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. Author manuscript; available in PMC: 2025 Aug 1.
Published in final edited form as: Int J Ment Health Nurs. 2024 Feb 7;33(4):1003–1012. doi: 10.1111/inm.13294

Intimate Partner Violence in the lives of Indigenous and Black Women in the Upper Midwest of the United States During the COVID-19 Pandemic: a Mixed Methods Protocol Examining Help-Seeking Behaviors and Experiences

Alexa A Lopez 1, Anne Dressel 2, Jeneile Luebke 3, Joni Williams 4, Jennifer Campbell 5, Jessica Miller 6, Jennifer Kibicho 7, Diane Schadewald 8, Hanan Abusbaitan 9, Anna Pirsch 10, Kaboni W Gondwe 11, Erin Schubert 12, Ashley Ruiz 13, Peninnah Kako 14, Lucy Mkandawire-Valhmu 15, Leonard E Egede 16
PMCID: PMC11260249  NIHMSID: NIHMS1958782  PMID: 38323681

Abstract

Violent behavior perpetrated against women has long-lasting negative physical and mental health consequences for women, their children, their families, and their communities. Intimate partner violence (IPV) is associated with many adverse physical, psychological, and emotional consequences. Structural racism and historical trauma affect women’s trust and further hinder the ability of Indigenous and Black women to seek help after experiencing IPV. The availability of IPV support services, which can include shelter, food, group therapy, legal assistance, and advocacy, can be inaccessible to women due to the inability to access often limited resources in urban environments and reasons compounded by potential geographic distance if living in rural areas or living in community. Understanding the unique reasons why Indigenous and Black women do not seek help, and the barriers they experience when seeking help after IPV, is critical. Pandemics have the potential to create further complexities on how IPV is experienced. Black and Indigenous women experiencing IPV were therefore at even greater risk for IPV-related harm because of state and local “stay at home” measures put in place to minimize the spread COVID-19. The purpose of this manuscript is to explicate the methods for a large R01 study in the Upper Midwest.

Keywords: Black, Community Resources, COVID-19, Indigenous, Intimate Partner Violence

1. Introduction/Background

The World Health Organization (WHO, 2021) has identified intimate partner violence (IPV) as a serious and widespread public health concern, which impacts women globally. The WHO estimates that 27% of women aged 15–49 years around the world have experienced some form of physical or sexual violence by their intimate partner (WHO, 2021). Violence against women can have grave consequences for their health, including long-term mental and physical health challenges that affect women, as well as their families, children, and communities. Examples of adverse health outcomes include depression, disrupted sleep, post-traumatic stress disorder (PTSD), substance misuse or abuse, suicidal ideation, and decreased productivity, among other emotional, psychological, and physical health consequences. (Campbell, 2002; Dillon et al., 2013; Gone, 2012). Structural racism and historical trauma have implications for the trust that Indigenous and Black women have in the systems they must navigate in order to access help and support, and thus further hinder the ability of Indigenous and Black women to seek help after experiencing IPV (Hulley et al., 2022). Structural racism has been defined as “macro-level societal conditions that limit opportunities, resources, and well-being of less privileged groups on the basis of race/ethnicity and/or other statuses, including but not limited to, gender identity, sexual orientation, disability status, social class or socioeconomic status (SES), religion, geographic residence, national origin, immigration status, limited English proficiency, physical characteristics, or health conditions” (Alvidrez & Tabor, 2021). Historical trauma is defined as cumulative, multigenerational, collective experiences of trauma and emotional injury in communities and descendants (Brave Heart et al., 2012).

1.1. Indigenous Women

In the United States (U.S.), 66.4% of Indigenous women have experienced emotional or psychological abuse by an intimate partner; and 55.5% have been subjected to physical violence by an intimate partner, according to the U.S. National Intimate Partner and Sexual Violence Survey (NISVS) (Rosay, 2016). Compared to other groups in the U.S., the highest rates of homicide are perpetrated against Indigenous women. Homicide is the sixth-leading cause of death among Indigenous women aged 20–44; more disturbingly, it is the third-leading cause of death among young Indigenous girls, aged 1–19 (Heron, 2018). These sobering statistics about violence on the health and well-being of Indigenous women make addressing violence experienced by them especially urgent. Many Indigenous women have left tribal land and now reside in racially segregated inner-city environments where they experience social isolation in environments wrought with racialized disinvestment and resultant poor social, educational, and health outcomes. Racialized disinvestment in urban metropolitan areas in regions such as the Upper Midwest of the United States manifests as gentrification, racial segregation, or racial displacement. This is especially true during a global pandemic, in which experiences of IPV have been exacerbated and help-seeking becomes even more complicated.

