P A T I E N T P E R S P E C T I V E SThe lived experience .docx

P A T I E N T P E R S P E C T I V E S
The lived experience of women victims of intimate partner
violence
Alice Yuen Loke, Mei Lan Emma Wan and Mark Hayter
Aims and objectives. This study aims to gain a better
understanding of the lived experience of female victims of
intimate partner
violence.
Background. Intimate partner violence (IPV) is a complex and
prevalent social problem associated with significant impairment
in the physical and psychological health of victims.
Design. Exploratory, qualitative design.
Methods. Face-to-face interviews were conducted among nine
IPV female victims who presented themselves at an emergency
department of a regional hospital. Data were subject to thematic
analysis.
Results. Victims are often ashamed to disclose their situation
and reluctant to seek help, afraid of being ridiculed or ignored.
Violent experiences also lead to low self-esteem, depression,
and suicidal ideas. They are ambivalent about staying in an
abusive

relationship and endure violent incidents in silence until they
cannot tolerate any more and seek help at an emergency
department. They have negative experiences in help-seeking:
other family members and health professionals coloured by
cultural restraints generally ignore their complaints and need
for help.
Conclusions. Provided a preliminary understanding of the
experience of Chinese women in Hong Kong. In support of
these
women’s help-seeking behaviours, continuing education
programmes are needed to better prepare health professionals
for
caring for these women.
Relevance to clinical practice. Health professionals should be
astute in identifying IPV victims with whom they come into
contact at work. They should assess the immediate physical and
emotional needs of these women, be empathetic, show
acceptance, extend a helping hand and assess home safety
before discharge.
Key words: Chinese women, intimate partner violence, lived
experience
Accepted for publication: 26 February 2012
Introduction

Intimate partner violence (IPV) is a serious social health
concern worldwide (WHO 2002). Reports from various
studies indicate a high prevalence of IPV in all societies.
Although Hong Kong is a westernised society, no matter how
productive or independent women in Hong Kong are, they
are no exception to this prevalence. A review of studies
conducted in different parts of China reported the average
lifetime and annual prevalence of male on female IPV as
19Æ7% and 16Æ8%, respectively, for any type of violence
(Tang & Lai 2008). Another study, which surveyed a total of
1132 women in Hong Kong, concluded that marital dissat-
isfaction and age difference within a couple are predictors of
IPV (Tang 1999).Although prevalence and causal factors
have been reported quantitatively, there has been no in-depth
Authors: Alice Yuen Loke, RN, PhD, Professor, School of
Nursing,
The Hong Kong Polytechnic University, Kowloon; Mei Lan
Emma
Wan RN, MSc, Registered Nurse, Accident & Emergency
Department, Alice Ho Miu Ling Nethersole Hospital, Hong

Kong,
Hong Kong; Mark Hayter PhD, RN, Cert Ed, FRSA, Professor,
Faculty of Health and Social Care, University of Hull, Hull, UK
Correspondence: Alice Yuen Loke, Professor, School of
Nursing,
Division Head, Division of Family and Community Health, The
Hong Kong Polytechnic University, Hong Kong. Telephone:
852 2766 6386.
E-mail: [email protected]
! 2012 Blackwell Publishing Ltd
2336 Journal of Clinical Nursing, 21, 2336–2346, doi:
10.1111/j.1365-2702.2012.04159.x
qualitative work into women’s experiences of IPV in Hong
Kong and how they relate to the international empirical
evidence on this important health and social issue. This study
is designed to address this gap in the literature.
Background
Chinese culture and intimate partner violence
In traditional Chinese families, the husband has the final

authority on family issues. The social norms provide/dictate
that a ‘good woman’ should obey her husband and perform the
roles of a virtuous wife and mother well. Although the
patriarchal social structure in China may have diminished
somewhat, Chinese women (25–40%) still believe that a good
wife obeys her husband and is obliged to fulfil her husband’s
requests even if she does not feel like it (Hollander 2005).
Fear of losing face and the traditional notion of keeping
things within the family have also made it difficult for the
Chinese families to break the silence regarding the violence in
their homes (Xu et al. 2001). As many as 70% of Chinese
women agreed that family problems should not be discussed
with outsiders (Hollander 2005). Chinese women should
never point out their husbands’ inadequacies or mistakes in
public, a likely cause of IPV victims’ hesitation to disclose
their family problems (Tai 1994). Women endure humiliation
and conceal their experience for fear of being reprimanded by
their husbands.

