstract

This article examined general help-seeking utilization and barriers among U.S. Black women reporting severe physical intimate partner violence (IPV). Data from the National Survey of American Life (NSAL), the largest and most detailed survey on Blacks residing in the United States, were analyzed. Among U.S. Black women reporting severe physical IPV, many sought the help of a psychiatrist (13.8%) or other mental health professionals (14.0%). Multivariate findings revealed associations between help-seeking utilization and sociodemographic factors. Queries from open responses suggested potential cultural and ethnic differences between African American and Caribbean Black women reporting intimate partner violence in relation to barriers to help-seeking.

Keywords

intimate partner violence help-seeking behaviors African American and Caribbean Black women

Introduction

Intimate partner violence (IPV) is a serious threat to health and well-being, and may have even more dire consequences for women found to be at greater risk (Dillon et al., 2013; Lacey et al., 2013; Lacey & Mouzon, 2016; Lagdon et al., 2014). U.S. Black and immigrant women have been identified as especially vulnerable to IPV compared with other racial/ethnic and nonimmigrant groups (e.g., White, Hispanic; Arnette et al., 2007; Breiding et al., 2014). Recent studies estimate that more than one third (41%) of women within the Black population, including African American and Caribbean Blacks, experience lifetime physical assault by their partners (Breiding et al., 2014), and these women may be in greater need for assistance due to generally poorer health, role strain, double jeopardy (race and gender status), and limited community resources (Ward et al., 2009).

Seeking help can either mediate or protect women from IPV (Coker et al., 2012; Goodson & Hayes, 2018; Morrison et al., 2006). However, past historical events and discriminatory practices have created distrust in mainstream institutions and serve as important barriers to formal help-seeking utilization among U.S. Blacks (Arnette et al., 2007; Bent-Goodley, 2007; El-Khoury et al., 2004; Nickerson et al., 1994; Rodriquez et al., 2009; Sabri et al., 2013, 2015; Ward et al., 2009). This, incidentally, has contributed to an overreliance on informal networks in addressing needs (Ansara & Hindin, 2010; Kennedy et al., 2012). Studies have generally found that Blacks are likely to seek the assistance of family, friends, and clergy for a range of support, including mental and physical health, among others (El-Khoury et al., 2004; Gillum et al., 2006; Morrison et al., 2006; Neighbors, Caldwell, et al., 2007; Postmus, 2015; Potter, 2007; Sabri et al., 2015; Taylor et al., 2000; Ward et al., 2009).

Although more recent research has begun to explore and examine the role of formal network utilization for mental health needs among Blacks within the United States (e.g., Neighbors, Caldwell, et al., 2007), little is known about the help-seeking behaviors of women who experience IPV (Draughton et al., 2015; El-Khoury et al., 2004; Stockman et al., 2015). Furthermore, limited research has differentiated help-seeking behaviors between African American and Caribbean Blacks who report IPV. Despite racial similarities between African American and Caribbean Black women, the groups differ in sociopolitical histories and may hold distinct cultural frameworks. One’s cultural background may influence how IPV is addressed. Cultural expectations and social consequences can either discourage or encourage intimate partner victims from disclosing and seeking help (Goodson & Hayes, 2018; Powell Sears, 2018). An intersectional lens provides a useful heuristic to understand the use and choices of help-seeking between different cultural groups. The intersectional framework contends that social positionalities such as gender, race, and ethnicity, for example, have effects on women’s experiences (Crenshaw, 1991). From this perspective, both the experience of IPV and the decision to seek help, as well as types of help-seeking utilization, may result from complex and multidimensional social processes and positionalities.

According to studies, help-seeking utilization among women who experience IPV is linked to severity and frequency. The more frequent and severe the abuse, the greater tendency to seek help (Bonomi et al., 2006; Cheng & Lo, 2015; Dutton et al., 1999; Flicker et al., 2011; Goodson & Hayes, 2018; Henning & Klesges, 2002; Lucea et al., 2013; Postmus, 2015; Sabri et al., 2013). However, the decision to seek help is also shaped by a number of factors that enable or dis-enable help-seeking, including age, education, employment, access to resources, and ethnicity (Bent-Goodley, 2007; Goodson & Hayes, 2018; Lipsky et al., 2006; Satyen et al., 2019). Previous research suggests age plays a key role in service utilization among U.S. Black women (Snowden, 2001). Flicker et al. (2011) found that older women were less likely to seek help from family members and friends, and were more likely to seek mental health services. Conversely, cross-cultural research has found that the older the victim, the greater likelihood of her seeking help (Goodson & Hayes, 2018).

