Exploring Help-Seeking Predictors Among Colombian Victims of Intimate Partner Violence in Different Age Groups

Abstract

This study examined the extent, source, and individual, microsystem, exosystem, and macrosystem-level (Heise's Ecological Model) predictors of help-seeking behaviors among women of different age groups in Colombia. Data on 12,915 married or cohabitating women who had experienced diverse forms of intimate partner violence (IPV) were obtained from the Colombia Demographic Health Survey 2015. More than half of the Colombian women who reported some form of IPV experience did not seek any help. Women aged 25–39 were less likely to seek help. Type of violence and experience of IPV and education were the strongest predictors of help-seeking among women in all age groups. Implications for research and programming are discussed.

Keywords

help seeking behavior intimate partner violence Colombia ecological factors age differences

Introduction

Intimate partner violence (IPV), defined as violent “behavior by an intimate partner or ex-partner that causes physical, sexual or psychological harm, including physical aggression, sexual coercion, psychological abuse, and controlling behaviors,” is a serious problem (WHO, 2017). About 66% of women in Colombia aged 13–49 have experienced some form of IPV in the past 12 months, and women aged 20-24 are at the greatest risk of IPV (Ministerio de Salud y Protección Social [MINSALUD] & ProFamilia, 2017). Most women who suffer abuse (76%) do not seek help from family, friends, medical professionals, or the police (Ministerio de Salud y Protección Social [MINSALUD] & ProFamilia, 2017). Studies conducted in Colombia and around the world have demonstrated that a lack of help-seeking exacerbates health problems for women (Karakurt et al., 2014; Lacey et al., 2013), including injury or death, depression, and post-traumatic stress disorder (Friedemann-Sánchez & Lovatón, 2012; Zapata-Giraldo, 2013). Research on help-seeking behaviors in Colombia is scant, yet international studies have linked help-seeking to a lower risk of repeated violence (Liang et al., 2005) and post-abuse trauma (Folger & Wright, 2013).

IPV in Colombia

Based on Heise’s (1998) gender-based violence ecological framework, risk factors for IPV victimization exist at the individual level (e.g., being young [20–24 years], being less educated; Friedemann-Sánchez & Lovatón, 2012; Jones & Ferguson, 2009; MINSALUD & ProFamilia, 2017); microsystem level (e.g., gender-based household decision making; Friedemann-Sánchez & Lovatón, 2012); and contextual level (including the exosystem and macrosystem levels) (e.g, living in urban areas, low socio-economic status, migration related to armed conflict; Burgos et al., 2012; Friedemann-Sánchez & Lovatón, 2012). Among partnered women living in Colombia, a third of the women aged 15–49 (33%) have experienced physical and/or sexual violence in their lifetime (Bott et al., 2019), which is higher than the average for Latin America and the Caribbean of 30% (WHO, 2021). IPV victimization is more common in urban areas than in rural areas (Jones & Ferguson, 2009; Zapata-Giraldo, 2013). Two possible explanations for this phenomenon are that IPV victimization in rural areas is not often reported by women and that there are still very few comparative studies (García & Camarero, 2015). IPV also differs by region and ethnicity. The Andean region has the highest prevalence of IPV in Colombia, followed by the Pacific and Atlantic regions [National Institute of Legal Medicine and Forensic Sciences (INMLCF), 2019]. Living in poverty might increase women's risk of experiencing violence. The regions in Colombia that are poor and which have large populations of Afro Caribbean and Indigenous women, such as the Pacific, Atlantic, Orinoquía, and Amazonía, reported some of the highest IPV (MINSALUD & ProFamilia, 2017). These regions also have a high presence of armed groups, crime, and drug syndicates contributing to community violence and internally displaced persons [IDPs] (Hynes et al., 2016; Tamayo-Agudelo & Bell, 2019). As previously mentioned, these factors have been associated with IPV victimization risk among Colombian women.

Help-Seeking Behaviors

Help-seeking behavior is defined as any behavior or activity involved in the process of seeking help that is external to the self about “understanding, advice, information, treatment, and general support in response to a problem or distressing experience” (Cornally & McCarthy, 2011, p. 281; Satyen et al., 2019). Help-seeking can be formal (e.g., seeking help from a counselor or police) or informal (e.g., family and friends; Barker, 2007). It is seeking support when in need or when services and supports are available. In Colombia and other developing nations, however, research shows that most survivors do not seek formal help (Goodson & Hayes, 2021; Mookerjee et al., 2015). Like most women in Latin America (Bott et al., 2012), women in Colombia prefer to seek help from informal sources, including parents, family members, neighbors, or friends (Rico & Méndez, 2015). Some seek help from formal sources, such as family commissariats and the police (Wirtz et al., 2014), and others do not seek formal or informal help, but instead employ private intrapersonal strategies of “do it yourself,” and the confidence of feeling “strong and capable of solving own problems” (Akl Moanack et al., 2016).

Also, previous research suggests that the help-seeking behaviors of women in Colombia and other developing countries vary by type of IPV. Some women in these contexts do not perceive psychological violence to be serious enough to merit seeking help (Sierra et al., 2013; Tenkorang et al., 2017). This is not surprising, as until very recently, researchers in the field of IPV were in disagreement regarding whether psychological violence should be classified as trauma (Dokkedahl et al., 2019). While psychological violence is equally or more pervasive in Colombia than other forms of violence, research has primarily focused on examining physical or sexual violence (Rueda, 2011).

Theoretical Framework

Several socio-ecological theoretical models have been applied to understand IPV and the factors associated with and barriers to help-seeking (Bronfenbrenner, 2002; Heise, 1998; Liang et al., 2005). This study was informed by the Ecological Model of Gender-Based Violence developed by Heise (1998). This theoretical framework integrates international and cross-cultural research and has widely informed studies examining IPV victimization and help-seeking in Colombia (Almanza Martínez, 2016; Mootz et al., 2019) and in Latin America (Enríquez-Canto et al., 2020). According to this model, there are four levels of ecological influence nested within each other moving from innermost to outermost levels as individual characteristics, microsystem, exosystem, and macrosystem, which all impact survivors’ experiences of victimization and behaviors, including their understanding of victimization and their decision to seek help (Heise, 1998; Liang et al., 2005). Individual factors refer to those attributes of a person's developmental experience or personality that configure their response to the microsystem and exosystem stressors (e.g., age, educational attainment, history of witnessing family violence). The microsystem level alludes to “the interactions in which a person directly engages with others as well as to the subjective meanings assigned to those interactions” (Heise, 1998, pg. 270). Examples of factors at this level include male control of wealth in the family and marital or verbal conflict. The exosystem level refers to the environmental factors and social structures that influence the immediate setting in which a person lives and what happens in that setting. Examples of factors at this level include employment status and the community in which the survivor resides. Finally, the macrosystem level refers to a larger set of cultural values and beliefs that filter through and inform the other three levels of the social ecology. Examples of macrosystemic factors include acceptance of interpersonal violence and rigid gender roles.

Approaching help-seeking from an ecological perspective identifies and recognizes the multifaceted nature of help-seeking, which is influenced by factors at the individual, microsystem, exosystem, and macrosystem levels. Women in Colombia and across the globe have differential experiences of IPV and help-seeking, which can vary according to, for example, age, ethnicity, employment, attitudes towards IPV, place of residence, and adherence to strict gender norms. These factors can coalesce in unique ways that may further create individual, microsystemic, and contextual sources of privilege and oppression, impacting Colombian women's help-seeking behaviors.

Factors Associated with Help-Seeking

Existing research conducted in Colombia and across other developing countries has identified several individual, microsystem, exosystem, and macrosystem factors associated with a higher probability of seeking help. At the individual level, women belonging to an ethnic minority group (Ghose & Yaya, 2019) are less likely to seek help. Evidence is mixed regarding age, with some studies suggesting that younger women (Gomez et al., 2013) are less likely to seek help, while others suggest that older women are less likely to seek help across their life course (Yoshihama et al., 2011). Other studies have found no effects for age (Linos et al., 2014; Parvin et al., 2016). Similarly, there is conflicting evidence regarding the association between education and help-seeking across developing nations. While some studies have found that women with higher educational attainment are more likely to seek help (Leonardsson & San Sebastian, 2017), others have not found any association (Linos et al., 2014). In Colombia, studies have found that highly educated women demonstrate passive attitudes towards help-seeking (Akl Moanack et al., 2016).

At the microsystem level, women who experience more serious IPV forms are more likely to seek help (Hayes & Franklin, 2017). Exposure to family violence during childhood and limited household decision-making power are factors impeding women's help seeking (Leonardsson & San Sebastian, 2017; Metheny & Stephenson, 2019; Sardaryan, 2017). The limited scholarship in Colombia that explored exposure to parental IPV did not find any association between this factor and help-seeking behaviors (Hembling & Do, 2014).

