Strategies Used by Rural Women to Stop, Avoid, or Escape From Intimate Partner Violence

Abstract

In this mixed methods study we examined the strategies rural women use to deal with intimate partner violence (IPV). The Intimate Partner Violence Strategies Index (IPVSI) was used to analyze results from a sample of 43 rural women who had left abusive partners.

Qualitative interviews then were conducted with a different sample of nine rural women to explore their perspectives about the findings and their impressions of the influence of rural culture and context on women's experiences of IPV. Findings exposed the degree to which social control acts as a key determinant of health for rural women exposed to IPV.

Intimate partner violence (IPV) is a pattern of emotional, sexual, and material degradation, including threats as well as physical and sexual assault that occur within a partner relationship (Campbell & Parker, 1992). Women living in rural communities are at a higher risk of violence than their urban counterparts (Canadian Public Health Association, 1994; Sutherns, McPhedran, & Haworth-Brockman, 2004). Research about violence against rural women is notably lacking, especially given that one in five Canadian women lives in a rural area (Sutherns et al., 2004). Aspects of rural culture may prevent women from leaving abusive relationships (Biesenthal & Sproule, 1997; Gagne, 1992; Merritt-Gray & Wuest, 1995; Wendt, Taylor, & Kennedy, 2002), yet research has not systematically examined the strategies rural women use to deal with IPV or the outcomes of these efforts. In this study, we sought to develop such an understanding by focusing on rural women's perspectives of the strategies they used to stop, avoid, or escape from IPV, the helpfulness of such strategies, and their reasons for using particular strategies within the context of their rural communities.

LITERATURE REVIEW

Rurality can be defined both in terms of physical location and as an abstract system of common understandings, values, ideas, and practices that allow people to interpret and live in their social worlds (Jiwani, Moore, & Kachuk, 1998; Moscovici, 1984). Several features of rural culture, such as public visibility, patriarchal views of the family, isolation, and economic stress, are relevant to understanding the experiences of rural women who have experienced IPV.

In rural communities, personal habits and routines are well known to neighbors, and individuals have difficulty shielding their personal lives from public scrutiny (Helpers Exploring Abuse and Responding Research Team [HEAR], 1997). This high level of visibility creates a heightened desire to protect privacy at all costs. Rural people often are reluctant to seek professional help because of privacy concerns related to the publicly visible location of services, unintentional breaches of confidentiality, or personal relationships with services providers (Merritt-Gray & Wuest, 1995). In the context of IPV, women may not involve police because their neighbors may be listening to the police scanner or a telephone party line (Biesenthal & Sproule, 1997), or the responding officer may be a close friend or relative of the abuser (HEAR).

Patriarchal views of the family, including traditional roles about gender relations and gender inequality, are commonly held in rural communities (Gagne, 1992; Websdale, 1998). These factors may affect a woman's ability to speak out about abuse, reinforcing the message that what happens between a husband and wife is a private matter (Wendt et al., 2002). This social structure perpetuates the use of violence as a means of social control (Gagne). Thus, rural communities are generally more socially cohesive, pride themselves on sharing consensus in values, and have less tolerance for diversity (Hornosty & Doherty, 2003). Rural women are likely to share these beliefs and values, and, consequently, may feel reluctant to disclose IPV, to seek help, or to leave the relationship (Wendt et al., 2002).

The physical isolation of women is an attractive feature of rural life for abusers who may intentionally relocate to rural areas to isolate their partners (Websdale, 1998). Geographic isolation may be compounded by sociocultural and psychological isolation, as the abusive partner limits a woman's contact with her family and friends (Jiwani et al., 1998; Websdale, 1998). Although this is a practice common to abusers in all settings, the physical distance of rural women from networks of support or social services may compound this problem (Fishwick, 1993; Jiwani et al., 1998; Leipert, 1999).

Rural families frequently endure periods of economic stress related to low crop prices, crop failures, and other crises, resulting in increased levels of stress and poverty (Berntson, 1993). Such stress may increase rates of violence against rural women (Berntson, 1993; Jiwani, Moore, & Kachuk, 1998; Marshall & Vaillancourt, 1993). Women's participation in paid work off the farm to help provide for the family (Berntson, 1993; Kubik & Moore, 2002) may represent a challenge to patriarchal ideals about men as breadwinners, which may result in an escalation of woman abuse (Websdale, 1998). Lack of money and job skills with which to gain employment are other significant reasons for rural women remaining in abusive relationships (Jiwani et al.). For farm women, their home is also their place of business, and they risk losing their economic interest in the enterprise if they leave (Landau, 1998). Furthermore, the prospect of leaving the farm and jeopardizing the farming operation may be unacceptable, given that the tradition of passing the property down to future generations, especially sons, is highly valued (Wendt & Cheers, 2002). Rural women may fear that their partners will harm family pets or small farm animals if they leave—a threat that is very real, since many rural households own at least one gun (Hornosty & Doherty, 2003). These facts, combined with the geographic isolation of rural women, may intensify women's fear of reprisal (Hornosty & Doherty). Although there is some evidence linking aspects of rural culture and values to rural women's experiences of IPV, how rural culture and values affect the strategies women use to deal with IPV has not been systematically studied.

Much has been written about women's struggle to leave abusive relationships, with most researchers focusing on factors that influence a woman's decision to stay or leave (Anderson & Saunders, 2003; Belknap, 1999; Strube & Barbour, 1984; Ulrich, 1991) or on the process of leaving (Landenburger, 1989; Merritt-Gray & Wuest, 1995). Inherent in much of this research is the assumption that women have a dichotomous choice: either endure the violence or leave. This approach fails to recognize that IPV occurs within wider social contexts that influence the strategies women use to deal with the violence (Cavanagh, 2003).

The strategies used by women to deal with IPV have seldom been studied due, in part, to the lack of a reliable and valid measurement tool. The IPVSI (Goodman, Dutton, Weinfurt, & Cook, 2003) was developed for this purpose and has been used in studies of Caucasian and African American women living in urban centers in the United States (El-Khoury et al., 2004; Goodman et al., 2003; Goodman, Dutton, Vankos, & Weinfurt, 2005). In one such study (Goodman et al., 2003), women were more likely to use private strategies (e.g., placating, resistance) than public strategies (e.g., seeking formal and informal help), even though private strategies, were the least helpful in stopping or preventing the violence. More severe violence was associated with greater use of strategies, and resistance was a risk factor for subsequent re abuse (Goodman et al., 2003, 2005). The use and helpfulness of these strategies by rural women is not known.