Research suggests that women’s socioeconomic status influences utilization of services. In particular, living in poverty poses challenges to accessing resources to address basic needs, and creates barriers to both formal and informal means to address violence in relationships (Anyikwa, 2015; Bent-Goodley, 2007; Dutton et al., 2000). This is especially the case for poor and ethnic minority women who frequently face barriers such as inaccessible services, limited program eligibility, child care problems, and transportation issues (Bent-Goodley, 2004, 2007; Fugate et al., 2005; Kennedy et al., 2012; Sabri et al., 2015). Studies also suggest that having a higher socioeconomic standing or greater access to resources is associated with a greater likelihood of service utilization among women reporting intimate partner violence, and the ability to avoid or resist violence (Dutton et al., 2000). For instance, higher service utilization patterns were found among more educated individuals (Flicker et al., 2011; Goodson & Hayes, 2018; Hodges & Cabanilla, 2011; Kaukinen et al., 2013). Chen and Lo (2014) additionally found a positive association between seeking the help of a mental health professional and women’s income and educational level. Meanwhile, secure employment was positively associated with increased service utilization (Kaukinen et al., 2013).

Social and cultural norms and sentiments surrounding the personal nature of IPV may also influence Black women’s use of outside or formal sources of support, even when necessary (Flicker et al., 2011). Coupled with a general distrust of formal institutions, for some Blacks, going outside of community networks for assistance is viewed as a betrayal and/or devaluing of one’s race or cultural group (Hien & Ruglass, 2009; Leiner et al., 2008; Moss et al., 1997; Potter, 2008; Stockman et al., 2014, 2015; Sylaska & Edwards, 2014), causing them to seek informal means for dealing with the violence. There is evidence that these attitudes and sentiments may particularly resonate among Black immigrants to the United States (e.g., Stockman et al., 2015; West, 2016), specifically among some Caribbean Black women who may view abuse by an intimate partner as private and a potentially normative aspect of relationships (Powell Sears, 2018; Stockman et al., 2014). Women who experience IPV within these populations may only disclose their experiences to those close to them or with similar experiences rather than going outside community networks.

The Present Study

Using data from a nationally representative sample, this study sought to fill an important gap in the literature on the help-seeking behavior of U.S. Black women with a history of severe physical intimate partner violence. Specifically, this study examines prevalence rates and sociodemographic correlates of help-seeking behaviors and utilization among U.S. Black women (e.g., African American and Caribbean Black) who have been exposed to severe physical intimate partner violence. We further explore barriers to help-seeking behaviors among women within this population. Based on extant literature (e.g., Neighbors, Caldwell, et al., 2007; Taylor et al., 2011; Woodward, 2011), we expected that women in the sample will report utilizing informal means of help-seeking more frequently, but these alternatives will differ between African American and Caribbean Black women. We additionally hypothesize that help-seeking behaviors will be influenced by sociodemographic factors with older women, higher socioeconomic status women, non-foreign-born women, and women who report greater frequency of IPV more likely to seek help.

Method

Data

Secondary data from the National Survey of American Life (NSAL), the most detailed sample on the health of U.S. Blacks, and the first probability sample collected on Caribbean Blacks residing in the United States, were used for this study (see Jackson et al., 2004, for details). As part of the National Institutes of Mental Health (NIMH) Collaborative Psychiatric Epidemiology Survey (CPES), data were collected between February 2001 and March 2003. A multistage probability sampling method was used to generate the sample. There were 6,082 participants who were interviewed either in person or by phone: 3,570 African Americans; 1,621 Caribbean Blacks; and 891 non-Hispanic Whites. African Americans were participants who were of African descent but without a Caribbean heritage. Caribbean Blacks were participants of African descent but were (a) of West Indian descent, (b) from a Caribbean-area country, or (c) had parents or grandparents who were born in a Caribbean-area country (Neighbors, Njai, & Jackson, 2007; Williams et al., 2007). The average length of time it took to complete interviews was 2 hr and 20 min. A response rate of 72.3% was obtained for the overall sample. Participants who completed the survey received compensation in the amount of US$50. Both quantitative and open responses from the U.S. Black women, which includes African American and Caribbean women who reported severe physical IPV, were analyzed.

Predictors

Sociodemographic measures

The sociodemographic predictors were age (continuous), marital status, educational level, occupational status, poverty status, ethnicity, and nativity. Marital status was separated into married, partnered, separated or divorced, widowed, and never married. Educational level was categorized as less than high school, high school graduate, and college education (whether some or completed). Occupational status was coded as employed or not employed. Poverty status is an income-to-poverty ratio consisting of the participant’s household income divided by the 2001 U.S. Census poverty threshold for the number of adults and children living in that household. Ratios below 1.00 indicate that the income for the participant’s household is below the official poverty threshold, whereas a ratio of 1.00 or greater indicates income above the poverty level. For example, a ratio of 1.25 indicates that income was 25% above the appropriate poverty threshold (Proctor & Dalaker, 2002). Ethnicity was separated into African American and Caribbean Black. Nativity was categorized as U.S.-born and foreign-born.