At the exosystem level, living in poor households has been associated with low levels of help-seeking (Gomez et al., 2013). Another socioeconomic factor associated with help-seeking is being employed (Leonardsson & San Sebastian, 2017). Regarding place of residence, women living in rural areas are less likely to seek help (Peek-Asa et al., 2011). The literature about violence against rural women in Colombia has found that the combination of a lack of state presence, traditional gender role norms, higher levels of internal armed conflict activity, and lack of services, may be impacting the manifestation of IPV and women's decision to seek help (Vargas Montero, 2019). Women's help-seeking behaviors can also be negatively impacted by the geographical region (e.g., North, South) in which they live (Gomez et al., 2013). Finally, the state or departmental level prevalence of IPV has been negatively associated with help-seeking (Linos et al., 2014), as well as the high presence of armed groups in communities (Murphy et al., 2020).

At the macrosystem level, attitudes and beliefs supporting IPV have affected women's likelihood of help-seeking (Goodson & Hayes, 2021). As well, religion and cultural beliefs, such as rigid gender roles, have been linked to low levels of help-seeking among women (Ariza Ruiz, 2013; Leonardsson & San Sebastian, 2017).

Barriers to Help-Seeking

Research in Colombia has found that barriers to informal and formal help-seeking include mistrust, fear of retaliation, and women's normalization of abusive behaviors (Akl Moanack et al., 2016; Rico & Méndez, 2015). Other barriers involve the strong adherence to a culture of honor and attitudes towards IPV among Latin American women.

There is ample evidence in Colombia (Ariza Sosa, 2013; Caicedo González & Monroy Rosero, 2017) and in Latin America (Béjar, 2009; Bucheli & Rossi, 2019) demonstrating that the cultural practices of familismo, machismo, and marianismo may “normalize” IPV by upholding tradition and social norms. Central to these practices is the affirmation of family pride, a sense of solidarity, loyalty, and cultural reciprocity (Rivera et al., 2008). Familismo prides itself on maintaining societal order and familial loyalty (Ariza Ruiz, 2013). Safeguarding family reputation and image can be an obstacle to help-seeking in the face of violence (Agoff et al., 2006). Also, Latino culture embraces defined gender by roles and social responsibility (Ariza Sosa, 2013; Béjar, 2009). Although the culture may not directly subscribe to a gender essentialist supposition that there is a fixed, intrinsic difference between women and men, machismo portrays the male gender as strong, courageous, and responsible (Béjar, 2009). Marianismo, glorifies purity and self-sacrifice, consistent with the virtues of the Virgin Mary (Galanti, 2003). Therefore, women living in Colombia may face social norm constraints, which may be a barrier to help-seeking (Akl Moanack et al., 2016; Ariza Ruiz, 2013). Different factors at the individual, microsystem, and contextual levels intersect to impact help-seeking behavior among women in Colombia (Overstreet & Quinn, 2013; Postmus et al., 2014).

Current Study

While the prevalence of IPV victimization in Colombia is high, minimal attention has been paid to the help-seeking behaviors of women who have experienced IPV. There is little understanding of the extent, source (i.e., formal, informal), and individual, microsystem, exosystem, and macrosystem factors associated with help-seeking. Exploring the extent, source, and factors which influence help-seeking will help us develop assumptions about how these factors may relate and help inform future research and interventions aiming to reduce barriers and increase women's help-seeking behaviors and opportunities. Additionally, while evidence points to age group differences in IPV prevalence in Colombia, there are few, if any, studies examining age group differences in help-seeking. Research has demonstrated all phases of development present unique opportunities and challenges and that behaviors vary as individuals progress through these phases (Noftle & Fleeson, 2010). Being in a particular age group (eg.., youths vs. old adults) may also impact the type and nature of romantic relationships and the way in which IPV is experienced (Johnson et al., 2015). As previously noted, Heise's ecological framework implies that a person's age could be an important personal factor influencing a person's experience of IPV, and consequently their help-seeking behavior (Liang et al., 2005).

To address these gaps, the purpose of this study was threefold. First, we investigated the prevalence of IPV among women in different age categories in Colombia (13–24, 25–39, and 40–49). Second, we examined the extent to which IPV victims in Colombia sought help and from whom IPV victims in Colombia sought help. Finally, we assessed individual, microsystem, exosystem, and macrosystem factors that affect women's help-seeking behaviors, including age, ethnicity, place of residence, geographic region, occupation, education, history of family violence, attitudes towards IPV, and perspectives of decision making.

Hypotheses

Following the literature, for aim 1 we expected that younger women would have a larger prevalence of IPV. For aim 2, we hypothesized that survivors of IPV will report low levels of both informal and formal help-seeking. Finally, for aim 3, we predicted that predisposing risk factors at the different levels of the ecological framework proposed by Heise (1998), including individual (i.e., age, ethnicity, education), microsystem (i.e., experiences and type of IPV), exosystem (i.e., unemployment), and macrosystem (i.e., place of residence, geographic location) would significantly predict help-seeking.

Methods

Data

The study used nationally representative couple's data from the most recent Colombian Demographic and Health Survey (CDHS) collected in 2015. The CDHS sample (n = 38,718) included diverse demographic, socio-economic, and health information for women living in rural and urban areas from Colombian regions who reported being married or living in a consensual union. Specifically, our analysis included a subsample of 12,915 women aged 13–49 years who disclosed information on IPV and help-seeking behavior. The survey contains a domestic violence module, which we used to examine help-seeking behaviors for IPV, and individual, microsystem, exosystem, and macrosystem level factors associated with help seeking.

As suggested in the literature, the prevalence of IPV among Colombian women varies by age group and being in a specific age group may be a risk factor for IPV. Consequently, for this study, women were grouped into three age groups to explore any differences in the help-seeking behavior patterns between younger and older women. Women were grouped as follows: (1) Group 1 included women aged 13–24 years, (2) Group 2 included women aged 25–39 years, and (3) Group 3 included women aged 40–49 years. Evidence which suggests that adolescents and young adults do not differ substantially in their risk-taking behaviors (Balocchini et al., 2013) provides a rationale for including adolescents and young adults in a single category (Group 1, 13–24). Therefore, the World Health Organization and the United Nations use an encompassing definition of youth to include adolescents and young adults between the ages of 14 and 25.

The procedures and questionnaires for standard and country-specific DHS surveys have been reviewed and approved by the global consulting and digital services provider (ICF) Institutional Review Board (IRB) and an IRB in the host country. More rigorous ethical guidelines are available for the domestic violence module, which can be accessed at https://dhsprogram.com. The CDHS surveys are collected every five years. They use a standard questionnaire that can be extended with additional questions and areas of research if the context of the country has changed (e.g., war, migration). For this study, we have selected variables from survey questions/areas that were also used in the 2010 CDHS survey. We consider that the data are valid as they are measuring the same domestic violence and women's status constructs in both survey periods (2010 and 2015). Missing data were anywhere from 0.0% to 2% for all variables. Listwise deletion was used to address missing data. Given that these are significantly less than 5%, we used the original data (Graham, 2009). The sample size that we used for the analysis is n = 12,643.

Measures

The developers of the CDHS decide which measures of IPV they will use to collect data (every country government decides which questions/areas will be covered in the survey). Our strategy was to identify variables which represented our theoretical constructs and were adequate for statistical analysis (i.e., no/minimum missing data). The CDHS item response categories were “Yes,” “No,” and “Don’t know.” We converted items into “Yes” (ever)/ “No” (never), as the response category “Don’t know” does not imply a clear and definitive “No,” particularly when referring to experiences of violence. Don’t know responses can be considered a signal of worry and a possible cry for help, but the sensitivity of the problem may preclude some women from calling the problem by its real name. Therefore, “Yes” and “Don’t know” items were combined into a single item, resulting in “Yes/No” response items. More specifically, regarding the variables measuring experiences and type of IPV, we used a dichotomous level of measurement of categorical and ordinal data, representing “Never” experienced violence and “Yes” ever experienced violence (i.e., once or frequent).

Outcome Measure

Help-seeking was the dependent variable in this study. Help-seeking was measured by asking respondents if they sought help after experiencing physical, sexual, or psychological IPV (“Have you ever tried to get help to prevent or stop this person/these persons from hurting you?”). The variables were dichotomized as “sought help from someone” and “no help was sought.” For those who reported seeking help, a follow-up question was asked regarding the source of help (“From whom have you sought help?”). Participants could select from a menu of multiple choices of formal and informal support sources (n = 12), and these were condensed into formal (i.e., religious leader, doctor/medical personnel) and informal (i.e., friend, mother, neighbor) sources.

Independent Measures

Based on Heise's (1998) ecological framework of gender-based violence, the choice of independent variables included variables at four different levels of analysis: personal, microsystem, exosystem, and macrosystem. The number of variables included at each level was limited by the variables available in the CDHS dataset.

