TMC Spotlight: Judith McFarlane, RN, Dr.P.H., at Texas Woman’s University
JUDITH McFARLANE, RN, Dr.P.H., is a professor of nursing and the Parry Chair in Health Promotion and Disease Prevention at Texas Woman’s University. She speaks with Pulse about her passion for helping people, the roundabout way she began to study violence against women and a new smartphone app to help identify risk for abused women and their children.
Q | What motivated you to want to help people?
A | In his 1961 inaugural address, President John F. Kennedy said, “Ask not what your country can do for you, but what you can do for your country.” Two months later, he established the Peace Corps, and I knew it was going to be wonderful people who were going all over the world. I went right down to the Peace Corps office, but I was told I needed to get an education first. Well, I was 12 or 14 at that time, so that made sense! I went to college, got my nursing degree and went into the Peace Corps as a young nurse.
Q | What did you take away from your Peace Corps experience?
A | I wanted to see global nursing first-hand—culture and health—and how the two intersect. I was in Chile for a couple of years, and I got to learn some Spanish. I also met some inspiring people and developed a life-long interest in global health, especially in women’s health, because women are the central person for family and for community—the gateway for health.
Q | Where did you go after the Peace Corps?
A | When I came home, I worked at several universities, including the University of Arizona, the University of Georgia and the University of Florida. I ended up getting a Doctorate of Public Health from The University of Texas.
Q | How and why did you begin to study domestic abuse?
A | I got involved with domestic violence against women after being recruited to teach at Texas Woman’s University. At the time, we had one hour to teach domestic violence. This was 20 years ago, before we really appreciated the extent of the problem. I had a student ask me if women were abused when they were pregnant, and I said, ‘Yes.’ She asked how I knew, and I told her it was because I volunteered at a shelter. In fact, I was over at a shelter for abused women in Houston the night before and I had worked with two pregnant women. Then she asked me how often this happened, so we stopped class and went over to the library. At this time there were no word processors, no Internet, so we had to look in the card catalog, and we didn’t find any references, citations or books on how many pregnant women were abused. After that, the student said that she was going to graduate school and wanted to answer this question as part of her thesis. I always loved answering questions, so I worked with her, and we interviewed several hundred women in private hospitals and public health. We found that one in six women were assaulted or sexually abused during their pregnancy. That research went on to be published in the Journal of the American Medical Association in the early 1990s. It was a precedent-setting piece.
Q | Have you gotten any other questions from students over the years that inspired additional study and investigation?
A | A couple of years after helping my student study abuse during pregnancy, I had another student ask: ‘What effect does abuse have on the baby?’ Low birth weight is always a major issue in our country. If you start at a low birth weight, you are not likely to see your first birthday. You are also more likely to have long-term cognitive learning disabilities and chronic illnesses. I wanted to learn if women reporting abuse during their pregnancies because of stress or violence were more likely to not carry the baby to term or have a low-weight baby. We did another study in the Texas Medical Center of many hundreds of women, and, indeed, we found they were four times more likely to deliver a low-weight baby if they reported physical or sexual abuse during pregnancy. Not only is the pregnant woman affected by the abuse, but the child she bears is affected, too. So now we have two people to worry about.
Q | Tell us about your ongoing eight-year study of abused women—funded by the Houston Endowment—and the app you helped create called First Assessment Screening Tool (FAST).
A | I am leading the longest-ever study, in the sixth year of eight, to learn about what happens after women report abuse and reach out for help. What facilitates their healing and maximizes their children’s return to normalcy, and what can we as health care providers do when we detect that women are abused? Are their children at risk? To help answer these questions, we created the First Assessment Screening Tool, or FAST app, that can be used on a smartphone. It is ready for use by front-line providers and health care providers when women report violence. It was recently released in app stores and is the first app of its type in the world.
Q | Once you have determined the risk level for a woman and her children, what kind of help can they get?
A | Once they disclose, we give them resources on safety and places for them to go. The FAST app can facilitate that by getting a specific level of information about a woman’s safety and exposure to violence and her children’s safety and exposure. Children are affected differently depending on gender and age. Boys are more impacted than girls. We are not sure why, perhaps because their male role model is violent toward women, and they can’t protect their mother. Frequently they try to help their mother and get hurt. We want to track how this affects school, work and mental and physical health, so we can give evidence-based intervention. The FAST app is helping us tailor those interventions.
Q | What are the typical challenges faced by women who are victims of domestic abuse?
A | Women are affected differently depending on the support system they have, resources and pre-existing conditions. Post-Traumatic Stress Disorder is a common aftermath of the violence. It makes you sleepless edgy and lack focus, all of the factors you need to do a job, so it is hard for them to be employed and stay employed. Frequently, women go back to abusers. Not because they want to, but because they need them for shelter, food, and basic needs—to pay the utility bill. They are forced back into that dependency role because of the trauma, PTSD, the depression, anxiety or behavior problems of the children. They can’t move forward on their own to be economically solvent. It becomes a vicious cycle that reinforces his power over her. Violence happens because of power and control, and he has more than she does. It continues because of isolation. He isolates her so he can have things his way. She becomes shameful and embarrassed by the situation. Plus, she is scared and frightened, because he has told her, if you try to leave, you won’t see the children again. She stays because of fear and a perceived lack of options.
Q | What surprised you the most about your research?
A | I was surprised by the intergenerational impact. We didn’t realize how much children are impacted by exposure to the violence, and the long-lasting impact of the violence. It may be interrupted, but the impact goes on for a long period. We have years and years of data to document and chronicle the impact. It is one of the most important health problems in the world. It affects one in three women in the world.
Q | Where are you in your research?
A | We work with 300 women and children. About 93 percent of them have been with us since we started six years ago. I have a dedicated team of 12 that is in the field every day, and I carry 10 percent of the sample. We talk to ladies who are homeless, but we follow them, have safe contact lists for each woman and permission to contact them to find their whereabouts once or twice a year. We have women in 27 states and six foreign countries, but the majority are here in the Houston metroplex.
Q | What’s next for you?
A | I definitely want to extend the eight-year study to a 16-year study. As I told Houston Endowment, we have children who entered at two years old who will be 10 when the study concludes. We need to follow them through adolescence to look at delinquency, school dropouts and find out how their exposure to violence impacts them in early adulthood, in dating. We only know a few answers, and we have to know more if we are going to do right by our youth. I would like to continue this story. What we all aim for in the end is policy. I want the legislature to have evidence for violence intervention programs, so we make laws that work best. You want your research to inform policy, and policy is made with evidence.