Intimate partner violence

Of the participants in the sample, Black women reporting IPV were those who responded in the affirmative about whether they had “ever been badly beaten up by a spouse or romantic partner” (see Lacey et al., 2015). The IPV measure used in the study compared with the U.S. National Comorbidity Survey Replication dichotomously defined severe partner violence Conflict Tactic Scale (CTS) measure within the Collaborative Psychiatric Epidemiological Study (CPES), and was found to have a fair association across different approaches to estimating agreement (odds ratio [OR] = 4.5; confidence interval [CI] = [1.49, 14.98], p < .001; area under curve [AUC] = 0.6>). Another focus was on a follow-up question that assessed the number of times (frequency) participants had experienced severe physical violence by an intimate partner.

Outcome Measures

Mental health services

Two questions in the study addressed the use of mental health services. The first question queried general participants about ever seeing a psychiatrist for any problems. The other question inquired whether participants had ever seen other mental health professionals such as a psychologist, a psychotherapist, a social worker, a mental health nurse, or a counselor. Both questions were measured on a binary scale (yes/no). An index of the measures was created representing at least one mental health service (1 = yes, no = 0).

Physician health service

Three questions were used to identify whether women had sought the help of a doctor or physician. Participants, in general, were asked whether they had ever (in their lifetime): (a) seen a family doctor; (b) seen any other medical doctor like a cardiologist or gynecologist; and (c) seen any other health professional like a nurse or a physician’s assistant. The questions were measured on a binary scale with response options of “yes” and “no.” These measures were combined to reflect physician health service, with 0 = no service and 1 = yes representative of participants receiving at least one of these services.

Help from clergy

In reference to seeking the help of clergy, participants generally were asked whether they had ever seen “a religious or spiritual advisor like a minister, priest, or rabbi.” Response options were “yes” or “no.”

Analytic Strategy

Descriptive statistics on sample characteristics, help-seeking behaviors, and the open response of barriers to help-seeking utilization were conducted. Rao-Scott chi-square representing the design corrected measure of association and t tests were used to address associations between women reporting severe IPV (n = 505) and non-IPV women (n = 2,646) and help-seeking behaviors, as well as the frequency of abuse. Multivariate logistic regression analytic procedures examined key predictors (e.g., age, education, employment status, poverty level, ethnicity, nativity, frequency of IPV) on the help-seeking behaviors (physician, mental health, clergy) of women reporting severe physical IPV. For these analyses, odds ratio estimates and 95% confidence intervals were computed. Due to the NSAL’s complex sample design, the analysis corrected for clustering and stratification. The conventional .05 alpha level was used to determine significance. Bonferroni correction–adjusted alpha level was used for the multivariate analyses.

Results

Sociodemographic Characteristics

On average, women in the sample were around 43 (M = 42.5) years of age, and most had never married (32.4%; see Table 1). Around a third (39.1%) of women reported having a college education. More than half of participants were living at or above poverty (64.1%), were employed (63.7%), or resided in the Southern region of the country (54%). Around 94% of the sample identified as African American (n = 2,299), and 6% as Caribbean Black (n = 978). Most (94.5%) of the respondents in the sample had been born in the United States.

Table 1.

Sample Characteristics.

Characteristics	Total sample of women(N = 3,277)	Women report severe IPV(N = 505)	Women not reporting severe IPV(N = 2,646)	p value difference
Age, M (SD)	42.5 (16.4)	42.7 (13.1)	42.0 (16.9)	.526 (−2.8, 1.4)
Marital status
Married	27.4	20.6	28.7
Partnered	8.4	10.0	8.2
Separated/divorced	20.3	33.6	17.7	.000
Widowed	11.5	8.9	11.7
Never married	32.4	26.9	33.9
Education
Less than HS	24.7	34.1	23.1
HS graduate	36.2	31.2	36.5	.000
College	39.1	34.7	40.4
Poverty index
Below (or at) poverty	35.9	47.1	33.5
Above poverty	64.1	52.9	66.5	.000
Occupational status
Employed	63.7	58.8	65.0
Not employed	36.3	41.2	35.0	.030
Region
Northeast	18.8	20.7	18.8
Midwest	18.9	23.3	16.6
South	54.0	46.2	56.4	.110
West	8.3	9.8	8.2
Ethnicity
African Americans	93.8	95.7	93.3
Caribbean Blacks	6.2	4.3	6.7	.032
Nativity
U.S.-born	94.5	96.7	94.0
Foreign-born	5.5	3.3	6.0	.034

Note. Percentages are weighted. HS = high school; IPV = intimate partner violence.

