"Persist. Persist.": A Qualitative Study of Women's Decisions to Disclose and Their Perceptions of the Impact of Routine Screening for Intimate Partner Violence

Objective: To understand the conditions under which a group of women recruited from antenatal, mental health, and substance abuse services disclose abuse in response to routine screening for intimate partner violence and their constructions of the impact of routine screening. Method: In-depth interviews with 20 women followed up 6 months after disclosing abuse in response to screening. Results: Women were in diverse situations relating to trajectories of abuse that included continued abuse despite interventions and abuse cessation within relationship. Women disclosed their abuse after making active judgments about safety on three dimensions: from the abuser, from shame and from relinquishing control. Most women described valued impacts from screening, though this was less common for those who had previous contact with statutory agencies. The process of asking shaped constructions of abuse, giving name to it. Health workers' responses to disclosures often helped to create a sense of connection. Conclusions: These effects align with Herman's work identifying naming and reconnection as important steps in recovery from trauma. The diversity of women's situations may explain difficulties in achieving significant findings by RCTs on screening impacts. Screening can bring about important changes for some women and is not simply a strategy for identification and referral.