Need for better understanding of IPV
Recognising women who are vulnerable to victimization is
essential for health professionals. However, when health
professionals hold the cultural belief that family affairs are a
private matter, this may affect their approach towards
women who suffer from intimate partner violence. Even if
women seek health care, most people, including nurses, still
believe that IPV is a private family matter in which other
people should not intervene (Chung et al. 1996). A study
conducted among accident and emergency nurses in Hong
Kong revealed that although 57% of nurses agreed that they
had a duty to intervene, all of them also believed in the
Chinese saying that ‘even a good judge cannot adjudicate
family disputes’ (Chung et al. 1996). A study among emer-
gency room physicians also revealed that nearly half (48%)
agreed with this Chinese saying, with 24% being neutral
(Wong et al. 1997). As many as 61% of these nurses
indicated that they would not directly ask a woman who

was suffering from domestic injuries whether the injuries
were inflicted by the woman’s male intimate partner. While
these nurses can play a crucial role in screening and caring for
victims of IPV, their attitude may interfere with their
willingness to fulfil this responsibility.
While most studies have been conducted in Western
countries, there is a dearth of studies that explore the lived
experiences of women in intimate violent relationships in
Hong Kong. A list of 312 publications on intimate violence
from 1983–2005 was compiled by Coughlan (2006). The
articles focused on populations around the world, including
Cambodian, Vietnamese, Korean, Filipino, South African,
Hispanic, Arab, Jordanian and many more. Only 12 of the
studies were conducted among Chinese women, five of them
among Chinese immigrants in western countries. These
studies mainly identified the prevalence and risk factors of
IPV; only one was a qualitative study focused on the
experiences of victims.

A review of literature was also conducted on IPV in China
(Tang & Lai 2008). Based on the results, among the 19
studies published from 1987–2006, only six were conducted
among Hong Kong Chinese. All of the studies were quanti-
tative and adopted the Conflict Tactics Scale (Straus 1979,
Straus et al. 1996) and the Abuse Assessment Screen (McFar-
lane et al. 1992) to identify the demographics of the female
victims and their family relationship factors. Another study
examined the relationship between domestic violence and
postnatal depression among Chinese women in Hong Kong
(Leung et al. 2002).
As most of these studies focused on identifying the
demographic and family predictive factors of IPV, a quali-
tative study is needed to explore the lived experience of
female IPV victims. This understanding of IPV female
victims’ lived experience of domestic violence will fill the
health professionals’ knowledge gaps of these victims’ strug-
gle and needs. Sharing their experience with the health

professionals can eliminate the stigma attached. The recog-
nition of the lived experiences and help-seeking process of
IPV female victims can also provide healthcare providers with
information to improve their screening approach and services
and to develop effective strategies to meet the needs of IPV
victims.
Methods
Study design and aim
This is a descriptive qualitative study focusing on individual
interpretations of lived experiences, aiming to gain a better
understanding of the lived experiences of women suffering
from intimate partner violence. The objectives of this study
are to explore (1) women’s experience and feelings in violent
Patient perspectives Chinese women victims of intimate partner
violence
Journal of Clinical Nursing, 21, 2336–2346 2337
relationships, (2) their decision to disclose or stay in the

abusive relationship and (3) their help-seeking experience and
needs.
Purposive convenience sampling was used to recruit women
who were admitted in the Accident and Emergency Depart-
ment (AED) of a regional hospital in Hong Kong from August
2006 to January 2007, reporting physical assault by their
intimate partners. This setting was selected because it was the
intention of this study to recruit women who had not left the
situation. The inclusion criteria were as follows: Hong Kong
Chinese women over the age of 18 and living with the assailant
and who agreed to take part in this study. Those who
demonstrated signs of cognitive impairment or mental illness
and those who were in police custody were not recruited.
Data collection
After receiving treatment and before discharge from the AED,
eligible women were informed of the purpose of the study
and invited to take part. All were ensured of confidentiality
and that their participation in this study would not be