General Prevalence of Help-Seeking Behaviors Among U.S. Black Women Reporting Severe IPV

As shown in Table 2, among women who reported severe IPV, many sought the help of a psychiatrist (13.8%) and other mental health professionals (14.0%). In addition, 13.4% sought the help of a family doctor, whereas around 7% (6.8%) of women reporting severe IPV sought the help of a clergy member. Fewer women endorsed seeking help from other medical doctors (4.1%) and health professionals (2.1%).

Table 2.

Prevalence Rate of Help-Seeking Behaviors of Women Reporting Severe IPV.

Help-Seeking Behaviors	U.S. Black women	African Americans	Caribbean Blacks	Ethnic differencesp value
Ever see psychiatrist	13.8	14.1	8.6	.033^*
Ever see other mental health professionals	14.0	14.1	13.0	.580
Ever see family doctor	13.4	13.6	10.3	.273
Ever see other medical doctor	4.1	4.3	2.2	.053
Ever see other health professional	2.1	2.1	2.2	.923
Ever see minister	6.8	7.0	3.1	.001^***

Note. IPV = intimate partner violence.

p < .05. **p < .01. ***p < .001.

There were differences found in help-seeking utilization between ethnic groups. A significantly higher percentage of African American women in comparison with Caribbean Black women sought the help of a psychiatrist (14 vs. 8.6%, p < .05) and clergy (7.0 vs. 3.1%, p < .001) for any problems. Although not statistically significant, more African Americans reporting severe IPV compared with Caribbean Black women sought the help of other medical doctors (4.3 vs. 2.2%, p = .053).

Help-Seeking Behavior Among Women Exposed to Severe IPV Compared With No IPV

Notable differences were found between U.S. Black women reporting severe IPV and those not reporting severe IPV (see Table 3). For example, there was a significantly higher percentage of women reporting severe IPV who utilized psychiatric care than those that did not report IPV (28.0 vs. 10.7%, p < .001). The percentage of women seeking help from clergy was also twice as high among women reporting severe IPV compared with those who did not report IPV (11.5 vs. 5.8%, p < .01). Similarly, women reporting severe IPV as compared with those who did not report IPV were twice as likely to report seeking the help of other mental health professionals (24.6 vs. 11.7%, p < .001). These differences were also observed among women who sought the help of a family doctor (19.5 vs. 12.1%, p < .01), where the percentage was higher among victims of severe IPV than nonvictims.

Table 3.

Help-Seeking Behaviors and Exposure to Violence Between Victims of Severe IPV and Nonvictims.

Help-seeking behavior	U.S. Black women			African Americans			Caribbean Blacks			Ethnic differencesp value	Ethnic differencesp value
Categories	Report IPV	Not report IPV	p value	Report IPV	Not report IPV	p value	Report IPV	Not report IPV	p value	African American vs. Caribbean IPV	African American vs. Caribbean non-IPV
Ever see psychiatrist	28.0	10.7	.000***	28.1	11.1	.000***	25.4	6.3	.017*	.795	.063
Ever see other mental health professionals	24.6	11.7	.000***	24.6	11.8	.000***	25.0	11.2	.032*	.961	.780
Ever see family doctor	19.5	12.1	.002**	19.6	12.3	.005**	16.1	9.4	.298	.653	.362
Ever see other medical doctor	7.3	3.5	.000***	7.5	3.6	.000***	3.4	2.0	.385	.128	.150
Ever see other health professional	3.8	1.7	.056	3.9	1.7	.053	2.3	1.2	.554	.126	.693
Ever see minister	11.5	5.8	.002**	11.7	6.0	.004**	6.0	2.6	.150	.223	.002**

Note. IPV = intimate partner violence.

p < .05. **p < .01. ***p < .001.

Subgroup analysis further showed differences in response patterns among African American and Caribbean Black women reporting severe IPV and nonvictims. Among African American women, a significantly higher percentage reporting severe IPV compared with non-IPV women sought the help of a psychiatrist (28.1 vs. 11.1%, p < .001), other mental health professionals (24.6 vs. 11.8%, p < .001), family doctor (19.6 vs. 12.3%, p < .01), other medical doctor (7.5 vs. 3.6%, p < .001), and clergy (11.7 vs. 6.0%, p < .01), whereas among Caribbean Black women, a significantly higher percentage of women who experienced severe IPV sought the help of a psychiatrist (25.4 vs. 6.3%, p < .05) and other mental health professionals (25 vs. 11.2%, p < .05) compared with women who had not experienced severe IPV.

