A woman writing on a pad with others standing in the background
Photo by UN Women (cc license).

Initial Considerations for culturally competent screening

  • Proper use of an interpreter can facilitate the disclosure of violence or the potential for violence in the lives on non-English speaking patients.  Using the patient’s family members, friends, or partner to interpret when asking about domestic violence puts the patient’s safety at risk. 
  • Interview patients alone
  • Providers should be aware that patients may not feel comfortable disclosing abuse for many reasons.  These include:
    • Fear of authority
    • Fears related to being an undocumented alien
    • Lack of familiarity with the medical and/or legal system
    • General unease in the medical setting
    • Cultural/religious norms about disclosing abuse to people outside of the family or community of origin

Culturally Sensitive Screening and Risk Assessment

Framing the Questions

  • Using open-ended questions is crucial to cultural sensitivity.  In order to work effectively with any battered woman, we must ask open-ended questions rather than read the abuse victim a list of things we can do for her.
  • Many women minimize abuse as a survival mechanism and will volunteer more information if they receive culturally sensitive encouragement.
  • When asked broad questions, almost all women will describe what they need and fear from their own cultural perspective.
  • Review confidentiality.

Asking the Questions

  • In the U.S., it is against the law for your partner to threaten, hit, kick, or punch you. Does this ever happen to you?  I will not tell your partner or any member of your family or friends what you are telling me.
  • General Questions: “Do you ever feel unsafe at home?”; “Have you ever felt afraid of your partner?”; “Has anyone at home hit you or tried to control you?”; “What are your concerns about your partner’s reaction?”

Planning for safety, offering support, and making referrals

  • “I’m glad you told me.  We see many patients in similar situations.  We can help.”
  • “What are your safety needs, fears, and concerns while you continue to live with your partner?”
  • “Do you have a safety plan?”
  • “What are the means your partner might use to continue controlling your life?”
  • “Do you know where you could get help if you or someone you know was being hurt by a partner?
  • “Would you like more information about domestic violence?
  • “There are safe places to go if you are experiencing violence at home.  Would you be interested in talking to someone about going to a safe place?

Types of Abuse and Tactics Abusers May Use That May be Unique to Women from other Cultures:

  • Convincing her that if she seeks help for the violence, he will get custody of their children (men are given legal control over the children in many countries.)
  • Convincing her that his violence actions against her are not criminal unless they occur in public.
  • Threatening to have someone harm her family members in her home country.
  • Threatening to do or say something that will shame her family or cause them to “lose face”.
  • Isolating her from friends and family; Being the only person through whom she can communicate in English; Not allowing her to meet with social workers or other support persons; Not allowing her to meet with people who speak her language or who are from her community, culture, or country.
  • Threatening to report her to INS if she is undocumented or threatening to sabotage the documentation process.

Domestic Violence as a Crime

  • In a victim’s native country, domestic violence may be legal, and in many countries people are fearful of the police and other authorities.
  • The victim may believe that she cannot receive help.  In her home country, it may be that the person with the most money and the strongest political connections wins – usually the man.

Religious Beliefs and cultural expectations

  • In many cultures, women are responsible for keeping the family unit intact. She may be blamed for family disintegration, and shunned by friends and family members for talking about the abuse.