Help-Seeking Behavior in Survivors of Intimate Partner Violence: Toward an Integrated Behavioral Model of Individual Factors

Service-seeking behaviors among male victims of violence in five African countries: The effects of positive and adverse childhood experiences

BACKGROUND

Violence against boys and men is widely under-reported. Boys and men face unique and gendered barriers to accessing services following experiences of violence.

PARTICIPANTS AND SETTING

The study is a secondary data analysis of five nationally representative population-based Violence Against Children and Youth Surveys (VACS) conducted in Kenya (2019), Côte d'Ivoire (2018), Lesotho (2018), Mozambique (2019), and Namibia (2019). Analysis was limited to males between 18 and 24 years who experienced lifetime physical or sexual violence.

OBJECTIVE AND METHODS

We analyzed the association between positive and adverse childhood experiences (PCEs and ACEs), and seeking post-violence services among males using bivariate chi-squared tests and multivariable logistic regression.

RESULTS

8.02 % (5.55-10.50 %) of male victims between the ages of 18 and 24 sought services for any lifetime physical or sexual violence. Witnessing interparental violence and experiencing death of one or both parents were each associated with increased odds of having sought post-violence services (aOR 2.43; 95 % CI: 1.25-4.79; aOR 2.27; 95 % CI: 1.14-4.50), controlling for education, violence frequency, and violence type. High parental monitoring was associated with increased odds of service seeking (aOR 1.79; 95 % CI: 1.02-3.16), while strong father-child relationship was associated with lower odds (aOR 0.45; 95 % CI: 0.23-0.89).

CONCLUSION

These findings contribute to limited research on service-seeking behaviors among men and boys. While some parent-youth relationship factors were associated with higher odds of service-seeking, the outcome remained rare. Age and gender-related barriers should be addressed where post-violence care services are offered.

Intentions to Call a Helpline Among Targets of Intimate Partner Violence: The Role of the Theory of Planned Behavior and Gender Role Conflict

This research first aimed to test the Theory of Planned Behavior (TPB) as a model to understand the intentions to call a helpline of victimized males and females. A sample of 99 participants (53 males; 46 females) who were suffering violence at the time of participation were considered for analysis. Our results indicate that males and females' attitudes and subjective norms significantly predicted intentions. Second, this study aimed to measure Gender Role Conflict (GRC) in victimized men and test its association with TPB constructs. GRC occurs when rigid, sexist, or restrictive gender roles result in the restriction, devaluation, or violation of others or the self. Our results indicate that GRC was only negatively associated with perceived behavioral control. Additionally, in our sample of men who filled the GRC measure (n = 245), victimized men reported significantly higher GRC than non-victimized men. Overall, our findings indicate gender specificities in the intentions to call a helpline and suggest that GRC plays an important role in seeking help for men.

Help-seeking for Intimate Partner Violence and Abuse: Experiences of Serving and Ex-serving UK Military Personnel

Purpose

Intimate Partner Violence and Abuse (IPVA) is as a major health concern globally. The prevalence of IPVA perpetration and victimisation has been found to be higher in military compared to civilian populations. Of concern, help-seeking for other psychosocial difficulties among military communities has been shown to be both limited and challenging, and military personnel could face additional or amplified barriers to help-seeking for IPVA than their civilian counterparts. This study aimed to use qualitative methods to explore the experiences of, and barriers to, help-seeking for IPVA victimisation and perpetration among UK military personnel.

Methods

Thematic analysis was conducted on 40 one-to-one semi-structured interviews with military personnel (29 male, 11 female).

Results

Four superordinate themes were derived, thematically organised according to different levels of the social ecological model: Military cultural factors; Support service factors; Interpersonal factors; and Individual factors. At a military cultural level, participants described difficulties in help-seeking for IPVA resulting from widespread stigma and hypermasculine attitudes in military communities, minimisation of violence, perceived pressure from chain of command, and fear of consequences of reporting. At a support-service level, participants' negative views or experiences and lack of awareness of services were also significant in deterring help-seeking. At an interpersonal level, participants recounted how relationships with military colleagues, their partner and their family could be both instrumental or a hindrance to help-seeking for IPVA. At an individual level, lack of insight into IPVA and different forms of abuse were suggested through minimisation of violence and described to contribute to delay in help-seeking. Shame, compounded by multi-layered stigma present at each social ecological model level, was a key reason for delaying or avoiding help-seeking.

Conclusions

The findings indicate the added challenges in help-seeking for IPVA experienced by military personnel and highlight a need for a whole systems approach to improve the provision of support for IPVA in the military serving and ex-serving community to instil meaningful change.

Sexual Function and Help-Seeking Behaviors following Childbirth: A Cross-Sectional Study

This study examined 573 postpartum women's perceptions of changes in their sexual function and their help-seeking behaviors. Women residing in Ohio, Michigan, or Pennsylvania, USA, completed an online survey. Most women reported decreased postpartum sexual desire and/or arousal. Among women reporting decreased sexual function, most did not seek help from informal sources of support or health care professions (HCPs). Of those who did seek help from an HCP, in each domain of sexual function, only around half received helpful treatment. Women who did not seek help for their decreased sexual desire or arousal reported greater negative perceived impact of pregnancy/childbirth on their sexual function than women who did seek help.