Individual Level. The individual-level demographic variables included in this study were age (13–24, 25–39, 40–49), ethnicity [Indigenous, Gypsy (ROM), Raizal from archipelago (San Andres), Palanquero from San Basilio, Black/Mulato/Afro-Colombian/Afro-descendant], and education level (No education, Primary, Secondary, Higher).

History of Witnessing Family Violence. We tested whether having past experience of family violence influenced the help-seeking behavior of our respondents. This was measured by women's response to “whether she witnesses her father ever beat her mother,” with a dichotomous response “yes” and “no.”

Microsystem Level. Experiences and Type of IPV. We tested whether experiences of physical (i.e., “being pushed," “slapped,” “hit,” “kicked,” “attacked with a knife/gun”), sexual (i.e., “forced into unwanted sex”), and psychological (i.e. “threatened with a knife/gun”) violence with last husband/partner influenced help-seeking behaviors. All items had a “yes” or “no” response format.

Perspectives on Decision-Making. Variables on women's perspective of who usually makes decisions about 1) “how the money you/husband earns is spent," 2) “health care for yourself,” and 3) “large household purchases” were included. We tested whether these variables were associated with women's help-seeking behaviors. Response categories included “respondent alone,” “respondent and husband,” “respondent and other person,” and husband/partner alone.”

Exosystem Level. Occupation. We tested whether occupation (professional, clerical, sales and services, skilled manual, unskilled manual, domestic service, and agriculture) was associated with women's help-seeking behaviors. The variable was dichotomized as a “yes” or “no” for regression analysis. We combined all listed in the data jobs and professions (professional, clerical, sales and services, skilled manual, unskilled manual, domestic service [paid service], and agriculture) into “Occupied” and thus we dichotomized the variable into Occupied and Not occupied.

Place of Residence and Geographic Location. We tested whether type of residence (“uran”/“rural”) and geographic region (6 regions, including Atlántica, Bogotá, Pacific, Oriental, Amazona-Orinoquía, and Central) were linked to women's help-seeking behaviors. Regions were grouped based on DHS reports and scientific literature, which have used this categorization system.

Macrosystem level. Attitudes Towards IPV. We tested whether attitudes towards IPV influenced women's decisions to seek help. Specifically, we tested women's attitudes towards justification of wife beating. Five questions were asked including, “if wife goes out without telling husband,” “if she argues with husband,” “if she neglects the children,” “if she refuses to have sex with her husband,” or “if she burns food.” All items were asked as “yes,” “never,” and “don’t know.” A categorical "yes" or "never" variable was created from responses to the five scenarios. An answer of "yes" to at least one scenario meant the respondent justified wife beating and was coded as 1, while an answer of never in all scenarios meant the respondent did not justify wife beating and was coded as 0.

Statistical Analysis

Statistical Package for Social Sciences (SPSS) version 25.0 for Windows was used to analyze data and assess the characteristics associated with help-seeking behavior among Colombian women. Descriptive analysis was performed to present the respondents’ background characteristics in our sample and their attitudes towards IPV and perspectives on decision-making. Additionally, Chi-square non-parametric tests were used to determine the differences in the prevalence of IPV and women's willingness to seek help. Lastly, multivariate logistic regression was conducted to assess factors associated with help-seeking among women from the three age groups. Our analysis was based on separate logistic regression models for each age group. To conduct the regression analysis, we selected data that only referred to the particular age group. In this regard, we did not aim to include a comparison between the models because we wanted to distinguish the pure effect of each regression model by using the same set of variables.

Logistic regression analysis was used based on the findings from Ekström et al. (2018), which suggest that logistic regression is more appropriate for avoiding the risk of obtaining biased parameter estimators and standard errors, and erroneous interpretations about factors affecting the outcome when working with clustered data.

Results

Sample Characteristics

Our sample included a geographically and ethnically diverse group of 12,643 Colombian women aged 13 to 49 years. Most of them resided in the Atlántica (26.5%) and Central (21.9%) regions and self-identified as not belonging to any ethnic group (77.1%). Almost 13% identified themselves as indigenous and 9.1% identified as being of Black/Mulato/Afro-Colombian descent. The majority of the respondents had attained a secondary (44.8%) level of education. Thirty-one percent of participants reported being married, and 68.6% reported currently living with a partner. Additionally, most respondents were working (88%). Women in the sample expressed firm negative attitudes towards any form of gender-based violence. Over 98% of the respondents declared that beating a wife/partner is never justified if the wife argues or goes out without telling her husband, if she neglects the children, or refuses to have sex with him. Additionally, they reported being independent decision-makers who usually decide how to spend their earnings (64%) (See Table 1).

Table 1.

Sample Characteristics.

Characteristics	n	%
Region
Atlántica	3427	26.5
Oriental	1818	14.1
Central	2833	21.9
Pacifica	1959	15.2
Bogotá	602	4.7
Orinoquía/Amazonia	2276	17.6
Educational level
No education	375	2.9
Primary	3509	27.2
Secondary	5788	44.8
Higher	3243	25.1
Ethnicity
Indigenous	1638	12.7
Gypsy (ROM)	10	.1
Raizal from archipelago (San Andres)	117	.9
Palanquero from San Basilio	22	.2
Black/Mulato/Afro-Colombian/Afro-descendant	1174	9.1
None of the above	9954	77.1
Age
13-24 years	2502	19.4
25-39 years	6728	52.1
40-49 years	3685	28.5
Current marital status
Married	4052	31.4
Living with a partner	8863	68.6
Occupation
Not working and have never worked	1549	12.0
Occupied	11366	88.0
Beating justified if wife goes out without telling husband
No	12410	98.2
Yes	233	1.8
Beating justified if wife argues with husband
No	12431	98.3
Yes	122	1.7
Beating justified if wife neglects the children
No	12177	96.3
Yes	466	3.7
Beating justified if wife refuses to have sex with husband
No	12475	98.7
Yes	168	1.3
Person who usually decides how to spend respondent's earnings
Respondent alone	6894	64.0
Respondent and husband/partner	3605	33.5
Respondent and other person	30	.3
Husband/partner alone	185	1.7
Someone else	55	.5

Group Differences

Women in all groups reported experiencing acts of IPV, controlling issues, and lack of willingness to seek help (See Table 2). Specifically, women aged 25 to 39 years were more likely to report acts of physical violence such as being slapped (9.7%, X² = 236.80, p = .000) or being pushed, shook, or having something thrown at them by their partners (12.7%, X² = 252.67, p = .000) in comparison to women in the age groups 13 to 24 (pushed/shook/thrown: 4.8%, X² = 252.67, p = .000; slapped: 3.2%, X² = 236.80, p = .000) and 40 to 49 years (pushed/shook/thrown: 7%, X² = 252.67, p = .000; slapped: 5.8%, X² = 236.80, p = .000). Women aged 25 to 39 years also reported feeling more controlled by their partners by acts of jealousy (23.9%, X² = 342.92, p = .000), lack of attention (12.7%, X² = 60.23, p = .000), or accusations of unfaithfulness (13.9%, X² = 179.54, p = .000). Additionally, they were less likely to seek help from anyone (30.6%, X² = 9.86, p = 0.007) (Table 2). The variable sources of help-seeking had a significant number of missing values, but those few who reported sources of support in the age group 25 to 39 years included informal and formal support from mothers (4.6%, X² = 17.17, p = 0.00), family commissaries (entity responsible of managing intra-family violence cases) (4.1%, X² = 28.7, p = 0 .000), and public attorney (3.1%, X² = 9.07, p = .011) (See Table 3). Women in the age group 13 to 24 years also primarily sought help from their mothers (2.7% X² = 17.7, p = .000) and male friends (2.3%, X² = 0.49, p = .780), while women in the age group 40 to 49 years primarily sought help from a family commissary (2.5%, X² = 28.7, p = 0.000) or a male friend (2.1%, X² = 0.49, p = .780).

Table 2.

Percentage of Women who Experience Intimate Partner Violence, Controlling Issues, and Seek-Help.