Most researchers have studied the challenges faced by rural women who experienced IPV, including what they fail to do in responding to violence (Biesenthal & Sproule, 1997; Gagne, 1992; Hornosty & Doherty, 2003; Wendt, Taylor, & Kennedy, 2002). Merritt-Gray and Wuest (1995) used grounded theory to study the process of leaving among rural Canadian women. Within the core process of reclaiming self, they identified four stages of leaving (i.e., counteracting abuse, fortifying their defenses, breaking free, not going back). Their findings include a partial description of some of the specific strategies women used to leave an abusive partner as they engaged in the process of reclaiming self. The full range of strategies used by rural women to deal with IPV and women's reasons for using these strategies in the context of rural culture is not well understood.

In this exploratory study, we sought to achieve the following (a) describe the strategies used by rural women to stop, avoid, or escape from IVP and the helpfulness of those strategies; (b) examine whether strategy use and helpfulness vary by severity of abuse and women's demographic characteristics; and (c) understand, from the perspective of rural women, the ways in which rural culture affects their efforts to deal with IPV.

METHOD

This exploratory study was undertaken from a feminist perspective in which IPV is understood as an issue of gender-based power and control. While gender is the central issue, other factors, such as economic status, race, mental health status, education, geography, and culture, may compound the effects of IPV (Browne & Fiske, 2001; Lawson, Rodgers-Rose, & Rajaram, 1999; Leipert & Reutter, 1998; Sutherns, McPhedran, & Haworth-Brockman, 2004). Feminist principles, such as valuing women's diversity and experiences and an activist stance regarding the use of findings to create change of benefit to women, were incorporated in each phase of the study. For example, participants played a key role in constructing the findings during in-depth interviews. Furthermore, directors of women's shelters in rural areas were consulted about the purpose and methods, served as subject matter experts, helped recruit participants for individual interviews, and reviewed the findings, providing feedback. Incorporating their knowledge and experience was essential from both the philosophical and practical standpoints of doing a “reality check” on the premises and design of the study as well as the relevance of the findings.

A sequential, explanatory, mixed methods design was used, employing quantitative survey data along with in-depth qualitative interviews to address the research purposes (Creswell & Shope, 2006; see Figure 1). These complementary quantitative and qualitative approaches were selected both to minimize the limitations inherent in each approach (“what's” versus “why's”) and to provide a richer, more comprehensive, and more accurate understanding of rural women's responses to IPV than could be achieved using either approach on its own (Ford-Gilboe, Campbell, & Berman, 1995; Yllö, 1998). Ethics approval was obtained from the Research Ethics Board at the study site prior to data collection.

FIGURE 1 Explanatory sequential study design.

Quantitative Survey (Phase I). Data from 43 rural, Canadian women who were participating in the Women's Health Effects Study (WHES; Ford-Gilboe, Wuest, Varcoe, & Merritt-Gray, 2006), an ongoing longitudinal study of 309 adult, English-speaking women who recently had left abusive partners, were used to describe the frequency and helpfulness of strategies women used to deal with IPV and to examine associations between these strategies and their abuse histories and demographic characteristics. Wave one data from all women who resided in a community with a population under 10,000, or slightly more if the economic base was primarily agricultural, and not within reasonable commuting distance from a metropolitan area, were included in this analysis. Approximately one-third of the women were from Ontario (n = 13) and the remaining two-thirds were from New Brunswick (n = 30). Demographic characteristics of participants from Phase I are presented in Table 1.

TABLE 1 Sample Characteristics

Demographic characteristics	Phase I (%) (N = 43)			Phase II (%) (N = 9)
Employment
Employed full-time	42 (n = 18)			0 (n = 0)
Employed part-time	12 (n = 5)			11 (n = 1)
Unemployed	46 (n = 20)			89 (n = 8)
Dependent children	61 (n = 26)			67 (n = 6)
	Mean	SD	Range	Mean	SD	Range
Age	41	8.34	22–58	42	15.33	20–66
Length of partner abuse (yrs)	10.72	8.11	.33–31	10.7	8.95	2–28
Months out of relationship	20.84	9.75	6–37	15.38	11.59	3–36 ^a
Education (years)	13.4	2.34	8–19	—	—	—

In the larger study, women completed a combination of established self-report measures, survey items, and biophysical measures during a structured interview conducted in a safe location of the woman's choice. The participant's responses were entered as obtained into SPSS Data Entry Enterprise Software (http://www.spss.com/dataentry) using a laptop computer. Women were offered a participation fee of $35 for each session completed and reimbursed for childcare and transportation costs. A detailed safety protocol was used to guide all interactions between women and the research team (Ford-Gilboe et al., 2008). In this analysis, we used data from two summated rating scales and selected demographic questions (e.g., age, education, employment status, duration of abuse).

The 39-item IPVSI (Goodman, Dutton, Weinfurt, & Cook, 2003) was used to measure women's use of specific strategies to stop, prevent, or escape from IPV, and helpfulness of those strategies in dealing with the violence across six categories: (a) placating (five items), attempts to change the abuser's behavior without challenging him; (b) resistance (seven items), efforts that directly challenge the abuser's behavior; (c) safety planning (10 items), strategies to increase the woman's resources or options for escaping or protecting herself; (d) legal (four items), seeking help from the legal system; (e) formal network (nine items), accessing external resources other than legal help, such as health or religious services; and (f) informal network (four items), seeking advice or support from family members or friends in order to increase the woman's options and resources (Goodman et al., 2003). Women were asked to indicate if they ever have used each strategy (yes/no), and, if so, to rate its helpfulness in dealing with the violence on a 5-point Likert scale from “not at all helpful” (1) to “very helpful” (5). Overall and category scores for both use and helpfulness represent the mean number of applicable strategies used.

The 30-item Index of Spouse Abuse (ISA; Hudson & McIntosh, 1981) was used to measure the severity of physical abuse, including sexual assault (11 items), and non physical abuse, including emotional, psychological, and controlling tactics (19 items) inflicted on a woman by the male partner she recently left (i.e., the index partner). Women rated the frequency of specific abusive acts directed toward them on a 5-point Likert scale ranging from “never” (1) to “very frequently” (5). Scores for physical and nonphysical abuse were created by weighting each item for severity and then summing the values of applicable items to produce scores with a range of 0–100. The ISA has been widely used with diverse samples of women, with good evidence of reliability and validity. Internal consistency of the ISA in this study was 0.83 for physical abuse and 0.89 for nonphysical abuse.

