Intimate Partner Violence (IPV), Factors Influencing IPV, and Adverse Maternal Health among ...

221 Pages·2012·1.92 MB·English

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Intimate Partner Violence (IPV), Factors Influencing IPV, and Adverse Maternal Health among
Pregnant Thai Women

Division of Research and Advanced Studies
of the University of Cincinnati
In partial fulfillment of the requirements
for the degree of

Doctor of Philosophy
College of Nursing
April 2012
By
Treechada Punsomreung
B.S.N., Boromarajonani College of Nursing Praputhabat, 1993
M.S.N., Chulalongkorn University, 2000
Committee Chair: John Schafer, Ph.D.
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ABSTRACT
Background: Intimate partner violence (IPV) is recognized as a human rights violation
which has taken away certain rights of women; freedom from fear and want, to move, to be safe,
to be healthy, to live. IPV is of pandemic proportions because its prevalence is worldwide. In
Thailand, IPV and the safety of abused women remains a prominent problem. The World Health
Organization (WHO) studied women's health and domestic violence against women in several
countries including Thailand. The results revealed that 41% of women in Bangkok and 47% in
rural areas experienced physical or sexual violence at least once during their lifetime by an
intimate partner. IPV can occur at any time over a woman’s life, including during pregnancy.
IPV can lead to the risk of death for mother and unborn child. Victims of IPV, before or during
pregnancy, also face more complications of pregnancy. IPV during pregnancy is associated with
posttraumatic stress disorder (PTSD), depression, anxiety, increased use of cigarettes, alcohol,
and drugs, as well as later entry into prenatal care. Additionally, IPV impacts health care
delivery, economics, social services, the criminal justice system, and law enforcement.
Objective: The purpose of this research was to test a hypothesized model by using path
analysis to explain the relationships among IPV, factors influencing IPV, and adverse maternal
health.
Methods: The cross-sectional survey research design examined the direct effects of: a)
self-esteem; b) exposure to violence; c) acceptance of violence; and d) fear of partner on IPV
during pregnancy in pregnant Thai women and to examine the direct effect of IPV on adverse
maternal health using path analysis. The study was conducted at the Prenatal Care Unit at
Phraphutthabat Hospital, Saraburi Province, Thailand. Participants were selected by random
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selection. 304 pregnant women participated. Data were collected between June and September
2011 using one questionnaire composed of six sections. All instruments that were used in the
current study were tested for empirical construct validity and reliability. There were some
changes in some scales based on psychometric properties. Statistical Package for the Social
Science (SPSS/PC 20.0) and Mplus version 6.12 were used for data management and data
analysis.
Results: The fit indices indicated that the hypothesized model was not a good initial fit to the
observed data. The model needed to be modified based on theoretical reasonability and
modification indices. The fit indices indicated that the final model fit the observed data well (χ²
(7, N = 283) =12.865, p= .076, χ²/df = 1.84, RMSEA = .054, CFI = .980, and TLI = .941
Conclusions: Given the severe consequences and human costs and high economic costs of
IPV during pregnancy, these results suggest that many factors can be used to predict IPV during
pregnancy. Also, IPV during pregnancy has a huge direct effect on maternal health. Several of
these factors may represent potential targets for intervention. Strategies need to be developed for
effective interventions to reduce the incidence and prevalence of IPV and therefore promote
maternal health.
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Copyright 2012
Treechada Punsomreung
All Rights Reserved
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ACKNOWLEDGEMENTS
I could not have completed my journey without help from many wonderful people.
Without their support, I would not have come this far and completed this journey. First, I would
like to express my gratitude to my advisor and chairperson, Dr. John Schafer, for his guidance,
ongoing support, intellectual challenge, statistical expertise, encouragement throughout my
doctoral program, and belief in me. I also would like to express my sincere thanks to Dr. Donna
Shambley-Ebron for her positive support and attention to detail that she brought to the study.