	13-24 years		25-39 years		40-49 years		Total		Chi square/p
	Never	Yes	Never	Yes	Never	Yes	Never	Yes	Chi square/p
Ever been pushed, shook, or had something thrown by husband	14.6%	4.8%	39.4%	12.7%	21.5%	7%	75.5%	24.5%	X² = 252.67, p = .000
Ever been slapped by husband/partner	16.2%	3.2%	42.5%	9.7%	22.7%	5.8%	81.4%	18.6%	X² = 236.80, p = .000
Ever been physically forced into unwanted sex	18.7%	0.7%	49.7%	2.5%	26.3%	2.1%	94.7%	5.3%	X² = 100.19, p = .000
Husband jealous if respondent talks with other men	9.2%	10.2%	28.3%	23.9%	16.3%	12.1%	53.8%	46.2%	X² = 342.92, p = .000
Partner ignores/doesn’t address her	14.9%	4.5%	39.4%	12.75	21.9%	6.5%	76.2%	23.8%	X² = 60.23, p = .000
Partner insists on knowing where respondent is	14.4%	5%	39%	13.1%	22.1%	6.4%	75.4%	24.6%	X² = 80.93, p = .000
Husband/partner accuses respondent of unfaithfulness	14%	5.4%	38.3%	13.9%	20.7%	7.6%	73.1%	26.9%	X² = 179.54, p = .000
Respondent did not seek help from anyone	10.9%	8.8%	30.6%	21.8%	17.1%	10.8%	58.6%	41.4%	X² = 9.86, p = .007

Table 3.

Sources of Help-Seeking.

Respondent sought help from:	13-24 years	25-39 years	40-49 years
	[%/n]	[%/n]	[%/n]	Chi-square/p-value
Mother	2.7% (105)	4.6% (181)	1.4% (53)	X² = 17.17, p = .000
Own family	2.1% (82)	4.3% (169)	1.8% (70)	X² = 0.95, p = .620
Partner’s family	0.5% (20)	0.9% (34)	0.4% (16)	X² = 1.69, p = .420
Male friend	2.3% (91)	5.1% (194)	2.1% (82)	X² = 0.49, p = .780
Police	0.9% (53)	2.8% (162)	1.6% (90)	X² = 1.17, p = .557
Family commissary	0.7% (41)	4.1% (232)	2.5% (141)	X² = 28.7, p = .000
Public attorney	0.8% (48)	3.1% (177)	1.1% (65)	X² = 9.07, p = .011

Factors Impacting Help-Seeking Behavior

The results from the logistic regression showed a good model fit (Hosmer-Lemeshow Test was X² = 15.60, df = 17, p = 0.480). Three models tested women's help-seeking behavior in the age groups 13 to 24 years, 25 to 39 years, and 40 to 49 years. The models included variables representing each level of the ecology including measuring attitudes towards IPV, type and experiences of IPV, history of witnessing family violence, decision-making, type and region of residence, and demographic variables such as age, ethnicity, occupation, and level of education of the respondents (See Table 4). Results showed that the likelihood of women to seek help in the age group of 13 to 24 years was influenced significantly if they were indigenous (Exp(B) = .634, p = 0.042) or Raizal (Exp(B) = .185, p = 0.03); had primary (Exp(B) = 1.55, p = 0.019) or secondary (Exp(B) = 1.62, p = 0.05) levels of education; and if they have been pushed (Exp(B) = 1.31, p = 0.005), slapped (Exp(B) = 1.49, p = 0.018), attacked with a knife or gun (Exp(B)2.84, p = 0.008), and forced to have sex by their husbands/partners (Exp(B) = .392, p = 0.05).

Table 4.

Regression Analysis by Age Groups.

	Exp(B)/ 95% C.I.for EXP(B)
Variable	13-24 years	25-39 years	40-49 years
Region (Orinoquia/Amazonia reference)
Atlantica	1.06 [0.75-1.50]	1.25 [.99-1.57]	1.06 [.75-1.50]
Oriental	1.26 [.86-1.84]	1.06 [.83-1.36]	1.26 [.86-1.84]
Central	.921 [.65-1.28]	.922 [.73-1.15]	.921 [.658-1.28]
Pacifica	1.34 [.91-1.96]	.992 [.77-1.27]	1.34 [.917-1.96]
Bogota	1.51 [.70-1.87]	1.22 [.85-1.76]	1.15 [.707-1.87]
Ethnicity (none)
Indigenous	.634* [1.22-6.13]	.423 [.74-1.20]	.951 [.59-4.71]
Raizal from archipelago (San Anders)	.185* [1.05-3.31]	.034 [.55-1.81]	1.021[.80-2.39]
Palanquero from San Basilio	-	-	-
Black/Mulato/Afro-Colombian/Afro -descendant	.964 [.69-1.40]	.612 [.32-1.36]	1.518 [.27-16.1]
Type of residence (reference Rural)
Urban	.823 [.62-1.08]	.876 [.72-1.06]	.823 [.622-1.08]
Education (No education)
Primary	1.55* [1.07-2.24]	1.27 [.99-1.63]	1.06 [.575-1.97]
Secondary	1.62* [1.16-2.28]	1.29* [1.06-1.57]	1.55* [1.07-2-24]
High education	1.06 [.57-1.97]	2.31* [1.16-4.57]	1.62* [1.16-2.28]
Occupation (Reference “no occupation”)
Yes	.853 [.46-1.56]	1.18 **[.756-1.84]	.853 [.464-1.56]
Decision for money (someone else reference)
Respondent alone	.349 [.04-2.87]	.464 [.089-2.40]	.349 [.042-2.87]
Respondent and husband	.372 [.045-3.08]	.497 [.096-2.58]	.372 [.045-3.08]
Respondent and other person	.212 [.013-3.38]	.117 [.002-.998]	.212 [.013-3.38]
Husband/partner alone	.392 [.042-3.62]	.349 [.062-1.96]	.392 [.042-3.62]
Beating justified if wife goes out without telling husband (reference “Never”)
Yes	3.66 [.19-69.52]	.349 [.062-1.96]	3.66 [.193-69.51]
Beating justified if wife neglects the children (reference “Never”)
Yes	3.49 [.51-23.52]	3.39 [.514-22.44]	3.49 [.518-23.52]
Beating justified if wife argues with husband (reference “Never”)
Yes	1.76 [.99-2.43]	4.21 [.58-30.22]	3.49 [.518-23.52]
Beating justified if wife refuses to have sex with husband (reference “Never”)
Yes	.95 [.65-1.08]	1.11 [.69-1.80]	.264 [.048-1.45]
Respondent's father ever beat her mother (reference “No”)
Yes	.997 [.52-1.89]	.585* [.381-.899]	.992 [.526-1.89]
Ever been pushed, shook or had something thrown by husband/partner (reference “No”)
Yes	1.31* [.86-2.01]	3.26** [2.59-4.10]	4.05*** [3.00-5.47]
Ever been slapped by husband/partner (reference “No”)
Yes	1.49* [1.07-2.07]	2.08*** [1.62-2.66]	1.49* [1.07-2.07]
Ever been punched with fist or hit by something harmful by husband/partner (reference “No”)
Yes	.63 [.26-1.52]	.806 [.432-1.50]	.635 [.265-1.52]
Ever been kicked or dragged by husband/partner (reference “No”)
Yes	.93 [.45-1.94]	.600 [.344-1.04]	.938 [.452-1.94]
Ever been threatened with knife/gun or other weapon by husband/partner (reference “No”)
Yes	1.21 [.55-2.64]	1.39 [.79-2.44]	1.21 [.554-2.64]
Ever been attacked with knife/gun or other weapon by husband/partner (reference “No”)
Yes	2.84*** [1.31-6.15]	.803 [.408-1.58]	2.84 [1.31-6.15]
Ever been physically forced into unwanted sex by husband/partner (reference “No”)
Yes	.392* [.213-.722]	.639 [.404-1.01]	1.25* [.824-1.91]

*p ≤ 0.05; **p ≤ 0.001; ***p ≤ 0.0001; P-value here is .05. The star symbol explains its p.

Women in the age group 25 to 39 years were more likely to seek help if they had secondary (Exp(B) = 1.29,p = 0.011)or higher (exp(B) = 2.31, p = 0.016) levels of education, if they had an occupation (Exp(B) = 1.18, p = 0.001), and if they were victims of physical violence such as being pushed (Exp(B) =3.26, p = 0.001) or slapped (Exp(B) = 2.08, p = 0.0001) by their husbands/partners. Interestingly, they were less likely to seek help if they had witnessed parental violence when they were children (Exp(B) = .585, p = 0.014).

Likewise, women in the age group 40 to 49 years were willing to seek help if they had secondary (Exp(B) = 1.55, p = 0.019) or higher (Exp(B) = 1.62, p = 0.05) levels of education, had experienced any form of sexual (Exp(B) = 1.25, p = 0.003) or physical violence [i.e. ever been pushed (Exp(B) = 4.05, p = 0.0001; ever been slapped Exp(B) = 1.49, p = 0.018) by their husbands/partners].

In summary, the results demonstrated that while not all factors measured were significantly associated with help-seeking, one or more factors in each level of the ecology were found to be predictive of women's help-seeking behaviors, with variations by age groups.

Discussion

In Colombia, the majority of the studies on IPV help-seeking are descriptive or qualitative. Few, if any, studies have examined if the extent and type of help-seeking vary for women in different age groups, the factors at different levels of the ecology influencing help-seeking behaviors, and whether these factors differentially affect women in diverse age groups. Our study aimed to address these gaps in the literature. We found differential experiences based on age and diverse factors at all levels of the social ecology of an individual.