revealed to their partner. Interviews were conducted in a
private room with a comfortable atmosphere in the AED to
ensure privacy and provide a sense of security to enable them
to describe their experiences. The face-to-face interviews
lasted from 40–90 minutes and were recorded on an MP3
recorder.
Data were collected through semistructured interviews
with an interview guide developed for the purpose of this
study. A nurse specialist and a physician with over 10 years
of experience in caring for IPV victims in the AED were asked
to consider the relevancy of the interview questions. A pilot
interview was also conducted to test the interview guide for
clarity, coverage and representativeness. Probing questions
were used to encourage open communication.
All interviews were conducted in Cantonese (the dialect
commonly used in Hong Kong). Verbatim transcripts were
transcribed from audiotapes into written Chinese within two
weeks of the interviews.

Data analysis
Once the interviews had been transcribed verbatim, paper
copies were produced for analysis. The transcriptions of
interviews were analysed by the researcher and the nurse
educator independently, both of whom were fluent in both
Chinese and English languages.
The thematic approach to qualitative data analysis
described by Joffe and Yardley (2004) was used to derive
key themes from the data. Initially, line by line coding was
undertaken, as well as reading and rereading transcripts to
become familiar with the data. Coding at this stage was
linked to specific aspects of the women’s accounts and simply
reflected the specific emotion or issue described in that section
of the data. As this coding proceeded, notes were taken and
attempts were made to link them into larger and more
substantive codes or ‘subthemes’. During this process, the
data were explored for links, similarities and differences to
check the robustness of the emerging segments of data. The

two sets of analysed themes were compared and discussed
until a consensus was reached, and the themes were
combined, summarised and classified according to categories.
A final stage of analysis saw the larger codes amalgamated
into more encompassing and significant themes that provided
a picture of the key elements of the participants’ experiences.
These final themes represent the core elements of these
women’s experiences of IPV translated into English. The
statements given by women who shared the same sentiment
and meanings in the interviews were merged under the same
themes and presented in English.
Ethical considerations
Ethical considerations were a major concern because of the
complex and sensitive nature of IPV. Ethical approval was
obtained from the university and hospital ethical committees
prior to the commencement of the study. Interviews were
only commenced after each eligible woman had received a
clear explanation of the purposes of this study and consented

to the study. To protect their identity, the women were not
required to sign a consent form. Participants were informed
that they could withdraw from the study at any point during
the interview and assured that their identity would be
concealed. All the data collected were kept confidential.
A danger to women IPV victims exists when they either
return to their partners or attempt to escape from the abusive
relationship. After the interview, the researcher provided the
women with information on social workers’ availability, and
alternatives such as making arrangements to stay in a
nongovernment organization’s shelter for domestic violence
victims, if desired.
Results
Face-to-face semistructured interviews were conducted with
nine female victims. Six of the women were aged from 39 to
50 and three from 19 to 27; they were 1–14 years younger
than their husbands and had been married for 1–33 years.
Seven had secondary school education, one had primary

school, and another had completed university. Three of the
AY Loke et al.
2338 Journal of Clinical Nursing, 21, 2336–2346
women were housewives and six were employed, with an
average monthly income of HK$6700 (US$880). Two of the
husbands were unemployed and five had jobs with an average
monthly income of HK$12,700 (US$1,500), representing
families from the lower social class in Hong Kong.
The women reported that the violent incidents were
provoked by arguments regarding family finances or extra-
marital affairs. All interviewees reported different degrees of
physical abuse, including punching, slapping, shoving,
smothering and having objects thrown at them. Three women
reported psychological abuse, including hostility and intim-
idation, and one reported being sexually abused.
Identified themes of IPV women victims’ lived
experience

Four themes were derived from the thematic analysis process:
(A) feelings of shame, low self-esteem, depression and
suicidal ideas; (B) violent experiences leading to despair,
helplessness and insecurity; (C) ambivalence about staying in
an abusive relationship and enduring intimate partner
violence and (D) experiences of help-seeking and needs.
Feelings of shame, low self-esteem, depression and
suicidal ideas
The abused women were ashamed of the domestic violence.
The feeling of shame leads to low-self-esteem, depression and
suicide attempts. They considered family violence to be a
private matter and were ashamed to reveal their situation.
They were also ashamed to go out, for their partners’ violence
often resulted in bruises and swelling on their face and neck
that could readily be seen by others. They said:
I am ashamed to talk about the violence in my family; I don’t
want to
wash my ‘dirty linen’ in public or share it with others. (01, 02,
03, 06,

