Key findings in this study included the tension between denial and acknowledgement, varying views between the FCVs and MCLs, and the role of healthcare providers in amelioration. Several participants accepted the existence of IPV in the community at large, with a simultaneous denial of its existence within the participant’s home or family. Even when IPV was acknowledged, there was minimization of the problem. In addition, there were disparate FCV and MCL definitions and causes of IPV. FCVs emphasized control-based and sexual violence while MCLs defined IPV as having psychological and physical dimensions. FCVs saw cultural and gender norms as having a strong influence while MCLs felt that IPV was caused by jealousy, rumor and gossip. These differences are set amongst two unique groups of participants at varying levels in the community hierarchy. Despite their roles as community healthcare volunteers, the low literacy rate and relatively low community status of the FCVs as women are likely to influence their perspective. Responses from the FCVs on control-based violence and the influence of gender roles and cultural norms reflect a sense of immediacy as IPV has a pervasive influence on these participants’ lives and those of the women they serve. In contrast, as community leaders, male participants have a predefined role with higher levels of literacy and status and did not describe direct contact with IPV.
Further, the disparity in FCV and MCL definitions and causes also emphasize the importance of education and the involvement of varied genders and social roles in the design and execution of prevention programs. These differences suggest that education and prevention programs should be designed uniquely for target audiences. In this study, men were from the privileged class. Further research is needed to determine the role of gender and class in this context. Others have found that while females perceive male privilege and control as a significant contributor to IPV perpetration, males perceive traditional definitions of IPV (physical and psychological abuse) (Jewkes 2002
). As a solution, comprehensive IPV prevention approaches have emphasized the establishment of new narratives of gender, power and relationships (Parks et al. 2007
) Previous research suggests that cognitive-behavioral approaches may be effective in the establishment of new constructs relating to gender norms for male IPV prevention (Crooks et al. 2007
Participants identified health as a potential means to prevention. Their suggestions align with a traditional public health model and provide practical next steps for the community in addressing IPV. Participants suggested incorporating preventive education with existing public health activities. There was an identified role for both FCVs and MCLs with suggestions that they could meet with and educate the police. In addition, healthcare volunteers and community leaders could become sources of information for victims and perpetrators of IPV and facilitate their connection with the judicial system.
The identified role of healthcare as a bridge to IPV prevention is pertinent given the challenges to legal interventions in rural and developing communities compared to an urban setting. Existing literature demonstrates that in rural areas in developed and developing nations, the criminal justice system is seen as less helpful in addressing IPV (Shannon et al. 2006
). In rural Latin America, inadequate laws, excess bureaucracy, little privacy, a lack of specialized personnel and sense of slowness for emergencies contribute to the problem (Sagot 2005
). Further difficulties with the legal system in Latin America include the establishment of a two-track legal system, which criminalizes through penal code definitions while diverting offenses into legal arenas that tend towards the downgrading of social violence (Macaulay 2006
). Members of the San José community acknowledged that distance could perpetuate the challenges noted above. Their concerns are connected to research that suggests existing legal constructs can perpetuate fear and re-victimization, which is a central challenge in encouraging IPV victims to speak out (Garcia-Moreno 2002
Given FCV participant concerns regarding fear and re-victimization, women’s empowerment and momentum for change are worth mentioning. Women in the community of San José are often home alone for months while men go out to work as migrant farmers. Hence they reportedly run a household independently and experience safety within the home. When the men return with money and alcohol, violence often follows. For that reason the women are motivated to make changes in their homes that will continue when the men return.
The empowerment and engagement of FCVs in IPV prevention are consistent with published attempts to promote the establishment of female solidarity groups and support networks in Latin American nations including Mexico (Castro et al. 2008
; Pick et al. 2006
) and Nicaragua (Ellsberg et al. 2000
; Ellsberg et al. 2001
; Wessel and Campbell 1997
). In a comprehensive study spanning ten Latin American nations including Honduras, researchers found that optimal support for IPV victims came from women’s organizations that connected women’s health and legal rights (Sagot 2005
). Further research in Mexico demonstrated that women feel more comfortable turning to other women for help such as their mother or a mother figure, rather than turning to formal support services (Fawcett et al. 1999
). In the context of the previously established role of our study’s FCVs as “madreguías,” or “Mother-guides,” these suggestions are reinforced by our findings.
IPV prevention must also be addressed in a culturally sensitive manner. While the study was conducted within the context of an existing partnership between UR-DFM, a United States/Honduran NGO and a rural Honduran community, there was potential for mistrust and perpetuation of inequality. The partnership is forged on the guiding CBPR principles of enhancing community motivation and engaging in collaborative problem solving with an acknowledgment that the community members are the experts. The project aims to improve health for the community while maintaining sustainability. The authors endeavored to incorporate these core principles and aims at all stages of the study. The CBPR model was chosen for its emphasis on developing solutions through collaborative research, planned action, along with process and outcome evaluation (Israel et al. 2005
), while remaining accountable to the community of San José. While CBPR can help to address issues of inequity, there are additional limitations to this study including the PI’s male gender, outsider status and limited time to build trusting relationships. These limitations had the potential to inhibit open discussion among female focus group participants in particular. Further, the lack of professional facilitator training may have limited the PI’s effectiveness in following up salient points during discussion. It is also possible that this patriarchal culture had increased respect for males and physicians among study participants. An additional limitation is the lack of professional translation during the course of the interviews and focus groups. However, given these limitations, the findings nonetheless find support for community readiness to engage in interventions.
The results of this study contribute to the sparse literature on IPV in rural and Latin communities. The preponderance of prior studies examine IPV in urban jurisdictions rather than rural ones. Within this limited literature, however, there is one comprehensive examination of IPV cases in both urban and rural areas across several Latin American countries. That particular study aligns with the findings in our study as the authors describes the weaknesses of the legal sector in responding to IPV in rural jurisdictions, highlighting the role of health care systems as a bridge to IPV prevention. The authors found that existing women’s organizations provided the best support for IPV victims, especially those addressing women’s health and legal rights. In addition, existing research highlights that women’s organizations tend to lack information, skills and policies to respond to IPV and therefore would benefit from education and empowerment programs (Sagot 2005
The study’s findings can inform IPV prevention in a variety of settings. This rural Honduran community can incorporate these results to address IPV prevention in San José, which could be relevant to IPV prevention in rural areas and amongst other culturally diverse communities. These findings may also be relevant in immigrant communities in developed nations depending on degrees of acculturation. The success of our efforts in conducting these discussions illustrates the importance of a community-centered, culturally sensitive approach. Prevention programs with an emphasis on community education and the re-evaluation of gender and cultural norms may have merit. Female community members, particularly community healthcare volunteers, can be empowered further to bridge health and legal sectors in addressing IPV.