1.2. Black Women

Black women in the U.S. also suffer disproportionately from IPV, with results from the NISVS finding that 41% of Black women experienced physical IPV at some point in their lives. Black women often bear the brunt of the most lethal violence, with homicide being one of the leading causes of death for Black women aged 44 and younger (Smith, 2017). For example, in 2022 in Milwaukee County, Black women constituted the majority (77.6%) of homicides and related deaths due to domestic violence (Schubert E, unpubl. data, 2023) in a county with only 26.2% of the overall population being Black. Approximately three-quarters of African American women had experienced IPV, based on findings from a community-based study with nearly 500 African American women who provided care for adolescents living in extreme poverty(Mugoya et al., 2020). Mugoya points out that African American women residing in urban locations tend to be underrepresented in studies focused on IPV even though they experience IPV at higher rates (Mugoya et al., 2020). As is the case for Indigenous women, urban metropolitan areas have a unique landscape that impacts Black women’s livelihoods and their ability to seek help. Milwaukee, Wisconsin, one of the areas involved in the current study, is considered one of the most segregated cities in the U.S. (Rosenblatt & Cossyleon, 2018), with extreme inequalities in health and social well-being for approximately one-quarter of the population who identify as Black. Segregation entails not just the spatial division of communities but also the unequal division of wealth, thereby limiting resources available to predominantly Black communities. This leads to unequal access to higher education and thus limited employment opportunities. This extreme segregation manifests in poor health outcomes for Black women (Lee, Donley, Ciesielski, et al., 2021).

1.3. Resource Access

IPV support services, which can include shelter, food, group therapy, legal assistance, and advocacy, can be inaccessible to women due to potentially limited resources in urban environments and reasons compounded by potential geographic distance if living in rural or reservation-based areas (Hawkins, 2017; Klevens et al., 2008). Those living in urban locations may have barriers to accessing resources including socioeconomic status and other social determinants of health, lack information about services, or there may simply not be adequate community resources available to meet the needs of the population. For women living in rural areas, poverty intersects with isolation and places Indigenous and Black women at greater risk for poor health outcomes when they experience IPV. Neither Indigenous nor Black women ordinarily seek help after IPV due to the potential for severe negative impacts such as injury or even loss of life, in addition to the mistrust of systems (Satyen et al., 2019). We define help-seeking as women’s ability and willingness to access care through hospitals, other community health facilities, or domestic violence agencies, including through the support of social workers and police officers, which are often classified as formal services where women seek help following an experience of IPV (Satyen et al, 2018). Informal supports may include family, friends, neighbors, and online resources.

Understanding the unique reasons why Indigenous and Black women do not seek help, and the barriers they experience when seeking help after IPV, is critical. Apart from the health risks noted earlier, the literature is clear that ongoing IPV places women at increased risk of developing a mental health condition, including self-harming behavior, suicidal ideation, eating disorders, other anxiety and mood disorders, substance abuse, and sleep disturbances (Childress, 2013; Evans-Campbell et al., 2006) Additionally, IPV also impacts women’s quality of life, including the ability to perform self-care, education, employment, and women’s overall well-being and contributions to society (Stockman et al., 2015).

1.4. Impact of COVID-19 on IPV

Experiences of IPV can become more complex due to pandemics, such as COVID-19, Prior to the COVID-19 pandemic, the Milwaukee metropolitan area was already seeing an uptick in homicides, with twice as many occurring by mid-2020 compared to the same time in 2019 (Luthern, 2020). In 2020, two of every five homicides were IPV-related (Luthern, 2020). In Wisconsin, IPV advocates noted complex trends, which mirrored those at national and global levels, where higher rates of women were calling crisis lines, but fewer women sought help from relevant agencies (Luebke, 2020; National Institute of Health, 2023). Thus, the rates of IPV seemingly increased, and women were trapped at home with the people causing them harm, unable to seek necessary help for their experiences of IPV. The risk for lethality increased as opportunities for seeking help were made less accessible (Luthern, 2020). Black and Indigenous women experiencing IPV were therefore at an even greater risk for IPV-related harm because of state and local “stay at home” measures put in place to minimize the spread COVID-19.

