Conspicuous invisibility: A grounded theory approach to exploring the discovery and disclosure of violence against women attending general practice

Background Violence against women is recognised as a common problem worldwide. In Ireland, general practice is the first health service many women access. However, it was unknown how the general practice team (GPT) namely,... [ view full abstract ]

Background
Violence against women is recognised as a common problem worldwide. In Ireland, general practice is the first health service many women access. However, it was unknown how the general practice team (GPT) namely, general practitioners, practice nurses and administrators identified the issues and how women made known their circumstances of domestic violence (DV) during a clinical consultation.

Aim
This study explored how the GPT discovered (or not) women who experienced DV from an intimate partner and how women were enabled (or not) to disclose their circumstances during general practice consultations.

Methodology
Using a grounded theory approach, 30 in-depth interviews were conducted with the GPT and women. Data were analysed in accordance with grounded theory methodology. Health professionals’ clinical experiences of discovering (or not) violence against women and women’s experiences of living in abusive relationships informed the data. Ethical approval was obtained from Dublin City University and permission to interview women was obtained from the relevent support organisations.

Findings:
The findings identified the complexities of engagement and conspicuous invisibility. General practice consultations were influenced by factors concerning both the organisation and the person: Firstly, choreographing the consultation where engagement occurred through the iterative process of dance. Secondly, spiralling silences gave voice to the process of engagement (or not) with the issues during clinical consultations. Thirdly, compartmentalising identified how the setting of general practice both hindered, or enhanced the process of discovery and disclosure of violence against women.

Conclusion and Implications:
A theory of conspicuous invisibility illuminated our understanding of negotiating engagement between women in abusive relationships and the GPT which was conceptualised as "lifting the stones and seeing the slugs beneath." The theory refers to the experience of the GPT being physically present for the consultation, but not being wholly present, or not looking and enquiring about issues of domestic violence. Engagement was illustrated at three levels: 1) non-engagement 2) first impression engagement or ‘on the face of it’ engagement and 3) purposeful engagement or delving beneath what presented in the consultation. Implications for practice demonstrated the need for education by the GPT on the subject.