Descriptive statistics appropriate to the level of measurement were calculated for all study variables. Relationships between demographic characteristics and study variables were examined using appropriate measures of association. The level of significance was p < .05. From these analyses, we produced a descriptive summary of the mean frequency and helpfulness of specific strategies and categories of strategies as a basis for beginning to identify patterns of strategy use.

Qualitative Interviews (Phase II). Interactive, collaborative interviews were conducted with nine women who had experienced IPV while living in a rural area and who recently had left their partners. These interviews were conducted in order to seek study participants’ interpretations of Phase I findings and to gain a fuller appreciation of the influence of rural culture on women's responses to IPV by eliciting their personal stories. This new sample of women met the same inclusion criteria as the participants in Phase I and were recruited using media coverage, advertisements placed in various community locations, and through referrals from women's shelters, domestic violence services, and primary health care providers in rural areas of southern Ontario. Women who were interested in participating contacted the researchers directly. One woman who had left her abusive partner 17 years previously was included in this phase since she had excellent recall; was able to provide a detailed, rich account of her experience; and had a strong desire for her story to be heard. Women who took part in Phase II were similar to those in Phase I in terms of duration of abuse, time out of the abusive relationship, and the percentage who had dependent children living with them at the time of the interview (Table 1). Notably, the rate of employment was much lower for women in Phase II. No formal attempt was made to gather further demographic information from the Phase II participants given that the purpose of these interviews was to focus on women's interpretations of their responses to violence.

Interviews lasting an average of 60–90 minutes were conducted in a dialogic, conversational, and consultative manner, in a safe location of the woman's choosing. Using a semistructured interview guide, women were asked to describe their social history with respect to living in a rural area as well as their experiences of IPV. Findings from Phase I were presented to the women using a simple bargraph that illustrated the contrast between strategy use and helpfulness in order to elicit their interpretation of the findings. Participants then were asked to comment on if and how the bar graph data reflected their experiences, and what the graph indicated to them about strategy use. Open-ended questions were tailored to probe for rural women's perspectives regarding the impact of the rural context and culture on their experiences of IPV; their efforts to stop, prevent, or escape from the abuse; and the outcomes of these efforts. At the end of the interview, a debriefing was conducted and women were consulted about where the study findings should be shared and any advice they might offer to other women. Interviews were audiotaped and transcribed for analysis. Women chose pseudonyms to be used in the transcripts and study reports. Participants received $20 as partial remuneration for their time and appreciation for their participation.

TABLE 2 Strategy Use and Helpfulness (N = 43)

Strategy Categories and Items	% use (n)	% rated ≥ 3 (n) ^1	Helpfulness Mean (SD) ^2
Placating
Tried to keep things quiet for him	95 (41)	68 (28)	3.0 (1.43)
Did whatever he wanted to stop violence	86 (37)	59 (22)	2.7 (1.43)
Tried not to cry during the violence	81 (35)	31 (11)	1.9 (1.35)
Tried to avoid an argument with him	93 (40)	49 (20)	2.5 (1.36)
Tried to avoid him	93 (40)	71 (22)	3.0 (1.32)
Resistance
Fought back physically	63 (27)	31 (8)	1.9 (1.29)
Chose to sleep separately from him	86 (37)	35 (13)	2.2 (1.61)
Left home to get away from him	93 (40)	68 (27)	3.3 (1.52)
Used or threatened a weapon against him	19 (8)	50 (4)	2.8 (1.75)
Refused to do what he said	91 (39)	38 (15)	1.9 (1.20)
Ended (or tried to end) the relationship	95 (41)	59 (24)	3.0 (1.70)
Fought back verbally	93 (40)	58 (22)	2.7 (1.45)
Safety Planning
Put a knife, gun, or other weapon nearby	35 (15)	57 (8)	3.2 (1.81)
Hid the car or house keys	65 (28)	71 (20)	3.4 (1.60)
Kept money and other valuables hidden	65 (28)	86 (24)	3.9 (1.44)
Developed code so others know in danger	42 (18)	76 (13)	3.6 (1.42)
Worked out an escape plan	58 (25)	68 (17)	3.2 (1.51)
Removed or hid weapons	47 (20)	80 (16)	4.1 (1.36)
Kept important phone numbers to get help	63 (27)	85 (23)	4.0 (1.27)
Kept extra supply of basic necessities	33 (14)	86 (12)	4.1 (1.21)
Kept important papers hidden from him	63 (27)	93 (25)	4.4 (.93)
Changed locks or improved security	42 (18)	53 (10)	2.9 (1.76)
Legal
Filed a petition for a protection order	40 (17)	76 (13)	3.2 (1.33)
Called police or asked someone else to	77 (33)	64 (21)	3.0 (1.54)
Filed or tried to file criminal charges	54 (23)	43 (10)	2.7 (1.74)
Sought help from legal aid	42 (18)	72 (13)	3.5 (1.51)
Formal Network
Stayed at a shelter	44 (19)	100 (19)	4.2 (.92)
Tried to get help from clergy, pastor, etc.	44 (19)	63 (12)	3.3 (1.70)
Tried to get help from employer/coworker	35 (15)	87 (13)	4.1 (1.44)
Talked to a doctor or nurse about the abuse	58 (25)	76 (19)	3.8 (1.45)
Talked with domestic violence program	65 (28)	89 (25)	4.1 (1.17)
Called mental health counsellor for self	61 (26)	88 (23)	4.0 (1.15)
Tried to get help for self for alcohol/subst	21 (9)	44 (4)	3.0 (1.73)
Tried to get him help for alcohol or subst	47 (20)	10 (2)	1.3 (.80)
Tried to get him counselling for violence	61 (26)	4 (1)	1.2 (.51)
Informal Network
Sent children to stay with friend/relative	44 (19)	89 (17)	4.3 (1.24)
Talked with family/friends about protect	58 (25)	88 (22)	3.6 (1.22)
Stayed with family or friends	70 (30)	80 (24)	3.7 (1.39)
Made sure other people around you	74 (32)	49 (20)	2.5 (1.36)

Data collection and analysis occurred concurrently, with insights gained from previous interviews and analysis informing questions in subsequent interviews. Interview transcripts were coded using QSR NVivo 2.0 (NUD*IST; QSR International Pty, Ltd, 2002) software, with the goal of producing a focused description of women's strategy use in the context of rural culture. Initial-line-by-line coding was completed to identify strategies used by women based on the six categories used in the IPVSI: women's abuse experiences, elements of rural context or culture, and features of the woman's background, relationship with her partner, and social and economic circumstances that might affect the use and helpfulness of strategies for dealing with IPV. The coded data were summarized into patterns and themes that then were organized into a conceptually clustered matrix for analysis (Miles & Huberman, 1984). The interviews were reviewed many times in order to seek in-depth understanding about causes and explanations for women's decisions.