Unemployment of the abuser is a major risk factor for intimate partner homicide (Campbell et al, 2003), and the increased unemployment that resulted from COVID-19 restrictions increased danger to abused women. During a pandemic, such as during COVID-19 where quarantine measures are being enforced, home is not necessarily the safest place for many women. Constant messaging by health officials and the media of “Safer at Home” can inadvertently send an erroneous message that ignores or minimizes the violence that may be occurring in the home. These messages also do not convey how emotionally challenging it can be for survivors, who are traumatized because of being trapped at home with their abuser, and how increased isolation minimizes women’s ability to seek help.

Preliminary findings based on data collected by an investigator on this study indicated that Indigenous women in urban Wisconsin were hesitant to access services from both healthcare and social service agencies, for fear of contracting COVID-19 (Luebke, 2020). This led to women experiencing poorer health outcomes with injuries sustained due to not having alternatives to being with an abusive partner. Fear of seeking shelter or services during the pandemic was exacerbated by the fear of becoming ill (Luthern, 2020). Fear of acquiring infection was based on the fact that ethnic minority populations are at greater risk for contracting COVID-19 or experiencing severe COVID-related illnesses. The persistence of racial inequalities and historical trauma have directly contributed to health disparities between Indigenous and White populations (Sequist, 2020). According to the CDC, hospitalization rates and death attributed to COVID-19-related illness were highest among Indigenous and Black persons, followed by Hispanic or Latino persons (CDC, 2023).

To our knowledge, there are no studies examining the experiences of both Black and Indigenous women on a large scale and garnering their experiences of IPV during the pandemic. Our study is transferable and generalizable to not only Indigenous and Black women but to women globally in terms of understanding the unique presentation of IPV and how women navigate barriers to help-seeking during a pandemic, disaster, or under extraordinary circumstances. This new body of knowledge will be invaluable to healthcare providers, social service agencies and policymakers, in minimizing barriers and enhancing protections for women in the event of a pandemic in future.

We recognize that previous work has examined barriers to help-seeking, such as stigma, fear of retaliation, or guilt (see Wright et al., 2022). There is also a previous line of research that has considered cultural factors (e.g., Ocampo et al., 2007; Rizo & Macy, 2011). However, based upon the statistics regarding the rates that Indigenous and Black women experience violence, the Upper Midwest region has unique characteristics in terms of how these populations experience violence and engage in help-seeking. While studies from other parts of the country could translate to the Upper Midwestern context, it is important that we center women’s voices in acknowledging their unique experiences and in the development of interventions that are specific to their unique needs.

Understanding the barriers and facilitators to help-seeking can help prevent future violence in already dangerous relationships up to and including homicide. Connection to services can be vital to preventing a relationship characterized by IPV turning lethal. Among the 49 domestic violence homicides and related deaths in Milwaukee County in 2022, two thirds (66.7%) were couples that were unknown to the domestic violence agency as well as unknown to law enforcement (Schubert E, unpubl. data, 2023). In other words, the first time professionals became aware of an issue in these relationships was when someone was killed. Victims in these relationships endured IPV and coercive control without connecting to professional help for the issue. The current study will help us better understand what some of those barriers to help seeking were, particularly for Black and Indigenous survivors.

1.5. Aims

The purpose of this mixed-methods, community engaged study is to systematically document barriers to help-seeking for IPV during the COVID-19 pandemic among Indigenous and Black women in urban and rural Wisconsin. Specific aims are to: 1.) systematically describe the unique and intersecting structural, economic, and interpersonal facilitators and barriers to help-seeking for IPV during COVID-19 among Indigenous and Black women in urban and rural Wisconsin; 2.) quantitatively analyze characteristics associated with help-seeking behaviors among Indigenous and Black women in urban and rural areas of Wisconsin; and 3.) generate actionable recommendations for systems change to reduce barriers to help-seeking through the creation of a community advisory board.