07, 08, 09)
After my husband beats me, there are obvious bruises on my
face. So
I stay at home all the time to avoid having to explain the cause
of
these injuries to others. (07, 08)
Abused women have low self-esteem, feeling that they are not
worthy of respect and do not deserve love in the relationship.
The abused women kept thinking about their husband’s
insulting comments about their inadequacy as a wife. They
often blamed themselves and tried to change. They said:
After he reprimands me, I wonder if I am as useless as he said. I
often
blame myself, asking myself if I have not done enough as a
wife.
Perhaps I have done something wrong, and not paid enough
attention
to my husband? (01,03)
I must not be worth loving, the way he is treating me. He said
he
would make me happy when we got married. Now he makes me
feel

not worthy of being loved. (01, 02, 03, 04, 06, 09)
Most abused women reported symptoms of depression,
including insomnia, fluctuating emotions and loss of appetite,
and having lost satisfaction in life. These women expressed
that they could not see the beauty of living and that life had
no purpose and had suicidal thoughts because they found life
meaningless. They said:
I keep thinking about our relationship, so that I have to rely on
sleeping pills to sleep. I can also hardly eat. (01, 04,06)
When I am alone, I often think about our relationship and could
just
cry… (05)
Nothing really interests me in life. I don’t see anything good
about
life. I am like a walking corpse without a spirit. (01, 02)
I think I have lost the will to live. I have attempted suicide
many
times, but was saved. I saw how sad my children were, so I dare
not
attempt suicide again. (01, 04)

When a suicide attempt did not end her suffering, one woman
wanted to hurt her husband so that she could escape from the
situation by being in jail. She said:
I once attempted to leap from a building to end my life, but I
could
not. I then thought about hurting him and how being sent to jail
might be an escape. (06)
The above theme which emerged from the interviews revealed
that intimate partner violence (IPV) is associated with
significant psychological distress in victims, causing shame,
low self-esteem, depression and suicidal ideas.
Violent experiences leading to despair, helplessness and
insecurity
The abused women were despairing, helpless and insecure
about living with a violent husband.
They were in despair because of their husbands’ lack of
remorse and the repeated violence against them. They felt
helpless because they were living with their husbands under

the same roof and nobody else could protect them. They
said:
Initially, he apologized for his act and promised not to hurt me
again.
But his violence has grown over the years and is repeated
without
regret. (03, 05)
I can’t figure out any solution. It is hard for anyone to
intervene. He
doesn’t think he is wrong, and can’t control himself when he
gets
mad. (04, 05, 07, 09)
violence
I could not find anyone who could help. I told my relatives, but
they
can’t help as they don’t live with me. Even the police cannot
watch
him all the time. (03, 04, 07)

The women were afraid of arguing with their irritated
husbands, or they would end up being beaten. One woman
felt extremely unsafe and was kept awake by her fear. The
women remarked:
I am afraid all the time that I may irritate him. When he loses
his
temper, he beats me. I am frightened all the time and dare not
offend
him. (02, 04, 05, 09)
My husband pulls me out of bed when I am sleeping. I feel
unsafe and
am afraid that one day I will be murdered. I often wake up and
am
unable to fall back to sleep. (01)
Interviews also revealed that the experiences of intimate
partner violence (IPV) lead to despair helplessness, and
insecurity of these victims.
Ambivalence about staying in an abusive relationship and
enduring Intimate Partner Violence
Eight of the nine abused women interviewed had tried to

leave the abusive situation at some point. They were
ambivalent about staying in the abusive relationship. How-
ever, many of the abused women would do anything to keep
the family together. They believed a divorced woman and
children from a broken family would be socially stigmatised.
They also had conflicting feelings about the effects of
domestic violence and parental separation on children. They
said:
I want my children to live happily in a family, so I can’t divorce
my
husband. Both I and my children from a broken family would be
‘looked down on’ by others. (01, 03, 04, 07)
I don’t want my children to witness all this. I am afraid that he
will
hurt the children. But divorce is detrimental to children, they
are
innocent. (01, 02, 03, 05, 09)
The women tried to endure the pain or to withdraw from
arguments to prevent attacks. Financial insecurity was the
crucial reason why these IPV victims stayed in their abusive

