title: Breaking the silence. Battered women's perspectives on medical care.
abstract: OBJECTIVE
  To determine the barriers to identification and management of domestic violence from the battered women's perspective.
  
  
  METHODS
  Qualitative research methods using semistructured focus groups.
  
  
  METHODS
  Urban and suburban community-based organizations serving women and their families in the San Francisco Bay (Calif) area.
  
  
  METHODS
  Fifty-one women with histories of domestic violence comprised eight focus groups divided as follows: two groups of Latino (n=14), two groups of white (n=14), Asian (n=14), and two groups of African-American (n=9) women.
  
  
  RESULTS
  Participants from all ethnic groups identified major factors that affect identification and management of battered women in the health care setting. Factors that interfere with patient disclosure included threats of violence from the partner, embarrassment, adherence to gender roles, concerns about police involvement and lack of trust in the health care provider. One factor that predisposed a woman to seek help from providers was a need for the providers to exhibit compassion, awareness, and respect for the patient's need to make the final decisions about her situation. Most participants said that providers should take the initiative to ask directly about domestic violence, establish a supportive patient-provider relationship, and refer battered women to available community resources. The major institutional barriers to using the health care system included the high cost of medical care and long waiting periods.
  
  
  CONCLUSIONS
  Many battered women experience social, institutional, and provider barriers to obtaining help from the health care system for problems related to domestic violence. Providers as well as institutions can overcome these barriers through an understanding of the social context of domestic violence and the victim's needs. Identification may be improved through a trusting patient-provider relationship and by direct questioning about domestic violence.
authors.affiliation: Department of Family and Community Medicine, University of California-San Francisco, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Rodriguez
authors.forename: S S
authors.initials: SS
authors.lastname: Quiroga
authors.forename: H M
authors.initials: HM
authors.lastname: Bauer
mesh_terms: D000293:Adolescent; D000328:Adult; D018585:Battered Women / Q000523:psychology*; D005190:Family; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012649:Self Concept