In our final analysis, we integrated the findings from Phase I (the “what's”) and Phase II (the “why's”) to produce an interpretive description (Thorne, Reimer Kirkham, & O'Flynn-Magee, 2004) that attempts to explain rural women's experiences of dealing with IPV and that may be useful in informing clinical practice. Although the mixed methodology in this study was not specifically designed to seek convergence of findings across the two phases, it was a natural point of interest.

FINDINGS

Frequency and Helpfulness of Strategies to Deal With IPV (Phase I)

Descriptive statistics for use of strategies by category are presented in Table 2. Of the 39 strategies on the IPVSI, the mean number of strategies used by the women was 24 (range 11–34, SD = 5.9), or approximately 62%. Placating and resistance strategies were used most, both in terms of the percentage of women who used these strategies (most items > 80% usage), and in the number of strategies endorsed within the categories. In contrast, strategies related to safety planning, legal advocacy, and access to formal and informal networks generally were used by smaller percentages of women, with about half of the strategies within these categories being used. Having experienced more severe physical abuse was related to the greater use of safety planning (r = .32, p = .04) and resistance (r = .36, p = .02) strategies, while more severe nonphysical abuse was associated with less use of formal network strategies (r = −.39, p = .01). The younger the woman, the more informal network strategies she used (r = −.35, p = .02).

Descriptive statistics for the helpfulness of individual strategies are shown in Table 2, while overall helpfulness by category is shown in Table 3. The category of strategies rated most helpful was safety planning, while placating and resistance strategies were rated as least helpful. Informal and formal network strategies as well as legal strategies were rated as moderately helpful. Overall helpfulness was negatively related to the severity of both physical (r = −.38, p = .01) and nonphysical (r = −.43, p = .01) abuse. For specific categories, more severe physical violence was related to lower perceived helpfulness of resistance (r = −.40, p = .01), legal (r = −.38, p = .02), and placating (r = −.32, p = .04) strategies. Having experienced more severe nonphysical violence was related to lower helpfulness of formal network (r = −.51, p = .01), resistance (r = −.44, p = .01), and placating (r = −.34, p = .03) strategies. Women with children reported higher overall helpfulness of the strategies used (t(41) = −2.24, p = .03), as well as higher helpfulness for placating (t(41) = −2.74, p = .01), resistance (t(41) = −2.53, p = .02), and legal (t(18.3) = −2.65, p = .02) strategies, than did women without children.

TABLE 3 Use and Helpfulness of Categories and Total Scale (N = 43)

Category	# of items	Mean strategies used (SD)	Range	Mean Helpfulness (SD)
Total Scale	39	23.9 (5.99)	10–34	3.0 (.66)
Placating	5	4.5 (.77)	2–5	2.6 (.91)
Resistance	7	5.4 (1.16)	1–7	2.6 (.93)
Safety Planning	10	5.1 (2.62)	0–10	3.8 (.10)
Legal	4	2.1 (1.33)	0–4	3.1 (1.28)
Formal Network	9	4.4 (2.05)	1–8	3.0 (1.12)
Informal Network	4	2.5 (1.08)	0–4	3.3 (.92)

In summary, the categories that were used the most, placating and resistance, were rated as least helpful in dealing with IPV. Strategies of safety planning, seeking legal support, and seeking help from formal and informal networks were used by only half of the women, yet they were rated as helpful, with safety strategies receiving the highest helpfulness rating. Few demographic variables were related to either strategy use of helpfulness. More severe abuse, however, was related to greater use of some strategies (i.e., safety planning, resistance), lower use of others (i.e., formal network), and lower strategy use or helpfulness overall and in four of six categories.

Women's Interpretations of Dealing With IPV in the Context of Rural Culture (Phase II)

This focused description of rural women's explanations for using various strategies to deal with IPV builds on and extends the quantitative survey (Phase I) findings and provides a more contextualized understanding of strategy use than could be obtained from the survey alone. Women's interpretations of Phase I findings have been incorporated here.

Women's Emotional Responses to Abuse: Fear and Self-Blame

Women's descriptions of their abuse experiences and strategy use were interwoven with their comments about feelings of fear and self-blame. These emotional responses provide an important context for understanding the ways in which women tried to stop, avoid, or prevent the violence in their lives. Women described many types of fear that were closely related to the reality of living in a rural community. Fear related to their personal safety was especially pronounced by their physical isolation, which resulted in long response times for police, and long distances from neighbors or other sources of help. Stacey's abuser told her that “no one cared” as he drove her along a country road “pointing out, ‘I could bury you there, [or] I could bury you there, [or] I could bury you there and nobody would find you.’” They feared the unknown, and how they would support their children and raise them in “the city” if they left, particularly when their work experience outside of the family farm or business was limited. Stacey said, “the fear of getting out is overwhelming … It's worse than the fear of being there.” This fear was particularly acute because leaving the partner often meant leaving their communities, friends, or jobs to venture into the unknown. Fear of failure was especially pronounced, as the women knew that returning to the relationship would have dire and potentially lethal consequences.

Women also reported pervasive feelings of self-blame about causing the abuse, which were reinforced by others in their rural communities, such as a priest who convinced one woman that she was the problem, or police officers who accused women of provoking their partners. Women reflected on what they could have done differently to avoid the failure of their relationship (“If only I was a better mother, a better cook, a better housekeeper, then maybe…”) and held themselves accountable, at least in part, for the abuse. Thus, women's descriptions reflected an overwhelming sense that IPV results from personal failings.

Reasons for Strategy Use

Consistent with Phase I findings, the rural women interviewed in Phase II used placating and resistance strategies a great deal. Their explanations for how and why these strategies were used, however, help to illuminate the complexity of how rural women navigate partner abuse using their own experiential knowledge of their situations and contexts.

Placating. Rural women identified numerous placating or “keeping the peace” strategies, some of which included walking on eggshells, keeping the house spotless, waiting on him hand and foot, avoiding confrontation, trying to keep everything perfect, and hiding from him. While these strategies may appear to be reactive, in the moment, or even submissive responses, the women clarified that these strategies intentionally were used to decrease the violence in their lives. Women's goals in placating, however, varied. For some of the women, placating strategies were designed to buy time or keep the peace until she could “get her ducks in a row” (i.e., develop a plan to get out). Women's options for “getting out” were limited by the realities of rural life, such as lack of access to local resources or fear of using the resources and lack of money or employment opportunities. Thus, “getting her ducks in a row” took many years for some of the women.