relationships. They did not see any way out because of
financial self-insufficiency. They said:
If he beats me or throws things at me, I let him. I clean up the
mess
afterwards. I only try to stop him if it is serious or if I can
barely
endure the pain. (01, 02, 04, 08)
I am ambivalent. If I stay with him, the violence will continue.
If I
leave, I’ll confront financial and housing problems. I am
trapped in
this abusive relationship and can’t leave as I don’t know which
situation is worse. (09)
Women tend to withdraw or keep silent while enduring
IPV. Violence was seen by the abused women as an
aberrant event beyond the control of their husbands. The
women reported being beaten on a situational basis; they
believed that when the stressor was removed, their
husbands would stop. They described this in the following
statement:

I sometimes leave for a few hours after he beats me. Then I
pretend
that nothing has happened and go back home. (01, 05, 08, 09)
He’s fine if he doesn’t lose his temper, but he just turns into
another
person once he gets mad or drunk. He is out of control and goes
crazy, and he will beat me. (05, 07, 08)
Three women said their husbands had taken good care of the
family and the children, apart from the violent incidents.
They said:
I can’t leave my husband because he has provided for the family
and
deserves the family and our kids, even though he beats me
sometimes.
(03, 06, 08)
The above theme and quotes revealed that although these
victims were psychologically distressed by the intimate
violence, they had ambivalent and conflicting feelings about
staying in an abusive relationship. These women choose to
stay with the family for the sake of family completeness

and for the children, allowing themselves to remain
trapped in abusive relationships enduring intimate partner
violence.
Experiences of seeking help and needs
The women were more likely to keep their silence and endure
the pain of violence when the violence was less severe to
avoid confrontation. They knew they will require a shelter
and financial support to meet immediate needs but were
reluctant to seek help because they did not know what
services were available in the community for them. They also
expressed their fear that seeking help would make the violent
incidents even worse and felt that they will be in danger if
they returned home after seeking help.
Now that other people know about this, I’m afraid it will affect
our
relationship. Since I reported him to the police, I cannot face
him. I
am now in trouble. (03, 04, 05)
If I run away from home or get a divorce, I don’t know how I

will
cope with living. I do not know if there are any organizations
that can
help, and I need information. (06, 09)
AY Loke et al.
I want to find a place to live. I cannot even afford to rent a
small
room. If I had a place to live, many of the problems I am facing
could
be solved. (01, 06)
I just need money to maintain my children and myself. (02, 04,
05)
The women would only break the silence when they were
escalating in violence and perceived increased threat or threat
of death.
In the past, he hit me with his fists so I tolerated it. But this
time he
used a hard object. I realized that the children and I were in

danger,
so I called the police. (01, 04)
However, the abused women reported mostly their negative
help-seeking experiences. These women complained that
their friends or relatives were not able to be empathetic to
their situation and suffering and complained that most people
could only offer unrealistic solutions and not practical help.
They said:
I told my family that my husband had beaten me, but they
blamed
and scolded me for having a conflict/arguing with him face-to-
face.
(02)
Some people advise me not to argue with my husband. But I
don’t
know how to avoid irritating him; I don’t even know what I do
sometimes that irritates him. (07)
I told one of my relatives about my circumstances, and she just
keeps
giving me advice without being truly concerned about my
feelings.

She just told me to move out. (01,05,09)
Three abused women also reported that they had negative
experiences when seeking help from police and doctors. Two
complained that the police belittled their feelings and
recommended that they compromise and reconcile with their
partners. The abused women said that doctors merely provide
treatment for injuries and are not concerned about their
feelings; after all, they cannot help solve their domestic
problems.
I called the police for help, but they only told us to stop
quarreling. I
begged them to help, but all they said was, ‘Just forgive him, all
men
are like him; being a woman, you should know’. The police
were,
like, forming an alliance with him. (01,07)
When the policeman came, he just told us that money is not a
problem, and that we could apply for social assistance. Since
then, he is no longer afraid of the police.

