Thesis Nurs. 1995 N972i
c.2
Nunn, Barbara.
Identification of abused
women in health
1995.

IDENTIFICATION OF ABUSED WOMEN in HEALTH
SETTINGS

by

Barbara Nunn, RN, BSN

Submitted in Partial Fulfillment of the Requirements for
the Master of Science in Nursing Degree

Approved By:

b IHoa/ IS
G&t J&J'S___________
Date

Chairperson, Thesis Committee
Edinboro University of Pennsylvania

/ /Committee Member

Date

£Commi/^^e
£££££?‘Member

Date

Acknowledgements

The author wishes to express sincere

appreciation and gratitude to her advisor Dr.

Charlotte Paul for her continued guidance and
support and to her committee members, Ms. Beverly
Danielka and Dr. Dean Stoffer for their assistance.

In addition, the writer wishes to express special
thanks to her daughter Melissa Nunn for willingness
to help.

i

TABLE OF CONTENTS
PAGE
ABSTRACT

iv

LIST OF TABLES

vi

CHAPTER

1

2

3

1

INTRODUCTION

Background of the Problem

1

Purpose of the Study

3

Statement of the Problem

3

Assumptions

4

Definition of Terms

4

Limitations

5

REVIEW OF LITERATURE

6

Battering Syndrome

6

Dimensions of Abuse and Battering

7

Demographics and Vulnerability

11

Stress/Pathology Theory

13

Imbalance of Power Theory

15

Conceptual Framework

17

Conclusion

19

METHODOLOGY

23

Sample

23

Instrumentation

25

Collection of Data

26

ii

CHAPTER

5

3 cont.' Data Analysis

27

4

28

DATA ANALYSIS
Characteristics of the Sample

28

Family History of Abuse

34

Family of Origin

36

Comparison of Groups

38

Summary

38

CONCLUSIONS AND SUMMARY
Recommendations

40
45

APPENDICES

A

I.M. KING'S THEORY OF NURSING

49

B

ABUSE RISK INVENTORY (ARI)

50

C

CONSENT FORM

51

D

RESEARCH QUESTIONNAIRE

52

E

RESEARCH SURVEY CODED AS P QUESTIONS

53

F

ARI SCORES FOR RESPONDENTS

56

G

CHARACTERISTICS OF THE SAMPLE

57

H

ARI MEANS FOR SELECTED VARIABLES

60

REFERENCES

63

iii

ABSTRACT
The purpose of this study was to identify
battered women in a health setting.

The sample

studied were 100 women in a local family planning
clinic. 50 who reported themselves as having been
battered within the last year and 50 who did not.
Data was obtained by using a copywritten tool, the

Abuse Risk Inventory (ARI).

The tool included two

parts: demographic data in which the client
identified herself as having been battered and a
survey entitled Interpersonal Relationships.

The

questionnaire was distributed to the sample
population at a family planning clinic.

The researcher compared the means of the ARI

of the two groups. The difference between the means

was analyzed using a t TEST.

Findings were signif-

leant at the p<.01 level.

Several demographics were observed; among them
Length of Relationship, Annual Income, and Physical

Abuse for both the Respondent and Partner. Observa­

tions of the ARI means were made in each category.
Of note was the number of women who had been

either physically and emotionally abused either in

their current relationship or at a previous time
when the batterer could have been a family member.

Results from this study supported the premise

iv

that there is a difference between battered and

non-battered women in their interpersonal relation­
ships .

This information contributes to the body of

knowledge of health promotion for women who are
involved in domestic violence.

v

LIST OF TABLES

CHARACTERISTICS OF THE SAMPLE

29

1

AGE

2

MARITAL STATUS/LENGTH OF RELATIONSHIP... 30

3

RACE

31

4

LIVING ARRANGEMENTS

32

5

ANNUAL INCOME

33

6

EDUCATION

34

7

CHILD ABUSE

35

8

OTHER ABUSE

37

9

STATISTICAL ANALYSIS OF GROUPS

38

vi

Chapter 1

Introduction

Background oX the Problem
According to a recent study by the US

Department of Justice nearly 33 percent of female
homicide victims are murdered by their husbands or
male intimate partners. In addition, of all spousal-

violence reported, 81 percent constitutes victimizaticn of women by husbands or ex-husbands (1988).

Nationally representative surveys conducted on the
incidence cf wife abuse showed that in 1975 the

rate of husband-to-wife violence was 38 per 1,000
but in 1985 it was 30 per 1000 couples (Straus &

Gelles,19860.
Lewis (1985) acknowledges that the statistics

on the incidence of domestic violence directed
toward women by husbands or male partners fail to
reflect a true estimation of the incidence of the
crime.

Problems in definitions, reporting, and

recording make much of the relevant data unavail­

able for study (Flitcraft & Stark, 1985).
Gayford (1975) establishes that women who are
abused by their partners frequently do not report
the incident to appropriate authorities or to

DOMESTIC VIOLENCE/ASSESSMENT
2

helping professionals.

Many are likely to feel

shame and embarrassment and are unwilling to

discuss the facts with others.

They may fear

retaliation by their partner if the partner learns

the incident has been reported (Martin, 1976).
These and other issues prevent abused women

from disclosing the true source of injuries to

helping professionals.
However, abused women do present themselves at
physicians offices, hospital emergency departments,

clinics, and mental health agencies for treatment

of such symptoms as depression, apathy, anxiety,
and sleep disorders, rather than for the abuse per

se (Greany, 1984).

Direct questioning of the woman

is often ineffective because of the reluctance of

some women to respond truthfully or because of the

misinterpretation of the questions or of the
concept of what constitutes abuse (Gayford, 1975).

Physicians, nurses, social workers and other
helping professionals must know that physical abuse
is present if they are to be effective in their

treatment of these women.

Once identified,

appropriate treatment and services can be mobilized

to help them.
Presently, intervention is initiated after a

crisis situation and a woman is identified as being

DOMESTIC VIOLENCE/ASSESSMENT
3

a "battered woman."

However, this researcher's

focus was specifically concerned with intervention

before a crisis state occurs.

Given the serious

effects of violence for women, it is desirable to
have a method for identifying the women so that
appropriate measures can be taken to protect them

(Yegidis, 1988).

Purpose of this Study
The purpose of this study was to identify

women who were current victims of abuse or were at

risk of abuse by theii' male intimate partners.

Nurses are present in all areas of health care and
come into contact with abused women before many
other types of service providers.

At present there

has not been a way to identify women who are

current victims of abuse or are at risk of abuse by
their male partner or ex-partners.

The results of

this study will contribute to the increased know­
ledge base of intervention strategies in identify­
ing abused women in health settings.

Problem Statement:

There is a significant differ-

ence in intimate relationships between women who
are abused and those who are not.

DOMESTIC VIOLENCE/ASSESSMENT
4
Assumpt ions
This study is based on the following
assumptions:

1. Assessment is

the first step in a

successful treatment plan.
2. Women in abusive relationships may respond

differently to certain questions than nonabused
women.
3. Battered women seek services for treatment

of health problems resulting from abuse, rather

than for problems with abuse.
4.

Women answer personal questions honestly

when anonymity is guaranteed.

Definitions nf Terms
1. Battered woman (interchangeable with abused
woman): a female who has sustained physical injury,

including rape, as the result of assault from a

male significant other at least one time.
2. Battering: use of physical force by a man'

against a woman.
3.

Battering syndrome: a history of abuse

and/or injury, often including sexual assault,
unsuccessful help-seeking behaviors, medical

complaints, and serious psychosocial problems
(Flitcraft & Stark, 1985).

DOMESTIC VIOLENCE/ASSESSMENT
5
4. Domestic violence: physical abuse between

couples, not to include children.

Limitations
1.

The sample was limited to one geographic

2.

There was a limited time frame for the

area.

study since all measurements were taken during only

one association with the subjects.
3.

The definition of battering was only

inclusive of physical abuse and rape.

4. Those participating in the study were a
convenient Sample.

5.

Time allocation was limited to two months.

DOMESTIC VIOLENCE/ASSESSMENT
6

Chapter 2
Review of the Literature
The purpose of this study was to identify

women who were current victims of abuse or were at

risk of abuse by their male intimate partners.
Review of the literature provided an overview of

the problem of domestic violence when viewed from
the personal, interpersonal and societal

perspectives.
The Battering Syndrome

Battering refers to and includes a range of
health problems which follow an initial episode

abusive injury.

of

As defined by Stark (1981) and

Stark & Flitcraft (1981) a syndrome among abused
women includes: a history of abuse and/or injury,

often including sexual assault, unsuccessful help­
seeking, general medical complaints and serious
psychosocial problems. Straus, (1980) states that

although survey data suggests that a proportion of .

males are hit repeatedly by their wives that there

is no similar pattern of psychosocial, physical,

and social service problems that have been identi­
fied as there have been with women.