2. Methods/Design

2.1. Conceptual Framework and Study Design

Our study is informed by Black and Indigenous feminist thought, which are inherently intersectional and speak to how patriarchy interacts with colonialism and racism to impact women’s experiences of help-seeking following IPV (Cannon et al., 2020). We selected these feminisms based on input from community partner agencies that use the principles of Black feminist thought and Indigenous feminist thought, respectively, because they are consistent with their organizational philosophies. These feminist frameworks are also valuable because they incorporate historical processes that inform the racism and sexism that contextualize Indigenous and Black women’s experiences of IPV as well as their capacity for help-seeking.

Figure 1 below summarizes in pictorial form our recruitment strategy over the life of the study along with the structure of our specific aims. The figure also identifies the main systems central to our analyses. These include the healthcare system, community services, and the criminal justice system. Being able to access help in the form of health care, social services, and through the criminal justice system is important to minimizing the impacts and sequalae of IPV and improving health outcomes for women (Satyen et al., 2018). This figure also incorporates concepts that are central to Indigenous and Black feminist thought. It should be noted that development of our conceptual framework is ongoing as is data collection. Further discussion of our developing conceptual framework is provided elsewhere with additional explication of the intersection of these three systems and how Indigenous and Black women navigate them (Ruiz et al., 2021).

Figure 1.

Figure 1.

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Overview of aims with method, recruitment, and analysis outcomes

It is vitally important to systematically document help-seeking during the COVID-19 pandemic to analyze the pandemic’s impact on women’s ability to access services and to promote their health and well-being. Our study uses a mixed-methods, community engaged approach to systematically examine facilitators and barriers to help-seeking for IPV during the COVID-19 pandemic among Indigenous and Black women in urban and rural Wisconsin. We are utilizing a mixed-methods approach in order to provide a more robust understanding of these experiences through the integration of both the qualitative interview and quantitative survey findings. A convergent parallel design is being used for data collection and analysis, with areas of convergence or divergence being identified following study completion. Based on preliminary data from community partner agencies in the Milwaukee metropolitan area, we hypothesized that during the COVID-19 pandemic, these barriers were exacerbated and situated women in dangerous, isolated environments that placed them at greater risk for even worse health outcomes, including homicide.

2.3. Inclusion and Exclusion Criteria

To be eligible for the study, participants must be at least 18 years of age, identify as Indigenous or Black, self-report to have been in an intimate relationship for at least three months in which they experienced IPV since March 2020, when the COVID-19 pandemic began, and have the mental capacity to provide informed consent. There is no formal clinical mental health screening being conducted at recruitment. Women are excluded if they self-report that they have an active and acute episode of severe mental illness that could affect their ability to provide informed consent (e.g., untreated/uncontrolled major depression, bipolar, psychosis, schizophrenia), do not identify as Indigenous or Black, or have not been in a relationship in which they experienced IPV since the beginning of the pandemic. Women are recruited to participate in surveys and individual and focus group interviews. They can complete one or both aspects of the study (e.g., quantitative survey, qualitative interview), based on their preference and availability.

2.4. Recruitment

Recruitment began in July 2022 and will last through 2025, during which time we have been and will continue to recruit different samples of women and engage in data collection through surveys, focus groups, and individual interviews. This approach enables us to understand the impact of the pandemic on women’s experiences and on help-seeking behaviors over time. Recruiting from different sites at which women access help in rural and urban areas, while also recruiting women who have not accessed services, will enable us to gain an understanding of women’s various help-seeking behaviors and the unique presentation of barriers across various sites and across geographic areas. Those who are already in touch with resource agencies will be recruited through flyers at these locations, as well as through word of mouth from advocates. Women who have not yet accessed services will be recruited through word of mouth, flyers placed in the community, and online social media postings.