I don’t think physicians can help me; they only give me pain-
killers
and a physical check-up. They never ask me about the incidents
or
show caring. (05, 07, 08)
While there were abused woman who complained that social
workers did not offer realistic solutions or help, another had
a different experience and was appreciative of the support
from a social worker. This is what she said:
The social workers just told me to escape from violent scenes.
This is
impossible, for he can grab me. Another told me to get a
divorce. This
means they can’t help. (02)
I told a social worker that I have suicidal ideation. She
understood
that my emotion state was not stable, so she phoned me many
times,
enlightened me and taught me what to do. (07)
For some women, this interview provided an opportunity to
ventilate, and they appreciated the concern shown by the

interview nurse in the emergency department.
I would be suffering if I continued to hide this from others.
Now I feel
some relief. Of course, it is not appropriate to share my feelings
with
everyone. I really appreciate those who know how to comfort
me,
analyze my situation, and give me some advice. (03, 05, 08, 09)
The above suggests that victims do not receive the necessary
services until they are in danger. However, they had used the
interview as an opportunity to ask for help and information
and indicated their needs to the interviewer. They hoped that
nurses at the emergency department would provide them
with relevant information and expressed their appreciation to
those who listened and provided practical suggestions.
Discussion
This study aimed to explore the lived experience of women
who reported physical assault by their intimate partners at
the Accident and Emergency Department (AED) of a
regional hospital. Though the women in this study were

recruited in the AED, it is important to emphasise that
intimate partner violence is widespread in patient popula-
tions across different medical specialties. A study that
compared intimate partner violence among women in
hospital waiting rooms across medical specialties showed
that women in addiction recovery programmes reported the
highest rates of IPV, followed by those in emergency
departments and in obstetrics and gynaecology departments
(McCloskey et al. 2005). A large number of studies have
focused on the relationship between intimate partner abuse
and adverse pregnancy outcomes (Janssen et al. 2003) and
postnatal depression (Leung et al. 2002). Women who suffer
from intimate partner violence can present themselves in
different medical settings, including during pregnancy, thus
these women are not to be neglected.
violence

Psychological distress and decision to stay
The results of this study unveiled the feelings and lived
experiences of women suffering from IPV. The abused
women’s feelings of despair and helplessness were gradually
reinforced by the repeated violence of their husbands, their
self-insufficiency and their experiences of disclosure. They felt
helpless because they had no control over the violence
committed towards them. This feeling of helpless leads to low
self-esteem, depression and suicide attempts.
A previous study in the West suggested that the IPV cyclic
pattern usually went from tension rising to an abusive
episode, and then to a honeymoon period (Walker 1979,
Domesticviolence.org 2009). This honeymoon period
explained why victims repeatedly forgave their husbands, in
that the abusers usually apologised profusely, promising
never to do it again, professing love, crying and bringing the
victims flowers. However, this was not the case of women in

this study. This may be due to the cultural belief that Chinese
men do not necessarily view marital violence as a violation of
women’s rights, seldom apologise and do not show remorse.
Victimised wives with damaged self-esteem may not neces-
sarily feel that they have a right to complain (Yick &
Agbayani-Siewert 1997).
Chinese women choose to stay with the family for the
sake of their children and therefore allow themselves to
remain trapped in abusive relationships. The victims of IPV
in this study had endured the violence for years and
struggled to remain in their relationships. They had con-
flicting feelings and worried about the effect on children of
either parental separation or witnessing violence. They chose
to stay in the relationship to provide their children with ‘a
family’. It was the Chinese women’s belief that they should
obey and be good wives to their husbands and good mothers
to their children. A study among Mexican women also
found that women chose to stay in abusive families because

they worried about the psychological effects on their
children or chose to leave only when they thought the
abuser might become violent towards the children (Acevedo
2000).
Whether women can successfully leave their abusive
relationships depends on their ability to support themselves
financially after leaving (Lutenbacher et al. 2003). Even those
who had paid jobs were worried about their financial
situation and chose to stay. The reasons were that women
lived in the context of shared lives and the associated
resources. Leaving meant changing what they were used to
and could be perceived as threatening. It is a limitation of this
study that most women were from the lower social classes,
making it difficult for them to leave their homes.
Help-seeking behaviours and attitudes from professionals
Although women in this study expressed shame at disclosing
their experience, nearly all of them had told someone (family
members, policemen or social workers) before. They were

