Spangaro Jo, Koziol-McLain Jane, Zwi Anthony, Rutherford Alison, Frail Mary-Anne, Ruane Jennifer
School of Social Sciences, University of New South Wales, Sydney, NSW 2052, Australia.
Centre for Interdisciplinary Trauma Research, Auckland University of Technology, Private Bag 92006 Auckland, 1142, New Zealand.
Soc Sci Med. 2016 Apr;154:45-53. doi: 10.1016/j.socscimed.2016.02.032. Epub 2016 Feb 26.
Intimate partner violence (IPV) is a significant global public health risk causing premature death and morbidity that largely remains hidden. Understanding decisions about whether or not to disclose abuse when asked about it in health settings is important to ensuring that those experiencing violence are provided with access to services to support their safety and wellbeing.
This study tested a model for women's decisions to disclose IPV in response to routine inquiry as part of antenatal assessment.
Qualitative configurational analysis, suited to the study of causal pathways in complex social phenomena, was used to analyse interviews with 32 women who had experienced IPV in the past 12 months and who elected, when asked, to either disclose this to the midwife (n = 24) or not to do so (n = 8).
Multiple pathways to disclosure were identified. While no single factor was necessary or sufficient for a decision to disclose, direct asking and care, defined as showing interest and a non-judgemental attitude, were found to be key conditions. The absence of care was also central to decisions not to disclose, as were perceptions of relevance of the abuse at the time of assessment.
Confirming key elements of the original model, these findings highlight the importance of being asked about abuse in women's decisions to disclose, as well as the relational nature of this process. Trauma-informed practices for identifying and responding to intimate partner violence are needed.
亲密伴侣暴力（IPV）是一项重大的全球公共卫生风险，会导致过早死亡和发病，而这在很大程度上仍不为人所知。了解在医疗环境中被问及是否披露虐待行为时做出的决定，对于确保遭受暴力的人能够获得支持其安全和福祉的服务至关重要。
本研究测试了一个模型，用于解释女性在产前评估的常规询问中披露亲密伴侣暴力的决定。
采用适合研究复杂社会现象因果路径的定性构型分析，对32名在过去12个月中经历过亲密伴侣暴力的女性进行访谈分析，这些女性在被问及时选择向助产士披露（n = 24）或不披露（n = 8）。
确定了多种披露途径。虽然没有单一因素对于做出披露决定是必要或充分的，但直接询问和关怀（定义为表现出兴趣和非评判态度）被发现是关键条件。缺乏关怀也是不披露决定的核心因素，评估时对虐待相关性的认知也是如此。
这些发现证实了原始模型的关键要素，强调了在女性披露决定中被问及虐待行为的重要性，以及这一过程的关系性质。需要有创伤知情的做法来识别和应对亲密伴侣暴力。
