Ragavan Maya I, Query Lindsey A, Bair-Merritt Megan, Dowd Denise, Miller Elizabeth, Randell Kimberly A
Division of General Academic Pediatrics (MI Ragavan and M Bair-Merritt), Boston University School of Medicine/Boston Medical Center, Boston, Mass.
Division of Emergency Medicine (LA Query, D Dowd, and KA Randell), Children's Mercy Kansas City, Kansas City, Mo.
Acad Pediatr. 2021 Apr;21(3):548-556. doi: 10.1016/j.acap.2020.02.021. Epub 2020 Feb 22.
Childhood exposure to intimate partner violence (IPV) is a pervasive public health epidemic with profound impact on child health. While past work has demonstrated how abusive partners exert control over IPV survivors in a variety of settings (eg workplace, courts, home), scant research has examined how IPV power and control behaviors manifest themselves in pediatric healthcare settings. In this study, we explore the perspectives of pediatric IPV experts about: (1) behaviors used by abusive partners to control IPV survivors in pediatric healthcare settings; (2) how controlling behaviors impact healthcare access and quality; and (3) recommendations for the pediatric healthcare team.
Individual semi-structured interviews were conducted with pediatric IPV experts recruited through snowball sampling. Interviews were individually coded by two research team members and analyzed using thematic analysis.
Twenty-eight pediatric IPV experts participated. Participants described several types of controlling behaviors including limiting healthcare access, dominating conversations during medical visits, controlling medical decision making, and manipulating perceptions of the healthcare team. Participants acknowledged the challenges of recognizing controlling behaviors and provided several recommendations to addressing behaviors such as leveraging the expertise of multidisciplinary teams.
Participants described how abusive partners may attempt to control or discredit their partners in pediatric healthcare settings, using subtle behaviors that may be easily missed by the healthcare team. These results set the stage for further research and clinical practice innovation including triangulating the findings with IPV survivors, examining how frequently these behaviors occur, and developing multidisciplinary IPV training for the pediatric healthcare team.
儿童期遭受亲密伴侣暴力（IPV）是一种普遍存在的公共卫生问题，对儿童健康有深远影响。虽然过去的研究表明虐待伴侣如何在各种环境（如工作场所、法庭、家庭）中对IPV幸存者施加控制，但很少有研究探讨IPV的权力和控制行为在儿科医疗环境中是如何表现的。在本研究中，我们探讨了儿科IPV专家对于以下方面的观点：（1）虐待伴侣在儿科医疗环境中控制IPV幸存者所使用的行为；（2）控制行为如何影响医疗服务的可及性和质量；（3）对儿科医疗团队的建议。
通过滚雪球抽样招募儿科IPV专家进行个体半结构式访谈。访谈由两名研究团队成员分别编码，并采用主题分析法进行分析。
28名儿科IPV专家参与了研究。参与者描述了几种控制行为，包括限制医疗服务可及性、在就诊期间主导谈话、控制医疗决策以及操纵对医疗团队的看法。参与者认识到识别控制行为的挑战，并提出了一些应对这些行为的建议，如利用多学科团队的专业知识。
参与者描述了虐待伴侣如何在儿科医疗环境中试图控制或诋毁其伴侣，使用一些可能容易被医疗团队忽视的微妙行为。这些结果为进一步的研究和临床实践创新奠定了基础，包括将研究结果与IPV幸存者进行三角验证、研究这些行为的发生频率，以及为儿科医疗团队开展多学科IPV培训。
