Statement of Need: Women have become the focus of research, public health and human rights concerns. Social scientists, legal and health professionals, and governmental entities have produced a body of research related to disparities in health care services provided to abused women. In the United States, between 2 and 4 million women are abused by their intimate partner (spouse, ex-spouse, boyfriend, ex-boyfriend). This translates into the abuse of one woman every nine seconds and into an act of violence in one of every four families. Numerous studies evaluating the relationship between abuse and health outcomes have found that abused women report multiple physical and emotional symptoms, and higher health care utilization than nonabused women. One of every four families experiencing abuse will seek temporary residence in a shelter. Their entry into a shelter is a critical time to assess their health needs.
Objective: The purpose of this study was to compare post-treatment improvement in health outcomes between subjects in Social Support Intervention (SSI) and No Treatment Control (NTC). The specific aims are to evaluate the differences in the improvement in health outcomes of psychiatric symptoms, social functioning, and health care utilization between subjects in SSI and NTC.
Conceptual Framework: Abuse is a stressor that places the abused woman at risk for poor health while social support improves health. Our conceptual foundation rests on the buffering (protective) function of social support. The protective function of social support may play a role at two different points in the abuse-poor health relationship. First, social support mediates between abuse and health by attenuating the negative response in the abused woman causing her to redefine the experience as not too stressful. Second, social support intervenes by directly influencing health enhancing decision-making processes and health-promoting behaviors.
Sample: The sample consisted of women (N=30) who were first time shelter residents. A majority (56.7%, n=17) of the 30 participants were white, not Hispanic and the rest were African Americans. Their ages ranged from 21 to 45 years with a mean of 35.50 years (S.D.=7.02). Eighty per cent (n=24) were unemployed and eighty per cent (n=24) reported having an annual income below $10,000. A majority of the women (56.7 %, n=17) completed high school education.
Design and Methods: This pilot study utilized a randomized 2-group (SSI and NTC) by 2-occasions (pre and post treatment) design. As soon as 8-10 participants were randomly placed in the SSI or the NTC groups, SSI group intervention (8 sessions once every week) was started. Since sample sized of two groups were small and uneven, the Mann-Whitney U test was conducted to compare two intervention groups using difference (change) scores.
Research Findings: Simple descriptive statistics of the demographic variables were performed before testing study hypotheses. The two treatment groups were well balanced with regard to baseline demographic characteristics. Results showed that the two groups (SSI and NTC) did not differ at baseline as to race, age, education, employment, status and income. Hypotheses testing results showed that 1) the SSI group showed significant improvement (U=33.0, p=.026, one-tailed) in emotional symptoms as measured by the BSI post treatment than the NTC group, 2) the SSI group showed significant improvement in social functioning (U=34.5, p=.015, one-tailed) as measured by the ISEL belonging subscale post treatment than the NTC group, and 3) the SSI group showed significantly fewer health care utilization (U=39.5, p=.031, one-tailed) as measured by the HHQ post treatment than the NTC group.
Conclusions: This feasibility study demonstrated the acceptability of SSI as a treatment modality. However, we also learned that the length of time (8 sessions, one session every week) of the SSI was not feasible due a shorter length of stay at the shelter (4 weeks). We plan to develop individual SSI using the Internet as a complement to the face-to-face SSI.
Implications: A need exists to develop effective and efficient interventions to narrow disparities in health care services provided to abused women. However, there is a need to balance our intervention with the woman's right to privacy, her right to choose, and her access to the state-of -technology in health care. To wait and do nothing would be unconscionable as abused women await help. Funded by the University of Pittsburgh Central Research Development Fund.
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