embarrassed to start the conversation about their violent
experiences because many were being ridiculed or prejudiced.
They were also disappointed that others were reluctant to
help, creating barriers to their help-seeking.
Women in this study reported that they would not have
sought help if they had not perceived a threat to their safety.
This is consistent with reports that most women tend to put
up with IPV until they perceive danger (Ellsberg et al. 2001).
When the abuse is less severe, women are more likely to
endure the pain of violence, withdrawing from the argument
or scene. When the violence became severe, involving the use
of deadly objects, the women would call for help. This
suggests that victims do not receive the necessary services
until they are in danger.
The women in this study were ridiculed when they told
others of their IPV experience, which was consistent with the
findings of other studies (Flinck et al. 2005). These women
complained that their friends or relatives were not able to

offer practical help. They were also disappointed with the
police officers and social workers, who were prejudiced and
underrated their experience. As a result, these women were
reluctant to seek help, believing that the ‘helping’ profes-
sionals could not offer help. Intimate partner violence is a
taboo subject in the mainstream Chinese culture of Hong
Kong. Health professionals, including doctors and nurses,
who hold the cultural belief that a ‘family affair is a private
matter and that other people should not intervene’ may
affect their compassion, empathy and their approach to IPV
victims and become reluctant providers (Inoue & Armitage
2006).
Although women expressed that they hoped that health
professionals would be able to help, none of them mentioned
their experience in approaching nurses for help related to
their IPV experience. However, the women who took part in
this study considered the interviews as a way to call for help.
This incident, which had resulted in their needing emergency

care, had opened up an opportunity for them to share their
experience with the interviewer, a nurse working on the
accident and emergency department.
Literature on the help-seeking of abused women from
formal support groups often refers to policemen, social
workers, medical personnel, crisis hotline workers, mental
health professionals, clergymen, women’s group advocates
and staff at women’s shelters (Goodman et al. 2003, Liang
et al. 2005). It is unfortunate that the nursing profession, the
AY Loke et al.
largest group of health professionals and comprised of mostly
women, is not included in the list of formal support for
abused women, even though in most circumstances nurses are
the first healthcare professionals to come into contact with
these women.

It has been reported that IPV victims are ashamed at
disclosing their situation but are willing to discuss their
problems if professionals approach them directly with respect
and a guarantee of privacy (Fraser et al. 2002). They also
value direct questions with nonjudgmental understanding
and support (Rodriguez et al. 1996). The acceptance and
appropriate response of nurses can encourage women to seek
help according to their needs.
The insensitivity of others and their reluctance to help
also hindered the abused women’s efforts to make the
decision to leave and seek help from others or to reshape
their lives. It is of concern that the perception of the general
public and the associated social stigma attached to IPV have
contributed to these women’s feelings of helplessness,
influencing their decision to stay in the abusive relationship
and compromising their help-seeking experience. A study
conducted in Thailand also shared this concern (Saito et al.
2009).

Assisting battered women to identify their health needs
The results of this study suggest that abusive relationships
had negative psychological effects on battered women.
However, these women mainly expressed their needs relating
to financial assistance and shelter arrangements to reshape
their lives. This is consistent with other studies (e.g. Shim &
Haight 2006). Women were concerned about the danger
lurking when they returned home. Others were not aware of
the resources available to help them.
These were women who had been injured acutely and
severely enough to seek medical treatment. The degree of
stress and disorientation experienced by these victims under
these circumstances also made it difficult for the interviewed
women to clearly articulate their needs and utilise their
problem-solving skills. Studies have found that IPV decreases
victims’ decision-making and problem-solving skills and
lowers their perceptions of self-efficacy and self-esteem
(Gianakos 1999, Yick et al. 2003).