Help-Seeking Behaviors and Frequency of IPV

As shown in Table 4, few differences were found across populations between frequency of IPV and help-seeking utilization. In general, there were inconsistencies in mean scores between women who reported severe IPV and non-IPV women. Only in rare instances, significant differences were observed, whereby Caribbean women sought the help of a medical doctor (p < .05).

Table 4.

Frequency of IPV and Help-Seeking Behavior.

Help-seeking behavior	U.S. Black women			African Americans			Caribbean Blacks
Categories	No	Yes	p value	No	Yes	p value	No	Yes	p value
Ever see psychiatrist	2.6 (2.7)	3.0 (2.9)	.175	2.6 (2.7)	3.1 (2.9)	.153	3.1 (3.2)	2.5 (3.3)	.487
Ever see other mental health professionals	2.7 (2.8)	2.6 (2.6)	.669	2.7 (2.8)	2.6 (2.6)	.682	3.0 (3.2)	2.8 (3.3)	.844
Ever see family doctor	2.7 (2.7)	2.8 (2.8)	.601	2.7 (2.7)	2.8 (2.8)	.578	3.0 (3.1)	NA	.860
Ever see other medical doctor	2.7 (2.8)	2.5 (2.4)	.738	2.7 (2.8)	2.6 (2.4)	.814	3.0 (3.1)	NA	.015*
Ever see other health professional	2.7 (2.7)	3.2 (3.0)	.637	2.7 (2.7)	3.2 (3.0)	.649	2.9 (3.1)	NA	.274
Ever see minister	2.7 (2.8)	2.5 (2.5)	.651	2.7 (2.8)	2.5 (2.6)	.702	3.0 (3.1)	NA	.304

Note. IPV = intimate partner violence.

p < .05. **p < .01. ***p < .001.

Multivariate Analysis of Relationship Between Sociodemographic Factors and Help-Seeking Behaviors

Of women in the sample reporting severe IPV, multivariate analysis showed that nativity was predictive of mental health service utilization when other factors were controlled (see Table 5). The results show reduced odds of seeking any mental health services among foreign-born women (adjusted odds ratio [AOR] = 0.111, CI = [0.040, 0.309], p < .001) compared with U.S.-born women. Associations were not found between other help-seeking behaviors (e.g., physician and clergy services) and predictive factors (see Tables 6 and 7).

Table 5.

Summary of Logistic Regression Predicting Mental Health Services (N = 505).

Variable	B	SE	Odds ratio	95% CI
Age	−0.004	.010	0.996	[0.975, 1.017]
Education level
Less than HS	1	1	1	1
HS graduate	0.261	.288	1.298	[0.727, 2.317]
College	0.499	.332	1.647	[0.844, 3.213]
Marital status
Married	1	1	1	1
Partnered	−0.179	.529	0.836	[0.288, 2.422]
Separated/divorced	−0.071	.346	0.931	[0.464, 1.868]
Widowed	−0.135	.485	0.874	[0.329, 2.320]
Never married	−0.029	.431	0.971	[0.408, 2.313]
Race/ethnicity
African American	1	1	1	1
Caribbean Black	0.717	.671	2.048	[0.531, 7.906]
Poverty level
Above	1	1	1	1
Below	−0.013	.255	0.987	[0.591, 1.649]
Employment status
Employed	1	1	1	1
Not employed	0.368	.295	1.445	[0.798, 2.616]
Nativity
U.S.-born	1	1	1	1
Foreign-born	−2.197	.508	0.111	[0.040, 0.309]***
Frequency of IPV	.022	.040	1.022	[0.943, 1.108]

Note. Bonferroni adjustment for multiple testing at an alpha level of .006 (p < .006) was used to determine statistical significance for multivariate test. CI = confidence interval; HS = high school; IPV = intimate partner violence.

***

p < .001.

Table 6.

Summary of Logistic Regression Predicting Physician Services (N = 505).