All women experienced some form of IPV and these experiences varied by age group. Consistent with other studies in Colombia and other developing countries in Latin America, our results indicated that women between the ages of 25 and 39 experienced more controlling and violent behaviors from their partners and husbands than women in other age groups (Coll et al., 2020; Tuesca & Borda, 2003). In agreement with our expectations and previous findings in Colombia and other developing countries, our results demonstrated that the majority of women did not seek help. Somewhat in line with our expectations, women who sought help appear to rely on informal sources of help, primarily mothers and male friends. However, they also relied on formal sources of support, such as a family commissaries. The primary source of help slightly varied by age groups, with very young women (13–24) preferring to seek help from mothers and male friends. As previously noted, the variable sources of help-seeking had a large number of missing values, and therefore we should not generalize findings.

An in-depth exploration of the format of the question inquiring about the sources of help-seeking did not reveal an explanation for why this question was left unanswered by many participants. The question provided a list of diverse and relevant sources of help, allowed for the selection of multiple sources, and provided space to enter other sources of help not described in the list. All these aspects should have facilitated participants' understanding of the question and their comfort in responding to it. Interestingly, some studies on IPV and help-seeking using the CDHS dataset have defined and analyzed the variable sources of help-seeking in broader terms, as formal and informal, instead of disaggregating the data by specific sources (e.g., friend, family, police) due to the low number of respondents who reported seeking help from formal sources (Leonardsson & San Sebastian, 2017; Metheny & Stephenson, 2019). Other studies have provided detailed results on specific sources of help-seeking without reporting any significant issues with missing data (Goodson & Hayes, 2021). The sample sizes used for analyses in these studies were significantly larger than the one used in this study (for an exception, see Metheny & Stephenson, 2019). Qualitative studies exploring in-depth specific sources of help-seeking and the rationale for selecting or not selecting those sources are warranted. Controlling behavior by men, for example, can be attributed to a machismo attitude, with dominating women through manipulation, coercion, or threats and intimidation (Ramírez et al., 2017). It is forcing someone into doing what they want, including physical abuse (hitting or verbal abuse), financial abuse (taking control of someone else's money), sexual coercion, and emotional abuse (insults, intimidation, or gaslighting). Although a good number of our participants (75%) did not seek help, people in controlling situations must often seek help, mainly from trusted friends and family members, and designating safe places and escape points (Brito, 2020).

The high percentage of women who did not seek help suggests the existence of multiple barriers. As expected, factors at different levels of the social ecology were predictive of women's help-seeking. At the individual level, ethnicity differentially impacted the help-seeking behaviors of women. As indicated in the literature, Indigenous and Afro Colombian (Raizal is a protestant and afro-Caribbean group) women between the ages of 13 and 24 were less likely to seek help for IPV. Ethnic group differences in IPV help-seeking behaviors have seldom been explored in Latin American literature. The reasons why ethnic differences regarding help-seeking are particularly salient among youth and young adult Colombian women have yet to be explored. Nonetheless, children and youth from these ethnic groups are among the age groups with the largest number of gender-based and sexual violence victims (Observatorio de Asuntos de Género, 2013) in Colombia. Women from these groups have historically experienced oppression and discrimination, which have generated marginalization and extreme poverty. State or departmental level disempowerment has been linked to help-seeking in developing countries (Rowan et al., 2018). In addition, indigenous Colombian and Latin American women's views on IPV and help-seeking are anchored in long-standing patriarchal traditions, in which marriage is seen as permanent, and violence in the relationship is normalized and perceived as something that women should endure (Ceballos Casas et al., 2019). It is possible that the confluence of age, cultural norms and values, and oppression and marginalization put young minority women in a particularly precarious position to seek help resources. In the future, research should explore the link between these factors and their impact on the help-seeking behaviors of Colombian women.

Also, at the individual level, history of witnessing family violence played a negative role in help-seeking, as suggested by the literature in other developing nations. Although, as stated in the extant findings, our results are not consistent with the study conducted in Colombia by Hembling and Do (2014). However, this factor was only significant for women aged 25 to 39 years. While few, if any, studies have examined the relationship between age, history of witnessing family violence, and help-seeking behaviors, the evidence in Colombia and elsewhere indicates that exposure to family violence during childhood is related to maladaptive coping strategies in adulthood, including disengagement strategies, such as denial and self-blame, which have been found to be barriers to help-seeking by survivors of IPV (Hembling & Do, 2014; Leitenberg et al., 2004). Our data also suggest that not all women exposed to family and childhood violence normalize it and conform to it as adults, suggesting the presence of other mechanisms. There is mounting evidence demonstrating that the simple imitation hypothesis falls short of explaining future victimization of violence. Not everything a child observes impacts their behaviors later in life (Fishbein & Ajzen, 2010). The impact that observations will have on their behavior is a continuous interaction between factors at different levels of their social ecology. Studies in Colombia should examine the mechanisms through which witnessing family violence impacts future victimization by violence.

Finally, at the individual level, education played a positive role in women's decision to seek help in all age groups. As noted, this is in contrast to other studies in developing countries which have yielded mixed findings in regard to the role of education in help-seeking. While it is plausible that educated women are more aware of the consequences of IPV and help resources, as described in other studies, the conflicting role of education in the help-seeking behaviors of women could be due to the intersecting relationship between education, maladaptive cognitive and emotional strategies employed by women, and cultural norms and values which influence those maladaptive strategies (e.g., aguantarse [endure, put up with], justification of behavior, low self-esteem, guilt; Miracco et al., 2010).

In addition to education, at the microsystem level, women in our sample appear to be empowered through household decision-making. However, while both of these factors can empower women, their ability to seek help may be largely constrained by intrapersonal and sociocultural barriers (Akl Moanack et al., 2016; Rowan et al., 2018). We can speculate from our findings that women may be challenging these stereotypes, but as evidenced in the literature, women are still raised under strict gender role and family norms based on patriarchal notions socially transmitted across multiple generations and which greatly impact women's help-seeking strategies by influencing how they internalize and process IPV incidents and help-seeking (Echeburúa & De Corral, 2009; Labrador et al., 2008). Further research is needed to validate this assumption.

Another microsystemic level factor which influenced the likelihood of help-seeking was experiences and type of IPV. Our findings demonstrate that women across all age groups who had experienced physical violence were more likely to seek help. Only women aged 40 to 49 also sought help for sexual violence. Similar to the findings of other studies, women in our sample appear to be less inclined to seek help for experiences of psychological violence. These findings suggest that women may only seek help for more visible forms of violence and that less visible forms of violence may be handled by using intrapersonal strategies. Liang et al. (2005) propose that women's decision to seek help depends on whether survivors problematize their abusive situation. Consequently, women may be more inclined to seek help when they perceive the abusive situation poses a serious threat to their lives (Tenkorang et al., 2017). Other studies conducted in developing countries have found that women who experience severe physical and sexual violence, violence incidents resulting in injury, and a higher number of controlling behaviors are more likely to seek help (Goodson & Hayes, 2021; Leonardsson & San Sebastian, 2017).

Another issue of concern is that younger women were less likely to seek help for sexual violence incidents. A plausible explanation is machista and marianista attitudes and cultural stereotypes prevalent in Latin America, which preclude girls from having independent control of their sexuality. As noted, the patriarchal structure of many Latin American societies systematizes gender inequality and increases the vulnerability of minors in relation to men. Women are expected to get married, maintain their virginity until marriage, and have children, thus shifting control of their sexuality from their parents to their husbands (Boesten, 2016). Furthermore, girls are socialized to serve men in the family and serve their partners' sexual needs (González-López, 2015). The internalization of these family transmitted messages coupled with familial expectations of loyalty based on the notions of familismo may preclude younger girls from seeking help for sexual violence.

At the exosystem level, in comparison to the findings from research in other developing nations, occupation also emerged as a significant predictor for women aged 25–39. A plausible explanation is that the employment rate of Colombian women in this age group tends to be higher than for women in other age groups (71%, OECD, 2020). In Colombia, studies have shown that women who work feel empowered and are able to proactively enact help-seeking strategies and exit violent relationships (Escobar Castillo & Lafaux Castillo, 2019). Place of residence and geographic location did not emerge as significant exosystemic predictors.

Finally, at the macrosystem level, having some favorable attitudes towards IPV only predicted the help-seeking behaviors of women in the age group 25 to 39 years. While in this study the majority of women expressed unfavorable attitudes towards the use of partner violence, research studies in Colombia have found that women of diverse ages normalize the occurrence of violence in the context of relationships (Cárdenas Serrato et al., 2019; WHO, 2005). As previously mentioned, the normalization of violence is facilitated by macrosystemic factors, including traditional gender roles and familismo. Consistent with the literature, having favorable attitudes toward violence have been found to negatively impact women's help-seeking behaviors in different countries, as women who normalize experiences of violence may not view them as problematic and as behavior that requires support and attention.

