Health Care Experiences of Rural Women Experiencing Intimate Partner Violence and Substance Abuse

Abstract

Primary health care providers are often some of the only helping professionals in rural communities, where community resources to treat substance abuse or shelter survivors of intimate partner violence (IPV) are scarce. This article reports on qualitative findings from a larger study examining the responsiveness of rural health care providers to IPV and substance use. Findings from 27 interviews revealed that providers rarely assessed for IPV or substance use, and patients with a history of substance abuse described their health care encounters in negative terms. Providers and patients differed in their descriptions of typical health care encounters involving women concurrently experiencing IPV and substance abuse, but agreed on several basic points, among them the severity of IPV when substances were involved and the unfortunate shortage of social services to address violence and addiction. The article concludes with suggestions for future research on addressing IPV and substance use in primary care settings and the implications for social work.

KEYWORDS:

• health care
• intimate partner violence
• rural
• screening
• substance use/abuse

Notes

1. TREM = Trauma, Recovery, and Empowerment Model.

2. Under federal provisions, a rural health clinic is located in an area designated as rural or small town according to the Economic Research Service and also qualifies as medically underserved or a Health Professional Shortage Area (both are official federal designations).

3. See the Appendix for sample questions from each interview questionnaire.

4. The interview protocols did not specifically ask about substance abuse. This construct emerged during data analysis.

5. State-level estimates from the National Survey of Drug Use and Health place the prevalence of adult substance use disorder (having carried a diagnosis of alcohol or drug dependence within the year prior to the survey) at 477,000, roughly 10% of the state’s population (Missouri Department of Mental Health, 2008).

Additional information

Funding

Funding support for this project was provided by grant number R36HS022818 from the Agency for Healthcare Research & Quality.