This suggests

that woman battering is different from husband

abuse.

DOMESTIC VIOLENCE/ASSESSMENT
7

Once a woman is assaulted by a social partner,
there is a probability that the "battering syn­
drome" will develop, particularly given the

limitations of present interventions (Anwar, 1986).

Hilberman (1987) and Dobash (1985) found that as

the adult trauma history and unsuccessful help­
seeking continue, battering may present as com­
plaints of pain, injury during pregnancy,- fear or

anxiety associated with family conflict, and many
psychosocial disorders, including alcoholism, drug

abuse, rape, child abuse, attempted suicide and
mental illness.

Studies by Russell (1980) identify

a much higher rate of such problems among battered

women as compared with women who are not battered.
He concluded that since these problems occurred

only after the onset of violence, abuse is a major

factor in the etiology of these problems.

Dimensions

abuse and battering

Survey data shows that 12-20% of all couples
experience intracouple violence (Kirchner, 1982).
Approximately 20% of the adult women in the United

States are at risk of being abused by a male

intimate (Appleton, 1980).

There have been studies

(Dobash, 1985, Haber 1985 and Flitcraft, 1985)
which conflict with each other on the frequency or

DOMESTIC VIOLENCE/ASSESSMENT
8
severity of intraspousal violence even though
spouse abuse is characterized by frequent beatings

often requiring medical attention.

Fried, (1990)

found that patterns of violence and injury among

non-married couples are comparable to patterns
among married couples.
Forty-seven percent of the husbands who beat

their wives do so three or more times a year

(Straus, 1980) and between 25%-30% of all abused
women suffer serial beatings, many beaten as
frequently as once a week.

Furthermore, battering

injuries are distinguished by their sexual nature,
not their severity (Flaherty, 1986). His findings

include the fact that battered women are thirteen
times more likely than non-battered women to be
injured in the breast, chest and abdomen and three

times as likely to be injured while pregnant, an
injury pattern suggesting the sexual nature of

domestic violence.
The greatest proportion of medical visits by

battered women do not involve trauma.

Rather, they

visit general medical, behavioral and psychiatric
settings.

Battered women are more likely to report

depression, anxiety, and vague medical complaints
(Stark, 1983). It follows then that battered women
are seen by those health care providers that are

DOMESTIC VIOLENCE/ASSESSMENT
9

nontraumatic.

Stark,(1986) found that 25% of all

obstetrical patients are abused women, an even
higher percentage than for all women seen in the

emergency department. Clearly, identification of

the abused woman is not limited to just emergency
or trauma services.
As a result of abuse, battered women experi-

ence a rate of alcoholism and drug abuse that is

significantly greater than non-battered women
(Eisikovits & Edelson, 1989). Abuse has been
reported as the single most important factor in

alcohol problems among women, accounting for as
much as 50% of female alcoholism (Gondolf & Rus-

sell, 1985), Eisikovits & Edelson, (1989) found
that alcohol has been consistently associated with

violence in men, but it has not been found to cause
abusive episodes.

Flitcraft (1985) identified attempted suicide
as a significant consequence of abuse among women,
affecting 1 abused woman in 10. Moreover, she

reports of the 10% of the abused woman who attempt

suicide, fully 50% do so more than once.

The

impact of abuse is further demonstrated by the fact
that 26% of female suicide attempts presented to
the hospital are preceded by abuse. Fifty percent

DOMESTIC VIOLENCE/ASSESSMENT
10
of African/Amerlean women who attempt suicide are

abused (Hilberman, 1987). Battered women who
attempt suicide are significantly more likely to

use traumatic means, to attempt suicide repeatedly
and to mention marital conflict as the precipi­

tating factor (Greany,1984).
Descriptive studies by Finley (1981) frequent-

include sexual assault as a factor in abusive

relationships.

Although rape is a relatively rare

event in medical settings, almost one-third of the

rape victims seen in the hospital have a history of
abuse and among rape victims over the age of
thirty, 58% are battered women (Stark, 1984).

In

addition, woman battering may be the single most

important context for child abuse. Douglas (1991)
identifies fathers or father substitutes as the

typical assailants of both women and children.
Furthermore, the finding identified that 45% of the

mothers of abused or neglected children are

them­

selves abused in the home.
Severe mental health problems are considered
in the case of abused women.

Battered women have a

significantly higher rate of psychiatric problems

than do non-battered women (Favazza & Centerio,
1988) .

Studies by Flitcraft & Stark (1987)

indicate that only 37% of battered women use

DOMESTIC VIOLENCE/ASSESSMENT
11

psychiatric services; furthermore 78% turned to

such services only after the onset of violent
injuries.

The most common diagnosis carried by

abused women is depression, but 1 abused woman in

10 suffers a psychotic break (Stark, 1984).

Stark

found that battered women are also far more likely
than others to be given labels such as
hypochondriac .

Noting the severity of the consequences of

abuse it would seem that there would be some
commonalities among the women.

Demographic and vulnerability factors
Research on domestic violence has focused far
more closely on the acts and their consequences

than on the background of victims. Efforts to test
major causal theories suffer from a lack of

consistency in how the problem is defined (Yegidis,
1988).

For these reasons the researchei' considered

certain personality, demographic and social fac-

tors.

While such factors do not cause domestic

violence, the literature review supported the

theory that these factors do increase the like­
lihood that violence will result and that women

will be abused.
Attempts to create at risk profiles lack the

DOMESTIC VIOLENCE/ASSESSMENT
12

sensitivity to identify battered women according to

Yegedis (1989).
Dobash (1985) and Hilberman (1987) have

identified race as an indicator.

Their studies

have shown that African/American women are 2-3

times more likely than White women to present to
hospitals as abuse victims.

Quann & Petro (1978)

found that there was a slight inverse relation

between income and domestic violence.

Further,

among the adult population, age is inversely

related to acts of domestic violence, but does not
differentiate abused women from nonabused women.
Women who are married, separated, divorced, or
single are equally at risk for battering once they

have sustained injury.

The risk of domestic

violence falls only among widowed women (Hilberman,

1987).

Straus & Gels (1986) site pregnancy as

being associated with more frequent assaults.
Kirchner (1982) Dobash (1985) and Flitcraft & Stark

(1987) all report that the risk of battering is
greatest where a woman has a higher occupational

and educational status than her partner.

Haber

(1985) has found that there were few significant

differences in the personality traits of battered
and non-battered women.

An apparent lack of a

DOMESTIC VIOLENCE/ASSESSMENT
13

clear picture of the dynamics of abuse have led
social scientists to categorize the problem of

domestic violence into two competing paradigms Stress/Pathology and the Imbalance of Power

Flitcraft & Stark, 1987).

Further research is

presented to support these models.
Stress/Pathology

According to the Stress/Pathology framework
violence is a family affair.

It is learned and

transmitted in childhood and culturally supported
and provoked by certain stressors such as poverty
and unemployment.

Violence in a woman's family of

origin appears to be an indicator of a woman's
vulnerability to abuse as an adult (Weitzman &
Dreen, 1982).

They continue that the violence

circulates from family member to family member

until all of domestic life becomes enmeshed.
Carmen, Rieker & Mills (1984) distinguish abused

women by a common profile: they are dependent,
hostile, unable to communicate or empathize, and

have low self-esteem.

They also found that the

abused women in particular suffer from self-blame

and helplessness, often delay reporting their
problem, and may refuse help when it is offered.
Because of its emphasis on family dynamics,

DOMESTIC VIOLENCE/ASSESSMENT
14

the Stress/Pathology model equates violence with
acts of force used among cohabitants. (Flitcraft &

Stark, 1987).

Survey data from Check (1985) report

an incidence of such acts as ranging from 4% for

abuse of the elderly to 80% for sibling fights.
With respect to women, fear and helplessness result

from the battering- syndrome. Men respond to abuse

with embarrassment which leads to concealment of
the fact and as such, do not seek help (Lurie &

Quinkin, 1980).

Mental health treatment sought by

women is emphasized to resolve primary psychiatric

and behavioral problems and to provide counseling
designed to overcome personal and/or interpersonal
deficits (Favazza & Conterio, 1988).
Survey data implicate women as well as men in

homicides and assaults.

However, these homocides

and assaults are most frequently the result of

domestic violence (Andrews, 1988). It should be

noted that reports of these incidents become part

of the legal system and as such separated from
social services and the health care delivery
system. As a result there is not a uniform way to
identify abused women.

Schulman (1986) indicates that abused women
seek medical help for as few as 1 in 5 assaults.
Moreover, the self-blame and impaired self-esteem

DOMESTIC VIOLENCE/ASSESSMENT
15

that are hallmarks of other post-traumatic stress
disorders appear to characterize those abused women
who use mental health services (Carmen et. al,
1983).

