Developing an insight into mothers' experiences of domestic abuse: exploring the relationship between mothers and health professionals during historic periods of domestic abuse to identify how these might prevent or promote disclosures of abuse.

BackgroundDomestic abuse between intimate partners continues to affect large proportions ofpeople living in the UK and internationally. Domestic abuse can be physical,emotional, financial, sexual, and includes coercive and controlling behaviours, and isassociated with a variety of physical and psychological health impacts for women andtheir children. Women rarely disclose abuse to health professionals, despite thepresence of routine enquiry within current Health Visiting practice. A plethora ofbarriers prevent women from seeking help and also prevent professionals from askingwomen about abuse.Relationship-based practice is fundamental to improving outcomes for children andtheir families, and this relationship is valued by both parents and professionalsalike. Although it is usually intended that the same Health Visitor will support familiesto provide consistency, in practice it is often disrupted by staffing challenges andadapted service delivery models. This in turn affects the opportunity to establishpositive relationships which provide a basis for disclosures of abuse and earlyintervention and support. MethodologyThis study was undertaken qualitatively, using an interpretative phenomenologicalapproach based on Heideggerian principles and underpinned by Matricentric Feministtheory. Nine women who had experienced historical domestic abuse were identifiedfrom health visiting caseloads, and Women’s Aid organisations, and were interviewedusing semi-structured interviews, supported by the use of a life history calendar to aidretrospective data collection and develop a timeline of events for each participant.Data analysis was undertaken using thematic analysis of interview transcripts,hermeneutic methods, and supported by NVivo 12 software and analysis of individualtimelines. FindingsStudy findings suggest that positive relationships between women and healthprofessionals are not sufficient to promote domestic abuse disclosures, however theserelationships are valued. Domestic abuse is a complex phenomenon; disclosures areoften unplanned, with multiple factors impacting on women’s decision-making duringperiods of abuse, including fear, stigma and self-blame, and a lack of awarenessregarding non-violent forms of abuse. Abuse that is not witnessed by others, or thatdoes not result in a heightened risk to children, is rarely reported to healthprofessionals even where significant injury is sustained. Abuse always impacts onsurvivor’s mental health, and perpetrator drug and alcohol use is closely associatedwith abuse. There is an association between experiences that survivors have had aschildren and the types of abuse experienced as adults.