In summary, our study results coincide with recent global systematic reviews, which suggest that the help-seeking concerns and needs of IPV survivors vary by age (Gerino et al., 2018; Pathak et al., 2019). As suggested by ecological-based theories of IPV and help-seeking, our results demonstrate that age appears to converge with other factors at the individual, microsystem, exosystem, and macrosystem levels.

Limitations

Our findings should be interpreted cautiously. Over 50% of the sample were women between the ages of 25 and 39, and some of the findings for this age group could be explained by the proportion of the total sample this group represents. An additional limitation concerns the theoretical model utilized. We chose a socio-ecological model to illustrate and emphasize the complex, multi-factoral, and hierarchical nature of the problem at a theoretical level. However, a problem inherent in secondary data analysis is that datasets may not contain all the information a researcher may need or the information contained is not examined sufficiently (Cheng & Phillips, 2014). While the dataset was large and comprehensive, the inclusion of adequate and sophisticated risk-factor variables representing each level of the ecology was limited. Related to this limitation, while the use of a multi-level analytical model would have been desirable, we were unable to employ this type of analysis due to the aforementioned limitations in the dataset.

Another limitation that should be addressed in future scholarship is that the study did not differentiate how factors at different levels of the ecology (e.g., education, attitudes towards IPV) relate to type of help-seeking (i.e., informal vs. formal). For example, future scholarship could examine if education or family history of violence is differentially associated with formal and informal sources of help. Additionally, our study was limited in the number of contextual level factors explored. Future studies should consider exploring armed conflict-related variables, including internal displacement, and national socioeconomic wealth variables, which have been found to impact IPV in Colombia and other developing countries (Mootz et al., 2019; Pineda Duque & Otero Peña, 2004).

Our cross-sectional study used secondary data and does not offer final and conclusive evidence. The literature regarding help-seeking and IPV is very limited in Colombia, and many of the studies found were theses or dissertation research; while important and relevant, more peer-reviewed research articles are needed. Finally, our study was cross-sectional; in order to examine the impact of age in help-seeking, longitudinal studies are merited. It also does not allow the establishment of a cause-effect relationship and the generalizability of the results.

Implications

Our results demonstrate that age plays a role in IPV experiences and the help-seeking behaviors of Colombian women, and future interventions should be sensitive to age and development needs. Still, longitudinal research is needed to adequately assess differences in help-seeking over time. In addition, still unclear are the pathways through which predictors at the individual, microsystemic, exosystemic, and macrosystemic levels influence the help-seeking behaviors of women in diverse age groups. Future studies should explore the mechanisms that may explain variations in help-seeking behavior trajectories for women in diverse age groups.

Our results also suggest there are variables at all levels of the ecology that influence the help-seeking behaviors of women in diverse age groups. However, additional scholarship is needed to explore other important factors, particularly those relevant to the Colombian context, such as cultural beliefs about gender roles, laws supportive of IPV, and internal displacement due to armed conflict. As noted, our selection of variables representative of each level of the social ecology was limited by the variables available in the dataset. Qualitative and subjective analyses are needed in order to explore in depth how factors at all levels of the ecology intersect to influence women's help-seeking behaviors. An in-depth exploration of these factors can allow programs to better respond to the interactional needs of women, consequently increasing positive help-seeking behaviors among women (Kulkarni, 2019).

More studies are needed to explore how different types of violence influence help-seeking. Researchers, practitioners, and agencies should pay specific attention to psychological violence, and increase women's knowledge and awareness of the nefarious health and mental health consequences psychological violence poses for women. Our results show that education plays an important role in women's decision to seek help, and future interventions should seek to integrate into primary and secondary education curriculum content addressing risk factors at the individual, interpersonal, and contextual levels. Considering that women from indigenous and Afro-Caribbean groups may lack access to traditional education settings, research partnerships should be developed with local community organizations to find adequate modalities to deliver content addressing these factors.

Finally, mothers and male friends appear to be important sources of informal help-seeking. Engaging victims’ mothers and friends might improve help-seeking behaviors in Colombia. Intervention strategies may involve empowering mothers and male peers to report IPV to the authorities.

Footnotes

Declaration of Conflicting Interests

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

Funding

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

ORCID iDs

Diana M. Padilla-Medina

Eusebius Small

Author Biographies

Diana M. Padilla-Medina is an Assistant Professor in the Graduate School of Social Work at the University of Puerto Rico and a U.S. Fulbright Scholar alumna. She is a current New York University School of Medicine PRIDE scholar. Her research focuses on sexual and intimate partner violence in racially and ethnically minoritized adolescents and adults in the U.S. and abroad.

Eusebius Small is an Associate Professor in the School of Social Work at the University of Texas at Arlington and a U.S. Fulbright Scholar alumnus. His research focuses on HIV epidemiology, prevention, and implementation. Dr. Small studies the cultural context of disease and effective intervention strategies to address them.

Silviya Pavlova Nikolova is an Assistant Professor at the Medical University of Varna, Bulgaria and a Fulbright Scholar alumna. Her research focuses on identifying pathways for understanding health inequalities. Her research interests include disability, disease prevalence, eHealth and e-interventions, social justice, social policy and planning, community development, HIV/AIDS prevention, and gender-based violence.

References

Agoff

Rajsbaum

Herrera

(2006). Perspectivas de las mujeres maltratadas sobre la violencia de pareja en méxico. Salud Pública de México, 48(S2), 307–314. https://www.medigraphic.com/pdfs/salpubmex/sal-2006/sals062k.pdf https://doi.org/10.1590/S0036-36342006000800011

Akl Moanack

P. M.

Pilar Jiménez

Aponte

F. L.

(2016). Estrategias de afrontamiento en mujeres víctimas de violencia intrafamiliar. Cultura, Educación y Sociedad, 7(2), 105–121. https://revistascientificas.cuc.edu.co/culturaeducacionysociedad/article/view/1105/pdf_238 https://doi.org/10.17981/cultedusoc.07.2.2016.7

Almanza Martínez

(2016). La violencia de pareja contra las mujeres en la prensa escrita de Montería (Córdoba) durante 2014–2016 [Master’s Thesis, Universidad del Norte]. https://manglar.uninorte.edu.co/bitstream/handle/10584/7465/Margarita.pdf?sequence=1&isAllowed=y

Ariza Ruiz

(2013). Comportamiento de la violencia intrafamiliar, Colombia, 2013. Instituto nacional de medicina legal y ciencias forenses. Forensis. Datos Para la Vida 2013, 335–420. https://www.medicinalegal.gov.co/documents/20143/49517/Violencia + intrafamiliar.pdf

Ariza Sosa

(2013). Las representaciones sociales de la violencia en las relaciones de pareja en medellín en el siglo XXI. Revista CES Psicología, 6(I), 134–158. https://www.redalyc.org/pdf/4235/423539419009.pdf

Balocchini

Chiamenti

Lamborghini

(2013). Adolescents: Which risks for their life and health? Journal of Preventive Medicine and Hygiene, 54(4), 191–194. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4718319/24779278

Barker

(2007). Youth, social support, and help-seeking behaviour. https://www.who.int/maternal_child_adolescent/documents/9789241595711/en/.

Béjar

B. O.

(2009). Machismo y violencia contra la mujer. Investigaciones Sociales, 13(23), 301–322. https://doi.org/10.15381/is.v13i23.7235

Boesten

(2016). Sexual violence against minors in Latin America. European Parliament’s Subcommittee on Human Rights. https://doi.org/10.2861/116757

10.

Bott

Guedes

Goodwin

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 Journal of Public Health, 43. https://oig.cepal.org/sites/default/files/violence1.24-web-25-febrero-2014_0.pdf

11.

Bott

Guedes

Ruiz-Celis

A. P.

Mendoza

J. A.

(2019). Intimate partner violence in the americas: A systematic review and reanalysis of national prevalence estimates. Revista Panamericana de Salud Pública = Pan American Journal of Public Health, 43, e26. https://doi.org/10.26633/RPSP.2019.26

12.

Brito

(2020, July 14). How to deal with controlling people. Medical News Today. https://www.medicalnewstoday.com/articles/controlling-people

13.

Bronfenbrenner

(2002). La ecología del desarrollo humano. Paidós.

14.

Bucheli

Rossi

(2019). Attitudes toward intimate partner violence against women in Latin America and the Caribbean. SAGE Open (July-September), 1–13. https://doi.org/10.1177/2158244019871061

15.