There is growing evidence that a significant

proportion of battered women are abused as children
(Star, 1978).

The intergenerational theme of

domestic violence continued to surface throughout

the literature review.

In summary, the

Stress/Pathology theory sees environmental factors

of unemployment, low income, minority status,
alcohol and abuse in childhood as vulnerability

factors in developing abusive relationships as
adult women.

Imbalance of Power
An alternative paradigm focuses on male vio­

lence as a cause of female abuse and views male
abuse as a desperate defense against male domin-

ation (Flitcraft & Stark, 1987).

They continue to

elaborate that in this theory, the abuse of women
is traced to gender politics. Not only do they feel

that men dominate women in the domestic setting but
see an extension of this power to other women and

children in virtually every institution. Eisikovits

DOMESTIC VIOLENCE/ASSESSMENT
16

& Edleson (1989) identify that violence is one
option employed by men when they feel their access
to money or sex is threatened by female independence or when women fail to fulfill perceived

domestic responsibilities. Certain ethnic groups

including Hispanic, African/American and Japanese
have been identified as having rigid role defini­

tions that support this theory (Gondolf & Russell,
1989) .

According to Adams (1988) the need to

control is socialized early in a young

boy' s

childhood and is maintained into adulthood through
continued societal messages that allow for male

violence against women. This way of thinking is
further supported by systems theory investigators

Weitzman & Dreen (1982) and Weidman (1982).

They

believe that battering is learned in the home and
is culturally supported through the media. Weitzman

and Dreen (1989) see violence as a pattern exhib-

ited by a couple.

In studies done by Neidig,

Friedman, and Collins (1990) it was found that both

parties participate in abusive behavior, although
not equally.

They also put quotes around the terms

abuser and victim and imply that these labels are
not accurate.

Other researchers use terminology

such as conjugal violence instead of battering.

(Coleman, 1990).

All of this research, however,

DOMESTIC VIOLENCE/ASSESSMENT
17

focuses on an unequal balance of power between the

man and the woman and contributes to the secretive—

ness of the relationnship.

According to Star (1978), battering is not
increasing; rather it suggests that society's

attention to battering is due to the visibility of

the Women's Movement and a growing disparity
between traditional roles and the increasingly
complex economic and social responsibilities of
women. The assumption of imbalance of power bases

its assessment for intervention with the abused

women on the increased service needs in health
settings.

Makepeace, (1984) has identified that
battering has extended to dating violence which

approximates domestic violence in frequency and

severity.

According .to Makepeace, male violence

against women has extended from the family

boundaries.

However, this cannot be explained by

the legal operational definition of domestic

violence since there is no legal commitment in this

setting.

Conceptual fnamewfiiik
The theoretical framework identified as a

DOMESTIC VIOLENCE/ASSESSMENT
18
basis for intervention is the Nursing Conceptual

Framework proposed by Imogene King.

This model

contains multidimensional systems as criteria for

assessment and intervention (King, 1981).
The King Model is broad enough to accommodate

domestic violence because of the interaction of the

three variables: personal, interpersonal, and
social systems (Appendix A).

Domestic violence can

be conceptualized in all three areas.

Domestic

violence can be experienced on a personal level.

Results from abuse that set up the Battering
Syndrome result in serious physical and emotional

consequences.

Interacting with the next level, the

interpersonal level, the abuse within the dyad of

that relationship closes the normally functioning
open system to the Self and to Society and isolates
the individual with only the abusive partner.

When

viewed from this perspective it may become apparent
how child neglect could occur since no input or
output would occur in the interpersonal system.

Intervention for domestic violence occurs in the

social system usually through legal channels.
Nursing theories had not been widely used in
the literature to identify complex social

situations.

The investigator hoped to increase the

body of data of abused women by conceptualizing the

DOMESTIC VIOLENCE/ASSESSMENT

19
problem of domestic violence from this systems
approach.

The battering syndrome is presented to

health care providers with a covert set of

problems. The King Model recognizes that the

intensity of a relationship existing between
members of a dyad changes as multiple societal and

individual factors impact the couple.

When given

the information of the epidemic proportions of the

problem of domestic violence and the significant
consequences to the individual, the identification
of the battered woman is imperative to all three

systems.
For successful intervention to occur,

identification would be made in the personal

system.

Women seek health services in a multitude

of settings such as family planning clinics,
medical offices and through mental health

professionals.

This investigator would hope to

utilize King's Nursing Theory as she researches the

question of identification of women for abuse.
Conclusion
Female abuse seems to be the product of many

forces operating and interacting at different

levels between the individual and the environment.
Research has

included individuals, couples, and

DOMESTIC VIOLENCE/ASSESSMENT
20

social institutions with regard to the problem of

domestic violence.

Several points have evolved that lend them­
selves to further exploration.

Identification

procedures established which estimate the incidence
of domestic violence are rare.

If a consolidated

medical record system were available that lists all

patient visits, including those to the emergency
department, the potential population for primary

prevention could be identified by a retrospective

review of the full health records of a sample of
adult women.

In such a review, all women could be

identified as at risk for abuse if their history
contains at least one injury attributed to assault

by a male intimate or a family member or if there
was an assaultive episode not attributed to street
crime or where the etiology of the injury was

inconsistent with the injury sustained.

Studies related to health promotion recognize
that health, while it is a personal experience,

does not exist without direction (Woods, Laffrey,

Duffy, Lentz, Mitchell, Taylor and Cowan, 1988).
If identification of a woman as abused does not

occur at a beginning level of the battering cycle
the violence will continue to escalate and the

DOMESTIC VIOLENCE/ASSESSMENT
21

consequences to the women become devastating.

The

direction for health then, will regress or remain
static before it ultimately declines.

Nurses are

confused as to their role in the mire of domestic
violence perhaps since the problem has been defined

in legal and sociological terms and via the
clinical model of health care delivery.
Identification of the abusive relationship is

necessary in the health setting.

Currently

intervention strategies for domestic violence are
focusing on the legal system for assistance after
the abuse occurs.

However, the damage is done.

There were no studies found that address the

identification of the battered woman unless this
information comes from the woman herself.

In

situations where women may be at risk for battering

or the woman doesn't realize that her help-seeking
behaviors are the result of one or more battering

episodes, the nurse has no tools to assist in that
assessment.

To ask directly if a woman is battered

may result in a furtive attempt by the woman to

hide the problem of battering.

Until the abuse

situation is identified there can be no further
action.
The researcher hoped to add to the base of

knowledge of domestic violence with the current

DOMESTIC VIOLENCE/ASSESSMENT
22

study.

Use of the "Abuse Risk Inventory for Women"

(Yegidis, 1989) hopefully provided the researcher

with a tool that can identify women in abusive
relationships or those who are at risk for abuse

(Appendix B).

With the expansion of the role of

the professional nurse and the increasing emphasis

on the provision of holistic health care, research

in this area may indicate the need for the nursing
to include assessment of each woman as they present
in a multiple of health settings.

The health care

provider has a responsibility to become aware of
which women are abused, since the consequences are
so devastating.

DOMESTIC VIOLENCE/ASSESSMENT
23
Chapter 3

Methodology
The purpose of this study was to identify
women who were current victims of abuse or were at
risk of abuse by their male intimate partners.

battered women in a health setting.

Women who

exhibit the battering syndrome present frequently
at a multiple of health settings, rather than only

in the emergency department after overt abuse has

occurred. The Abuse Risk Inventory (Yegidis, 1989)
(Appendix B) was identified in the literature and
the materials were obtained by purchasing them

through Consulting Psychologists Press, Inc.,
located in Palo Alto, California.

Sample
The subjects in this study were drawn from the
family planning clinic at a local county health

department.

There are three sites and approx-

imately 20 clients per day were seen at each site.
Permission to distribute the questionnaires

was granted by the head of the family planning
department under the condition of anonymity and
without coercion to the clients.

A consent form was signed before the survey

was distributed (Appendix. C). The data was col-

DOMESTIC VIOLENCE/ASSESSMENT
24
lected by means of a sample of convenience, using
every client as they arrived until a total of 50

women identified themselves as never having been
abused (N) and 50 identified themselves as having
been either physically abused or raped (A). This

information was gathered from the Research Survey

(Appendix D), a demographic questionnaire that was
on the reverse side of the ARI form.

Membership in either Group A or Group N
resulted from selecting either question 13 (Have

you been physically abused within the last year) or

question 15 ( Have you been raped within the year).

This section of the questionnaire consisted of
demographic information including age, occupational

level, marital status and a history of abuse for

both partner and self.
participated.

A total of 147 clients

Forty-seven questionnaires were

discarded: sixteen clients didn't finish the survey
and 31 clients didn't meet the necessary criteria
for the survey (answering yss to 13 or 15 on the

research questionnaire).

