Women Veterans' Experience with Research on Intimate Partner Violence

HSR&D’s monthly publication Veterans’ Perspectives highlights research conducted by HSR&D and/or QUERI investigators, showcasing the importance of research for Veterans – and the importance of Veterans for research.

In the May 2019 Issue:

• Introduction
• Study Recruitment
• The Interviews
• Women Veterans' Motivations for Study Enrollment
• Women Veterans' Experience with Research
• Moving Forward

Introduction

Intimate partner violence (IPV) – including psychological, physical, and/or sexual violence and abuse by a current or former intimate partner – is a sensitive topic associated with wide-ranging adverse impacts on health and well-being. Women Veterans face disproportionately high rates of lifetime IPV, making this an important population to include in research. Due to concerns regarding stigma, emotional distress, and potential for increased violence (i.e., perpetrator retaliation) resulting from disclosure of IPV experience, research with women who have experienced IPV requires safety and confidentiality measures that may pose challenges to recruitment and data collection. However, little is known about successful strategies for recruiting and retaining women who experienced IPV in research studies, or their experiences with participating in research.

Information from a study led by Dr. Melissa Dichter – part of the leadership team for HSR&D’s Center for Health Equity Research and Promotion – provides some insight into how women with IPV experience being part of a research study.  Her study sought to identify the patient population in need of IPV-related care within the VA healthcare system, explore disparities in care or outcomes, and identify services or supports most helpful in improving patients' safety and well-being. In an article in Women’s Health Issues (Dichter et al., 2019), study investigators discuss recruitment strategies and  findings on women Veterans’ motivations for – and experiences with -- their participation in VA research.

⇪

Study Recruitment

The study sought to include women who had received care at two VHA sites and who had experienced past-year IPV to participate in interviews about their experiences. [Note: This study also included non-Veteran VA patients (i.e., spouses/dependents of Veterans receiving VA care).] Recruitment strategies included provider referral, in-clinic research team recruitment, direct mail outreach (with telephone follow-up), and flyers for self-referral. A total of 169 women VA patients were enrolled from two VA medical centers. Only six study participants were recruited through provider referral. Seven participants responded to the recruitment flyer. Nearly one-third (29%) of participants were recruited through in-clinic research team recruitment, and nearly two-thirds (63%) were recruited via direct mailing. The letters used in direct mailing:

• Introduced the study without specific mention of IPV;
• Invited recipients to contact the research team to either learn more – or to opt out of future contact; and
• Informed recipients that the research team may follow-up by telephone to provide additional information.

To protect the Veterans’ safety and privacy, written recruitment materials did not specifically refer to IPV, and phone calls to potential participants followed a safety protocol to ensure privacy.

Core members of the research team (L to R): Anneliese Sorrentino, MSS, MFT, Terri Haywood, MPH, and Melissa Dichter, PhD.

⇪

The Interviews

All 169 women Veterans completed baseline assessments, and 149 (88%) women were retained for follow-up assessments at 6-9 months post-baseline. In-depth qualitative interviews were conducted with 50 of the women Veterans enrolled in the study. Interview questions included asking about their views on participating in the study, such as what motivated them to participate and what it was like sharing their IPV experiences with researchers. Participants received $20 for completion of the baseline interview, $30 for the follow-up interview, and $50 for the qualitative interview.

⇪

Women Veterans' Motivations for Study Enrollment

Participants overwhelmingly indicated that they felt (and/or hoped) that their participation in the study may help others who have experienced or might experience IPV, even if they did not experience direct benefits. For example, women Veterans stated:

“I think it might help somebody… It might even help me.”

“If it’s going to help other women, then I’m willing to share.”

“Hopefully whatever I contributed will help someone else down the line.”

Some women Veterans expressed a sense of responsibility to speak out for others, who, for various reasons, may not be able to do so themselves.

“This is not just about me. This is about all of us as women. This is about all of us as vets. If all us vets stay quiet, then we can’t help other vets that are either here with us now or that’s coming up. If we don’t talk about it, we can’t make it better for them, too… The only thing I was hoping to get out [of participating in the study] was my voice, and, like I said, to help someone else, because not everybody can talk about it.”

Study participants also wanted to make sure that what they said would make a difference.

“I just want to be able to help somebody. That’s why I ask, what happens in the end? Have I—or what I’ve said—made a difference for somebody else?”

Their motivation to participate in the study was inextricably tied to questions about how study results would be applied to VA programs, policies, or practice.

⇪

Women Veterans' Experience with Research

Some participants also expressed a sense of having benefited personally from participating in the study—and that their disclosure of personal experiences was helped by the interviewers’ empathic and neutral stance, as well as the relative anonymity and time-limited nature of the research relationship.

“It was a great relief to share some of those things. I thought it would be hard, but, no, it was actually a relief. I think it was helpful. And it makes me think about seeking more help.”

“ There are some things that I want—wish—I could forget that you just can’t. But at the same time, being able to talk about those things makes me stronger, makes me feel more confident in myself.”

“I’m glad that I was approached [to participate in the study]. I’m glad that you all have taken the time. It’s made me incredibly introspective… So it’s been therapeutic for me to… think about the whole process.”

Responding to questions about violence in their relationships helped some women Veterans identify and reflect on patterns in their relationships. In addition, several women expressed a new sense of perspective on their own experiences as a result of participating in this study.

“During the research, it made me dig deep… made me go home and realize there was something wrong… I think that this research experience made me look at myself in a whole different way.”

“[The study] has me really thinking about that relationship and where it stands… Just sharing everything that I’ve dealt with in the last almost seven, eight, nine months, more than that, about almost a year, it’s shown me that It’s going downhill.”

Study participants stated that talking about their experiences with IPV was not always easy or comfortable, yet they also saw value in doing so – for others, as well as themselves.

Interviewer: “What was it like to be asked these questions?”

Participant: “Like eating gravel. It was hard. And at the same time, it’s something that needs to be done. It’s something that it’ll make the next patient seem like more of a whole, than just addressing the parts… Hard, but necessary.”

Characteristics of the interviewer and research staff were important for participants’ willingness to share their experiences and perspectives. Some participants noted that they had shared information in the study interviews that they had not shared with others, including their healthcare providers, either because no one had directly asked about such experiences previously or because they had not felt comfortable sharing so openly in other contexts.

“It’s uncomfortable, especially at first. But then… I don’t get so uncomfortable. Maybe because it’s just how you are. I feel like you are listening to understand, not just listening to judge me or to diagnose me or anything like that.”

“ You’re comfortable to talk to. [It’s important to] make sure that people feel comfortable, and they don’t feel interrogated. Because you already feel dirty. You already feel judged. You don’t wanna sit in a room and talk to someone and still let them question you in a way where you still feel like I’m being judged.”

⇪

Moving Forward

Overall, study findings suggest that women who experienced recent IPV may be willing and interested, even eager to participate in research, even if the research does not necessarily offer any direct benefits to them. Moreover, given participants' interest in how study findings might be used, it is important for researchers to consider how to share findings and implications with Veterans and other stakeholders beyond the typical academic channels. Thus, in addition to dissemination through typical channels, study investigators are working on developing dissemination materials that are more accessible to general audiences and disseminated through social media and other avenues targeted to Veterans and VA patients. Also, while the study team is explicit in enrollment and consent processes with participants that they will not be contacted beyond the data collection period (as required by IRB regulations), investigators invite participants to contact the research team to follow-up or request any information.

⇪