Knowledge, Information Empower Abused Women

The message on her office voice mail was barely audible, but the nurse could tell it was a woman who was crying and in need of help.

Only a few weeks earlier, the tearful woman had been at a Harris County Hospital District clinic. She told the nurse then that her husband of nine years used to abuse her, but in the last 12 months, the beatings had stopped.

Now, her face was swollen and bruised, and she was too embarrassed to see a doctor.

But she remembered the research nurse who had asked her about domestic violence, and she felt comfortable enough to meet with her again and enroll in a study that is designed to empower women with knowledge and resources and protect them from abuse.

The University of Texas Health Science Center at Houston recently was awarded a $1.97 million grant by the Agency for Healthcare Research and Quality to study whether nurse case management and education can save women from domestic violence.

"It's not just a study. It's a service," said Dr. Janet Groff, assistant professor and research director of family practice and community medicine at The University of Texas Medical School at Houston.

Dr. Groff is directing the research with Dr. Judith McFarlane, who is the Parry Chair in Health Promotion and Disease Prevention at Texas Woman's University Institute of Health Sciences-Houston College of Nursing.

Dr. Nancy Pomeroy, of The University of Texas School of Public Health at Houston; the Harris County Hospital District; Houston Area Women's Center; and Women, Infants and Children clinics operated by UT-Houston, are assisting in the trial.

Since February, research nurses Ruby Holm, Bertha Ortiz and Nancy Palomarez have screened more than 5,000 women between the ages of 18 and 44 for abuse. Presently, 200 women have enrolled in the study, which is being conducted at four UT-Houston WIC clinics, which provide services for low-income women with children younger than 5, who are at nutritional risk.

The research also is being carried out at the Acres Homes and Aldine Health Centers, which are operated by the Harris County Hospital District.

"Best estimates are that one in two women will experience physical or sexual abuse from an intimate partner at least one time in her life," Dr. McFarlane said. "Domestic violence is not an issue. It's an epidemic. We need to develop effective interventions that will help these women who have been identified as abused."

All women who visit the health centers will be given an abuse assessment screening and a referral card from the Houston Area Women's Center, which includes telephone numbers and information on what to do in the event of domestic violence.

A nurse will ask each patient if, in the last 12 months, she has been physically or sexually abused by an intimate partner. If a patient discloses that she recently was battered, she will be invited to participate in the research.

Drs. Groff and McFarlane said the referral card will serve as the standard care intervention for half of the 360 women who eventually will be enrolled in the trial.

"Violence is all about power and control," Dr. McFarlane said. "Give her information, and information is power. She will be able to establish some sort of balance, and that gives her more control to end the violence."

Nurses will serve as advocates and case managers for each of the women in the second intervention group. If a woman needs help coming up with a safe escape plan or maneuvering through the legal system, a nurse will help her overcome obstacles. The nurse also will frequently check on each woman's progress and safety.

The nurses will reassess participants every six months during a 3-year period to monitor their health and safety. The researchers, including project coordinator Jennifer O'Brien, also will examine how children of abused women are affected by the interventions. Additionally, they will calculate the cost-effectiveness of such programs.

In contrast, one hundred women in the same age and socioeconomic group who have not experienced recent physical abuse will be followed for three years. This group will allow the researchers to determine how much of an effect abuse has on the well-being of women entered in the trial.

"To us, success would be a decrease in the severity and frequency of abuse," Dr. Groff said. "We are assessing people's safety and helping them to promote safety."

To participate in the study, call Dr. Groff at (713) 500-7590 or Dr. McFarlane at (713) 794-2138. If you or someone you know needs help, call the National and Domestic Violence hotline at 1-800-799-7233 or the Houston Area Women's Center hotline at (713) 528-2121.

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©2006 Texas Medical Center

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