Only one family planning

client refused to pax'ticipate in the study after

reading the questionnaire.

total of 100 surveys

remained which met the sample requirements of 50
women who had been abused and 50 who had not.

DOMESTIC VIOLENCE/ASSESSMENT
25

Instrumentation
The ARI was designed to serve as a screening
instrument for potentially abused women receiving

medical care from health care providers or social
service agencies. The scale provides an alternative
to direct questions, based on the assumption that

some women may not respond truthfully or may
misinterpret what the researcher meant by abuse.

A number was assigned to each answer so that this
data could be analyzed (Appendix E).

The one-page

ARI is entitled Interpersonal Relationship Survey.

The first 15 items focus on the husband/partner and
the remaining 10 items are questions about the

couple.

The scale was self-administered.

It was

written at a sixth grade level (Rohrbeck, 1989).

Each item was answered on a 4 point scale (Rarely
or Never, Sometimes, Often, and Always).

Total

scores range from 25 to 100. A score above 50
suggests that the respondent may be in an abusive
situation or be at risk for abuse.
Reliability information is available only for
internal consistency;

test-retest reliability was

still needed to establish stability of the

inventory over time..

The ARI has shown an alpha

reliability of .80 for a combined sample of abused

DOMESTIC VIOLENCE/ASSESSMENT
26
women (in spouse abuse shelters)
and a comparison
group (King & Cervera, 1987).
An earlier version
of the ARI showed concurrent validity when it
successfully discriminated a group of abused women
from a comparison group, classifying approximately

90% of the cases correctly.

In the current study

the question about physical abuse or rape on the

questionnaire was the criteria for determining

whether or not the client had been abused.
There has not been evidence in the literature

of predictive validity; therefore, the ARI scores

would not be used to predict future abuse.
Co1lection of Dofa

Data was collected through the local health
department during Family Planning sessions. As each

subject arrived the researcher introduced herself
and continued to explain the purpose of the

research without identifying abuse as the overt
topic of the study.

The questionnaire form was distributed, accompanied by a consent form that included an

explanation that the researcher was collecting data
studying interpersonal relationships.

A guarantee

of confidentiality of the replies was also included
on the consent form at the time of the ARI

DOMESTIC VIOLENCE/ASSESSMENT
27
distribution.

There was no identification of the

participant on the ARI questionnaire
itself. As
each consent form was filled out, the respondents
were asked to place it in an envelope with others
SO

that anonymity could be maintained. Consent

forms were left with the nursing supervisor of the
family planning clinic.

Procedures for Analysis of Data
Each survey was scored using the scoring key
that was provided by the ARI. Those who had indi­
cated that they had been abused by checking yes for
question 13 or 15 were coded into Group A. The

remaining 50 were assigned to Group N.

Scores are

listed in Appendix F.
A t TEST was performed using the means of the

ARI scores for groups A and N.

Significance was

accepted at the .01 level.
Mean ARI scores were located in Tables 3, 5,

and 6 were also obtained for the demographics of
Length of Relationship, Income, and Physical Abuse
for Self and Partner.

No statistical inferences

were made with this information.

Patterns of

distribution were shown that indicated areas for

further research.

The data was also helpful for

validating the use of the ARI in further studies.

DOMESTIC VIOLENCE/ASSESSMENT
28

Chapter 4
Analysis of Data
The primary purpose of this study was to

identify women who were current victims of abuse by
their male intimate partners. In order to accom-

lish this, an Interpersonal Relationship Survey

was administered at a family planning clinic in
Southern Chautauqua County.

A research question­

naire was also included.
Characteristics of the Sample

The demographic characteristics of the
participants were taken from the Interpersonal

Survey Research Questionnaire (Appendix D) that was

handed out as part of the Abuse Risk Inventory

(Appendix B).
Since there are equal numbers in each group,

the demographics were presented here as the mean
scores of the Abuse Risk Inventory (ARI) and/or the
percentages of those in each category.

Age
The subjects ages ranged from 15-46 years.

The

ages were coded into one of five ranges, from below
eighteen years to over 30.

The mean age for those

women identified as abused ' (Group A) was 21.40 and

DOMESTIC VIOLENCE/ASSESSMENT
29

23.18 for those not abused (Group N). The
partners' ages ranged from 18-49 years.
Ages of

men in Group A averaged 23.68 years old; those in
Group B, 25.72 years. See Table 1.
TABLE 1
Characteristics of the Sample
n=50
n=50
Characteristics
Group A
Group N

Age
<18
18-21
22-25
26-30
>30
Mean years

Partners" Age
<18
18-21
22-25
26-30
>30
Mean years

11
22
7
13
7

6
13
18
8
5

21.40

23.18

n=50
Group A
6
21
6
10
7

n=50
Group N
3
14
10
10
13

23.68

25.72

The average length of the relationships for
Groups A and N was 3.50 and 4.10 years, respec-

tively. However, ARI scores were the highest for

those in relationships at ten (72.00) and thirteen
years (72.00) (Appendix F).
Almost three-fourths (A39%)(N35%) were

single. Married

couples comprised nineteen percent

DOMESTIC VIOLENCE/ASSESSMENT
30

(A7%)(N12%) of the Participants.
Six percent (A3%)
(N3%) were separated or divorced and only one

respondent was widowed (Al%). See Table 2.
TABLE 2
Characteristics of the Sample
n=50
n=50
Characteristics
Group A
Group N
Marital Status
Single
Married
Sep./Divorced
Widowed

39
7
3
1

35
12
3
0

Longevity of Relationship
1-3 years
4-6 years
>6 years

33
11
6

34
8
8

3.50

4.10

Mean years

Race

The population served through the family
planning clinic was almost exclusively Caucasian.
African/American respondents numbered two (A2%);
Hispanic women numbered two also (A2%).

There were

no respondents in Group N for either African/

American or Hispanic categories.

The White

population dominated the sample with Group A
comprising 48% and Group N 50% exclusively.
The partners' racial patterns were similar:

African/American (A4%)(N2%); Hispanic (Al%). Again
in this category. The
Group N had no respondents

DOMESTIC VIOLENCE/ASSESSMENT
31

White population was the majority in the
research
project with Group A45% and Group N 48%. This

information is presented in Table 3.
TABLE 3
Characteristics of the Sample
n=50
Characteristics
Group A

Race
African/American
Hispanic
Caucasian

2
2
48

Partners" Race
African/American
Hispanic
Caucasian

4
1
45

n=50
Group N
0
0
50

2
0
48

The findings to the questions on living
arrangements were coded into seven categories as

identified by the Interpersonal Relationship
Research Questionnaire (Appendix D).

One percent

of Group A lived with a spouse while (N)9% were

married. Living with a male partner was about equal
fro both groups (A8%)(N9%).

The smallest group

comprised those who lived alone (A3%)(N4%).

Six

percent of the Group A lived with their husbands
while only 2% of Group N did so.

Living with a

male partner with children had equal scores with

percentages of 6% for both groups. The largest
who lived with their parents
group was the women

DOMESTIC VIOLENCE/ASSESSMENT
32
(A20%)(N16%). This would be

logical since the mean

age of the women was 22.29 years. The remaining
women lived with friends and relatives not named
in
the previous categories (A7%)(N4%). See Table 4.
TABLE 4
Characteristics of the Sample
n=50
Characteristics
Group A

Li vi ng Arrangemen t
Husband
Male Partner
Alone
Husband/Ch iId.
Male Part./ChiId.
Parents
Other

n=50
Group N

1
6
3
5
10
20
5

10
9
7
2
6
15
1

Annual Income

Under the category of income 8 categories were

used as defined by the research tool. Twenty
percent of the women (A1O%)(N1O%) reported having
an annual household income less than $9400. Twenty

one percent (A13%)(N9%) had income between $9401
and $16000.

The remaining gradations of income

occur in ten thousand dollar increments into which
the rest of the participants fall.

The mean income

range was $16000-$23000 for all respondents.
The literature speaks to the issue of poverty
in relationships
as providing for increased stress
and therefore, contributing to abuse. It should be

domestic VIOLENCE/ASSESSMENT
33

noted with this Population that
a full 42% of the
total population came from
a household whose income
was less than $16,000. Average ARI scores were the
highest for those in Group A (62.67) for those with
income of less than $9400.

This information is

presented in Table 5.
TABLE 5
Characteristics of the Sample
n=50
Characteristics
Group A

Annual Household Income
$0 - $9400
$ 9401 - $16000
$16001 - $23000
$23001 - $30000
$30001 - $37000
$37001 - $44000
> $44000

Mean Income

n=50
Group N

10
13
8
6
5
4
4

$16000 - $23000

10
9
6
9
3
6
7
for both groups

Education

The mean years of education for abused women
was slightly less at 11.62 years than for those

women who were not abused (12.28).