Burgos

Canaval

G. E.

Tobo

Bernal de Pheils

& Humphreys

(2012). Violencia de pareja en mujeres de la comunidad, tipos y severidad cali, Colombia. Revista de Salud Pública, 14(3), 377–389. http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0124-00642012000300002&lng=en&tlng=.23912429

16.

Caicedo González

L. E.

Monroy Rosero

D. C.

(2017). Violencia de género en el rol que asume la mujer en la familia colombiana [Undergraduate Thesis, Universidad Cooperativa de Colombia]. http://repository.ucc.edu.co/handle/ucc/11232

17.

Cárdenas Serrato

González

Saldarriaga

Velásquez

(2019). Creencias sexistas que justifican la violencia contra la mujer en estudiantes Universitarios del área de la Salud de una Institución de Educación Superior de la Ciudad de Cartagena 2018 [Master’s Thesis, Universidad del Bosque]. https://repositorio.unbosque.edu.co/handle/20.500.12495/4040

18.

Ceballos Casas

M. A.

Narváez Zambrano

L. L.

Ortega Apraez

M. E.

(2019). Aproximaciones a la violencia doméstica en Mujeres indígenas de Jambaló Cauca, desde una mirada socioecológica [Master’s Thesis, Pontificia Universidad Javeriana de Cali]. http://vitela.javerianacali.edu.co/bitstream/handle/11522/11300/Aproximaciones_violencia_domestica.pdf?sequence=1&isAllowed=y

19.

Cheng

H. G.

Phillips

M. R.

(2014). Secondary analysis of existing data: Opportunities and implementation. Shanghai Archives of Psychiatry, 26(6), 371–375. https://doi.org/10.11919/j.issn.1002-0829.214171

20.

Coll

C. V.

Ewerling

García-Moreno

Hellwig

Barros

A. J.

(2020). Intimate partner violence in 46 low-income and middle-income countries: An appraisal of the most vulnerable groups of women using national health surveys. BMJ Global Health, 5(1), 1–10. http://dx.https://doi.org/10.1136/bmjgh-2019-002208

21.

Cornally

McCarthy

(2011). Help-seeking behaviour: A concept analysis. International Journal of Nursing Practice, 17(3), 280–288. https://doi.org/10.1111/j.1440-172X.2011.01936.x

22.

Dokkedahl

Kok

R. N.

Murphy

Kristensen

T. R.

Bech-Hansen

Elklit

(2019). The psychological subtype of intimate partner violence and its effect on mental health: Protocol for a systematic review and meta-analysis. Systematic Reviews, 8(1), 198. https://doi.org/10.1186/s13643-019-1118-1

23.

Echeburúa

De Corral

(2009). Manual de violencia intrafamiliar. Siglo XXI.

24.

Ekström

Esseen

P. A.

Westerlund

Grafström

Jonsson

B. G.

Ståhl

(2018). Logistic regression for clustered data from environmental monitoring programs. Ecological Informatics, 43, 165–173. https://doi.org/10.1016/j.ecoinf.2017.10.006

25.

Enríquez-Canto

Ortiz-Montalvo

Y. J.

Ortiz-Romaní

K. J.

Díaz-Gervasi

G. M.

(2020). Ecological analysis of intimate partner sexual violence in Peruvian women. Acta Colombiana de Psicología, 23(1), 272–286. http://doi.org/10.14718/ACP.2020.23.1.13

26.

Escobar Castillo

S. L.

Lafaux Castillo

(2019). Estrategias de afrontamiento de mujeres con experiencias de violencia de pareja en el municipio de Villa Rica, Cauca [Master’s Thesis, Pontificia Universidad Javeriana de Cali]. http://vitela.javerianacali.edu.co/handle/11522/12842?show=full

27.

Fishbein

Ajzen

(2010). Predicting and changing behavior: The reasoned action approach. Psychology Press.

28.

Folger

S. F.

Wright

M. O.

(2013). Altering risk following child maltreatment: Family and friend support as protective factors. Journal of Family Violence, 28(4), 325–337. https://doi.org/10.1007/s10896-013-9510-4

29.

Friedemann-Sánchez

Lovatón

(2012). Intimate partner violence in Colombia: Who is at risk? Social Forces, 91(2), 663–688. www-jstor-org.web.bisu.edu.cn/stable/23361105 https://doi.org/10.1093/sf/sos131

30.

Galanti

G. A.

(2003). The hispanic family and male-female relationships: An overview. Journal of Transcultural Nursing, 14(3), 180–185. https://doi.org/10.1177/1043659603014003004

31.

García

M. Á. M.

Camarero

L. A

. (2015). La reproducción de la violencia de género: Una lectura desde las áreas rurales. Ager. Revista de Estudios Sobre Despoblación y Desarrollo Rural, (19), 1–30. https://www.redalyc.org/pdf/296/29642953004.pdf

32.

Gerino

Caldarera

A. M.

Curti

Brustia

Rollè

(2018). Intimate partner violence in the golden age: Systematic review of risk and protective factors. Frontiers in Psychology, 9(1595), 1–14. https://doi.org/10.3389/fpsyg.2018.01595

33.

Ghose

Yaya

(2019). Experience of intimate partner violence and help-seeking behaviour among women in Uganda. Psych, 1(1), 182–192. https://doi.org/10.3390/psych1010013

34.

Gomez

Murad

Calderón

(2013). Historias de violencia, roles, prácticas y discursos legitimadores. Violencia contra las mujeres en Colombia 2000–2010. Ministerio de Salud, 1–95. https://colectivajusticiamujer.org/product/historias-de-violencia-roles-practicas-y-discursos-legitimadores-violencia-contra-las-mujeres-en-colombia-2000-2010/.

35.

González-López

(2015). Family secrets: stories of incest and sexual violence in Mexico (Vol. 1). New York University Press.

36.

Goodson

Hayes

B. E.

(2021). Help-Seeking behaviors of intimate partner violence victims: A cross-national analysis in developing nations. Journal of Interpersonal Violence, 36(9-10), NP4705–NP4727. https://doi.org/10.1177/0886260518794508

37.

Graham

J. W.

(2009). Missing data analysis: Making it work in the real world. Annual Review of Psychology, 60, 549–576. https://doi.org/10.1146/annurev.psych.58.110405.085530

38.

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. https://doi.org/10.1080/01924036.2016.1233443

39.

Heise

L. L.

(1998). Violence against women: An integrated, ecological framework. Violence Against Women, 4(3), 262–290. https://doi.org/10.1177/1077801298004003002

40.

Hembling

(2014). Type and severity of intimate partner violence, exposure to childhood physical punishment and IPV help-seeking in Colombia [Conference paper]. VI Congreso ALAP 2014, Lima, Perú. http://www.alapop.org/Congreso2014/DOCsComAutoria/ALAP_2014_FINAL800.pdf

41.

Hynes

M. E.

Sterk

C. E.

Hennink

Patel

DePadilla

Yount

K. M.

(2016). Exploring gender norms, agency and intimate partner violence among displaced Colombian women: A qualitative assessment. Global Public Health, 11(1-2), 17–33. https://doi.org/10.1080/17441692.2015.1068825

42.

Johnson

W. L.

Manning

W. D.

Giordano

P. C.

Longmore

M. A.

(2015). Relationship context and intimate partner violence from adolescence to young adulthood. Journal of Adolescent Health, 57(6), 631–636. https://doi.org/10.1016/j.jadohealth.2015.08.014

43.

Jones

J. H.

Ferguson

(2009). Demographic and social predictors of intimate partner violence in Colombia. Human Nature, 20(2), 184–203. https://doi.org/10.1007/s12110-009-9064-6

44.

Karakurt

Smith

Whiting

(2014). Impact of intimate partner violence on women’s mental health. Journal of Family Violence, 29(7), 693–702. https://doi.org/10.1007/s10896-014-9633-2

45.

Kulkarni

(2019). Intersectional trauma-informed intimate partner violence (IPV) services: Narrowing the gap between IPV service delivery and survivor needs. Journal of Family Violence, 34(1), 55–64. https://doi.org/10.1007/s10896-018-0001-5

46.

Labrador

Paz

De Luis

Fernández-Velasco

(2008). Mujeres víctimas de la violencia doméstica. Pirámide.

47.

Lacey

K. K.

McPherson

M. D.

Samuel

P. S.

Powell Sears

Head

(2013). The impact of different types of intimate partner violence on the mental and physical health of women in different ethnic groups. Journal of Interpersonal Violence, 28(2), 359–385. https://doi.org/10.1177/0886260512454743

48.

Leitenberg

Gibson

L. E.

Novy

P. L.

(2004). Individual differences among undergraduate women in methods of coping with stressful events: The impact of cumulative childhood stressors and abuse. Child Abuse & Neglect, 28(2), 181–192. https://doi.org/10.1016/j.chiabu.2003.08.005

49.