2.5. Qualitative Interviews and Focus Groups

A total of 300 women are being recruited for the focus group and individual interviews. As mentioned by one of the reviewers of the grant proposal, this is the first study of its kind, of which we are aware, that systematically analyzes the experiences of help seeking among women who are most predisposed to violence during a global pandemic, which will provide critical data to inform safety interventions in the event of a future pandemic. More importantly, of note is that there are 11 federally recognized American Indian Tribes in the state of Wisconsin. The experiences of IPV and help-seeking across women of different tribes is different even before we account for their geographic location. Our sample therefore constitutes a diverse statewide sample of not only Indigenous but also Black women in both rural and urban areas of the state. It will be important that we achieve saturation for the various samples of women enrolled in our study, hence the importance of targeting a large sample. Our team has vast experience conducting large qualitative studies. With the necessary resources, we are fully capable of comprehensively conducting a statewide study that will advance the science and inform the work of healthcare and social service agencies seeking to meet the needs of survivors of IPV in the U.S. Our initial plan was to start with surveys so that the initial survey data would help us determine how to approach our interviews with women; however, our community advisory board (CAB) expressed concern about the survey tools and their appropriateness for Indigenous and Black survivors of IPV. It took time to determine the most appropriate survey tools for use in the study. We therefore began with the qualitative inquiry portion of the study first.

The interviews currently being conducted include women who access various types of services, to deepen our understanding of the diversity of help-seeking in women’s lives, following IPV. Women are given the option of participating in focus group interviews or individual interviews, which are audio recorded and transcribed by an outside transcription agency. On average, interviews are expected to last approximately 60 minutes in length depending on the modality (i.e., individual interview or focus group). The length of the interview also depends on how much women are willing to share. We are sensitive to the fact that this is a very heavy topic for women and that while women have expressed the desire to contribute to meaningful change in support of other survivors by participating in our study, actually discussing their experiences of intimate partner violence can be difficult. We allow participants to share as much as they are able, which also determines the length of the interview. Ultimately, we have been able to garner rich data and to date, we have reached saturation for the data collected through interviews with Black women in urban areas. Interviews are conducted either in person at our community resource organizations, over the phone, or virtually. Some women have indicated that they want to maintain their privacy, and not share their experiences in a group setting. Women who have experienced IPV are oftentimes under the control of the perpetrator who uses their power to control the survivor in harmful ways. Providing women with an opportunity to make a choice about how they want to talk about their experiences is one way of creating space for women to take back their power, especially for women whose ability to control their own lives and to make their own decisions has been subjugated. We are thus keeping the option of engaging in a focus group or individual interview open to women. Individual interviews are also valuable because they allow for the creation of a space where women who would prefer to speak privately about their experiences can do so. Black and Indigenous feminist thought informed development of the interview questions. Initial questions posed to women are more general and focused on their well-being: what life is like for them generally and their experiences during the pandemic. As rapport is established, questions more directly focus on their experiences of living with IPV, how and when they accessed services, how they came to know about services in their community and the barriers and facilitators to help-seeking. We also explore, through interviews with women, their interaction with other agencies in the community including law enforcement and health care and how their access to these resources or lack thereof impacts their health, safety, and well-being. In asking these questions, we are able to gather data that can lead to the implementation of more effective strategies for health care for a more effective response not only during pandemics but also more generally, taking into account that both populations of women that we are targeting experience not only the highest levels of violence of any ethnic group, but also the most disparate outcomes following IPV experiences (Decker et al, 2019; Fedina et al, 2018). This is especially critical to Indigenous and Black women who are disproportionately affected when it comes to violence against women and whose communities were also disproportionately affected by the COVID-19 pandemic. Analysis will be conducted using ethnographic coding (LeCompte & Schensul, 2010). Through the data gathered from interviews with women, we anticipate themes focused on the various barriers and facilitators to help-seeking. We also anticipate intersecting themes related to poverty, race and racism, and gender and how these manifest during extraordinary circumstances to impact women’s help-seeking when they are experiencing IPV. We will diagram qualitative similarities and differences between women in rural versus women in urban areas of the state; women who sought help and women who did not. In our analysis, we seek to identify patterns of experience that begin to build a cultural portrayal of help-seeking during and after a pandemic from women’s viewpoints.

The qualitative component of the study is yielding knowledge about where women in both rural and urban areas of the state ordinarily go to seek help when they are experiencing IPV and whether their help-seeking is effective in ensuring better health outcomes. Knowledge garnered from this study will also offer guidance as to where investments need to be made in terms of public services. It is important to note that while the study and approach are parameterized through deductive application of theory, inductive methods allow the data to speak for themselves. As such, we expect to garner additional valuable knowledge from the data to inform how to best support Indigenous and Black women who have experienced IPV during the COVID-19 pandemic, that we did not necessarily anticipate.