Many thanks go to Dr. Bonnie Fisher for her insightful suggestions.
Also, I would like to thank to Dr. Carol Deets, Dr. Jan Dyehouse, Dr. Jean Anthony, Dr.
Edith Morris, Dr. Sue Davis, Dr. Yin Xu, and Dr. Susan Elek, my late previous advisor, for
teaching and supporting me from the beginning of my journey. Thank you to my cohort in the
doctoral program who shared this journey with brilliant discussion, especially to Dr. Kate York
and Carolyn Smith. I appreciate and treasure your friendship and support. You made my stay in
the U.S. so wonderful.
Also, I would like to take this opportunity to thank Praputthabath Hospital where I
collected the data. Special thanks go to the 304 participants, the chief nursing officer, and the
staff nurses at this site for their cooperation.
To my close friends, Dr. Kittiya Evans, Dr. Jinjutha Chaisena Dallas, and Sriprapai
Inchaithep, thank you for your assistance with tool development, translation, data analysis, and
for the warm support. Many thanks go to my Thai friends in Cincinnati – Dr. Mayom, Ple, Lynn,
Kob, Toy, and Steve. It is hard to list all the names here, but thanks to everyone for being so
supportive throughout all my endeavors.
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I would like to thank the Royal Thai Government and the University of Cincinnati for
financial support throughout these years. I would also like to acknowledge the generous funding
for my study from the Deets Dissertation Award and the Graduate Student Governance
Association Award.
Last, many thanks and love go to my parents for their faith, hope, and belief in me. Also,
thank you to my sisters, brothers-in-law, and relatives for their support and taking care of Mom
and Dad when I am far away. This dissertation is dedicated to them.
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CONTENTS
Abstract …………………………………………………………………………………….. II
Acknowledgements…………………………………………………………………………. V
List of Tables.………………………………………………………………………………. IX
List of Figures ……………………………………………………………………………… X
Chapter One: Introduction................................................................................................... 1
Introduction………………………………………………………………………………… 1
Problem……………………………………………………………………………………… 3
Purpose of the Study............................................................................................................... 7
Significance for Nursing…………………………………………………………………….. 8
Hypothesized Model………………………………………………………………………… 9
Definitions of Terms................................................................................................................ 10
Intimate Partner Violence (IPV)………………………………………………………… 10
Self-Esteem……………………………………………………………………………… 10
Acceptance of Violence………………………………………………………………… 11
Fear of Partner…………………………………………………………………………… 12
Exposure to Violence…………………………………………………………………… 12
Adverse Maternal Health………………………………………………………………… 13
Research Questions and Hypotheses....................................................................................... 14
Chapter Two: Literature Review…………………………………………………………. 17
Prevalence of IPV in General Population and Pregnant Women…………………………… 17
Worldwide……………………………………………………………………………….. 17
Thailand………………………………………………………………………………….. 17
Thai Culture Influencing IPV……………………………………………………………….. 22
Family……………………………………………………………………………………. 22
Religiosity………………………………………………………………………………... 25
Media…………………………………………………………………………………….. 28
Alcohol…………………………………………………………………………………... 30
Barriers to seeking outside help…………………………………………………………. 32
Relationships between Self-Esteem, Acceptance of Violence, Exposure to Violence, Fear
of Partner, and IPV………………………………………………………………………….. 34
Self-esteem and IPV…………………………………………………………………….. 34
Acceptance of Violence and IPV………………………………………………………... 38
Exposure to Violence and IPV…………………………………………………………… 42
Fear of Partner and IPV………………………………………………………………….. 45
Exposure to Violence and Fear of Partner……………………………………………… 48
Fear of Partner Mediating Exposure to Violence and IPV………………………………. 50
Relationships between Self-Esteem, Acceptance of Violence, and Exposure to Violence 51
Self-Esteem and Acceptance of Violence………………………………………………. 51
Self-Esteem and Exposure to Violence……………………………………………… 52
