Intimate Partner Violence (IPV) and sexual violence are serious andwidespread problems all around the world. According to a multi-countrystudy, 15-71% of women reported experiencing physical and/or sexualviolence by an intimate partner at some point in their lives (Garcia-Moreno, Jansen, Ellsberg, Heise, & Watts, 2006; World HealthOrganization [WHO], 2010a). Moreover, in Asian countries, 41-61% ofrespondents reported intimate, physical, and/or sexual, violence duringtheir lifetime (Raj & Silverman, 2002 and Yoshihama, 1999, as cited inYoshihama & Dabby, 2009). Regarding the prevalence of IPV in Iran,psychological violence, sexual abuse, and physical violence were reportedin 82.6%, 43.7%, and 30.9% of respondents respectively (Vakili, Nadrian,Fathipoor, Boniadi, & Morowatisharifabad, 2010). Another study reportedpsychological violence in 81.4% and sexual abuse in 42.5% ofrespondents (Faramarzi, Esmailzadeh, & Mosavi, 2005). On the whole,79.7% of women reported IPV (Nouri et al., 2012).

To clarify what is meant by violence and IPV in this study, here thedefinitions provided by the United Nation (UN) and WHO arepresented. UN (2010) defines violence against women as a “any act ofgender-based violence that results in, or is likely to result in, physical,sexual or mental harm or suffering to women, including threats of suchacts, coercion or arbitrary deprivation of liberty, whether occurring inpublic or in private life.” WHO (2012) defines IPV as a “behavior byan intimate partner or ex-partner that causes physical, sexual or psychologicalharm, including physical aggression, sexual coercion, psychologicalabuse and controlling behaviors” (WHO, 2012).

IPV has serious consequences from which we can trace mental, sexualand reproductive health problems for victims and their children. Alsothere is a high social cost, and headaches, back pain, abdominal pain,fibromyalgia, gastrointestinal disorders, limited mobility and poor overallhealth, as well as both fatal and non-fatal injuries are results of IPV(WHO, 2011). Besides, violence against women is one of the limitationsto attaining development goals, and the resulting economic costs are anotherfactor that indicates the importance of violence against women’sissues (International Center for Research on Women, 2007; WHO,2011).

Education, acceptance of violence (attitude towards violence), community-level factors, traditional gender norms and social norms supportiveof violence are some of the risk factors associated with intimatepartner violence (Abramsky et al., 2011; Andersson, Ho-Foster, Mitchell,Scheepers, & Goldstein, 2007; WHO, 2010a). For example, Bangladeshhas the world’s second-highest rate of domestic violence against women,but older women believed that men have the right to abuse their wivesand they said that “There is no domestic violence act in Bangladesh”(Akhter & Ward, 2004). Mahapatra (2012) indicated that women withmore social support reported less abuse by their partners. A study onKoreans and Vietnamese in southern California showed that women hadless pro-violent attitudes than men. 23.7% of Koreans and 13.4% ofVietnamese agreed that a husband should have the right to punish hiswife, and 3.5% of Koreans and 10.2% Vietnamese agreed that “Somewives seem to ask for beatings from their husbands” (Kim-Goh &Baello, 2008). Another study by Kim-Goh and Baello (2008) indicateda negative relationship between education levels and attitudes towardIPV. In Bangladesh, a study on 1,200 women indicated that 67% ofthem had experienced domestic violence at sometime in their lives and35% had experienced it in the past year. Participants believed womenwith more education are less vulnerable to IPV (Bates, Schuler, Islam,& Islam, 2004). All this evidence illustrates the importance of social factorslike education, attitude, social norms, and traditional norms in IPV.Therefore, the importance of primary prevention of violence by intimatepartners is often overshadowed by the importance of the large numberof programs that, understandably, seek to deal with the immediate andprevalent results of violence (WHO, 2010b). According to WHO guidelines,“To achieve change at the population level, it is important to targetsocietal-level factors in the primary prevention of intimate partnerand sexual violence. Approaches include the enactment of legislationand the development of supporting policies that protect women, addressingdiscrimination against women and helping to move the cultureaway from violence - thereby acting as a foundation for further preventionwork” (WHO, 2010a, 2010b).