2.6. Quantitative Survey

To achieve Aim 2, we are conducting a survey of 600 women recruited during the study period. Through our recruitment methods, women are invited to complete a survey, which is administered in person or over the phone. All items on the survey were agreed upon by the research team and the CAB. The survey questionnaire asks, as potential predictors or co-variates, participant demographics including age, age at first marriage, duration of marriage/relationship, ethnicity, insurance status, highest education level, number of living children, and employment status. We are also inquiring about sense of safety during COVID-19 (independently developed), racism experiences (Landrine & Klonoff, 1996), food insecurity which is adopted from Hunger Vital Sign, the first two items from the Household Food Security Survey Module (HFSSM) and three original questions (Economic Research Service- US Department of Agriculture, 2012), experiences of IPV related specifically to the pandemic (independently developed), and a lethality assessment (Campbell, 2005). We also use five measures of the dependent variable (i.e., help-seeking behaviors), including: 1.) a binary variable based on response to the question: Have you ever tried to seek help? (Yes/No); 2.) If the participant answers “Yes”, they will be asked: From whom have you sought help? List formal institutions including healthcare systems (emergency room, primary care provider), social services, and criminal justice (police), religious leaders, or informal sources (own family, partner’s family, friends, neighbors, and current/former partners, and others); 3.) Participants are asked to indicate their actual past use of formal and informal help-seeking strategies: hotline/therapist/counselor, police, order of protection, shelter, medical care, clergy/minister/rabbi, and friend/relative; 4.) Help-seeking endorsement score in which we ask them to rate how likely they would be to seek help or advice when experiencing IPV from: friend (not related to you), parent; other relative/family member, health professional (e.g., psychologist, psychiatrist), neighbor, phone help line (e.g., Lifeline), family doctor/GP, domestic violence shelter, counseling, or a call to the police, someone else not listed above, or if they would not seek help from anyone; and 5.) Helpfulness beliefs measure, in which we ask participants to rate how helpful the strategies will likely be if used in the future on a 9-point scale ranging from 1 (not at all likely to be helpful) to 9 (totally likely to be helpful). Items will be averaged to reflect a mean helpfulness score. The association between help-seeking behavior outcomes and demographic factors will be analyzed. Univariate tests will be used to compare the proportion of help-seeking experience, the list of formal agencies participants contacted, and the list help-seeking strategies between Indigenous versus Black and rural versus urban by using Chi-square tests. To evaluate the interaction between ethnicity and location, one-way ANOVA tests will compare help-seeking endorsement scores and helpfulness belief scores across the four subgroups (AI, rural; AI, urban; Black, rural; and Black, urban) and Chi-square tests will compare help-seeking experience, the list of formal agencies participant contacted, and the list of using formal/informal help-seeking strategies across the four subgroups. Generalized linear mixed effects models for each outcome will evaluate other demographic factors and adjust for other factor effects. The model will include fixed effects for AI versus Black, rural versus urban, waves by default, and other factors selected by using a stepwise selection procedure.

2.6.1. Database Creation and Management

The Research Electronic Data Capture (REDCap) database is being used for data entry and management. REDCap is a secure application that allows for online data entry and management. Data entry is completed by the researchers.

2.7. Community Advisory Board

In keeping with community engaged and feminist methodologies that call for research that is transformative, a CAB of diverse stakeholders has been convened to offer guidance on the research methods and study implementation, as well as guidance on how to implement solutions in the communities to enhance the health, well-being, and safety of Indigenous and Black women. The CAB includes women from tribal communities in both rural and urban Wisconsin; community advocates working in the violence space; and women who openly identify as survivors of IPV. We identified and invited CAB members based on their participation in community resource centers as well as through personal connections. In keeping with community engaged research, members of the CAB are compensated for the time they spend attending meetings and doing the work of the advisory board. Meetings of the advisory board are held in a space where individuals representing different segments of society come together to provide tangible, workable, and effective actionable solutions to addressing IPV in the lives of Indigenous and Black women. This includes spaces at the agencies where advocates work and where women seek help following experiences of IPV. This also includes spaces where data are being collected with women for the current study. The CAB also plans to work with the academic team to verify the analyses of data that will then lead to intervention mapping. Finally, the CAB will also assist with recommendations for health policy and intervention through meetings with the research team.

