Addressing Intimate Partner Violence With Latina Women: A Call for Research

Abstract

Latina women, especially those who are immigrants, have an increased vulnerability to intimate partner violence, yet they also have a low rate of using formal services (i.e. health care and legal services). Existing research focused on Latina women’s help seeking for intimate partner violence has identified multiple factors, such as the presence of children, cultural values, and type of victimization, that influence women’s formal help seeking. Immigrant Latina women in particular commonly report many barriers to formal services; however, heterogeneity and nuanced patterns of help seeking exist across Latina survivors. While research has focused mainly on understanding factors that are barriers to help seeking by Latina women, there is an overwhelming dearth of research about interventions and factors that facilitate effective help-seeking experiences for Latina IPV survivors. In an effort to improve Latina IPV survivors’ access to services, we examine the gaps in research across dimensions of access to care (i.e. availability, affordability, accessibility, accommodation, and acceptability of services). Research within each of these facets of access to services for Latina survivors is lacking. This brief commentary illustrates the sparse data to inform evidence based interventions for Latina IPV survivors and is a call for research in order to determine best practices and to move the knowledge base from the vast descriptive base to evidence-based, culturally appropriate and acceptable interventions.

Keywords

Intimate partner violence (IPV) is a pervasive problem, globally affecting women of all ethnicities and socioeconomic strata. In the United States, one in four women experience abuse from a partner. Although Latinas do not experience higher rates of IPV compared to other women, they are disproportionately affected by the sequelae of IPV. Compared to non-Latina women who have also experienced IPV, Latina women report higher rates of poor physical health and psychological distress (Bonomi, Anderson, Cannon, Slesnick, & Rodriguez, 2009; Cuevas, Sabina, & Picard, 2010). The worst outcome of IPV is intimate partner homicide (IPH). Latina women have been shown to have the greatest likelihood of being victim to IPH compared to other types of homicide (27, 32.7, and 70.5 times greater odds for White, Black, and Latina victims, respectively; Swatt & Sabina, 2013). These disproportionately high rates for Latina women highlight the need for successful prevention and response interventions, including safety planning, to improve health outcomes among Latinas. In the majority of cases of IPH among Latina women, there was a documented history of abuse—in other words, there was an opportunity for intervention (Swatt, 2013).

Latina women—particularly, those who are immigrants—have specific vulnerabilities to IPV that relate to intersections of gender, place, and socioeconomic status to name a few (Erez, Adelman, & Gregory, 2009). The interdependent factors of vulnerability and the impact of abuse often negatively influence women’s access to formal support services, which are an important resource for reducing repeat victimization, increasing safety, and improving health outcomes. Latina survivors have a much lower rate of using formal services, such as health and social services, than other IPV survivors (Alvidrez, 1999; Sherry, Raul, Craig, & Gregory, 2006). As Latina women are not a homogenous population, specific barriers and facilitators to services exist among subpopulations of Latinas. In this brief report, we argue for more research linguistically and culturally appropriate intervention strategies to increase Latina IPV survivors’ access to formal care, particularly, in order to engage in prevention and response interventions for IPV. Intervention strategies include a range of activities, such as the following: intervention research on developing, implementing, and testing social programs (Fraser, Richman, Galinsky, & Day, 2009); examining the impact of enhanced provider education and referrals to IPV shelters (Klevens et al., 2012); and considering a range of secondary and tertiary prevention efforts (García-Moreno et al., 2015). Overall, developing evidence-based practice recommendations for Latina populations relies on expanding research on best practices for this population.