Understanding and identifying situations and settings in each countryare important in preventing IPV, this fact is emphasized by WHO(2010a). In addition, Harvey, Garcia-Moreno, and Butchart (2007) statedthat prevention of IPV requires understanding the circumstances andfactors that influence IPV; changing individual knowledge, attitude, andbehavior, enabling social environment, including non-violent socialnorms; and finally, responsive and protective community institutions.Several studies have been carried out in regard to IPV in Iran. Behnam,Moghadam Hoseini, and Soltanifar (2008) showed that 92.4%, 6.9%,and 7% of women reported very mild, mild, and moderate IPV,respectively. Another study showed that the prevalence of IPV beforepregnancy was 51.7% and a woman’s not having finished high school,living in an extended family, and her husband’s not having finished highschool were some risk factors of IPV (Mohammadhosseini, Sahraean, &Bahrami, 2010). Taherkhani, Mirmohammadali, Kazemnejad, and Arbabi(2010) found that the prevalence of domestic violence against womenin the previous year was 88.3%. Moreover of the women who reportedabuse; 25.4%, reported physical abuse, 87.3% reported emotional abuseand 39.1% reported sexual abuse (Taherkhani, Mirmohamadali,Kazemnejad, Arbabi, & Amelvalizade, 2009). Although there have beensome studies in Iran that looked at violence, little is known about therole of attitude, subjective norms, and enabling factors related to IPV.As we can see through all of these factors in the BASNEF model, thismodel was chosen for studying IPV in Sabzevar, Iran.

BASNEF model

Beliefs, Attitudes, Subjective Norms, and Enabling Factors are themain constructs of the BASNEF model introduced by Hubley for understandingbehaviors in health communication. A person’s attitudes arethe consequences of individual beliefs and the values about the consequencesof certain behavior (Hubley, 1993, as cited in Ray, 2006). Infact, attitudes and beliefs are influenced by mass media, values, traditions, and experiences (Hubley, 2004, as cited in Story & TenBroek,2005). “The subjective norms consists of the net balance of the perceivedattitudes of other people concerning the act” (Hubley, 1998).Indeed, beliefs about influential people that cause certain behaviorsmake subjective norms (Hubley, 1993, as cited in Ray, 2006), and subjectivenorms are also influenced by family, community, social network,and culture. Enabling factors include health services, transportation, andemployment (Hubley, 2004, as cited in Story & TenBroek, 2005). In theBASNEF model, in order to change behavior, the availability of enablingfactors is necessary. Behavioral intention is formed from attitudesand subjective norms (Hubley, 1993, as cited in Ray, 2006). TheBASNEF model constructs are summarized infigure 1.

Figure 1 
BASNEF model for understanding behavior.

(Hubley, 1993, as cited in Heather, 2005)

The BASNEF model is very useful in understanding the role of valuesand beliefs in health behavior (Hubley, 2004, as cited in Story &TenBroek, 2005). In the BASNEF model, an understanding of the influenceson behavior can lead to interventions that go beyond family, community and national levels and consider both educational, social, economicand political changes (Hubley, 1993, as cited in Ray, 2006). Hubley(1998) states that the “BASNEF model can be used to design health educationprograms based on an understanding of the community.”

Similar theories have been tested in IPV fields, but the BASNEFmodel has not been tested in this field. Kernsmith (2005) applied the“Theory of Planned Behavior” in a cross-sectional study to examine therelationship of attitudes toward behavior, social norms, and behavioralcontrol with violence behavior in an intimate relationship. Moreover, the“Theory of Reasoned Action” applied by Natan (2011) in a correlationalquantitative study to understand the factors that influence the decisionof Ethiopian women to report domestic violence provides another toolto examine the relationship of societal attitudes to IPV. This studyfound that the decision to report violence was not influenced by women’sattitudes, but rather by family and social welfare workers. Nabi,Southwell, and Hornik (2002) have investigated the beliefs related to domesticviolence from a “Theory of Reasoned Action” perspective, butdid not find any significant relationship between beliefs and behavior ofviolence. Tolman, Edleson, and Fendrich (1996) conducted a study thatexamined men’s attitudes toward behavior, men’s understanding of others’expectations about violence, and men’s beliefs about perceived controlof abusive behaviors in trying to predict men’s intentions towardviolence against women. In addition, they considered violence thatwomen had reported. Their study provided that the “Theory of PlannedBehavior” to stop men’s violent behaviors had moderate predictive abilitiesregarding intent toward abusive behaviors. With respect to understandingIPV behaviors and importance of preventive approach in IPV,this study examined the application of the BASNEF model in predictingIPV to answer the main research question: “Can the attitudes, subjectivenorms, enabling factors, and the intention to go to a health center toseek help and ask for consultation predict IPV?”

Based on the results taken from the questionnaires, demographics variablesare presented intable 1. The Chi-square test did not show anysignificant relationship between IPV and women’s job, whether she wasa housewife or worked out of the home (p > 0.05). According toKruskal Wallis test, there was a relationship between IPV and the levelof women’s education (p = 0.007), as well as the level of husband’s educationand IPV (p = 0.03).