Acceptance of Violence and Exposure to Violence……………………………………… 53
Relationships between IPV and Maternal Health…………………………………………… 55
Pregnancy Complications……………………………………………………………… 56
Physical Health Problems………………………………………………………………... 61
Psychological Health Problems………………………………………………………... 64
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Philosophy Underpinning the Current Study……………………………………………….. 67
Summary…………………………………………………………………………………….. 69
Chapter Three: Methodology……………………………………………………………... 70
Research Design…………………………………………………………………………….. 70
Study Setting........................................................................................................................... 70
Sample....................................................................................................................... ………. 71
Measurements......................................................................................................................... 73
Self-Esteem………………………………………………………………………………. 73
Acceptance of Violence………………………………………………………………….. 75
Exposure to Violence…………………………………………………………………….. 77
Fear of Partner…………………………………………………………………………… 79
IPV……………………………………………………………………………………….. 80
Adverse Maternal Health………………………………………………………………. 82
Demographic Information and Pregnancy History……………………………………… 86
Data Collection……………………………………………………………………………… 86
Data Management and Data Analysis………………………………………………………. 89
Protection of Human Participants…………………………………………………………… 91
Chapter Four: Results……………………………………………………………………... 97
Participants............................................................................................................................... 97
Psychometric of Study Instruments…………………………………………………………. 97
Study Variables……………………………………………………………………………… 103
Univariate analysis……………………………………………………………………….. 103
Bivariate analysis………………………………………………………………………… 109
Path analysis……………………………………………………………………………… 111
Summary…………………………………………………………………………………….. 122
Chapter Five: Discussion…………………………………………………………………... 124
Discussion of the Study Findings…………………………………………………………... 124
Research Question One………………………………………………………………….. 124
Research Question Two………………………………………………………………….. 126
Research Question Three…………………………………………………………………. 138
Conclusion.............................................................................................................................. 139
Implications for Nursing…………………………………………………………………….. 140
Strengths and Limitations of the Study……………………………………………………… 143
Recommendations for Future Research……………………………………………………... 144
Summary…………………………………………………………………………………….. 145
References…………………………………………………………………………………… 146
Appendices…………………………………………………… …………………………….. 191
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LIST OF TABLES
Table 2.1 Pregnancy Complications in Victims of IPV …………………………………….. 60
Table 2.2 Physical Symptoms and Chronic Diseases in Victims of IPV…………………… 63
Table 4.1 Factor loading for Confirmatory Factor Analysis of the RSS…………………… 98
Table 4.2 Factor loading for Confirmatory Factor Analysis of the TAIPVS……………….. 99
Table 4.3 Factor loading for Confirmatory Factor Analysis of the TIPVFS……………….. 99
Table 4.4 Factor loading for Confirmatory Factor Analysis with Promax of Exposure to
Violence Scale………………………………………………………………………………. 100
Table 4.5. Factor Loading for Confirmatory Factor Analysis of the WHO Violence against
Women Instrument………………………………………………………………………….. 101
Table 4.6. Factor Loading for Confirmatory Factor Analysis with Promax of Negative
Physical and Psychological Heath…………………………………………………………... 102
Table 4.7. Internal Consistency Reliability Estimates of Instruments………………………. 103
Table 4.8. Frequencies of Participants Demographic Characteristics ……………………… 104
Table 4.9. Frequencies of Experience of IPV during Pregnancy and Exposure to Violence. 106
Table 4.10. Test of Normality of Study Variables………………………………………… 108
Table 4.11. Means, Standard Deviation, Range, Skewness, and Kurtosis of Study 108
Variables……………………………………………………………………………………..
Table 4.12 Variances, Covariances, Correlations, Means and Standard Errors of the Means 111
of the Study Variables in the Path Analysis…………………………………………………
Table 4.12. Kendall’s Tau Correlation Matrix of Study Variables…………………………. 111