Others stated that placating strategies were used to keep themselves alive or to minimize a beating, noting that the abuser would have killed them if they had resisted. For others, placating was used to avoid upsetting scenes in front of their children. Stacey described a severe beating from her spouse because the bathroom was not as clean as he wanted it: “He shut the bathroom door and he beat … me … The kids were on the other side of the door … I didn't want to cry out and scare the kids.” For some women, even verbal altercations would rapidly escalate to physical violence. Several participants stated that they encouraged the abuser's drug or alcohol use because keeping him high or drunk made her life easier as he became more “mellow” and less abusive.

The rural location (with physical isolation and long distance from neighbors or other sources of help) figured prominently in women's use of placating strategies to deal with IPV. One woman's husband deliberately had chosen to locate to a rural area to isolate her from potential sources of assistance and told her that “nobody cared” and that there was “nobody else to take care of you but me.” Mona Lisa expressed feeling isolated from help as her spouse took the keys from the vehicle or took the spark plugs out of the vehicle so she couldn't leave. She considered harming herself because she saw it as the only way out: “I thought, ‘I'm never going to leave except in a pine box. I'll never get away from him.’

Resistance. The ways in which women described their attempts to actively resist the violence were varied and highly context dependent. Some women did not resist even verbal abuse, because, as Betty stated “It became physical too fast from him when I was verbal.” She said that she was not allowed to have an opinion on anything but had to agree with him and described her abuser as “the playground bully”—someone who outweighed her by 100 pounds and often was fighting with male coworkers. Women who used physical resistance strategies (such as hitting him with a coffee cup or threatening him with a plastic pipe) in response to physical violence often found these efforts to be futile due to the abuser's greater size and strength. Others did not resist the physical abuse because they feared that they would be killed, and struggling made the beatings worse. Even verbal resistance was seen as not helpful, except in the short term. Mona Lisa, however, described her success in using resistance as a way of controlling her partner's pattern of abuse, stating that the pattern had become very predictable.

After a while you see a pattern building. … I could kind of tell where it was going to lead to and if I responded a certain way, I provoked it even farther. And at times I did. I would do it deliberately to make him mad so I could get that explosion over with, because then it wasn't in his control, it was in my control.

Afterward, her abuser would be kind and gentle, and she could get him to do needed jobs around the house. Her manipulation of the situation restored a sense of control that otherwise was lacking.

Women spoke openly about male power and control in the rural setting as a barrier to their resistance, specifically using the term “patriarchal attitudes” to describe this characteristic of rural life. Many of the women had grown up in abusive rural homes in which the man was the head of the household. Throughout their lives, they were exposed to statements such as “The man is the man,” and “You do as you're told,” and these attitudes continued in their adult relationships. Several women characterized their spousal relationships as “father–child” or were objectified as “the wife.” Women's own fathers often were inclined to support the abuser, stating, “If you're married, you don't leave …[and] the occasional smack is acceptable.” Stacey observed, “It wasn't a relationship, it was an ownership.”

Safety Planning. Women described extensive safety planning strategies such as stockpiling groceries, hiding money or opening secret bank accounts, keeping copies of important papers, and even gaining weight in order to diminish the effects of beatings and reported that these strategies were among the most helpful in dealing with IPV. Planning restored a sense of control and gave the women feelings of strength and belief in themselves. Grace and Meg said they felt stronger with each small step they used to regain control, and another participant said, “Having a plan motivates you, [and] makes you believe that you can do it.”

The steps women took in safety planning depended on their individual situations. Stacey tried to accumulate small amounts of cash by returning groceries for cash credit, until her spouse discovered this strategy. Several other women opened personal bank accounts, but they were discovered when statements came in the mail. Another woman hid money in the freezer until a “friend” told her husband about it. Women were very focused on the financial constraints of leaving the abusive relationships. For example, several women pointed out the lack of subsidized housing in rural towns as a huge obstacle in making plans to leave. Others felt trapped by having no transportation, no job, and no money. Those who were engaged in farming operations or other rural businesses knew that they would lose their economic interest in the farm enterprise when they left and that they would not be eligible for Employment Insurance benefits or Canada Pension Plan benefits. Meg remarked about the enormous debt related to their farm operation: “If you owe half a million dollars, what are you going to do?” She was not willing to “push” her spouse for a fair economic settlement when she left because it would have collapsed the farm operation and she feared that her grown children would not forgive her for ruining their father's enterprise. Women were prepared to compromise their well-being, their entitlements, and perhaps their lives, for the well-being and security of their children.

Women's ability to take preparatory steps to leave also was dependent upon their abuse situation and the extent of their geographic and social isolation. For instance, Stacey's spouse monitored her every move, even unplugging the telephone and taking it to work with him so that she could not make telephone calls. Every day she was left alone and isolated, with no contact with the outside world, not even the ability to contact her own family. At the other extreme, Mona Lisa's spouse mocked her and told her to get out, saying she could not manage without him. Another woman did not make plans to leave until the violence changed from nonphysical to physical. Although she recognized the nonphysical violence as abuse, she wanted to maintain the traditional nuclear family unit, and she did not feel “justified in uprooting [her] children” until the violence became physical.

Legal. All of the women described mixed reactions to police intervention and expressed frustration with the inability of police to act without a restraining order and lengthy delays in getting such orders. Many women were skeptical of police motivation to help, citing examples of police suggesting that they must have provoked the abuser in some way or that the blame was equally theirs, as well as ignoring women's requests to drive by the house or speak to the abuser. Others believed that the police wanted to help, but that their “hands were tied” by the lack of a restraining order. Grace expressed frustration about the fact that the town police knew about her spouse's history of violence but did not act: “[When I call the police] I don't have to say my name and they know who I am, but still they can't do anything about it. He is stalking me, basically.” When Mona Lisa's spouse threatened people in her workplace, the police advised her employer to “get rid of her, [and] you get rid of the problem.” Mona Lisa described the feelings of fear and abandonment when the police drove away in the middle of the night, leaving her alone with the abuser, miles from their nearest neighbor.