However, it

should be noted that this indicates that fewer in

Group A finished high school much less sought post
secondary education.

Their partners' education

included 12.00 years of education for Group A and
12.22 for Group N.
finished

Thus the men from both groups

high school and were equally educated.

domestic VIOLENCE/ASSESSMENT
34
See Table 6 fop presentation of this data.

TABLE 6
Characteristics of the Sample
n=50
Characteristics
Group A

Education
HS graduate
Some college
Bachelor's or
Mean years

Partners ' Education
HS graduate
Some college
Bachelor's or
Mean years

n=50
Group N

15
26
5
4

5
31
11
1

11.62

12.28

24
6
4
2

7
30
10
2

12.0

12.22

FAMILY HISTORY OF ABUSE

Child abuse may provide the foundation for
entering and continuing in abusive relationships.

Thirty-six percent of Group A reported being abused
as a child as opposed to 10% of Group N.

Group A

also identified only 9% of their partners as having

been abused and 11% didn't know if the men had
been.

Group N knew more about their partners and

reported that 2% of their partners had been abused
and did not know this information for 7% of them.

Thirty-six percent of Group A women and 18% their

partners reported that they had been physically
abused as children.

It is of note that those women

DOMESTIC VIOLENCE/ASSESSMENT
35
in Group N scored the highest averages (72.75) on

the ARI for not knowing if they had been abused,
even higher than if they had been abused.

There

were only four respondents in this category but the
ARI scores were higher than any other in the study.

Fourteen in Group A did not know if their partners

had ever been abused.

Their mean ARI score was

63.57 compared with 39.14 from the seven respon­
dents of Group N.

This would be consistent with

the ARI response item no. 16 (Appendix B) "maintain

close contact with our families."

It has been

documented in the literature that abused women are

isolated from their families.

See Table 7.

Table 7
Mean ARI Scores
Physical Abuse as a Child

Child Abuse
Yes
No
Don't Know

Group A
62.21
53.70
72.75

Group N
38.40
37.85
42.00

Mean
54.00
44.33
66.60

58.46

38.04

48.25

Mean

Physical Abuse as a Child for Partner
Mean
Group N
Group A
Child Abuse
Partner
59.55
44.50
62.89
Yes
44.21
37.54
54.33
No
55.43
39.14
63.57
Don't Know
Mean

Family af origin

58.46

38.04

48.25

domestic VIOLENCE/ASSESSMENT

36
Family of origin

Family of origin was examined as Group A said
32% of their mothers were abused and 18% of their
partners' mothers were abused.

Less than half of

those percentages were true for Group N; 18% of the

women report their mothers had been abused while
only 10% of the partners' mothers were.

However, a

full 22% of Group A did not know if their mothers
had been abused.

Fifty percent did not know if

their partners' mothers had been.

Only 4% of Group

N did not know the status of their mothers and only
20% did not know if their partners mothers had been
abused.

This finding is consistent with those of

Check (1982) citing that domestic violence becomes

the norm for those involved and an isolating factor

even from family members where the incidence is

either denied or minimized.
Regarding the question of abuse by a male other

than the current partner and including family
members, responses of yes, no and don't know were
chosen.

Thirty - two

percent of Group A had been

raped compared with 10% for Group N.

Furthermore

82% of Group A had been emotionally abused while
32% of Group N were noted.

Finally 66% in the

a male
abused group had been physically abused by
current male partner versus 24% of
other than their

DOMESTIC VIOLENCE/ASSESSMENT
37
the women who were not

Presently in abusive

relationships. See Table 8.
TABLE 8
Characteristics of the Sample
n~50
n=50
Characteristics
Group A
Group N

Mother Physically Abused
by Male Partner
Yes
No
Don't know

16
23
11

9
39
2

Mother Physically
Abused by Male Partner
Yes
No
Don't know

9
16
25

5
35
10

Physically Ab used wi thin
Last Year
Yes
No

37
13

0
0

Emotionally Abused within
the last year
Yes
No

38
12

5
45

Raped within the Last Year
Yes
No

10
40

0
0

Raped, Emotionally, or
Physically Abused by Any
Other Male Including
Family Members
Rape
Yes
No

16
34

5
45

Partners '

DOMESTIC VIOLENCE/ASSESSMENT
38
Comparison nl the Groups

One research question was generated for this
study.
"Is there a significant difference
in
intimate relationships between women who are abused

and those who are not?"

The researcher did a comparison of the scores

of Group A and Group N as they scored on the Abuse
Risk Inventory (Appendix B).

The difference

between the means of the ARI scores from the two

groups was investigated using a t TEST.

The data

revealed a t TEST score of 12.129 which is

significant at .01 level, indicating a difference
between women who are abused and those who are not.

The data is presented in Table 9.
Table 9
Statistical Analysis o_f Difference Between AHI
Scores
Group
n=lOO
Gp .
Gp.

Sum of Scores

A
N

2923
1902

Sum of Sq_.

176105
74070

SD

1.68

■t

Test

12.129

F>

. O1

Summary of Data Analysis
The characteristics of the sample population

included in the present study indicated a young,
White population with the majority of the subjects
of less than
single and having an annual income
$23,000.

DOMESTIC VIOLENCE/ASSESSMENT
39

The results of the t TEST analysis demonstrated
that there was a significant difference between the

means of the abused and nonabused women (p=<.01).
Based upon this data analysis this tool could be
useful to identify women who were victims of

current abuse by their male intimate partners.

DOMESTIC VIOLENCE/ASSESSMENT
40
Chapter 5
Conclusions and Summary
The purpose of this study
was to identify
women who were current victims of abuse
or were at
risk of abuse by their male intimate partners.

Literature review has shown that there had been
difficulty identifying abused women unless they
sought help for the abuse.

Help had usually been

sought after physical injury was severe or advanced

mental disorders were established.

Survey results

from this study appeared to be consistent with
findings from other studies that looked at
interpersonal relations to identify battered women

(Lewis, 1985; Yegidis, 1989; Bagwell, 1986; and

Choate, 1990).

Data analysis did show a

significant difference between Group A and Group N
at the p<.01 level.

Twenty-two percent of the

abused group scored below 50 on the ARI.

The mean

ARI scores for Group A was 58.46 compared with
similar groups: 68.00 (Yegidis, 1989), or 75.36
(Bagwell, 1896).

In a study by Hudson (1992), the

results of the classification analysis showed that

88.1% of 193 cases were correctly classified based
on ARI scores alone.

This percentage was higher

than the 78% for this current study.

So it would

DOMESTIC VIOLENCE/ASSESSMENT
41
seem that even without the
questions 13 or 15
(Physical abuse and Rape) on the demographic survey

to aid in the selection of groupings, the majority

of women would have scored over 50 on the ARI.
Information on the Length of Relationships showed

that those women in Group A had the highest ARI

scores as the length of their relationships

increased.

The data is limited, however, since the

years in which the highest ARI averages occur

contain only two respondents.

In a study by Choate (1990) there was no
significance for duration of relationships between
the abused and nonabused groups in that study.

The data does not support this finding in the
current study.

Group A, the length of relationship

was shorter than that Group N.

Statistical

analysis was not performed but perhaps the

difference of less than 1 year is not significant.
Sixty-seven percent of the current people in the

It
study were in a relationship between 1-3 years.
ARI scores
is not surprising that the highest mean
10 and 13.
would be included in Group A for years

This supported the conclusion found in the
literature that abuse is a

chronic condition and

deepens in severity as the length of the
However, the finding is
relationship increases.

DOMESTIC VIOLENCE/ASSESSMENT
42

consistent with a study done by Bagwell (1986) that
found that abused women have relationships of
longer duration.

Perhaps another study done with a

more evenly distributed population for length of

relationship would show different results.

Another variable looked at was income level.
Studies by Dobash (1985) and Kirchner (1982) were

supported by the findings of the current study.
Even though women of Group A had the highest ARI

scores for income between $0-$9400, the mean scores
of both groups was the only one in this category

that was over 50 (52.52).

The average income for

the geographic area in which this study was done
was $11,750 per household. As such the study was
qualified with the population used.

Validity studies (Yegedis, 1989) cautioned

that the ARI was tested on women of low
socioeconomic backgrounds and should be used
primarily on this population until further research

is completed.
Race was not an issue since the population had

few non-White respondents.

It should be noted

that Chautauqua County, in which this study took
6% minority for Race and
place has only a total of

Hispanic backgrounds.

DOMESTIC VIOLENCE/ASSESSMENT
43
An area that was striking to the
researcher
was that of child abuse.
It has long been known

that child abuse has longlasting consequences.

While 36% of Group A admitted they were abused, the
corresponding ARI scores were higher compared to

overall Group A averages of 58.21.

Surprisingly

abused women who didn 't know if they were abused
as a child had the highest ARI scores.

The

question of "do the women know what constitutes

abuse" surfaces.