Latina IPV Survivors and Formal Help Seeking

Help seeking refers to the complex process of establishing the problem and decisions around how and where to elicit formal forms of assistance due to IPV victimization (Liang, Goodman, Tummala-Narra, & Weintraub, 2005; Sabina, Cuevas, & Schally, 2012). Researchers have established that Latinas, in particular immigrant Latinas, experience a myriad of barriers when seeking help for IPV; for example, a study with national survey data found that only 37% of Latina victims sought medical help, 27% police services, 25% legal services, and 14% social services (Cuevas, Bell, & Sabina, 2014). The help-seeking process for formal services is shaped by contextual factors, including individual, interpersonal, and sociocultural factors (Liang et al., 2005). At the individual level, barriers include feelings of shame, lack of awareness about formal resources, cultural values, the presence of children, and level of acculturation. Multiple cultural values that are common among Latinos are suggested to also negatively impact women’s help seeking when experiencing abuse (Amerson, Whittington, & Duggan, 2014). Some of these values include marianismo, the value that women should maintain virginity until marriage, should avoid talking and learning about sex, and leave sex decision-making to the male partner/husband; simpatía, the value that a woman should not be confrontational and rather always aim to maintain harmonious relationships with her partner and family members; and familismo, the belief of loyalty and respect for the family, in considering the family when making decisions about one’s life (Faulkner & Mansfield, 2002). Latinas who are experiencing IPV and ascribe to these cultural values are posited to be more likely to not seek formal assistance and services, may be more accepting of the abuse, and opt to resolve the problem within the family (Vidales, 2010). However, the empirical research demonstrating the relationship between cultural values and help seeking remains lacking and contradictory. Results across studies have ranged from no association between cultural values and help seeking (e.g., Sabina, Cuevas, & Schally, 2012) to evidence of a significant role of specific cultural values (e.g., Bauer, Rodriguez, Quiroga, & Flores-Ortiz, 2000). Examinations of the role of cultural values may require a nuanced investigation; for example, women who have endorsed a high level of familismo are more likely to seek informal help than women with low levels of this value (Brabeck & Guzmán, 2009).

Acculturation and immigration status

Level of acculturation has also been associated with help-seeking behavior for Latinas. Acculturation is the dynamic process that involves the change in values, personal attitudes, cultural beliefs, and consequently behaviors due to regular interaction between majority and minority group members (Dana, 1996). Acculturation is often studied within IPV research as low, medium, or high acculturation, and differences have been found across these levels in terms of the frequency, type, and intensity of the occurrence of IPV for Latinas (Caetano, Schafer, Clark, Cunradi, & Raspberry, 2000). Thus, acculturation also has nuanced connections to help seeking. Sabina, Cuevas, and Schally (2012) found that being more acculturated to the United States was associated with a greater likelihood of formal help seeking for Latinas (Sabina, Cuevas, & Schally, 2012). Latina survivors, especially those who do not speak English, have encountered challenges with navigating the health and legal systems (Cuevas et al., 2014). Among a sample of Mexican-origin women in the United States experiencing IPV, those who did not speak English and were undocumented in terms of immigration status were less likely to seek help (Brabeck & Guzmán, 2009). Less acculturated (e.g., measured as Spanish-speaking dominant) women are less likely to seek formal help (West, Kantor, & Jasinski, 1998) and more likely to experience some social isolation in part due to language barriers and are also less aware of their rights and resources available to them, especially in regard to IPV (Reina, Lohman, & Maldonado, 2014). However, Latina survivors have also shared that had they known of resources, they would have sought help sooner than when they did (Postmus, McMahon, Silva-Martinez, & Warrener, 2014; Reina et al., 2014). Women have also described that it took them awhile to recognize the abuse occurring within their relationships and to label it as IPV (Fuchsel, 2013; Reina et al., 2014), especially if the abusive behaviors did not include physical assault.

Immigrant Latina survivors face institutional barriers from legal concerns about their immigration status (Vidales, 2010). Reporting to formal help services is often considered a risky endeavor, as some Latina immigrant women describe concerns about the consequences of disclosing the abuse, particularly that they might lose custody of their children or be deported (either themselves and/or other family members) or jeopardize the status of their family members (Kelly, 2009; Lewis, West, Bautista, Greenberg, & Done-Perez, 2005). A national survey found that Latina immigrant women are less likely to access formal help agencies than either Latina survivors or non-Latina survivors (Ingram, 2007), and a study examining Latina women of varying immigration statuses found the lowest rate of formal service use for women with an undocumented status (Zadnik, Sabina, & Cuevas, 2016). These findings are connected to more general studies related to how Latina immigrant women often experience multiple intersecting barriers, including limited English proficiency, legal limitations, and social isolation (Sentell, Shumway, & Snowden, 2007). While rates of IPV are similar between Latina immigrants with permanent legal status and those who are undocumented, Latinas who are undocumented have significantly lower rates of seeking formal help (Zadnik et al., 2016). Given the heterogeneity of Latina women’s experiences, the interaction of different factors (e.g., immigration status and cultural beliefs) may work together to influence their decisions for formal help seeking (Rizo & Macy, 2011).