Skepticism about legal strategies also extended to the courts, with women frequently expressing beliefs that the quality of help available from legal aid lawyers is less than what can be obtained from those who are hired privately. None of the women, however, could afford the expense of a private lawyer. They expressed frustration that, even after leaving, the abuser maintained his ability to exert control over them through legal manipulation through the courts. For example, Grace's husband requested, and was granted, a child support schedule that required payments to be made every 2 weeks rather than monthly. Grace interpreted this action as part of her former partner's plan to keep in frequent contact with her so that he could continue to monitor, manipulate, and control her life. Such contact and behavior by the abuser was particularly unnerving in her isolated rural setting.

Formal Network. Women were reluctant to seek help from outside agencies or professionals for a variety of reasons. Several women said that rural women just do not know what services are available, and, even if they do, they often do not have transportation to access the services. Even in small towns in which a shelter was within walking distance, there was hesitation about going there. Sue said she felt that other people stared when they saw her walking in and out of the shelter. She stated that everyone in town knew who she was, and that “it's like they look down on you. It's like you're the dirt that they walk on almost. … It's like … you're below …human level. … You've dropped on the food chain.” Grace avoided the shelter because, “The shelter, to me, was just like going to jail. It was the equivalent in my mind.” Stacey described the lack of confidentiality and anonymity associated with using services in her own town where everyone, including her former partner, knew everyone else's business. She said, “He could sit outside that door. … I'm going to have to walk out that door eventually.”

Women frequently recounted negative experiences seeking counseling or expert advice about how to deal with the abuse. Participants noted that counselors often did not understand, were not competent, or took the abuser's side, implicitly facilitating the abuse. One woman stated that several counselors revictimized her by believing the abuser's side of the story, and one counselor told her to “thank her lucky stars” that she had her former partner. Another woman expressed frustration with her mental health counselor, stating that she felt like a wounded animal who was supposed to “get back out there and get up and get on with life,” and she just did not know how to do that. In the small rural town where she went for counseling, there was no choice about who would be assigned as her counselor—“You either see these people or you don't see nobody.” Sarah went to the priest in her rural parish for counseling with her abusive spouse, but together her husband and the priest made her believe that she was the one with the problem. In some cases, there was overt victim-blaming and, in others, outright incompetence. For example, an interviewer at the office of the children's lawyer told Sue, “When people get older, they mellow out,” referring to the expectation that the abuse would abate as her husband aged.

A recurring theme with participants was the lack of assistance they received from rural physicians, either because they ignored the situation or refused to become involved. Women were not inclined to raise the issue with their physicians, nor were they ever asked about abuse. Nevertheless, most women felt that their physicians were aware of the abuse. Several physicians congratulated or commended the women for their decision to separate from their partners after they had left the relationship, even though the subject of IPV had never been discussed. In another situation, both the woman and her spouse were being treated for injuries inflicted during a physical altercation between them, yet the physician deliberately avoided asking about the circumstances, telling her spouse to “keep [his] mouth shut.” The first time Sue sought help from her physician, he said that she was making a mistake and needed to go back to her husband. The second time, “He told the lady from the children's lawyer that if we didn't keep this out of his office, he was going to have us both [Sue and her baby] kicked out of the practice.” In rural areas, where there may be only one physician, this would have resulted in no medical care for this woman, and possibly for her children.

Some physicians fit the stereotype of the “old country doctor” in that they were seasoned practitioners who had lived and worked in the area for many years, while others were younger and newer to the community. Regardless, women's depictions of negative treatment by rural physicians represents a surprising and disturbing revelation, especially given that, for many of these women, their physician was their only contact with the health care system. In the absence of other help or resources for abused women in rural areas, physicians and other health care professionals may be the only source of formal help available.

Informal Network. Women perceived the help provided by family members and friends as having both positive and negative dimensions. Some women were entirely isolated both physically and socially from family members and friends, and, thus, were unable to ask for help. Further, in most cases, their spouses did not allow these women to work. One woman said, “This farm thing really suited him because … I was totally under his control.” She had very little interaction with neighbors other than at church because of their heavy schedule milking cows twice daily. Her acquaintances at church thought that “everything was peachy because I hid it.”

All of the participants remarked that others in their community knew about the abuse, but no one would discuss it: “People keep things hush-hush around here;” “Everyone will know about the situation and they're going to talk … They see it from the guy's perspective;” and “Everyone talks; no one gets it right.” This high level of visibility created a heightened desire to protect privacy at all costs and acted as a deterrent to confiding in neighbors or contacts in the community.

Most of the women talked about the “Jeckyl and Hyde” persona of their abusive partners, oozing “sweetness and light” in social situations, but becoming abusive when they were alone. Betty said they had a lot of “superficial friends” because that's how he wanted it—“nobody too close.” She was forced to “latch on to everything [her abuser] said and be the lovey-dovey wife out in public.” After leaving their partners, women often discovered that their friends had suspected abuse for several years, but they did not discuss it openly. Woman abuse was like the “elephant in the room” that everyone saw but no one talked about. Meg's neighbors gave them a going-away party when they moved, presenting the couple with a ball and chain that they said was to tie her to the stove. It made her realize that they did not have any “illusions” about her spouse. These findings reveal the influence and power of the patriarchal rural culture in shaping public personae and disguising the truth of women's situations.

Those who sought assistance from family and friends sometimes found them helpful in speaking with the abuser, providing a place to hide, providing needed time and space to think and survive a crisis, or keeping their children safe. In other situations, however, family members rejected the woman's requests for help, reinforcing the status quo of man as head of the household. For example, one woman's father took the side of her abusive partner, and another woman's friend reported the family to the Children's Aid Society, hoping to jar the woman into the reality that she needed to get counseling or leave the relationship. Although her friend claimed good intentions, Grace felt threatened by this action and interference in her right to make her own decisions. In keeping with the view that the man is the head of the household, Grace's mother, who disagreed with her husband's support of Grace's husband, refused to intervene with her husband on Grace's behalf. Findings here reveal the power of the rural patriarchal culture in silencing women and in perpetuating lack of support for rural women.

Despite the struggles the women endured, many of which were supported directly or indirectly by the rural culture. Six of the nine women interviewed continued to live in rural areas after leaving their abusive partners. The other three were living in second-stage housing in a small city located near their rural homes. The women stayed in rural areas because they liked the peacefulness of the country—“Walking is just more comfortable to me [here] than walking in the city,” or they felt that rural life was where they belonged.