Professionals should be astute in detecting, assessing and
identifying these women’s needs and should respect their
privacy and provide protective measures. Healthcare profes-
sionals, nurses working across medical specialties and the
police should be aware of the needs of these women and have
understanding of IPV and the importance of helping these
victims.
Conclusion
The findings from this study contribute to a better awareness
and understanding of IPV victims and their needs. Help-
seeking behaviours are usually triggered or hindered by
feelings of insecurity, an increase in the severity of IPV and
previous help-seeking experiences. IPV has severe impacts on
the physical and psychological health of victims that warrant
special attention from health professionals. The position
statements of the American Nurses Association (ANA 2008)
and the Emergency Nurses Association (ENA 2006) clearly
declare the prevention, assessment and research on violence

against women as healthcare priorities.
Health professionals may find themselves incapable of
handling these women, who usually present with multiple
social problems (Hamberger et al. 1998). It is not uncommon
for physicians to treat only the physical injuries, belittling the
abusive act, blaming the victim, finding excuses for the
abusive man and failing to make referrals to social workers or
follow-up appointments. Health professionals, particularly
nurses working in accident and emergency departments, who
are often the first to come into close contact with these
women in need of help should learn to overcome this obstacle
and approach suspected victims with assured respect and
sincerity.
Relevance to clinical practice
Early and effective interventions can reduce the negative
consequences of IPV and the likelihood of women tolerating
potentially fatal violence. The results of this study highlight
the deficiency of the healthcare sector in dealing with IPV

victims, and the influence of a cultural perception of IPV.
Helping professionals should play an important role in the
identification and management of victims of IPV. The
emergency department is the healthcare facility most likely
to be the first point of contact for women in abusive
relationships, for treatment of injuries or manifestations of
stress inflicted by IPV (Jackson et al. 2001, ENA 2006).
Alertness to presentations of possible IPV cases and under-
standing of women’s abusive experiences are paramount.
Screening for suspected IPV cases is essential for the early
identification of IPV victims. Asking questions directly about
IPV as a routine part of a patient’s history will help providers
become more familiar and comfortable with these difficult
questions (Lutenbacher et al. 2003).
A screening protocol for identifying and caring for IPV
victims is needed for effective and efficient service in the
protection of these victims. Health professionals should also
assess the physical and psychological health ramifications of

violence
these victims (Xu et al. 2001). There is a lack of culturally
appropriate instruments for assessing IPV against Chinese
women (Xu et al. 2001), and instruments from western
countries are therefore adopted, such as the most commonly
used tools for assessing IPV, the Conflict Tactics Scale (CTS)
and the Abuse Assessment Screen (ASS). Screening tools
adopted from other countries are often inadequate, as
translated phrases may not have the same meaning across
different cultures (Lopez 2001). It is important to incorporate
cultural values to reflect the realities of these women’s
experience and to adapt and develop an appropriate and
culturally sensitive screening tool for the assessment of IPV
(Kasturirangan et al. 2004, Xu et al. 2001).
The traditional Chinese cultural attitude of nurses and

other health care professionals regarding privacy and family
affairs has hampered their ability to recognise the need to
provide services to these IPV victims. Nurses and health
professionals should be empathetic towards these victims and
provide them with the needed respect and care. Educators
should take into consideration these cultural beliefs in their
curriculum to prepare health professionals who are capable
of managing these patients who are victims of intimate
partner violence (Chung et al. 1996).
Many battered women are revictimised when they return
home after seeking professional help. There is a need for
collaboration and communication between health profes-
sionals from the AED, social workers, the police and battered
women’s advocates for continual care. A cohesive community
response to IPV will tackle some of the barriers that women
encounter when seeking help. Interventions for these women
should include essential services such as assessment of home
safety before discharge, follow-up visits, counselling, infor-

mation about community resources and family-oriented
services to prevent revictimization.
Implications
Most nurses have no formal training in working with
domestic violence. An educational programme on IPV is
needed to promote acceptance and appropriate screening for
victims through an understanding of their feelings, appropri-
ate communication skills and effective interventions to
protect these victims.
Future studies should include women from different
settings, identification of high-risk groups, the association
between spouses’ personalities and violence, and male
perceptions of their violent behaviours. Particularly impor-
tant in further study is to explore the attitudes and percep-
tions of healthcare professionals towards intimate partner
violence.
Contributions
Study design: AYL, MLEW; data collection and analysis:

MLEW, AYL, MH and manuscript preparation: MLEW,
AYL, MH.
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