Using Mixed Methods Integration to Evaluate the Structure of Help-Seeking Barriers Scale: A Survivor-Centered Approach

Despite the high prevalence of adverse health and trauma-related outcomes associated with intimate partner violence (IPV), help-seeking and service utilization among survivors is low. This study is part of a larger mixed-methods and survivor-centered validation study on the Icelandic Barriers to Help-Seeking for Trauma (BHS-TR) scale, a new barriers measure focused on trauma recovery. A mixed-methods legitimation strategy of integration was employed to evaluate the BHS-TR structure in samples of IPV survivors. The merging of qualitative (n = 17) and quantitative (n = 137) data through a joint display analysis revealed mainly complementarity findings, strengthening the scale’s overall trustworthiness and validity evidence. Divergent findings involved items about mistrust, perceived rejection, stigmatization, fearing vulnerability, and safeguarding efforts that were significant help-seeking barriers in the survivors’ narratives, whereas factor analysis indicated their removal. These BHS-TR items were critically evaluated in an iterative spiraling process that supported the barriers’ influence, illuminated core issues, and guided potential refinements. This work contributes to the growing field of mixed methods instrument validation placing equal status on qualitative and quantitative methods and emphasizing integration to provide more complete insights. Moreover, the study’s findings highlight the added value of further exploring divergence between two sets of data and the importance of giving attention to the voices of the target population throughout the validation process.

The Contextual Influences of Police and Social Service Providers on Formal Help-Seeking After Incidents of Intimate Partner Violence

Police notification and social service acquisition are two forms of formal help-seeking linked to improved outcomes among survivors of intimate partner violence (IPV), including better socio-emotional health, improved physical health, and, importantly, increased safety. The majority of research devoted to the study of formal help-seeking among survivors of IPV focuses on incident- and individual-level factors and their relationship with formal resource utilization. Much less is known about community-level factors. Using a nationally representative sample of incidents of IPV from the National Crime Victimization Survey (2006-2016), this work explores how law enforcement and social service resources in a community are related to police notification and survivor acquisition of a victim service after an incident of IPV, net of incident- and individual-level factors. Logistic regression models indicate that the number of law enforcement personnel per 1,000 residents in a county is positively associated with police notification after an incident of IPV, and it exerts an indirect effect on survivor service acquisition through police notification. Additional analyses reveal that the race/ethnicity of the survivor of IPV is a key demographic in the explanation of this relationship, as incidents of IPV involving White and Hispanic survivors of IPV are more likely to come to the attention of police as the number of law enforcement personnel increases. The reverse is true for incidents involving Black survivors of IPV. No differences across survivor sex emerged. Potential reasons to account for varying effects across race/ethnicity are discussed as well as the importance of additional funding for police and social service agencies to serve survivors of IPV and meet the dual goals of offender accountability and survivor safety and well-being.

Understanding and Measuring Help-Seeking Barriers among Intimate Partner Violence Survivors: Mixed-Methods Validation Study of the Icelandic Barriers to Help-Seeking for Trauma (BHS-TR) Scale

Intimate partner violence (IPV) against women is a global human rights violation of vast proportions and a severe public health problem. Despite high rates of adverse outcomes related to IPV, help-seeking and service utilization among survivors is low. This exploratory sequential mixed-methods study using a combined etic-emic approach describes the validation of the Icelandic Barriers to Help-Seeking for Trauma (BHS-TR) scale. The qualitative phase involved developing new items based on the experiences of 17 Icelandic IPV survivors, identifying barriers including beliefs that help-seeking is a sign of weakness, and the desire to safeguard oneself from re-traumatization. The quantitative phase examined the psychometrics of the BHS-TR in a sample of 137 IPV survivors in Iceland. Results supported an eight-factor structure (Financial Concerns; Unavailable/Not Helpful; External Constraints; Inconvenience; Weakness/Vulnerability; Problem Management Beliefs; Frozen/Confused; and Shame), which when grouped comprised two indices of Structural and Internal Barriers. The scale's internal consistency was high (α  =  0.87), and the results provided evidence of convergent, discriminant, and known-group validity. This study adds to the growing literature supporting the advantages of applying mixed methods for instrument development and validation, and its results highlight the significance of giving rise to the voices of survivors. The BHS-TR is the first trauma-specific and survivor-centered measure of help-seeking barriers available in Iceland. It can be used to provide valuable information that may guide the development of evidence-based interventions to break down barriers and help survivors find ways to trauma recovery.

