Developing a framework for understanding the pathways and trajectories of housing instability and poor health among women experiencing intimate partner violence

Intimate partner violence (IPV) has been associated with poor health and housing instability (HI) among women, however little is known about the pathways and trajectories of this interrelationship. We draw on the grounded theory to better understand these interconnections among low-income women in Ontario, Canada. We conducted in-depth interviews during 2010-11 with 41 women (ages 18- 45 years) residing in diverse geographic settings.  As a consequence of experiencing IPV, all women suffered from depressive symptoms combined with other health problems. Thematic analysis revealed multi-tiered pathway with complex trajectories acting between IPV, HI and poor health.  The trajectories included material HI (homelessness, high mobility, evictions, problems paying rent, hiding and landlord discrimination), psychological HI (feeling unsafe, low self-esteem, and poor control) and social trajectories affecting their social determinants of health (financial problems, loss of employment, income or social networks and leaving school).  These trajectories were further characterized by elevated stress and decreased self-care (unhealthy behaviors, substance abuse, and reduced medical compliance). Depending on her specific context, each woman experienced these pathways and trajectories differently. Moreover, the women’s experiences differed across three time periods: before, immediately after, and long after leaving an abusive relationship. The complex multi-tiered pathways we found suggest that achieving stable housing for these women can only be accomplished through multi-sectorial policies acting on the social determinants of health to tackle the multiple social and health problems they face as a consequence of IPV.