The ARI scores for Group N

admitting to being abused as a child were almost

equal to their general population mean.

Less than

half of the partners of Group A were reported as
abused compared with 28 of the women.

However, the

participants did not know this information for 21

of the men.

Group A had more affirmative answers

for this topic, almost 2 to 1 for abuse for the

women as children and over 4 to 1 for the men.
Having a relationship of one year duration was

one of the criterion for taking part in the study.
It would seen then that within the last year 37

women were physically abused;

41 were emotionally

abused and ten reported as being raped by their
current partners for those in Group A.

None of

or raped.
women in Group N were physical abused
report being
More than seven times as many women

DOMESTIC VIOLENCE/ASSESSMENT
44
emotionally abused as those in Group N where
only 5
were present.
In conclusion. emotional abuse did

not exist without either physical abuse or rape.

Group A also had a higher frequency of reporting

for physical and emotional abuse and rape from
males other then their current partner, to include

family members than those from Group N.

It would

seem that having a history of abuse for a woman

would make her at risk for entering into abusive
relationships. In all three categories of abuse,
yes responses were present at least 2 1/2 times
more frequently for those abused than not.

Perhaps

this is the key to the problem of the etiology of
abusive relationships.

In the current study there

was no delineation of who abused the women when
they were children: male or female. However, the

rate of abuse was less than that reported than for

that of abuse from other males.
Children present in the home are also at risk

of abuse.

Research has shown that children from

abusive homes are more likely to become abusive

adults.

Given the serious effects of violence for

both women and children, it is desirable to have a

method for identifying women so that appropriate
protect them and other
measures can be taken to

DOMESTIC VIOLENCE/ASSESSMENT
45
abused women.

The data collected regarding the mothers of the

participants again identifies Group A members as
having almost twice as many yes answers both for
self and more than twice as many for their partners.

This would support the literature's findings

that abuse is learned in the home and the
interactions are continued into many relationships.

In conclusion, the ARI was a useful tool in
determining if a woman has been abused.

At this

point it seems simplistic to say that to identify a

woman as abused one may "just ask" as does the
research questionnaire and not perform assessment

with a tool such as the ARI.

It must be remembered

that domestic violence has an almost furtive
quality about it and few women would willingly

admit to being abused.

anonymously.

The current study was done

However, the results showed a

significant difference between the two groups and
added validity to using the ARI alone for the

identification of abused women.

Re co:110 Hlendations
This research project was limited to a family

planning clinic in a rural area of Western New York

where the population was homogeneous for such

DOMESTIC VIOLENCE/ASSESSMENT
46

variables as Race and Income Levels. I would rec­
ommend that replication of the study be done with

another group from the same family planning clinic.
This would strengthen the validity of the screening

tool at this site.

It should be noted that the

clinic provided services on a sliding scale based
on income.

Therefore, the clientele necessarily

had lower incomes and were not representative of a
greater population. This finding may suggest that

the ARI tool could be valid for assessment of those
of lower socioeconomic backgrounds. A study of this
nature would then take on greater significance.

There is a need for continual assessment of

women in health settings in response to the changes .
in our society.

Women at risk present frequently

at nonacute settings for vague complaints. General

practitioners and family practice offices see women

for the many somatic complaints that have an
etiology of abuse at their source.

I recommend

that women be assessed for abuse at a multiple of
health provider sites routinely.

Further studies into the interplay of the
variable of emotional abuse is recommended.

While

the current study documented the presence of
emotional abuse along with physical abuse and rape
there was no mention of which came first, the

DOMESTIC VIOLENCE/ASSESSMENT
47

emotional abuse or the physical.

The literature

(Makepeace, 1984; Schulman, 1986) finds that
domestic violence is a continuum with emotional

abuse occurring first followed by more observable

consequences.
Identification tools should be used routinely
to screen women for abuse initially on intake at a

health office but also at regular intervals.
Identification is only the beginning, however.

Research on assessment and identification will
hopefully initiate the beginning of treatment
programs for women before the abuse escalates to

The dynamics of family

the point of serious harm.

violence have been sited as part of the Research

Survey used with the ARI.

The enmeshment of the

variables of child abuse and partner abuse cannot
be separated.

The mean population of the family planning

clinic was young and single.

It goes without

saying that many of these young women may be living

a lifestyle that is high at risk for abuse.

Questions on the ARI speak to the issues of partner
use of drugs and alcohol but not for themselves.

Intervention at an early age for women may preclude
them from forming abusive relationships.

DOMESTIC VIOLENCE/ASSESSMENT
48

Confronting women with the fact that their

inventory scores indicate that they may be at risk
for being in an abusive relationship could be the
impetus to seek assistance for the problem of

current abuse.

If the women

are not abused but

score in a high range, nursing intervention
strategies could be aimed at helping women reassess

their relationships by providing them with a

directory of appropriate sources.
Finally, abuse is not unidirectional.

Liter-

ature review has shown that accountability for the

relationship also lies with women. Success in
identification of battered women must be followed
by successful treatment for the cycle of abuse to

stop.

An evaluation tool as versatile as the ARI

could then be used to evaluate the effectiveness of
treatment strategies.

DOMESTIC VIOLENCE/ASSESSMENT ’
' '
49
appendix a

A CONCEPTUAL FRAMEWORK fCR NURSING

SOCIAL SYSTEMS
(Society}

/

I

\

I

INTERPERSONAL SYSTEMS
(Groups)

f

!

\

!

PERSONAL SYSTEMS
j
(individuals)
*

f

i

i
L._____

I---

J

I

I

I

J
i

I

I

I

i

I

I

7
I

I
\

i
/

\

A conceptual framework for nursing: dynamic interacting systems.
I. M. King, Toward a Theory for Nursing, New York,

John Wiley & Sons, 1971, p. 20.

DOMESTIC VIOLENCE/ASSESSMENT
50
APPENDIX B

ABUSE RISK INVENTORY
4anic

Date

/

/

/

My husband/partner.
1. finds the role of breadwinner satisfying

2

3

4

2.

is frustrated about our economic situation

1

2

3

4

3.

accuses me of deliberately trying to attract other men.

1

2

3

4

4. starts arguments with me about matters in the home-

1

2

3

4

slaps or pushes me during a fight---------- --- ------------

_1

2

3

4

—1

2

3

4

1

2

3

4

has problems with sexual functioning--------------------

____ 1

2

3

4

9. accepts changes I make in our homelife routine-------

1

2

3

4

____ 1

2

3

4

1

2

3

4

5.

6. uses drugs (like marijuana or pills)
7. gets along well with others

8.

10.

drinks alcoholic beverages

11. slapped or shoved me while we were dating----------12.

tells me I'm inferior as a homemaker or mother—

-1

2

3

4

13.

is considerate of my sexual needs

_1

2

3

4

14.

changes jobs or is out of work------- --- -..........

1

2

3

4

.15.

shows concern for my health needs — .........-----------

1

2

3

4

1

2

3

4

---------------- ——

^4y husband/partner and I:
16.

maintain close contact with our families

17.

discuss problems when they arise

1

2

3

4

18.

get upset if we don't have enough money to do the
things we enjoy

1

2

3

4

19.

have satisfying sexual relationships with each other

1

2

3

4

20.

argue a lot

1

2

3

4

21.

share recreational activities

1

2

3

4

22.

discuss minor problems lx*forc they blow up

1

2

3

4

argue alxiut trivial or silly matters

1

2

3

4

I’.Ct upset Ixvause we don't have enough money
t<» buy (he (hinjy; we nml ..........................................

I

2

3

4

pl.m for
I

>

3

4

23.
24.
?'i

fa ‘

I.

.............

APPENDIX C

DOMESTIC VIOLENCE/ASSESSMENT
51

CONSENT FORM

Hello,

I am conducting a research study about women

and their relationships.

The information that is

collected from you will be used by myself in an
attempt to understand women and their husbands or

partners.
I am asking that you complete a survey

consisting of 25 questions.

This should not take

longer than 10-15 minutes to complete.

You will

remain anonymous in the study as your name will not

appear on any of the forms.

The consent will not

be attached to the survey that you will complete.

This allows you to fill out the survey without

anyone knowing which information you provided.
You Are not obligated to participate in the
study.

Whether you participate in the study or

not has no influence in the care you will receive
today.

Thank you for agreeing to participate in

the survey.

Barbara Nunn, RN
I have read the above information and agree to

participate in the research study.
Signature

Date

DOMESTIC VIOLENCE/ASSESSMENT
appendix d

RESEARCH SURVEY
This questionnaire is to be used in conjunction with the Interpersonal Relationship Survey and is designed for research
purposes only to obtain additional information regarding your current marital or intimate relationship together with
basic sociodemographic information. All responses are strictly confidential.
1. Current marital status. Circle one.
a. Single
b. Married
c. Separated
d. Divorced
e. Widowed

9. Were you physically abused as a child?

Yes
If yes, by whom?

