Abstract
The paper under review presents findings from a qualitative interpretive study exploring the perceptions and experiences of women being screened for intimate partner violence (IPV) and receiving an intervention during perinatal home visits. Researchers conducted semi-structured face-to-face interviews with 26 women in rural and urban locations in the United States; of these, 18 had experienced intimate partner violence in the year prior to their current pregnancy and eight had not. Respondents were recruited from the DOVE (Domestic Violence Enhanced Intervention) trial, a study investigating the effectiveness of perinatal home visit interventions in reducing intimate partner abuse. The authors of this nested study sought to gather women’s opinion of the screening process and the perceived helpfulness of the DOVE intervention. They found that women generally welcomed being screened in their home, as they recognised the potential impact of IPV on the baby’s wellbeing. However, the acceptability by women of perinatal screening and intervention relied heavily on the quality of the rapport built with their home visitor. In particular, the women’s perception of the home visitor and of their reaction to a potential disclosure of IPV could act both as a facilitator and a barrier, with fear of judgement having an inhibitory effect.
IPV is a serious public health issue which often goes undetected, and perinatal visits can represent a valuable window of opportunity for professionals to receive disclosure. Nurses and midwives may therefore be best placed to identify abuse, and their role is recognised in official health guidance in England (Department of Health, 2013). Understanding how women perceive and react to screening for IPV in their home is fundamental to establishing its effectiveness. The importance of the rapport-building process between women and home visitors is a particularly interesting finding in this study, showing that a professional and non-judgemental demeanour from the visitor is essential to help build a relationship based on trust and facilitate disclosure. However, whilst health visitors in the UK are fully qualified professionals, home visitors in the US may have no formal qualifications and be lay people living in the same community as the women they visit. Whilst a perceived similarity with the home visitor was found by the study to aid disclosure, their status as ‘outsider’ made them more desirable candidates to receive disclosure compared to family and friends, whose judgement women feared most. This study did not highlight particular differences in how women in rural and urban areas responded to screening, and it is unclear whether such a comparison fell within the study’s remit. There may be scope to further investigate how women perceive perinatal screening for IPV by non-professionals, particularly within tight-knit communities, but also how confident home visitors feel with their readiness to appropriately receive disclosure.
Finally, the paper points at the difficulties faced by women leaving abusive relationships and the feeling of heightened threat perception that accompany them. This is an important reminder that IPV interventions need to focus not only on the individual, but also on improving those structural factors that enable and support positive choices. Separation from the abusive partner cannot and must not be the sole measure of a positive outcome.