2.8. Ethical Considerations

This study was approved by the Institutional Review Board at University of Wisconsin-Milwaukee. Verbal informed consent was obtained from all participants and documented by the research team. No identifying information is being collected from participants to maintain their anonymity and confidentiality. We have also developed strategies for harm prevention throughout multiple stages within the study, including input from our CAB, recruitment methods that prioritize the safety of the women, and the safety of our study team members (Mkandawire-Valhmu et al., under review).

3. Discussion

Data collected from the quantitative surveys and through the focus group and individual interviews will be used to understand barriers to help-seeking and the long-term impact of the pandemic on women experiencing IPV. As previously noted, the data collected are useful in informing interventions that need to be considered to prevent future violence and to address IPV during future pandemics. The knowledge obtained will also be generally useful for addressing IPV in the lives of Indigenous and Black women particularly in relation to minimizing barriers to help-seeking. For example, the data will be used to understand how women become aware of available services and resources in their communities for help-seeking, how these services can be more accessible, and how best to tailor services and interventions to be more culturally appropriate. Based on the findings from this study, and with input from the CAB, a representative sample of Indigenous and Black women will be provided a summary of proposed future interventions to elicit their perspectives regarding: 1.) the importance of the intervention; 2.) the feasibility of the intervention in their communities; 3.) the cultural relevancy and appropriateness of the intervention, and 4.) their reactions to the intervention components. Responses from the women will be used to outline and develop an intervention informed by them and deemed most appropriate for meeting their specific needs. Subsequent interventions will then be based on feedback from the women in areas such as structure, format, services, and topics. Our goal for the current study is not to implement or test an intervention but rather to inform the development of workable interventions that could be tested in follow-up studies. Future interventions need to include anti-racist educational opportunities for healthcare providers as part of continuing education - as this is one of the key barriers to help-seeking for Indigenous and Black women. Determining how to rebuild trust between women and Black and Brown communities and healthcare providers is critical.

4. Conclusions

The basic, descriptive knowledge gathered from this study is foundational to informing how community-based agencies as well as healthcare and social service institutions, can structure their services to better meet the needs of women and can inform new policies related to the management of pandemics and other such extraordinary circumstances in ways that support Indigenous and Black women experiencing IPV.

5. Relevance for Clinical Practice

It is imperative to meet the clinical needs of survivors of IPV. By understanding more about help-seeking behaviors and barriers, clinicians such as nurses can better direct these survivors to community resources and advocates that can assist with navigating these complexities. The findings from this mixed methods study, with the input of our CAB, will provide evidence for interventions to better assist Indigenous and Black survivors of IPV.

Funding Source:

This study is funded by NIMHD 1R01MD016388-01.

Footnotes

Conflict of Interest: The authors have no conflicts of interest to report.

Ethics Approval: This study has been approved by the IRBs at the University of Minnesota and the University of Wisconsin-Milwaukee.

Contributor Information

Alexa A. Lopez, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI;

Anne Dressel, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI;.

Jeneile Luebke, School of Nursing, University of Wisconsin, Madison, WI;.

Joni Williams, Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI;.

Jennifer Campbell, Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI;.

Jessica Miller, School of Medicine, Medical College of Wisconsin, Milwaukee, WI;.

Jennifer Kibicho, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI;.

Diane Schadewald, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI;.

Hanan Abusbaitan, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI;.

Anna Pirsch, School of Nursing, University of Minnesota, Minneapolis, MN;.

Kaboni W. Gondwe, School of Nursing, University of Washington, Seattle, WA;

Erin Schubert, Sojourner Family Peace Center, Milwaukee, WI;.

Ashley Ruiz, Edson College of Nursing and Health Innovation, Arizona State University; Phoenix, AZ,.

Peninnah Kako, University of Wisconsin-Milwaukee, Milwaukee, WI;.

Lucy Mkandawire-Valhmu, School of Nursing, University of Minnesota, Minneapolis, MN;.

Leonard E. Egede, Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI;

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