2. Number of years married or involved in current
relationship:years

Yes

No

Yes

Don't know

No

12. Was your husband or partner's mother ever physi­
cally abused by her husband?
Yes

Don't know

No

13. Within the last year, have you been hit, kicked,
punched or physically assaulted in other ways by
your husband or partner?

5. Race

Husband or partner’s race
6. Annual household income. Circle one.
e. $20,001 -$37,000
a. $ 0 - $9,400
f. $37,001-$44,000
b. $ 9,401 - $16,000
g. $44,001-$50,000
c. $16,001 - $23,000
h. Over $50,000
d. $23,001 - $30,000

Yes

Yes

No

What is your occupation or profession?

No

14. Within the last year, have you been emotionally
abused (verbal threats, put-downs) by your
husband or partner?
Yes

7. Highest grade completed

No

15. Within the last year, have you been raped (forced
to have sexual intercourse or other forms of sexual
penetration) by your husband or partner?

Yes

No

16. Have you ever been raped, emotionally abused, or
physically abused by a husband, male partner or
other male relative?

8. Your husband or partner's
highest grade completed

Is he employed?

Don't know

11. Was your mother ever physically abused by your
father?

Husband or partner’s age

Are you employed?

10. Was your husband or partner physically abused
as a child?

If yes, by whom?

3. With whom do you live? Circle one.
a. Husband
b. Male partner
c. Live alone
d. Husband with children
e. Male partner with children
f. Parents
g. Other (please specify)
4. Age

Don't know

No

Yes

What is his occupation or profession?

No

For rape

Yes

No

For emotional abuse

Yes

No

For physical abuse

Yes

No

DOMESTIC VIOLENCE/ASSESSMENT
53
APPENDIX E

RESEARCH SURVEY CODED AS P QUESTIONS
GROUP 1
p QUESTIONS
GP

i

NUM ARI

i

2

3

4

5

8

7

1

82

i

7

18

W

1

2

58

i

6

15

W

6

9

3

86

i

3

6

16 W

B

IO

4

80

i

1

19

W

1

5

58

i

17

B

2

6

59

i

1

55

5

2

8

8

49

1

2

18

9

62

1

1

2

20

IO

45

1

5

6

22

67

1

3

5

20

12

54

5

2

21

5

28

6

4
1

1

1

1

2

1

1

3

3

3

3
3

12

IO

3

3

3

1

IO

12

1

3
3

3

3

1

1

3

3

3

1

1

11

13

56

1

4

14

72

2

IO

15

48

2

1

5

19

16

45

1

7

20

17

42

1

8

6

22

18

64

3

2

3

23

19

57

1

4

2

19

20

53

1

5

6

18

H

1

21

48

1

6

16

3

9

22

65

1

6

18

w
w

6

23

50

1

5

IB

H

24

40

1

6

16

w
w
w
w
w
w
w
w
w

25

62

26

52

27

54

1

66

1

40

79

1

58

1

2

2

2

1

2

2

1

3

2

1

2

2

2
2

1
2

2

2

2

2

3

12

12

2

5

18

14

2

2

2

1

12

14

2

2

2

3

1

12

12

2

2

2

3

2

2

2

3

2

1

2

2

2

12

12

1
2

3

1

3

2

1

1

1

1

2

2

2

1

1

2

2

1

1

1
2
2

2

3

12

12

2

2

2

2

2

1

2

1

2

2

3

12

12

2

2

2

2

2

1

2

2

1

2

6

12

12

1

1

1

1

2

2

2

9

2

1
2

1

1

2

2

2

1

2

IO

1

3

2

1

2

1
2

1

1

2

2

8

2

3

2

1

1

2

2

2

2

1

IO

9

1

1

2

1

2

2

1

1

3

9

12

1

2

1

2

2

2

2

2

8

IO

12

2

2

1

2

2

1

2

2

1

1
2

1

1

2

2

1

1

2

1

2

2

2

2

1

1

1

2

2

2

1

2

2

2

1

1

2

2

2

1

1

1

1

1

14

16

2

2

2

2

1

2

2

2

2

1

3

14

16

2

2

2

2

1

1

2

2

1

1

6

13

16

2

2

2

2

2

2

2

1

2

23 W

1

12

12

2

21

W

3

12

12

1

2

22

W

3

12

12

2

2

38

W

8

18

16

1

1

18 W

1

IO

1

1

12

2
3

32

3

3

22

11

1

3©

5
6

2

2

2

2

1

2

1

1

2

1

1

1

2

2

2

1

2

2

1

2

3

1

1

1

2

2

1

1

1

1

1

1

1

1

1

2

1

3

3

3

3

2

1

2

2

1

1

1

2

2

1

1

1

1

1

3

1

1

2

1

1

1

3

1

1

1

1

1

1

2

1

1

1

1

2

2

2

1

1

3

2

1

2

2

1

1

2

3

1

1

2

2

1

1

2

2

3

1

1

2

2

1

1

2

2

3

1

2

2

2

1

1

1

6

15

W

8

6

16

8

7

19

w
w

1

12

IO

3

3

3

3

8

19

B

2

12

12

1

3

3

W

1

11

12

1

1

1

w
w
w
w
w
w

5

12

12

1

2

1

12

12

2

1

3

3

3

12

12

2

3

2

7

16

13

2

2

1

12

15

2

12

12

2

42

5©

43

55

1

2

6

18

44

49

1

1

2

20

45

62

1

1

2

20

46

45

1

6

6

24

47

67

1

3

5

27

48

54

1

3

2

25

6

9

2

3

1

2

12

64

57

2

12

32

38

2

12

67

39

2

2

1

31

1

2

2

1

8

82

1
1

2

2

37

3
3
3

1

49

4

1

3

1
3

1

30

5

3

2

18

20

1
2

3

46

2

IO
12

2

8

2

1
2

1

5

58

1

12

1

47

2

11

2

36

1

1

3

1

35

2

2

2

4

3

1
1

2

58

1

1

2

73

3

2

2

29

1

1

1
1

IO

6

58

2

9

2

55

1

2

12

17

33

1

1

16

4

19

2

34

1

15

2

8
2

28

2

14

13

1
2

12

W

12

11

12

w
w
w
w
w
w
w
w
w
w
w
w

2

IO

9

IO

17 W

34

8

3

1

17

IB

DOMESTIC VIOLENCE/ASSESSMENT
APPENDIX

GP

NUM

E

ARI

2

3

49

46

1

2

6

50

72

2

13

4

Avg :

58.46

1.90

2.32

54

oont .

