Intimate partner violence (IPV) is common among women in the United States and associated with many deleterious health and mental health outcomes (Campbell, 2002). The public health burden of IPV, and its costs to the health care system, have led governing and policymaking bodies to recommend that health care providers ask all female patients of childbearing age direct, specific questions about whether they are experiencing IPV (Liebschutz &Rothman, 2012), usually termed "screening." Despite these recommendations, studies of health care providers reveal that routine screening practices are not widely implemented (Coker, Smith, McKeown, Le, Crawford &Flerx, 2012), and protocols on how to manage IPV following its identification in a health care setting are nearly nonexistent (O'Campo, Kirst, Tsamis, Chambers &Ahmad, 2011;Wathen &MacMillan, 2003). These gaps between policy and practice may be especially significant for under-resourced rural areas, where primary health care providers often represent the only helping professional with whom a woman experiencing IPV regularly has contact. Rural health care providers'screening and response to IPV may be influenced by personal, organizational, and community factors that in turn affect the extent and quality of care a survivor of IPV receives during her visit. Responses to IPV by rural health care providers may thus impact the survivor's decisions to seek additional help and/or take actions to resolve the abuse in her life. The proposed study employs a convergent parallel research design merging data from two sources: a survey measuring rural health care providers'knowledge, attitudes, and practices regarding IPV and qualitative interviews with survivors of IPV regarding their experiences with rural health care providers. Physicians and nurses at rural health clinics (N= 318) in a large Midwestern state will be asked to complete the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) (Short, Alpert, Harris &Surprenant, 2006) and a 16-item scaled questionnaire about the rural community in which the clinic is located. Adult women with a history of IPV who have received services at selected rural health clinics will be recruited to participate in semi-structured, faceto-face interviews about their experiences with their health care provider, their perceptions of the quality of care they received following their disclosure of abuse, and whether they took any actions recommended by the health care provider to resolve their abuse following the encounter. Quantitative data analysis will include several tests of association (chi-square tests of equal proportion, Pearson's correlation, and multiple regressions) between variables related to perspectives (knowledge, attitudes, training) of health care providers toward IPV and practices (screening, response to disclosure of IPV). Qualitative data analysis will focus on thematic content and similarities between key themes of the survivors'narratives. Findings will be particularly relevant for health and social science researchers regarding the currently available services and quality of care for rural survivors of IPV, the practices of rural primary care providers, and the help-seeking decisions and behaviors of rural abused women, and may lead to the development of standard treatment protocols suitable for rural areas.
Intimate partner violence (IPV) is a prevalent issue among women in the United States and a threat to the public health. The proposed study of rural health care providers and survivors of IPV will fill a knowledge gap between recommended policies toward responding to IPV in a health care setting and the effectiveness of that response as perceived by survivors who have disclosed their abuse to a health care provider. The proposed study will also provide public health researchers and practitioners with important information on the impact of the rural setting on rural providers'screening and response to IPV and the health-related help-seeking behaviors of rural IPV survivors.