Purpose: Evaluating the effectiveness of public health interventions requires the quantification of health related quality of life (HRQOL). Some conditions, including intimate partner violence (IPV), defy health state classification system measurement of HRQOL because of the domains of health that are affected. Using violence as an example, we identified domains of health that affect HRQOL but are not captured by existing health state classification system methods, and suggest approaches to capture the complete impact of such conditions.

Methods: Focus groups (n=8) with women exposed to IPV (n=40), recruited from shelters, service providers, and snowball sampling were conducted in Philadelphia in March-April, 2006. Following a structured focus group protocol, participants discussed the domains of health that were impacted by IPV, the extent to which each domain was affected, and the relative importance of each. Discussion comments were coded for domains mentioned, reported significance, and the frequency of mention across individuals.

Results: The average participant was 43 years old (range 18-64), African American (79%), and unemployed (72%). Half of the women were single and 23% had children (mean number =3). All reported physical or psychological abuse or both. Domains of health reportedly impacted by IPV include those that are measured by health state classification systems: overall health, physical injuries, emotional functioning, and ability to work; and those not commonly included in these measurement methods: addiction, physical and psychological functioning of one's children, personal freedom, and control over one's life. These latter domains had an equal or greater impact on the HRQOL of women in our study compared with the commonly measured ones.

Conclusions: HRQOL of abused women is defined in part by domains that fall outside the realm of existing health state classification system measures of HRQOL, and most generic health status measures. Emotional and psychological abuse, dependent children's HRQOL, and freedom play a significant role in diminished HRQOL of abused women. These effects on HRQOL may evade capture by existing measures, potentially leading to underreporting of the impact of IPV on HRQOL. Measurement of the HRQOL impact of IPV for use in economic evaluations of interventions may necessitate holistic measurement approaches or the development of expanded measures that capture the far-reaching effects of IPV on HRQOL.