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Disclosing victimisation to healthcare professionals in Sweden: a constructivist grounded theory study of experiences among men exposed to interpersonal violence
Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Thematic Studies, Technology and Social Change. Linköping University, Faculty of Arts and Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden .
2016 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 6, e010847Article in journal (Refereed) Published
Abstract [en]

Despite associations between being subjected to violence and ill-health being well known, most victims have never told health care professionals about their victimisation. Although both experiences of victimisation and help-seeking behaviour are gendered, male victims’ encounters with the health care system are under-researched. The aim of this study was to develop a theoretical model concerning male victims’ processes of disclosing experiences of being subjected to violence to health care professionals in Sweden. Constructivist grounded theory was used. Twelve men who had reported experiences of emotional, sexual, and/or physical violence by any type of perpetrator in an earlier quantitative study were interviewed. Conflicting thoughts within the men affected their likelihood of disclosing their victimisation. For example, a sense of urgency to seek help increased their likelihood, whereas shame and fear of negative consequences decreased their likelihood. Conformity to hegemonic masculinity had a strong negative influence, and was tipping the men towards a low likelihood of disclosing victimisation. Health care professionals strongly influence the disclosing process. For example, a good patient-provider relationship would help the men disclose, whereas a strong factor hindering disclosure was professionals’ adherence to gender norms, thus neither validating men’s experiences of violence nor acknowledging their psychological suffering.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2016. Vol. 6, no 6, e010847
Keyword [en]
Sweden; Violence; Abuse; Help-seeking; Screening; Gender; Masculinity; Constructivist Grounded Theory
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:liu:diva-114678DOI: 10.1136/bmjopen-2015-010847ISI: 000380237100066OAI: oai:DiVA.org:liu-114678DiVA: diva2:791964
Note

The status of this article was previous manuscript.

Funding agencies: Region Ostergotland, Sweden [LIO-340221, LIO-514621]

Available from: 2015-03-02 Created: 2015-03-02 Last updated: 2017-12-04Bibliographically approved
In thesis
1. Toward an integrated approach in research on interpersonal violence: Conceptual and methodological challenges
Open this publication in new window or tab >>Toward an integrated approach in research on interpersonal violence: Conceptual and methodological challenges
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: There is a growing understanding that different kinds of interpersonal violence are interrelated. Many victims report experiences of cumulative violence, i.e., being subjected to more than one kind of violent behaviour (sexual, physical, emotional) and/or violence from more than one kind of perpetrator (family members, partners, acquaintances/strangers). To gain a more comprehensive understanding of what violence entails for victims, how victims can be helped and how violence can be prevented, there is a need to learn more about the co-occurrence of violence. Also, despite strong associations repeatedly being found between exposure to violence and the reporting of different kinds of ill-health, only a minority of victims have told health care professionals about their victimization. Less is known about the process of disclosing victimization to health care professionals for men than for women.

Main aims: 1) Investigate the prevalence and co-occurrence of self-reported lifetime experiences of different kinds of interpersonal violence among male and female clinical and random population samples in Sweden (Study I-II). 2) Investigate whether cumulative violence is more strongly associated with       self-reported symptoms off psychological ill-health than with any kind of victimization alone (Study III).   3) Develop a theoretical model concerning male victims’ process of disclosing experiences of victimization to health care professionals in Sweden (Study IV).  

Method: The self-reported prevalence of interpersonal violence as well as self-reported symptoms of psychological ill-health were estimated by means of secondary analyses of data collected with the NorVold Abuse Questionnaire (NorAQ). Both sexes were represented in clinical (women n=2439 men n=1767) and random population samples (women n=1168 men n=2924). Descriptive statistics as well as binary logistic regression and ordinal regression analyses were used (Study I-III). In study IV, constructivist grounded theory was used, and 12 men were interviewed concerning their experience of disclosing victimization to health care professionals.

Results: A large proportion of victims (women: 47-48%, men: 29-31%) reported experiences of more than one kind of violent behaviour. Many also reported being subjected to violence by more than one kind of perpetrator (women: 33-37%, men: 22-23%). Reporting cumulative violence had a stronger association with symptoms of psychological ill-health than reporting only one kind of victimization. In study IV, the interviewed men’s own perceptions and considerations beforehand (e.g., perceived need for help and feelings of shame), as well as the dynamics during the actual health care encounter (e.g., patient-provider relationship and time constraints), were essential for understanding the process of disclosure. Also, the men’s own conformity to hegemonic constructions of masculinity and professionals’ adherence to gender norms had a strong negative influence on the men’s process of disclosure.

Discussion: Experiences of cumulative violence were common. Prevalence rates of experiences of different kinds of interpersonal violence were compared to previous studies on interpersonal violence in Sweden. Large discrepancies were found between all studies, which is a symptom of methodological and conceptual difficulties within the research field. Violence is a gendered phenomenon. Differences were seen in the kind of violence men and women reported. In addition to this, the results in study IV indicate that gender affects how violence is perceived and how victims are treated by health care professionals.

Conclusion: Integrated approaches in research on interpersonal violence, as well as in clinical work, are needed. If the co-occurrence of violence is ignored, it may hamper our understanding of the experiences and consequences of interpersonal violence for victims. More research is needed into what produces the differences found in prevalence rates between studies to improve the methodology.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. 99 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1434
Keyword
Violence, Abuse, intimate partner violence, Poly-victimization, Re-victimization
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-114605 (URN)10.3384/diss.diva-114605 (DOI)978-91-7519-156-0 (ISBN)
Public defence
2015-04-01, Berzeliussalen, Campus HU, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Funder
Swedish Research Council, 521-2007-3011
Available from: 2015-03-02 Created: 2015-02-27 Last updated: 2016-04-06Bibliographically approved

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Simmons, JohannaBrüggemann, Adrianus JelmerSwahnberg, Katarina

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