Leonardsson

San Sebastian

(2017). Prevalence and predictors of help-seeking for women exposed to spousal violence in India – a cross-sectional study. BMC Women’s Health, 17(99), 1–15. https://doi.org/10.1186/s12905-017-0453-4

50.

Liang

Goodman

Tummala-Narra

Weintraub

(2005). A theoretical framework for understanding help-seeking processes among survivors of intimate partner violence. American Journal of Community Psychology, 36(1-2), 71–84. https://doi.org/10.1007/s10464-005-6233-6

51.

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. https://doi.org/10.1136/jech-2012-202187

52.

Metheny

Stephenson

(2019). Help seeking behavior among women who report intimate partner violence in Afghanistan: An analysis of the 2015 Afghanistan demographic and health survey. Journal of Family Violence, 34(2), 69–79. https://doi.org/10.1007/s10896-018-0024-y

53.

Ministerio de Salud y Protección Social & Profamilia (2017). Encuesta Nacional de Demografía y Salud Tomo 2. https://dhsprogram.com/pubs/pdf/FR334/FR334.2.pdf

54.

Miracco

M. C.

Rutsztein

Lievendag

Arana

F. G.

Scappatura

M. L.

Elizathe

Keegan

(2010). Estrategias de afrontamiento en mujeres maltratadas: La percepción del proceso por parte de las mujeres. Anuario de Investigaciones, 17, 59–67. https://www.redalyc.org/pdf/3691/369139946006.pdf

55.

Mookerjee

Cerulli

Fernandez

I. D.

Chin

N. P.

(2015). Do hispanic and non-hispanic women survivors of intimate partner violence differ in regards to their help-seeking? A qualitative study. Journal of Family Violence, 30(7), 839–851. https://doi.org/10.1007/s10896-015-9734-6

56.

Mootz

J. J.

Muhanguzi

Greenfield

Gill

Gonzalez

M. B.

Panko

Mangen

P. O.

Wainberg

M. L.

Khoshnood

(2019). Armed conflict, intimate partner violence, and mental distress of women in northeastern Uganda: A mixed methods study. Psychology of Women Quarterly, 43(4), 471. https://doi.org/10.1177/0361684319864366

57.

Murphy

Ellsberg

Contreras-Urbina

(2020). Nowhere to go: Disclosure and help-seeking behaviors for survivors of violence against women and girls in South Sudan. Conflict and Health, 14(6), 1–11. https://doi.org/10.1186/s13031-020-0257-2

58.

National Institute of Legal Medicine and Forensic Sciences (2019). Versión web de cifras de lesiones de causa externa en Colombia 2019. Violencia intrafamiliar Colombia, 2019. https://www.medicinalegal.gov.co/cifras-estadisticas/forensis

59.

Noftle

E. E.

Fleeson

(2010). Age differences in big five behavior averages and variabilities across the adult life span: Moving beyond retrospective, global summary accounts of personality. Psychology and Aging, 25(1), 95–107. https://doi.org/10.1037/a0018199

60.

Observatorio de Asuntos de Género (2013). Algunos factores asociados a la Violencia contra las Mujeres indígenas, Colombia 2012-2013. http://www.equidadmujer.gov.co/oag/Documents/Investigacion_indigena.pdf

61.

OECD (2020). Employment rate (indicator). https://doi.org/https://doi.org/10.1787/1de68a9b-en.

62.

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. https://doi.org/10.1080/01973533.2012.746599

63.

Parvin

Sultana

Naved

R. T.

(2016). Disclosure and help seeking behavior of women exposed to physical spousal violence in Dhaka slums. BMC Public Health, 16(383), 1–8. https://doi.org/10.1186/s12889-016-3060-7

64.

Pathak

Dhairyawan

Tariq

(2019). The experience of intimate partner violence among older women: A narrative review. Maturitas, 121, 63–75. https://doi.org/10.1016/j.maturitas.2018.12.011

65.

Peek-Asa

Wallis

Harland

Beyer

Dickey

Saftlas

(2011). Rural disparity in domestic violence prevalence and access to resources. Journal of Women's Health, 20(11), 1743–1749. https://doi.org/10.1089/jwh.2011.2891

66.

Pineda Duque

Javier

Otero Peña

Luisa

. (2004). Género, violencia intrafamiliar e intervención pública en Colombia. Revista de Estudios Sociales, (17), 19–31. http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0123-885X2004000100003&lng=en&tlng=es. https://doi.org/10.7440/res17.2004.02

67.

Postmus

J. L.

McMahon

Silva-Martinez

Warrener

C. D.

(2014). Exploring the challenges faced by Latinas experiencing intimate partner violence. Affilia, 29(4), 462–477. https://doi.org/10.1177/0886109914522628

68.

Ramírez

Robayo

Cedeño

Riaño

(2017). El machismo como causa original de la violencia intrafamiliar y de género. CienciAmérica, 6(3), 58–62. https://dialnet.unirioja.es/servlet/articulo?codigo=6163705

69.

Rico

J. E. M.

Méndez

J. H. M.

(2015). Percepción de la experiencia de violencia doméstica en mujeres víctimas de maltrato de pareja. Universitas Psychologica, 14(3), 997–1008. https://doi.org/10.11144/Javeriana.upsy14-3.pevd

70.

Rivera

F. I.

Guarnaccia

P. J.

Mulvaney-Day

Lin

J. Y.

Torres

Alegría

(2008). Family cohesion and its relationship to psychological distress among Latino groups. Hispanic Journal of Behavioral Sciences, 30(3), 357–378. https://doi.org/10.1177/0739986308318713

71.

Rowan

Mumford

Clark

C. J.

(2018). Is women's empowerment associated with help-seeking for spousal violence in India? Journal of Interpersonal Violence, 33(9), 1519–1548. https://doi.org/10.1177/0886260515618945

72.

Rueda

(2011). La violencia sicológica contra las mujeres en Colombia. Revista de Economía del Rosario, 14(2), 165–188. https://dialnet.unirioja.es/servlet/articulo?codigo=5192450

73.

Sardaryan

(2017). Risk factors impeding help-seeking behaviors among victims of domestic violence. European Journal of Public Health, 27(suppl_3), 414. https://doi.org/10.1093/eurpub/ckx186.037

74.

Satyen

Rogic

A.C.

Supol

(2019). Intimate partner violence and help-seeking behaviour: A systematic review of cross-cultural differences. Journal of Immigrant and Minority Health, 21(4), 879–892. https://doi.org/10.1007/s10903-018-0803-9

75.

Tamayo-Agudelo

Bell

(2019). Armed conflict and mental health in Colombia. BJPsych International, 16(2), 40–42. https://doi.org/10.1192/bji.2018.4

76.

Tenkorang

E. Y.

Sedziafa

A. P.

Owusu

A. Y.

(2017). Does type and severity of violence affect the help-seeking behaviors of victims of intimate partner violence in Nigeria? Journal of Family Issues, 38(14), 2026–2046. https://doi.org/10.1177/0192513X16657128

77.

Tuesca

Borda

(2003). Violencia física marital en barranquilla (Colombia): Prevalencia y factores de riesgo. Gaceta Sanitaria, 17(4), 302–308. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-91112003000400008&lng=es&tlng=es.12975054 https://doi.org/10.1016/S0213-9111(03)71751-8

78.

Vargas Montero

S. M.

(2019). Mujer rural y derecho a la tierra: violencias basadas en género contra mujeres rurales. Centro de Investigación y Educación Popular. http://www.mujertierrayterritorio.org/wp-content/uploads/2020/03/MUJERES-RURALES-COLOMBIA_Profundización-VBG.pdf

79.

WHO (2017, November 29). Violence against women . https://www.who.int/news-room/fact-sheets/detail/violence-against-women

80.

WHO (2005). WHO multi-country study on women's health and domestic violence against women: Summary report of initial results on prevalence, health outcomes and women's responses. World Health Organization. https://apps.who.int/iris/handle/10665/43310

81.

WHO (2021, March 9). Violence against women. https://www.who.int/news-room/fact-sheets/detail/violence-against-women

82.

Wirtz

A. L.

Pham

Glass

Loochkartt

Kidane

Cuspoca

(2014). Gender-based violence in conflict and displacement: Qualitative findings from displaced women in Colombia. Conflict and Health, 8(1), 1–14. https://doi.org/10.1186/1752-1505-8-10

83.

Yoshihama

Bybee

Dabby

Blazevski

(2010, July 30). Lifecourse experiences of intimate partner violence and help-seeking among filipina, Indian, and Pakistani women: Implications for justice system responses (Report No. 236174). National Institute of Justice.

84.

Zapata-Giraldo

F. F.

(2013). Violencia de pareja en el departamento del quindío, Colombia. Revista de Salud Pública, 15(2), 247–257. http://www.scielo.org.co/pdf/rsap/v15n2/v15n2a08.pd24892668f