Development and Testing of a Community-Based Intervention to Address Intimate Partner Violence among Rohingya and Syrian Refugees: A Social Norms-Based Mental Health-Integrated Approach

Intimate partner violence (IPV) is the leading form of gender-based violence globally and increases during times of conflict and displacement. To reduce IPV and encourage help-seeking, a two-phase community-based intervention was co-designed with Rohingya in Malaysia and Syrians in Lebanon. Three day workshops, utilizing a social norms-based mental health-integrated approach, were implemented for women and men in each country (n = 148). Pre- to post-measures indicated reductions in beliefs about acceptability of violence and rigid gender norms, and improvements in mental health, functioning, coping, and self-efficacy for women and men following workshop participation. Workshop participation was also associated with increased help-seeking intent, for both mental health and IPV (victims and perpetrators). Workshops included community design of poster campaigns to address IPV, which were then tested in each setting using a randomized controlled trial in Malaysia (n = 240) and a matched cluster comparison in Lebanon (n = 260). Women in both settings found IPV less acceptable in the poster condition. Help-seeking preferences were also influenced by the poster for women and men in both countries. This participatory intervention research can provide a roadmap for use in other settings, emphasizing the value of community-generated solutions to IPV among displaced populations.

Can the Behavioral Model of Health Care Utilization Be Used to Predict Completion of a Mental Health Assessment Following Intimate Partner Violence?

Survivors of intimate partner violence (IPV) may experience mental health problems. Although some survivors access mental health resources to address these concerns, many discontinue prematurely. One model of health care utilization that has recently gained attention in the trauma literature is the behavioral model of health care utilization (BMHU). This model considers three groups of variables in predicting health care utilization: immutable predisposing variables (e.g., age), enabling resources (e.g., income), and measures of need (e.g., symptom severity). The current study tested the BMHU's ability to predict completion of a free, multisession mental health evaluation for female survivors of IPV (N = 214). Two models were tested, each assessing a separate need-based predictor: The first model assessed symptoms of depression and the second model assessed symptoms of posttraumatic stress disorder (PTSD). Results were consistent across both models and suggested that younger age and receiving public assistance were both associated with a lower likelihood of completing the evaluation. Contrary to the BMHU's assumed positive relation between symptom severity and health care utilization, greater severity of depression and PTSD symptoms were both associated with a lower likelihood of completing the evaluation. It is possible that following IPV, experiencing psychological distress may engender help-seeking but too much distress may serve as a barrier to continued utilization. Future research should seek to better understand the complex relation between need and access, in the context of mental health care, and develop strategies for retaining IPV survivors who access mental health resources.

Socioecological determinants of community resource utilisation among low-income women in Mexico City who experienced male-to-female intimate partner violence

Women who experience intimate partner violence (IPV) face multiple barriers to seeking help from community resources, but little research has examined the impact of ecological influences on community resource utilisation among women living in low- and middle-income countries. The current study investigated individual-, relationship-, family-, and community-level influences on community resource utilisation among Mexican women experiencing IPV. Using baseline data from 950 women in Mexico City enrolled in a clinic-based randomised controlled trial, multilevel regressions were performed to assess associations between socioecological factors and women's community resource utilisation. 41.3% women used at least one resource. At the individual-level, every additional resource that women were aware of, was associated with a 20% increase in the total number of resources used (p < .001). Every additional lethal risk factor was associated with a 5% increase in the total number of resources used (p = .004). At the family-level, women who reported having an in-law encourage IPV used 46% more resources (p < .001). At the community-level, stronger supportive norms around community resource utilisation was associated with a 6% increase in the total number of resources (p = .01). These findings suggest the importance of addressing family and community factors in the broader ecological context of Mexican women's help-seeking behaviours.

Help-Seeking Among Victims of Elder Abuse: Findings From the National Elder Mistreatment Study

OBJECTIVES

The vast majority of elder abuse (EA) victims remain hidden from formal institutional response systems. Guided by the Behavioral Model of Health Services Use, this study examined factors that facilitate or impede formal help-seeking among victims of elder emotional abuse, physical abuse, and sexual abuse.

METHODS

Data came from a national, population-based EA study in the United States with a representative sample (n = 304) of past-year victims. Gold-standard strategies were used to assess EA subtypes. Multivariate logistic regression was conducted to identify help-seeking facilitators/barriers.

RESULTS

Help-seeking through reporting to police or other authorities occurred among only 15.4% of EA victims. Help-seeking was higher among victims of physical abuse, poly-victimization, or those with a perpetrator having prior police trouble. Help-seeking was lower among victims who were dependent upon their perpetrator and in cases where the perpetrator had a large friendship network.

DISCUSSION

This study highlights the hidden nature of EA as a problem in our society and the need to develop strategies that incorporate victim, perpetrator, and victim-perpetrator relationship factors to promote greater help-seeking among victims.

Gender Differences in the Relationship Between the Nature of Intimate Partner Violence and the Survivor's Help-Seeking

This study used the National Intimate Partner and Sexual Violence Survey to examine how gender interacts with the nature of intimate partner violence (IPV) in the survivor's help-seeking. A total of 3,878 IPV survivors (869 male and 3,009 female) were included in the study sample. Dependent variables were help-seeking and the use of formal and informal sources. Independent variables included gender, race, income, and the patterns of victimization and consequences of victimization. The results showed that survivors' characteristics and the patterns of victimization and consequences affect help-seeking, and that gender moderates the relationship between consequences and the use of formal help.