Variable	B	SE	Odds ratio	95% CI
Age	0.036	.013	1.037	[1.010, 1.065]
Education level
Less than HS	1	1	1	1
HS graduate	0.008	.326	1.008	[0.523, 1.944]
College	0.587	.332	1.798	[0.921, 3.511]
Marital status
Married	1	1	1	1
Partnered	0.087	.507	1.091	[0.393, 3.025]
Separated/divorced	−0.151	.371	0.860	[0.408, 1.813]
Widowed	−0.365	.772	0.694	[0.147, 3.281]
Never married	0.075	.399	1.077	[0.482, 2.408]
Race/ethnicity
African American	1	1	1	1
Caribbean Black	0.254	.571	1.289	[0.408, 4.070]
Poverty level
Above	1	1	1	1
Below	−0.039	.247	0.962	[0.586, 1.580]
Employment status
Employed	1	1	1	1
Not employed	0.471	.385	1.601	[0.738, 3.474]
Nativity
U.S.-born	1	1	1	1
Foreign-born	−0.986	.514	0.373	[0.133, 1.050]
Frequency of IPV	−0.045	.042	0.956	[0.878, 1.040]

Note. Bonferroni adjustment for multiple testing at an alpha level of .006 (p < .006) was used to determine statistical significance for multivariate test. CI = confidence interval; HS = high school; IPV = intimate partner violence.

Table 7.

Summary of Logistic Regression Predicting Seeking Minister Help (N = 505).

Variable	B	SE	Odds ratio	95% CI
Age	0.014	.021	1.014	[0.973, 1.057]
Education level
Less than HS	1	1	1	1
HS graduate	1.221	.649	3.391	[0.919, 12.516]
College	1.744	.698	5.718	[1.402, 23.325]
Marital status
Married	1	1	1	1
Partnered	−0.437	.904	0.646	[0.105, 3.987]
Separated/divorced	−0.232	.528	0.793	[0.274, 2.294]
Widowed	−0.803	.709	0.448	[0.108, 1.866]
Never married	−0.686	.571	0.504	[0.160, 1.591]
Race/ethnicity
African American	1	1	1	1
Caribbean Black	−0.189	.507	0.828	[0.299, 2.297]
Poverty level
Above	1	1	1	1
Below	0.485	.452	1.624	[0.655, 4.031]
Employment status
Employed	1	1	1	1
Not employed	−0.483	.513	0.617	[0.220, 1.733]
Nativity
U.S.-born	1	1	1	1
Foreign-born	−1.003	.866	0.367	[0.064, 2.095]
Frequency of IPV	−0.006	.068	0.994	[0.866, 1.141]

Barriers to Seeking Help

Open response data provided general information on barriers to seeking help among participants (see Table 8). Data indicated that approximately one quarter (22.9%) of U.S. Black women did not seek help because they wanted to resolve the problem on their own. Nineteen percent (19.2%) of women thought the problem would get better by itself, whereas 15% (14.9%) stated that they did not think it would help. Moreover, some participants (11.6%) felt that they did not need help or did not think they had a problem.

Table 8.

Reasons for Not Seeking Help Among Women Reporting IPV.

Help-seeking behavior	U.S. Black womenN = 108	African AmericanN = 73	Caribbean BlackN = 35
Wanted to resolve problem on own	22.9	23.2	18.0
Thought problem get better by itself	19.2	19.8	11.1
Did not think it would help	14.9	15.6	4.7
Did not need help, did not think I had problem	11.6	11.6	11.7
Talked to friend, family	9.1	8.5	18.8
Did not bother me, not serious	8.2	8.1	9.6
Turned to God for help	5.5	4.8	15.4
Got better	4.4	4.6	0.8
Did talk to doctor	2.8	3.0	0.0
Cultural/religious reasons	2.6	1.8	13.8
Could not afford it, no insurance	2.3	1.6	11.9
Did not get help	1.4	1.5	0.0
Not want to talk about personal problems	1.1	1.2	0.0
Did not know where to go for help	0.4	0.0	5.4
Inconvenient, transit	0.1	0.0	1.7
Worried what others think, embarrassed	0.1	0.0	0.9
Did not want help	0.1	0.0	0.9
Do not like doctor	0.0	0.0	0.0
It was only a problem when I was a child	0.0	0.0	0.0
Did not think of it	0.0	0.0	0.0
Other reasons	4.5	4.8	0.0

These sentiments were largely echoed within the respective ethnic groups (i.e., African American, Caribbean Black women). Although there were some similarities in response patterns, there were also noticeable differences between ethnic groups for not seeking help. A higher percentage of African American women compared with Caribbean Black women reported not seeking help because they did not think it would help (15.6 vs. 4.7%). In contrast, a higher percentage of Caribbean women compared with African American women reported talking to a friend or family member (18.8 vs. 8.5%). A higher percentage of Caribbean women as compared with African American women also indicated they turned to God for help (15.4 vs. 4.8%). In addition, a higher percentage of Caribbean Black women as compared with African American women (13.8 vs. 1.8%) suggested that they did not seek help due to cultural/religious reasons. Finally, more Caribbean Black women compared with African American women (11.9 vs. 1.6%) pointed out that they could not afford it or had no insurance.

