title: Deciding to tell: Qualitative configurational analysis of decisions to disclose experience of intimate partner violence in antenatal care.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  This study tested a model for women's decisions to disclose IPV in response to routine inquiry as part of antenatal assessment.
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Social Sciences, University of New South Wales, Sydney, NSW 2052, Australia. Electronic address: j.spangaro@unsw.edu.au.
authors.forename: Jo
authors.initials: J
authors.lastname: Spangaro
authors.affiliation: Centre for Interdisciplinary Trauma Research, Auckland University of Technology, Private Bag 92006 Auckland, 1142, New Zealand. Electronic address: jane.koziol-mclain@aut.ac.nz.
authors.forename: Jane
authors.initials: J
authors.lastname: Koziol-McLain
authors.affiliation: School of Social Sciences, University of New South Wales, Sydney, NSW 2052, Australia. Electronic address: a.zwi@unsw.edu.
authors.forename: Anthony
authors.initials: A
authors.lastname: Zwi
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia. Electronic address: a.rutherford@unsw.edu.au.
authors.forename: Alison
authors.initials: A
authors.lastname: Rutherford
authors.affiliation: School of Social Sciences, University of New South Wales, Sydney, NSW 2052, Australia. Electronic address: m.frail@unsw.edu.au.
authors.forename: Mary-Anne
authors.initials: MA
authors.lastname: Frail
authors.affiliation: School of Social Sciences, University of New South Wales, Sydney, NSW 2052, Australia. Electronic address: j.ruane@unsw.edu.au.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ruane
mesh_terms: D000293:Adolescent; D000328:Adult; D003657:Decision Making; D030881:Disclosure; D005260:Female; D006801:Humans; D000066511:Intimate Partner Violence / Q000523:psychology*; D008403:Mass Screening; D008960:Models, Psychological; D011247:Pregnancy; D011295:Prenatal Care; D036301:Qualitative Research; D055815:Young Adult
keywords: Antenatal; Disclosure; Domestic violence; Intimate partner violence; Qualitative configurational analysis; Safety; Screening; Trauma-informed