Table 2.

Intimate Partner Violence: Major Themes and Subthemes Identified from PCP Interviews

Theme	Subthemes
Routine screening for IPV in clinical practice is not commonly performed	There was no standardized interval for screening. Some providers do not believe they should ask everyone about IPV. Lack of time and competing priorities, inadequate training, and discomfort with IPV prevents screening. PCPs were not convinced that screening for IPV would be helpful, due to a lack of effective resources for referral and follow-up.
Lack of consensus on the prevalence of IPV may contribute to practice variation in IPV management in rural primary care settings.	Rural PCPs inaccurately estimated the prevalence of IPV in their clinical populations. Rural PCPs perceive emotional abuse as more prevalent than physical abuse.
PCPs inquire about IPV when it is suspected, i.e., when “alarm” is raised	Psychological distress and somatic symptoms are the most common presenting complaints among women with IPV. IPV is suspected when partner control tactics are observed.
Rural PCPs use several appropriate counseling and referral techniques when addressing IPV among their patients	Validation and providing information - reassuring the patient that she is believed, not alone and not to blame for abuse – are key features in rural IPV-related care provided by rural PCPs. PCPs reported assessing for acute safety considerations and engaging in safety planning with their patients. PCPs referred to local resources and worked to develop a follow-up plan for women.
Rural populations present unique challenges for women to receive care for IPV on multiple levels – the PCP, patient, and the community	Acceptance of traditional gender roles prevents women in rural communities from seeking help for IPV. Lack of privacy in small rural communities is an important barrier to accessing care for IPV. Stigma and low self-esteem prevent rural women from accessing care for IPV. Patients may not consider primary care as a place they can go for help with IPV. Low socioeconomic status and financial dependence on the abuser in rural communities prevent women from receiving care for IPV. PCPs believe that community-level interventions are needed to help rural women who have experienced IPV. Lack of referral services to assist with the care of their patients who experienced IPV was an additional resource barrier for PCPs to address IPV with their patients. Interaction with the criminal justice system presents a challenge for rural PCPs who have identified women exposed to IPV.