For the five types of IPV, 76.7% psychological violence, 97.1% negotiationviolence, 28.1% injury violence, 63.8% sexual violence and 45.2%physical violence were reported. However, among 207 (98.6%) womenwho reported violence, 40 respondents (19%), 25 women (13.3%) experiencedall types and only one type of violence, respectively. Differentintensities of IPV are presented inchart 1.Table 2 shows the correlationsof the study variables. All of the predictor variables showed significantcorrelations with IPV measures, except enabling factors.

Structural Equation Modeling

Standardized total effects of intention and subjective norms were0.280 and 0.216, respectively (p = 0.01). Attitudes and enabling factorstotal effects were not statistically significant. Posterior predictive p-valuein the BASNEF model was 0.49, which is acceptable.

Figure 2 shows the model according to standardized direct effects, 24% and 28% of IPV variation explained by subjective norms and intention,respectively (p = 0.01).

Figure 2 
Path analysis of BASNEF model with Standardized Direct Effects

Sb: subjective norms, att: attitudes, enn: enabling factors, inte: intention, DD: IPV

Table 1 
Descriptive Statistics for demographics Variables

	Descriptive variables
	Women age	Husband age	Marital duration	Number of children
Number Mean(SD)	210 26.86 (5.53)	210 31.22(6.20)	210 7(5.5)	210 1.42(.89)
	Descriptive variables
	Women education			Woman’s employment
Frequency (%)	Lower than middle *school 53(25.2)	High school diploma ** 108(51.2)	University 23.6(49)	Housewife 188(89.8%)	Employee 22(10.2%)

* Middle school: literacy up to 7 years of official education

** High school diploma: literacy between 7 to 12 years of official education

Table 2  
Pearson Correlations among the variables of BASNEF model

	IPV	Subjective norms	Attitudes	Enabling factors
Subjective norms	0.218**
Attitudes	0.170*	0.183**
Enabling factors	-.057	0.037	0.012
Intention to go health centers	0.269**	-0.061	0.083	-0.107

* Correlation is significant at the 0.05 level (2-tailed).

** Correlation is significant at the 0.01 level (2-tailed)

Chart1 
The frequency percentage of domestic violence intensity

This study examined the application of the BASNEF model, includingattitudes toward IPV, subjective norms, intention to go to health centersand enabling factors in predication of IPV. The findings of the presentstudy indicate that this model predicts IPV only partially. One studyabout the theory of planned behavior application showed that this modelwas not appropriate for women, but appropriate for men (Kernsmith,2005). Similarly, Natan (2011) found that the theory of reasoned actionpredicted violence partially, and another study found that beliefs relatedto IPV correlated with the intention to act out violent behaviors, butrarely with reported actions (Nabi et al., 2002). Tolman et al. (1996)concluded that theory of planned behavior had a modest power to predictthe intention of abuse and subsequent abusive behavior. A studyof the Transtheoretical model (TTM) showed that the constructs of thismodel did not apply in IPV treatment programs very well (Brodeur,Rondeau, Brochu, Lindsay, & Phelps, 2006). The results of all of thesestudies partly support the findings of the present study.

Although in our study women’s attitudes were correlated with IPV;in final, the SEM model subjective norms and intention to go to healthcenters, predicted IPV. In another study, attitudes toward behavior didnot predict violent behaviors (Tolman et al. 1996). Nabi et al. (2002)found a correlation between beliefs and intention, but not with violentbehaviors. In Tolman et al. (1996), a study from TPB variables, perceivedcontrol seemed to be the most important factor in understandingviolent behavioral intention. Natan (2011) indicated that the intention ofwomen in reporting domestic violence was not supported by women’sattitudes and beliefs. In contrast, Abramsky et al. (2011) found that “Inalmost all sites, women who had attitudes supportive of a husband beatinghis wife had increased odds of IPV.”

In our study, subjective norms and intention predicted IPV. Thisfinding is congruent with Natan (2011), which found that the intentionof reporting domestic violence was supported by family and social welfareworkers [subjective norms]. Indeed, traditional gender roles and socialnorms are supportive factors of violence (WHO, 2010a). Caetano,Ramisetty-Mikler, and Harris (2010) did not show a correlation betweensocial control and intimate violence partners. Worden and Carlson(2005) found that most people think that the roots of domestic violenceare not in the society, but rather in families and individual factors.Similarly, Yount and Li (2010) showed a weak association between genderstratification and norms with physical violence. It seems that allthese differences about beliefs in the role of social norms and subjectivenorms depend on the social context in the countries in which the studieswere done.

