In the United States, husband-to-wife violence is widely prevalent and causes great physical and psychological harm. One in five women has been hurt by intimate partners in their lifetimes. Among them, 42 percent receive injuries and 12 percent require medical care. Victims have more frequent hospitalizations and more visits to emergency departments, outpatient clinics, and mental health services. Despite the devastating impact that husband-to-wife abuse has on the wives and society, there are many unresolved questions, including how women subjected to violence arrive at decisions to leave or continue their relationships. To improve understanding of the dynamics of women's decision making in violent relationships, this study will document daily patterns of violent events, perceived need for action, and the potential predictors of action over a 2-month period for each woman. The study will recruit 150 adult women attending routine office visits at six primary care clinics. Women who report abuse within the past month will complete a baseline interview and a daily telephone survey for 2 months. Daily questions will address the previous day's violence (events, stalking, perceived escalation), household environment (alcohol, stress, closeness, forgiveness), concerns (children, their safety, financial independence), perceptions (desire to "move on" or "keep the family together", ability to control violence), and perceived need for action (leaving, coping assistance, legal assistance). Weekly telephone discussions, and end-of-study qualitative and quantitative interviews will assess additional decision making factors and women's sense of safety during the study. In addition, subjects will complete baseline and end-of-study assessments of factors that may modify perceived need for action or its translation into actual action.
This work advances our understanding about decision making in violent relationships by applying innovative methods to study the variability of women's decision making. This line of inquiry could have significant clinical applications, guiding possible interventions, by identifying factors important in decision making to abused women and explaining the variability of decision making in violent relationships. In addition, this study advances discovery and understanding by joining research and teaching, integrating project results into a workshop series for medical students by promoting novel research methods. Key innovative features include real-time reports of violent events, decision making and triggers, use of cellular phones in data collection, and assessment of day-to-day dynamics. Study results are broadly disseminated in journal publications, national professional meetings, and multidisciplinary conferences attended by policymakers and investigators. The study team has partnerships with federal agencies (i.e. the Agency for Healthcare Research and Quality), and is informing policy development through organizations such as the American Academy of Family Physicians. Assessing violence in real-time could empower researchers to study violence dynamics "as it happens" rather than limiting investigation to recall of events. There is potential for such research to improve our understanding of decision making, while positively influencing subjects' lives.