In summary, participants possessed extraordinary insights into the influence of rural culture on their responses to abuse, specifically the patriarchal attitudes that condoned men's domination of women, the deliberate physical and social isolation that limited their choices, their economic challenges, an overwhelming sense of fear, and their feelings of self-blame. In the face of physical, social, economic, and cultural constraints limiting their ability to take control of their lives, women did whatever they had to do to stay safe and protect their children while planning to leave. In the rural context, safety planning is central to the use of all other strategies. Rather than a passive response to abuse, women used placating in an active, intentional way to enhance their safety. Similarly, the high rates of resistance documented in the survey must be understood in terms of the influence of women's personal understanding of their own situations in determining if, when, and how to resist their partners’ actions. The complexity of navigating personal and professional systems and the values of helpers within those systems explain, in part, the high degree of variation in women's use of legal, formal network and informal network strategies and the helpfulness of these strategies. Taken together, findings from both phases support the extent to which the severity of physical and nonphysical abuse influenced women's choices of strategies. While the quantitative survey in Phase I contributed numbers, the qualitative interviews in Phase II contributed the rich stories that help explicate and extend Phase I data (Ford-Gilboe et al., 1995).

Discussion

We found that women's responses to IPV are highly context dependent (Cavanagh, 2003; Goodman et al., 2003) and that key features of rural life, such as physical and social isolation, patriarchal attitudes, economic stress, and public visibility, factor heavily in men's domination of women and women's ability to respond to IPV. When compared with findings from a previous study of urban-dwelling women (Goodman et al.), rural women in our study reported higher rates of both placating and safety strategies and lower helpfulness of strategies in all categories than did their urban counterparts. Although these findings may be due to methodological differences or sample variations across the two studies, the impact of rural culture and environment cannot be discounted as a plausible explanation. Our findings illuminate the varied ways in which rural culture and context affect women's use of strategies in response to IPV and the results of these efforts.

We found evidence of the degree to which social control acts as a key determinant of health for rural women exposed to IPV. Participants experienced all three levels of social control described by Gagne (1992): normative control, referring to the social norms about women's roles; persuasive control, referring to verbal threats and isolation; and physical control induced by violence and intended to instill fear. The triple impact of these levels of control is important in understanding the context-specific challenges faced by rural women. Without cultural acceptance and social structures that condone men's domination of women, violence as a means of social control would be less effective (Gagne). While much has been written about traditional gender roles and gender inequality in rural communities (Gagne, 1992; Naples, 1994; Websdale, 1998; Wendt et al., 2002), few previous studies have linked the impact of these rural cultural attitudes to women's experiences of IPV. While gender inequality exists in urban centers as well, traditional attitudes toward gender roles are more pronounced in rural areas where communities are often more homogeneous and socially cohesive, and where they publicly pride themselves on value consensus (Hornosty & Doherty, 2003; Naples, 1994). Furthermore, we suggest, based on our findings, that the social control experienced by women in rural settings reinforces feelings of self-blame and interferes with women's help seeking, limiting their access to potential formal and informal network support. Given that the direct and buffering effects of social support on health are well documented (Anderson & Saunders, 2003; Coker, Watkins, Smith, & Brandt, 2003; Franks, Campbell, & Shields, 1992; Moss, 2002), lack of social support, especially when combined with gender inequity, creates an “explanatory framework for variations in women's health” (Moss, p. 656). The relationships among social control, social support, and the health of rural women who have experienced IPV is an important area of future research.

In this study, although services to help women often were not available, even when such resources were available, and women knew about them, social, cultural, and practical barriers as well as public location of resources stood in their way of getting the help they needed. Consistent with findings of previous studies, conducted in rural communities (HEAR, 1997; Merritt-Gray & Wuest, 1995), we found that public awareness of other people's business and high personal visibility, coupled with a desire for privacy, may negatively affect women's help seeking. Furthermore, the paradox created between what is known by others and what openly is discussed reinforced women's sense of shame and reluctance to share their experiences with others, including professionals. Rural women in our study were less likely to report that trying to get the abuser counseling for violence or substance abuse was helpful than urban women in Goodman and colleagues’ (2003) study. These differences may reflect the lack of counseling resources in rural areas, poorer quality of these services, or greater resistance of rural abusers toward counseling. The findings that counselors and other professionals often revictimized women by blaming them for the violence, discounting the need for help, or refusing to be involved, is particularly problematic, given the paucity of services that exist in rural communities. There are obvious implications for training of counselors and other professionals who interact with rural women and the need for these workers to be sensitive to the particular challenges, contexts, and needs of rural women.

Some aspects of the physical environment that were found to limit rural women's help seeking also have been documented previously (HEAR, 1997; Hornosty & Doherty, 2003; Jiwani, Moore, & Kachuk, 1998). Physical isolation, lack of transportation, lack of money, and lack of job prospects impact women's ability to leave and to support themselves after leaving. Based on our findings, we wish to underscore the importance of women's economic independence in shaping their responses to IPV, including whether and how she leaves the relationship. Material resources, especially employment and income, are stronger predictors of leaving an abusive relationship than are social psychological factors (Anderson & Saunders, 2003; Rusbult & Martz, 1995), and women's income is the best single predictor of women's leaving (Lesser, 1990). Our findings highlight the unique economic challenges faced by rural women during and after leaving, particularly when the woman's work was integrated with that of her spouse (as in farming), and when home was also their place of employment. Landau (1998) also documented women's concerns about losing their economic interest in the farm enterprise after leaving their partners. Furthermore, we suggest that women's economic dependence after leaving is partially due to more broad structural factors, including social policies, which act as barriers to economic independence and breaking free of the abuse. Women's ineligibility for Employment Insurance or Canada Pension Plan benefits when they leave the family farm, the reality of poor employment prospects for women who wanted to stay in their rural communities (Wendt & Cheers, 2002), and lack of subsidized housing and public transportation made it difficult to leave and remain out of an abusive relationships or to reach out for help. These challenges lead us to suggest the need for context-sensitive policies to support rural women who are in the transition of leaving abusive partners.

Women's reliance on private strategies for dealing with IPV, specifically placating and resistance, in spite of their lower perceived helpfulness in dealing with the violence, may be understood in a number of ways. Lempert (1996) theorized that women start out using private strategies such as placating and resistance and extend their use of strategies to public ones as the violence increases. Our Phase I results support this theory in that, as the severity of violence increased, women's use of strategies increased in all categories, with the exception of formal network, which was lower with more severe violence. Most importantly, as severity of violence increased, perceived helpfulness of all strategies decreased, reflecting the fact that the abuser's actions are outside of a woman's control. It may be that rural women are less able to access sources of outside help, or that they are prevented from accessing help because of their physical and social isolation, as was described by the women in Phase II and in previous studies (Fishwick, 1993; Jiwani, Moore, & Kachuk, 1998; Leipert, 1999; Websdale, 1998). Alternatively, as Gondolf and Fisher (1988) suggested, previous abuse and neglect by help sources may lead women to try other strategies. In addition, rural women's desire for privacy may account for the decreased use of formal network strategies, a finding supported by Wendt and Cheers (2002) in their qualitative study of rural Australian women.