Low level of education is, however, the most consistent factor associatedwith both the perpetrating and experiencing intimate partner violenceand sexual violence across studies (WHO, 2010a). In our study,the level of women and men’s education was related with domesticviolence. Women with less than seven years of education experiencedmore IPV and women with husbands with lower education experiencedmore violence. This finding agrees with the results of studies conductedby Mohammadhosseini et al. (2010), Yount and Li (2010), and WHO(2010a); but in Mahapatra (2012), despite a highly educated sample, ahigh level of violence was reported. In the current study, negotiation violence,psychological violence, sexual violence, physical violence, and injuryviolence were reported respectively. Although the rates of IPV werehigh, that intensity of reported violence was quite slight. Also we noticedthat the CTS scale considers even slight conflicts - for example,“insisting on sexual relationship.” It can be claimed that these kinds ofIPV are conflicts that might be solved with education and consultationat individual and community settings in cultural context as well as byinfluencing social norms. Our finding is congruent with Mahapatra(2012) , who showed a breakdown of IPV consisting of 94% of psychologicalabuse, 33% of sexual abuse, 27% of physical abuse, and 11% ofinjury. The types of abuse that women reported in Iranian studies indicatedthat physical, psychological, injury and sexual violence, respectively,were the most observed kind of violence that women reported(Mohammadkhani, Rezai Dogahe, Mohammadi, & Azadmehr,2008). Another study (Salehi & Mehralian, 2006) found that psychologicalviolence, physical violence, and sexual violence were the more reportedforms of violence, respectively. In addition, Vakili et al. (2010)reported psychological violence, sexual abuse and physical violence as82.6%, 43.7%, 30.9%, respectively. These rates of violence are near tothose obtained in this study.

Although most of the respondents reported domestic violence, the intensityof domestic violence was not especially high and almost 92% ofrespondents reported quite slight intensity. Jafarnejad, MoghadamHoseini, Soltanifar, & Ebrahimzadeh (2009) found 89.2% of violenceduring pregnancy was modest. This finding supports a study in Egyptclaiming that high percentages of women reported domestic physical violenceever (33%) and incidents of minor physical violence were reportedmore than severe physical violence (Yount & Li, 2010). AlsoMahapatra (2012) showed minor forms of abuse in 65% of participants.

Due to the low intensity of IPV in our study, education and consultationabout conflict resolution and life skills especially in primaryprevention are suggested. In addition, based on the Iranian context, inthe current study, the role of subjective norms is quite important. IPVis complex; to understand this phenomenon, more quantitative and qualitative studies are necessary to develop local models and preventive approachesto prevent IPV.

There are some limitations that need to be acknowledged and addressedregarding the present study. First, this study was conducted onlyon women, so a comparative study about committing violence againstmen is suggested. Second, although we would have preferred to do thisstudy through interviews, this was not possible due to organizationallimitations. Third, having at least primary education was one of eligiblefactors in the current study (because participants needed to completequestionnaires); therefore, this study did not cover the data of IPV inilliterate women.

Also there were some limitations with the CST scale. First, accordingto the CTS, the respondents were asked about frequency of violenceduring only the last twelve months, so the questionnaire failed to detectongoing systematic patterns of abuse. Second, the CTS scale focused onspecific acts and therefore did not provide information about the contextin which items occurred.

* We would like to thank the women that participated in this study for their cooperationSpecial thanks also go to Sabzevar University of Medical Sciences for their funding andsupport of this project.

Biographical Note:Zahra Sadat Asadi is a Ph. D. candidate of healthpromotion and health education at the school of health in TehranUniversity of medical sciences. She received her master’s degree fromEsfahan University of Medical Sciences in Health Education. Herresearch focuses on health promotion. E-mail: 2006.asadi@gmail.com

Biographical Note:Vahideh Moghaddam Hosseini is a faculty memberof Sabzevar University of medical sciences. She received her master’sdegree in midwifery from Mashhad University of Medical Sciences. Herresearch field is intimate partner violence and we can see her works injournals especially in Iranian Journal. E-mail: hosieni_v@yahoo.com

Biographical Note:Masumeh Hashemian is a faculty member ofSabzevar University of Medical Sciences in Iran. Also, she is a Ph. D.candidate in Health Education in Tarbiyat Modares University in Iran.She is a member of Social Determinants of Health (SDH) ResearchCenter in Iran. Her research focuses on women and related issues,E-mail: hashemian.research@yahoo.com

Biographical Note:Arash Akaberi is a faculty member of Biostatistics atthe North Khorasan University of Medical Sciences located in Bojnurd,Iran. Also he is a member of Addiction and Behavioral SciencesResearch Center in Bojnurd. His works focuses on biostatistics that isappeared in international and national journals. E-mail: arashdata@yahoo.com