Changing the Health Care Response to Battered Women: A Health Education Approach  By: Paige Hall Smith, PhD, M PH, Marion Danis, MD, and Laura Helmick Smith, P.H. , Danis, M., and Helmick, L. (1998). Changing the health care response to battered women: a health education approach. Family and Community Health, 20 (4): 1-18. Made available courtesy of Lippincott, Williams & Wilkins: http://journals.lww.com/familyandcommunityhealth/pages/default.aspx This format of the article is not the final published version. ***Note: Figures may be missing from this format of the document Abstract: Numerous factors are thought to prevent the successful implementation of domestic intervention protocols and programs that are designed to encourage physicians arid -purses to identify and appropriately treat battered women. Using the PRECEDE-PROCEED model of behavior change as a guide, this study investigated baseline factors associated with clinician screening behaviors prior to its implementation, Perceived competence, a composite measure of self efficacy around specific clinically relevant behaviors, emerged as the primary predictor of ail behaviors- En addition, belief that clinicians should screen all women as part of .a routine :r story or physical examination emerged as a predictor for routine screening. Key words: battered women, domestic violence, enabling factors, perceived competence, PRECEDE PROECED model. predisposing factors, reinforcing factors Article: AN ESTIMATED 2 TO 4 MILLION WOMEN are battered by their husbands or boyfriends each year in the United States and between 21% and 34% of all American women will be physically assaulted by a male partner at least once over their lifetime. 1 Research conducted with battered women on their perceptions of the violence in their lives reveals that battering i5 a complex experience that is conceptually distinct from episodic physical assault,» Battering generally consists of men's continuous use of physical. and often sexual. assaults along with verbally and emotionally abusive behaviors that include threatening, intimidating. and humiliating women: isolating them from family and Mends: restricting their access to money and other resources: threatening the safety of children and others in the women's families; and controlling women's activities outside the home.3 We define battering here as a process whereby one member of an intimate relationship experiences vulnerability, loss of power and control, and entrapment as a consequence of the other member's exercise of force through the patterned use of physical., psychological, sexual or moral force. Battering is a traumatic experience that shapes women's behavior, minimizes positive views of themselves, and undermines their confidence and beliefs in the controllability of their own lives.2 It is reasonable to expect that women who live in an environment that causes them to be fearful, to feel unsafe, and to suffer a continuous loss of personal power and shrinking self-concept would experience compromised health, indeed, there is growing evidence that battered women are at increased risk for many acute and chronic health problems including injury, sexually transmitted diseases. depression, anxiety, posttraumatic stress disorder, chronic pain, gastrointestinal disorders, substance abuse, suicide, and homicide.4 This recognition has been accompanied by a proliferation of domestic violence intervention programs in emergency department and outpatient health care settings, thereby increasing the level of responsibility physicians and nurses have in identifying and appropriately treating battered women.5 Research to date indicates, however, that there are numerous factors that prevent the suc-  Partial funding far this study was provided by Duke Endowment At the time of this study.