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The transtheoretical model of behavior change (TTM) has been extended to describe the process of change in victims of intimate partner violence (IPV); however, it has not been validated over time or in a population of women experiencing IPV who are not currently in shelter. This article examines the process of change in IPV victims longitudinally and identifies factors that may relate to staging and stage progression. Fifty-three women were enrolled on presentation to an emergency department for health care treatment and completed follow-up at 3 to 4 months. Measures of TTM staging, use of community resources, ongoing abuse, mental health, and social support were collected. Cluster analyses were conducted, and descriptive summaries of clusters and significant demographic, abuse, and outcome variables related to cluster membership are presented. A five-cluster solution was selected on the basis of parsimony, theory, and overall coherence with the data. Forward progression through the stages over time was related to both the use of community resources and ending the IPV relationship.
Keywords: intimate partner violence; stages of change; transtheoretical model ; medical advocacy; longitudinal studies
Intimate partner violence (IPV) is a pervasive public health problem (Basile, 2002; Caetano & Cunradi, 2003; Halpern, Young, Waller, Martin, & Kupper, 2004; Kramer, Lorenzon, & Mueller, 2004; Plichta & Abraham, 1996) involving physical violence, sexual violence, threat of physical or sexual violence, or psychological/emotional abuse occurring within the context of victim-perpetrator relationships among current or former intimate partners (Saltzman, Fanslow, McMahon, & Shelley, 2002). Findings from a representative telephone survey of 8,000 women and 8,000 men across the United States showed that as many as 1.9 million women are physically assaulted by an intimate partner each year (Tjaden & Theonnes, 1998). IPV is also a substantial burden to the health care system, resulting in an estimated $5 billion to $10 billion a year in physical and mental health care costs, lost productivity, and criminal justice interventions (American Medical Association, 1994; National Center for Injury Prevention and Control, 2003).
As health care institutions struggle to implement or maintain programs to assist IPV victims, it becomes crucial to effectively and cost efficiently match program goals with those of individual victims. Given the multiplicity of backgrounds, resources, and needs of each patient, however, promoting healthy change...