Facilitating Formal Help Seeking for Latina Survivors: Gaps in Research

As mentioned above, only a few key facilitating factors for formal help seeking have been identified for Latina survivors, with Latina survivors more often reaching out to informal help sources (Cuevas et al., 2014; Sabina, Cuevas, & Lannen, 2014). Research has focused mainly on understanding specific barriers related to formal help seeking by Latina women (Rizo & Macy, 2011), resulting in an overwhelming dearth of research about interventions and intervention strategies that facilitate Latina IPV survivors accessing and engaging in formal services. Phrased differently, there is a lack of focus on increasing the accessibility of formal services for secondary prevention of IPV and treating the sequelae. A recent systematic review to identify effective elements of interventions to address IPV among Latina women (Alvarez, Davidson, Fleming, & Glass, 2016) revealed that of over 1,000 studies of IPV interventions—only four studies met inclusion. These four studies did not all focus on samples of exclusively Latina survivors, lending to a lack of research specifically about this population of survivors. Further, when considering the major contributing factors for accessing formal services such as language, cultural values, and awareness of available resources, none of the four interventions addressed these areas. These indications of limited research are concerning and indicate that barriers to care may extend beyond the individual-level focus, as is evident and prevalent in the existing literature.

One framework that may help guide the development of this needed research is the access to care framework created by Penchansky and Thomas (1981). This framework provides insight into how to reduce barriers to formal help services in order to facilitate service engagement (Penchansky & Thomas, 1981). Five indicators are used for evaluating access to formal services: (1) availability—the adequacy and supply of care resources for the target population, (2) affordability—the ability of the clients to pay for the services, (3) accessibility—the location of services, (4) accommodation—the way in which services are offered to meet the clients expectations, and (5) acceptability—the fit between the client’s attitudes about service characteristics and those of the service providers. When this framework is applied to the experiences of Latina women seeking help for IPV, multiple gaps in research are apparent, indicating an urgent need to expand the research base on facilitative factors and interventions for Latina IPV survivors.

Availability, affordability, and accessibility of services for Latina IPV survivors

While Latina survivors of IPV have identified needing legal and social services at a higher rate than women not experiencing IPV (Eisenman et al., 2009), Latina women do not find services for IPV accessible (Rizo & Macy, 2011). The passage of the Violence Against Women Act included provisions to support the availability and affordability of such services. For example, domestic violence crisis agencies and advocacy services should mainly be offered at no cost to IPV survivors. Thus, the ability of Latina IPV survivors to pay for services should not be a barrier. Nonetheless, other nonmonetary barriers common to IPV survivors such as transportation and childcare may still impede access to these services and need to be understood specifically for Latina IPV survivors (Kulkarni, Bell, & Wylie, 2010). Further, in terms of availability, the lack of providers who can provide services for primarily Spanish-speaking women is a major concern (Acevedo, 2000; Bauer et al., 2000; Kelly, 2009). Likewise, while some immigrant Latina women fear deportation or other legal ramifications of seeking formal IPV services (Vidales, 2010), research is lacking that considers how IPV services address women’s immigration statuses and successfully relay to women agency policies concerning documentation status. Thus, research is needed that examines the geography of services, the types of services, and how these services are provided, especially in successfully addressing women’s language and documentation and immigration status.

Accommodation and acceptability of services for Latina IPV survivors

In regard to accommodation of services for IPV survivors, existing research indicates lost or missed opportunities for connecting women with care. For example, Latina IPV survivors have shared that they would have disclosed abuse experiences to their health-care provider, if the provider had asked them about abuse but did not realize that this was a source of help with IPV (Kelly, 2009).

While current policy recommendations and mandates focus on routine screening for IPV within formal health services, screening for IPV in primary care and mental health services remains inadequate (Rodríguez, Valentine, Son, & Muhammad, 2009). Some studies have found routine IPV screening rates in primary care at 10% or lower and only 79% when women presents with an injury (Alvarez, Fedock, Grace, & Campbell, 2016). Identification of IPV is a critical component of beginning to initiate plans to stop abuse. Low rates of screening have been attributed to both provider and clinic level factors (Alvarez et al., 2016). For example, providers also report lack of comfort with screening and decide not to screen because they have no solution or referral options in the event of a positive response (Alvarez et al., 2016). These barriers are exacerbated when there is language and cultural discordance between the patient and provider (Hindin, 2006; Rodríguez et al., 2009). Research is needed on how screening practices can be performed effectively in ways that are safe for Latina IPV survivors, especially those that may fear deportation for themselves and/or others if they disclose abuse.