Discussion

This study explored general help-seeking behaviors of U.S. Black women reporting severe physical IPV. The study findings suggest the use of both formal and informal networks for help-seeking among women with a history of IPV (e.g., Dutton et al., 2000; Flicker et al., 2011; Lucea et al., 2013; Postmus, 2015). Contrary to popular notions regarding the limited use of formal institutions in addressing health and other needs among Blacks, this study showed that many women reporting IPV sought mental health professional services (e.g., psychiatrist). Consistent with previous studies, women reporting IPV also utilized informal means of help in the form of clergy (Anyikwa, 2015; Bauman et al., 2008; El-Khoury et al., 2004; Potter, 2007). Moreover, the results, in general, show that women reporting IPV more often engaged in help-seeking behaviors than women not reporting IPV, providing evidence that many Black women victims of IPV actually do seek help when confronted with adverse circumstances. Overall, this finding is significant as the notion that U.S. Black women are less inclined to seek help was not supported by this study. This finding may be the result of improved help-seeking practices, increased awareness of health and mental health risks among the population, better understanding of the consequences of IPV, and/or a de-stigmatization of help-seeking behavior among Blacks over recent years.

In the multivariate analysis, we found a lower likelihood of mental health service utilization among foreign-born women reporting severe physical IPV. It is important to note that stigma associated with mental disorders may cause Blacks in general not to seek help (Neighbors, Caldwell, et al., 2007; Rodriquez et al., 2009), even more so among the foreign-born for whom such stigma might be amplified and present barriers to service utilization. Along with social stigma, foreign-born women may lack awareness of how to access help while simultaneously not having sufficient support networks or resources to do so. It is also possible that this finding may be a result of cultural norms of secrecy that discourage sharing personal information outside of one’s intimate family network (Powell Sears, 2018). Finally, some highly cultured immigrant groups may be reluctant to seek help or adopt behaviors outside their cultural framework.

Queries obtained among women reporting IPV provide some support for quantitative findings, and on barriers to seeking assistance. This is particularly reflected by the decision of women wanting to resolve the problem on their own. Despite recognition of Black women’s strength and resilience, some might consider seeking help for general problems, especially in relation to IPV, a private matter, and therefore may avoid outside interference due to pride, shame, or embarrassment (Fugate et al., 2005; Lucea et al., 2013; Rodriquez et al., 2009; Sabri et al., 2015). These sentiments in some instances may serve as a hindrance to disclosing violent experiences by an intimate partner (Hien & Ruglass, 2009; Satyen et al., 2019). This is also supported by research that suggests some Black women do fight back and may feel that they are capable of taking care of themselves in certain situations (Moss et al., 1997). In spite of this, there are women who may feel more comfortable talking to a friend or family member about their situation rather than going outside of their social network (Ansara & Hindin, 2010; Anyikwa, 2015; Bent-Goodley, 2007; Flicker et al., 2011; Fugate et al., 2005; Morrison et al., 2006).

It is important to recognize that the decision not to seek help might rest more on cultural factors for some ethnic groups. This was evident for Caribbean Black women as compared with African American women. Although the role of religion and the church should not be understated, serving as a symbolic center of African American life (Ellison et al., 2007), Caribbean persons have also been known to adhere to the principles and teachings of the church by turning to God for help, direction, and guidance in coping with daily encounters and traumatic events such as intimate partner violence (Satyen et al., 2019). Furthermore, queries from the study suggest that limited access to resources (financial, service, or otherwise) is an important issue facing immigrant women, and may pose a challenge to seeking help to address their situation, particularly among new arrivals to host countries. This was echoed by participants who stated a reason for not seeking help stemmed from not being able to afford it or having insurance.

Limitations

This study had several limitations that should be discussed. First, even though many help-seeking behaviors were captured by the survey, it was also limited by other alternatives (e.g., friends) that were not explored, as highlighted in the open response by participants in the study or the literature. Second, the study focused on the examination of help-seeking behaviors among women who reported severe physical IPV. Other forms (e.g., minor, sexual, psychological/emotional) of intimate partner victimization were not explored because of data limitations. Third, a single dichotomous variable was used to address severe physical intimate partner violence. The measure used in this study was compared with a standard severe IPV measure and was found to have a fair association (Lacey et al., 2015). Fourth, a limitation of the help-seeking behavior questions in this study was that they were not specific to IPV exposure. It is possible that women who sought help for IPV could have either solely or simultaneously sought help for other reasons, thus inflating our findings. Nonetheless, general help-seeking information remains relevant to the current study. Previous research on victims of abuse indicates that IPV-related support is often obtained in the course of interaction with general health service providers, even when persons were motivated to see providers for reasons unrelated to abuse (Miller et al., 2010; Swailes et al., 2017). Furthermore, the sample focus of analysis was on women who reported IPV. Fifth, the bivariate findings relating to the frequency of violence and help-seeking utilization should be interpreted with slight caution due to sample size issues. Sixth, the information obtained on participants were retrospective and may be subject to recall bias. Also, the study used cross-sectional data, limiting causal inferences. Finally, the data used for the study were collected over a decade ago. The NSAL is unique in that it contains variables that are not frequently captured among other large representative samples. In addition, it remains one of the few national data sets on U.S. Blacks, and still the only national sample to our knowledge on the Caribbean Black population residing in the United States, enabling more complex analyses that allow for addressing the study objectives.