We found that private strategies serve a strategic purpose and are not solely a ‘default’ option when other more public strategies are not available or are not helpful. Indeed, early suggestions that women experienced learned helplessness when their actions did not lead to changes in the abuser's behavior (Walker, 1984) largely have been dismissed. Authors of more recent studies suggest that abused women actively and persistently attempt to end the violence in their lives (Cavanagh, 2003; Gondolf & Fisher, 1988; Landenburger, 1989; Merritt-Gray & Wuest, 1995; Ulrich, 1991). Far from representing learned helplessness, we found that private strategies are intentional, long-term actions that are part of rural women's safety planning and are carefully undertaken using women's expert knowledge of their personal situations. Viewed in isolation, findings related to the high use and low helpfulness of placating are perplexing until placed into context through women's descriptions of how and why they employed such strategies in rural settings, highlighting the value of using mixed methods designs to study complex social problems. We suggest, based on the combination of findings from both phases of this study, that placating needs to be reconceptualized from a form of passive submission to a purposeful and intentional strategy.

Despite the pervasive influence of the multiple levels of social control, participants exhibited a resilient spirit that ultimately helped them to regain control in their lives. The strengths of women who have experienced violence have been described previously (Ford-Gilboe, Wuest, & Merritt-Gray, 2005; Lempert, 1996; Merritt-Gray & Wuest, 1995). Whether manipulating the “explosion” and using the ensuing honeymoon stage to get the abuser to complete household maintenance tasks, or “squirreling away” small amounts of cash, these steps contributed to the feeling that the women could take control and decrease the violence in their lives. In the process of leaving and beyond, a sense of control has been identified as a critical factor that positively affects women's ability to experience freedom from the oppressive control of the abusive partner, to promote their health and quality of life, and to create a better future (Ford-Gilboe, Wuest, & Merritt-Gray, 2005).

Implications for Rural Health Professionals

Rural health care requires an understanding of, and sensitivity to, rural cultural values and norms (Bushy, 2000; Leipert & Reutter, 2005b). Based on our findings, we propose that there is a compelling need to critically examine rural health care practice from the perspective of how rural culture and values may strengthen or impede the delivery of safe, effective care to women who have experienced IPV. Because rural health care providers are also members of rural communities, they also may subscribe to patriarchal beliefs and attitudes regarding gender roles that reinforce women's dependence and make breaking free from an abusive partner difficult. Providing rural health care providers with educational opportunities focused on understanding and appreciating rural women's perspectives may be useful in helping them re–evaluate their assumptions and judgments about IPV and in providing more appropriate support for rural women who have experienced IPV. Rather than reducing the complex process of leaving to the “single act of moving to a new address” (Merritt-Gray & Wuest, 1995, p. 411), educational opportunities should reinforce the idea that leaving is an incremental process that may take many years and is highly dependent on many factors external to the woman, including her access to financial resources and support from her network and professional helpers. Education and reflective practice may assist rural health care providers to understand that, for rural women, leaving often represents a complete cultural change, not just relocation.

Furthermore, the widespread concerns about unsupportive and sometimes punitive actions taken by health care providers expressed by women in this study suggest the need for rural health care providers to critically examine their own and each others’ practices related to IPV. Importantly, such actions on the part of health professionals implicitly or explicitly violate both ethical and more general practice standards across health disciplines (College of Nurses of Ontario, 2008; College of Physicians and Surgeons of Ontario, 2007). While inappropriate responses to IPV by health care providers are not confined to rural settings, rural women may not have access to anyone else with whom they could (or would) talk about the abuse. Accordingly, rural health care providers must create opportunities for women to speak privately during health care interactions. This demand may be cloaked in terms of a “departmental/clinic policy” or whatever measures are necessary to afford rural women the opportunity to speak openly and privately. In addition, rural health providers must take leadership roles in advocating for attitudinal change and for enriched resources for rural women who experience IPV (Leipert & Reutter, 2005a). Furthermore, nurses and other health care professionals must be held accountable for their actions, both by their peers and by community members who know about inappropriate actions but remain silent.

Health and social service practitioners have an important role to play in supporting women's access to the determinants of health, including food, shelter, housing, safety, social support, and other resources. Helping women get the information they need about their options and supporting them in learning to navigate the system are critical nursing roles in the context of IPV (Ford-Gilboe, Wuest, Varcoe, & Merritt-Gray, 2006). Study participants suggested that resource pamphlets be placed in examination rooms or private areas, rather than in waiting rooms, so that women could access information anonymously and confidentially. Providing information about IPV and community supports using mass mailings to rural homes, advertisements and articles in small town newspapers and women's magazines, and radio and television also were recommended.

Patriarchal views of the family and the role of women, the permanence of marriage, religious convictions, and rural cultural norms pose challenges for providing community resources in rural areas. One woman said that her community rejected the idea of women's services because “that sort of thing (abuse) doesn't happen here.” A community health assessment approach would help rural public health nurses work with their community to raise awareness of and develop strategies for addressing health-related concerns such as IPV (Bushy, 2000). Nurses who live and work in rural communities, and who have the trust of community members, are well positioned to facilitate the social networking necessary for community development initiatives (Bushy; Leipert, 1999).

CONCLUSION

Our results help to explain the strategies used by rural women to stop, avoid, or escape from IPV, and highlight the pervasive effects of rural cultural influences on the choices women make. Consistent with the literature about traditional gender roles and social control in rural settings, women faced significant barriers in escaping from their abusive partners. While their use of some strategies may not appear to others to be highly effective, our findings suggest that their choices were appropriately based on their unique understanding of the rural context in which they lived and of their personal situations, reinforcing the importance of women's agency and sense of control. The strengths, motivations, and resilience of these rural women are evident not only by their successful navigation out of their abusive relationships, but also by their commitment to help other rural women through their participation in this study.

Acknowledgments

This study was co–funded by the Chair in Rural Women's Health Research and by Iota Omicron Chapter of Sigma Theta Tau International.

Notes

^aExcluding outlier of 17 years.

¹Percentage who found the strategy helpful (ie. rated ≥ 3).

²Range for helpfulness was 1–5 for all strategies.