In terms of acceptability, there remains a dearth of literature on linguistically and culturally appropriate interventions geared toward empowering Latinas in supporting their safety as well as facilitating help from formal systems, such as the primary care clinic. For example, to date we have not found any evidence of successful prevention and response interventions in the health-care settings for appropriate safety planning to improve health outcomes among Latina survivors. A few IPV interventions have revealed some successful elements of interventions addressing IPV among Latina survivors (McFarlane, Groff, O’Brien, & Watson, 2006; Olds et al., 2004; Peragallo, Gonzalez-Guarda, McCabe, & Cianelli, 2012; Wray, Hoyt, & Gerstle, 2013). These interventions included multiple sessions and focused on improving relationships—both with one’s partner (Wray et al., 2013) and within the community (Olds et al., 2004). One intervention provided a safety plan for IPV survivors, but the safety planning was no better than offering a list of community resources (McFarlane et al., 2006). Otherwise, none of the interventions focused on how to better receive and support immigrant Latinas experiencing IPV. Thus, this lack limits the ability to address the acceptability of existing help sources and interventions. Future research is needed that examines multiple forms of support and safety planning for Latina IPV survivors with varying immigration statuses.

Given that previous research has indicated that Latina survivors more often reach out to informal help sources (Cuevas et al., 2014; Sabina et al., 2014), practices that incorporate informal help as a way to build safety may be especially beneficial and acceptable for Latina survivors and thus incorporated into future research. More research is needed to look at women’s pathways to engagement in specific forms of formal and informal help seeking and specific facilitating factors for successful entry into and outcomes from formal help seeking. In addition, understanding the heterogeneity of Latina survivors’ and nuances in help seeking is an essential step. For example, beyond the dichotomy of immigrant/nonimmigrant, research on the types of IPV experienced by Latinas has shown variations in experiences across subgroups of Latinas based on their place of birth (Cavanaugh et al., 2014). Even within the literature reviewed for this report, various definitions of Latina survivors are used, ranging from Mexican American women to Latina immigrant women as a subgroup of immigrants to exclusively Latina immigrant women who are undocumented. Deconstructing Latina women as a monolithic population, as well as establishing a framework for capturing the heterogeneity of this population, and understanding the multitude of services and accessibility factors for different subpopulations and types of services may help build effective best practices for addressing the service needs of Latina IPV survivors.

Moving Forward: Expanding Access to Culturally Competent Services for Latina IPV Survivors

Based on the help-seeking literature, insights for aspects of interventions for Latina survivors may be gleaned to inform future research. For example, intervention components may include specific engagement strategies to assess a woman’s cultural beliefs pertaining to IPV, her acculturation level and how it influences her perspective of IPV and decision-making behaviors, her immigration status and how she defines safety in relation to both immigration and IPV, and internalized feelings of shame or self-blame related to her forms of victimizations. Considering a woman’s connection to informal supports, adopting a multifaceted definition of safety planning, and involving a variety of community-level supports are important elements of an intervention. Future research may benefit from a community-based participatory research approach to engage both a range of community providers and Latina IPV survivors in crafting and testing interventions (Bloom et al., 2009; Gonzalez-Guarda, Cummings, Becerra, Fernandez, & Mesa, 2013), as these approaches have been utilized to gather feedback about intervention needs for Latina survivors.

Of additional particular concern, Latina survivors of IPV often face additional co-occurring risks and concerns, including substance abuse, risky sexual experiences, psychological distress, and risk for HIV (Gonzalez-Guarda, Vasquez, Urrutia, Villarruel, & Peragallo, 2011; Moreno, 2007). Thus, future intervention research may consider addressing these needs simultaneously in the context of Latina survivors cultured and gendered experiences (Gonzalez-Guarda et al., 2011; Moreno, 2007). Given Latina survivors possible multiple needs and documented structural, institutional, and cultural barriers to help (Vidales, 2010), future research may focus on facilitating help seeking across fragmented services in order to build and test models of culturally competent integrated services.

Conclusion

This brief commentary illustrates the available sparse research to inform evidence-based interventions for Latina IPV survivors. Researchers have called for research addressing multiple types of prevention for women of color and for increased research on the understanding of best practices for women of color who have experienced IPV (Bent-Goodley, 2007). This article is a further call for culturally and linguistically appropriate intervention research specifically for Latina IPV survivors in order to identify and test best practices to facilitate access to formal services in order to improve the safety and health of survivors of IPV.

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.

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