1.38

5

30

W

8

W

2

3.50

1.26

1.24

P QUESTIONS
6
3 9 IO

12

4.90
1.80

12

15

2

2

2

2

1

12

1

3

1

3

2

21.40
1.68

3.52

1.18

13

2

11.62

14

15

IB

2

2

1

2

1

1

1

2

12

1.70

17

18

2 . IO

1.34

RESEARCH SURVEY CODED AS P QUESTIONS
GROUP 2 P QUESTIONS
GP

2

NUM ARI

1

4

3

2

5

6

8

51

54

1

2

5

16

W

52

48

1

4

5

18

W

53

33

1

1

6

16 W

6

54

33

1

1

6

W

8

55

38

1

1

6

23 W

1

56

36

1

1

3

20

2

57

31

1

1

6

16 W

W

1

9

IO

13

14

15

10

2

2

2

2

2

2

2

1

2

1

1

3

2

2

2

2

2

2

1

2

1

3

2

2

2

2

1

1

13

1

2

1

3

2

2

2

2

1

3

3

3

2

2

2

2

IO

12

9

12

9

9

2

12

12
13

12

2

12

2

IO

12

1
1

3

3

3

2

2

2

1

1

1

3

3

3

2

2

2

1

2

2

58

36

1

6

19

W

3

12

12

2

2

2

3

2

2

2

2

1

59

48

1

12

7

37

W

3

12

12

2

2

2

3

2

2

2

2

2

2

60

35

1

1

6

18

W

4

12

12

2

2

2

3

2

2

2

2

2

2

61

40

1

1

22

W

1

16

14

2

2

2

3

2

2

2

2

1

2

62

33

1

6

5

33 W

2

12

12

1

2

1

1

2

2

2

2

1

1

63

37

1

1

2

18

1

2

2

1

1

2

2

2

2

2

2

18

W
W

84

39

2

1

65

51

4

1

2

24 W
22

2

12

12

1

3

1

1

2

2

2

1

1

1

12

12

2

3

3

1

2

2

2

2

1

2

14

12

2

3

3

1

2

2

2

2

2

2

13

1

2

1

2

2

2

2

2

1

1

W

2

W

4

W

2

14

12

1

2

1

2

2

2

2

2

1

1

24 W

1

13

12

2

2

1

2

2

2

2

2

2

2
J.

66

39

2

5

4

67

45

1

2

6

68

41

1

3

3

22

69

34

1

3

70

41

2

5

28

W

3

13

2

1

2

2

2

2

2

2

1

41

2

2

1

22

W

4

12

12

1

2

2

2

2

2

2

1

1

1

72

42

1

1

6

18

W

12

IO

3

2

2

2

2

2

2

2

2

2

73

37

1

2

2

20 W

7

14

14

2

2

2

2

2

2

2

2

2

2

4

13

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

1

2

2

2

2

2

2

2

2

2

2

2

2

74
75

76
78

1

3

6

19

W

47

1

2

2

21

W

3

14

34

3

3

5

20

W

1

12

39

2

6

1

31

W

5

14

12

2

2

2

2

2

2

2

2

2

2

34

1

2

28

W

1

12

12

2

2

2

2

2

2

2

2

2

2

W

2

12

12

2

2

2

2

2

2

2

2

2

2

43

IO

79

27

1

2

21

80

34

1

2

2

22

W

2

12

12

2

2

2

2

2

2

2

2

2

2

81

35

2

12

1

29 W

2

12

12

2

2

2

2

2

2

2

2

2

2

82

34

2

5

1

23

W

3

12

12

2

2

2

2

2

2

2

2

2

2

1

e

19 W

4

12

12

2

2

2

2

2

2

2

2

2

2

2

28

W

4

12

12

2

2

2

2

2

2

2

2

2

2

1

44

W

12

12

2

2

2

2

2

2

2

2

2

2

83

40

1

84

37

1

85

31

2

21

18

DOMESTIC VIOLENCE/ASSESSMENT
55
86

APPENDIX

29 W

30 2
3
H cont; .

87

36

2

12

88

26

2

23

89

44

1

4

90

40

1

2

91

34

6

92

36

6

12

12

2

2

2

2

2

2

2
2

2

2

2

2
2

2
2

2
2

2

2

2

2

2

2

2

2

2
2

2
2

2
2

2
2
2
2

30

W

6

12

12

45

S

12

5

19

W
W

2

9

12
12

2

2
2

2

2
2

6

6

12

12

2

2

2

2

2

2

2

2

2

1

3

18 W
19 W

6

12

12

2

2

2

2

2

2

2

2

2

2

1

2 3 24 W

a

16

14

2

2

2

2

2

2

2

2

2

2

5

13

13

2

2

2

2

2

2

2

2

12

13

2 2 2 2 2 2 2 2 2 2

4

93

45

1

8

19

W

94

31

1

2

6

20

W

95

33

20 W

4

14

14

2

2

2

2

2

2

2

2

2

2

38

1
2

2

96

IO

1

32

W

6

15

14

2

2

2

2

2

2

2

2

2

2

25

W

3

13

13

2

2

2

2

2

2

2

2

2

2

W

8

11

15

2

2

2

2

2

2

2

1
2

2

2

2
2

1

97

46

98

35

1

2

6

99

41

1

5

6

28

W

8

16

16

2

2

2

2

2

2

1OO

40

1

4

2

21

W

1

IO

12

1

3

2

2

2

2 2 2 2 2

Avg :

38.04

2 . IO

1.92

3

4 . IO

1.38
2 . IO

2

2

2

4.02

1.90

23 . IB

1.68

3.70

1.76

12.28

12.22

2

1.82

DOMESTIC VIOLENCE/ASSESSMENT
56
APPENDIX F

ARI scores of respondents

NUM GP ARI
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
.21
22
23
24
25

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

82
58
66
80
58
59
55
49
62
45
67
54
56
72
48
45
42
64
57
53
48
65
50
40
62

NUM GP ARI

NUM GP ARI

26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50

51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

52
54
58
73
49
67
64
58
55
47
58
82
57
66
79
58
59
55
49
62
45
67
54
46
72

2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2

54
48
33
33
38
36
31
36
48
35
40
33
37
39
51
39
45
41
34
41
41
42
37
43
47

n=100

NUM GP ARI
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100

2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2

34
39
34
27
34
35
34
40
37
31
30
36
26
44
40
34
36
45
31
33
38
46
35
41
40

DOMESTIC VIOLENCE/ASSESSMENT
57

appendix g
TABLE 1
Characteristics of the Sample
Characteristics

Abused
n=50

Nonabused
n=50

Age
<18
18-21
22-25
26-30
>30
Mean years

11
22
7
13
7
21.40

Partner's Age
<18
18-21
22-25
26-30
>30
Mean years

6
21
6
10
7
23.68

Marital Status
Single
Married
Sep./Divorced
Widowed
Longevity of Relationship
1-3 years
4-6 years
>6 years
Mean years

6
13
18
8
5
23.18

3
14
10
10
13
25.72
35
12
3
0

39
7
3
1

33
11
6
3.50

34
8
8
4.10

Race
African/American
Hispanic
White

2
2
48

0
0
50

Partner 's Race
African/American
Hispanic
Caucasian

4
1
45

2
0
48

DOMESTIC VIOLENCE/ASSESSMENT
58

Appendix G cont.'
Characteristic

Abusive
n=50

Living Arrangement
Husband
Male Partner
Alone
Husband/Child.
Male Part./Child.
Parents
Other

1
6
3
5
10
20
5

Annual Household Income
$0 - $9400
$ 9401 - $16000
$16001 - $23000
$23001 - $30000
$30001 - $37000
$37001 - $44000
> $44000
Mean Income

10
13
8
6
5
4
4

$16000 - $23000

Education
HS graduate
Some college
Bachelor's or
Mean years

Partner's Education
HS graduate
Some college
Bachelor's or >
Mean years
Physical Abuse as a Child
Yes
No
Don't know
Partner's Physical Abuse
as a Child
Yes
No
Don't know

Mother Physically Abused
by Male Partner
Yes
No
Don't know

15
26

5
4
11.62

Nonabusive
n=50

10
9
7
2
6
15
1
10
9
6
9
3
6
•7

for both groups

5
31
11
1
12.28

24
6
4
2
12.0

7
30
10
2
12.22

18
28
4

10
39
1

18
28
4

10
39
1

16
23
11

9
39
2

DOMESTIC VIOLENCE/ASSESSMENT
59

Appendix G cont.'

Characteristic

Abusive
n=50

Nonabusive
n=50

Par tn er 's Mo th er Physi cal ly
Abused by Male Partner
Yes
No
Don't know

9
16
25

5
35
10

Physically Abused within
Last Year
Yes
No

37
13

0
0

Emotionally Abused within
the last year
Yes
No

38
12

5
45

Raped within the Last Year
Yes
No

10
40

0
0

Raped. Emotionally, or
Physically Abused by Any
Other Male Including
Family Members
Rape
Yes
No

16
34

5
45

Emotional Abuse
Yes
No

41
9

16
34

Physical Abuse
Yes
No

33
17

12
38

DOMESTIC VIOLENCE/ASSESSMENT
60
APPENDIX H
ARI MEANS FOR SELECTED VARIABLES

Length of Relationships

Years

Group 1

1
2
3
4
5
6
8
10
11
12
13
14
20
21
23

57.72
56.13
63.57
64.83
49.75
45.00
45.50
72.00
64.00

Group 2
37.31
39.58
38.00
41.25
38.00
36.00

31.00
26.00

48.12
46.20
51.77
55.40
44.71
39.00
45.50
55.00
64.00
39.67
72.00
37.00
58.00
31.00
26.00

38.04

48.25

38.00
39.67

72.00
37.00

58.00

58.46

Mean

Mean

Annual Income
Income

0
$9401
$16001
$23001
$30000
$37001
$44001

- $9400
- $16000
- $23000
- $30000
- $37000
- $44000
-$50000

> $50000

Mean

Group 2

Mean

62.67
61.50
53.20
57.67
52.67
61.60
47.00
58.17

37.30
36.44
42.00
40.40
41.33
34.20
39.50
34.20

52.52
46.47
49.00
44.38
47.00
47.90
43.25
47.27

58.46

38.04

48.25

Group 1

DOMESTIC VIOLENCE/ASSESSMENT
61
Appendix H cont.' ARI MEANS

Physical Abuse as a Child
Child Abuse

Group 1

Group 2

Yes
No
Don't Know

62.21
53.70
72.75

38.40
37.85
42.00

54.00
44.33
66.60

Mean

58.46

38.04

48.25

Mean

Physical Abuse as a Child for Partner
Child Abuse
Partner
Yes
No
Don't Know

Mean

Mean

Group 1

Group 2

62.89
54.33
63.57

44.50
37.54
39.14

59.55
44.21
55.43

58.46

38.04

48.25

DOMESTIC VIOLENCE/ASSESSMENT
62

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