Conclusions and Implications

Notwithstanding the limitations, this is one of very few studies to explore the help-seeking behaviors of U.S. Black women who reported past exposure to severe physical IPV from a predominantly Black nationally representative sample, which might provide a more accurate assessment of the help-seeking behaviors of women victims of intimate partner violence in this population. The use of a national data set (NSAL) additionally made it possible to explore the heterogeneity of help-seeking alternatives among women within the Black population (African Americans and Caribbean Blacks), rarely done in studies of this nature. The study further incorporated open response data simultaneously with quantitative findings from a representative sample, also limited in studies. Importantly, this study made it possible to explore other factors associated with the help-seeking practices of Black women who have experienced IPV.

This study has implications for future research, prevention, policy, and practice. Notably, findings from this study point to the need for more in-depth research on formal and informal help-seeking behaviors concerning IPV exposure among diverse groups of U.S. Black women. Along with exploration of informal and formal help-seeking behaviors, studies are necessary to understand the role of associated social and demographic factors (e.g., age, education, nativity) that might affect women’s decisions, and may subsequently assist in contributing to viable intervention approaches to assist women victims of IPV. The link between demographic factors and help-seeking has yet to be thoroughly investigated among diverse Black women in the United States. Recent studies indicate that education and cultural background are important factors that shape the help-seeking behavior of women who face violence (Leonardsson & San Sebastian, 2017; Parvin et al., 2016; Powell Sears, 2018). In addition, there is a need for awareness surrounding formal and informal service availability for women exposed to IPV, who otherwise may lack the knowledge of how to access the resources necessary to address their situation (e.g., Lucea et al., 2013; Sabri et al., 2015). Reaching out to informal networks to strengthen capacity to address IPV may also be a valuable resource. Furthermore, working with informal networks to join with prevention and intervention efforts as well as improvements in service referrals are also positive steps toward addressing intimate partner victimization. Given the study findings, it is important to ensure that services are culturally specific and relevant to improve access and utilization, especially among groups known to experience other challenges and barriers.

Of priority, however, are continued efforts directed toward educating communities about IPV and its consequences, particularly among marginalized and immigrant groups who are at greater risk for violence. Improved community awareness surrounding viable sources of support and resources may encourage women victims who may not otherwise seek help or connect to services due to social and cultural constraints regarding the sensitive and private nature of intimate partner violence. At the same time, programs and policies that seek to break down cultural barriers while encouraging cultural groups to seek services and support without stigmatizing them are necessary to highlight that IPV is a public health issue and not necessarily a private matter (Goodson & Hayes, 2018; Satyen et al., 2019).

Footnotes

Declaration of Conflict of 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) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Krim K. Lacey

Author Biographies

Krim K. Lacey, PhD, is an assistant professor in the Department of Sociology and African and African American Studies at the University of Michigan-Dearborn. His primary research is on intimate partner violence, focusing on minority and immigrant populations. He has also been engaged in research that addresses the influence of social context and cultural factors on the physical and mental well-being of Caribbeans residing in the United States, Canada, and England, and within the Caribbean region.

Tina Jiwatram-Negron, PhD, is an assistant professor at Arizona State University. Her research interests include intimate partner violence (IPV)/gender-based violence (GBV), HIV risk behaviors (sex trading, substance use), and mental health outcomes among socially vulnerable and marginalized women. She specializes in developing and testing interventions to address GBV and associated risks among women, both domestically and internationally, in partnership with community organizations.

Karen Powell Sears, PhD, is a faculty member in the Department of Sociology and Anthropology at Denison University. Her research interests focus on how structural inequalities are reproduced in the mental and physical health of persons in the United States and the Caribbean. Her primary focus is on the health experiences of women, Caribbean immigrants, African Americans, and sexual minorities. In her most recent work, she employs comparative analyses of the cultural schema, coping strategies, and health outcomes of abused Black women in the U.S. and the Caribbean.

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