Patterns of Receiving Support and Barriers to Service Consumption among Young Arab Women in Israel

Abstract

The present study examined the links between background variables, exposure to child abuse, patterns of using support, and barriers to services consumption among 482 young Arab women in Israel aged (18–26). The participants are Arab citizens of Israel and were recruited through snowball sampling. The results show that their acquaintance with services was consistently higher than their consumption. Most participants believed they were capable of managing on their own or with the help of family or friends. More than a third reported distrust in the ability of the services to assist them, cultural misunderstanding, preference of services provided anonymously, and too much bureaucracy as barriers to service use. The greater the abuse or neglect in childhood, the lower the satisfaction with the use of services and the greater the barriers to services experienced. A positive link was found between poor economic status and the barriers. The findings suggest a need for adjustment of the services offered to young Arab women as ethnic minority group to increase their motivation to receive support.

Keywords:

• young Arab women
• barriers to services
• social services
• mental health
• Arab minority

1. Introduction

In the transition to adulthood, young women are in need of supportive and skilled figures to support and guide them¹ since the extended support and the availability of a safety net are critical for facilitating their developmental tasks.² Non-formal support may reflect, in general, a deep relationship with family and friends, which facilitates well-being and functioning.³ Several studies have shown that young women would rather receive non-formal support than formal support while facing the challenges of young adulthood.⁴ This is especially true among minority young women, who have a lower tendency to consume formal support, such as health and social services⁵ due to several barriers to accessing services, such as stigma⁶; perceived discrimination, and barriers to communication.⁷ Some barriers are related to cultural competence, namely the ability of providers and organizations to effectively deliver social and mental health services that meet the social, cultural, and linguistic needs of service users.⁸ Despite accumulated knowledge regarding the barriers to consuming services among minorities, little is known about the barriers to consuming formal services among young Arab women in Israel. Hence, the aim of the current study was to better understand the patterns of receiving support and barriers to service consumption among young Arab women in Israel. Moreover, we examined whether sociodemographic variables and exposure to violence in childhood explain the patterns of receiving support and barriers to service consumption.

2. Barriers to Receiving Support and Service Consumption among Minority Groups

Barriers to consuming services among minority groups are a well-known phenomenon. It has been studied among diverse minority populations of different ages, gender, and marital status e.g.⁹ Minority groups prefer to cope with problems within the nuclear family, extended family, and community support.¹⁰

Those who do manage to get past the initial barrier of receiving formal support, report difficulties in communication,¹¹ and absence of economic and financial resources.¹² Nevertheless, barriers concerning access to services were found to decrease with increased length of time in the country of residence.¹³ Patterns of consuming services are even more complex in cases of abuse in childhood, where issues such as disclosure, help seeking, and response to treatment are determined by cultural norms and values held by societies.¹⁴

A recent systematic review¹⁵ found four factors as barriers to disclosure among minority women who were abused: immigration status; community influences; problems with language and interpretation; and unsupportive attitudes of staff within mainstream services including insensitivity, indifference, and stereotypical behavior. It was found that young women with a history of physical and sexual abuse in childhood reported significantly more various medical symptoms than those without adverse childhood experiences.¹⁶ The higher prevalence of symptoms leads women who were abused in childhood to have higher medical services consumption rates.¹⁷

These studies have highlighted the barriers of women from minority groups, including those who have experienced abuse in childhood. However, the study of barriers among young Arab women in Israel who were abused in childhood, as belonging to an ethnic and gender minority group, is still lacking.¹⁸

2.1. Barriers Faced by Young Arab Women in Israel

Young Arab women in Israel are at the intersection of positions at the margins of society, because of their gender, ethnicity, age, and social status.¹⁹ They belong to an indigenous ethno-national group that has become a minority in its own land. This sub-minority can be distinguished from the Jewish majority society in culture, traditions, language, heritage, and customs.²⁰ Although they are recognized as Israeli citizens, they are exposed to social and political exclusion, discrimination, and oppression,²¹ which are manifested in limited access to social and economic resources.²²

The path that leads to consuming services can be experienced by young Arab women as unknown and complex.²³ In contrast to the accessibility of non-formal support, many young Arab individuals that just transitioned into adulthood are not aware of the formal services that are available to them. Furthermore, requesting assistance from formal services often requires dealing with cumbersome bureaucratic systems that are unfamiliar and can be experienced as intimidating. The perceived bureaucracy together with feelings of distrust and past negative experiences with the system may prevent young Arab women from trying to seek support.²⁴ Thus, Arabs in Israel usually do not to trust formal services or service providers, as they are perceived as representing the oppressive and discriminatory establishment,²⁵ and viewed as not relevant or responsible for resolving family or community matters.²⁶ For instance, Arab women in Israel believe that the institutions, organizations, and social service agencies designed to help them have racist tendencies and try to divide families.²⁷ These findings suggest that Arab women encounter various barriers, including socio-political barriers, such as communication obstacles, inaccessibility of professional services, and stigmatizing treatment when they consume services.²⁸ Alongside these barriers, there are socio-demographic variables which are related to the consumption of the services.

2.2. Socio-Demographic Variables as Predicting Patterns of Receiving Support and Barriers to Service Consumption

With respect to socio-demographic variables that predict patterns of receiving support and barriers to service consumption, these variables were associated with greater likelihood of consuming services among women who experienced abuse in childhood in general, including older age, ethnicity, legal status, marital status, etc.²⁹ Studies have identified several factors that may hinder consuming services particularly among young Arab women in Israel who experienced abuse. These factors include age, gender, and lower social and socio-economic status, marital status (being single), belonging to a collective culture, religious aspects, low education, lack of family and social support, lack of awareness of service availability, social stigma and self-stigma, stereotypical attitudes, language and communication difficulties, and inaccessibility of the service.³⁰

Moreover, it has been found that young Arab women in traditional societies are known to consume and have more familiarity with non-formal social support resources, such as nuclear and extended family, traditional healers, and other types of local support.³¹ For example, a recent report showed that only 21 percent of the Arabs who reported mental distress requested formal help.³² This preference of non-formal support may be due to the structure of social networks among the Arab minority, which lives in small communities close to family and extended family, thus their familial and community networks are relatively dense and tight.³³ This closeness is assumed to enhance one's sense of belonging and security.³⁴

Formal services accessible to young Arab women are mostly under the care of a male physician from their own village, in the absence of female nurses.³⁵ Thus, this setting emphasizes the young Arab women’s sense of domestic subordination. As such, this setting decreases the likelihood that Arab women, especially with lower education, unmarried, or more religious, would get screened for violence, or receive information on the subject from male family physicians. The latter are usually in their community and in some cases are even members of the family.³⁶

3. Exposure to Child Abuse as Predicting Patterns of Receiving Support & Barriers to Service Consumption

Regarding cases of child abuse, in a qualitative study, we found that young Arab women who were abused in childhood referred to sociopolitical barriers to formal support, such as discrimination against them and paternalistic attitudes towards them. As a result, they demonstrated a negative attitude towards the formal establishment.³⁷ On a more individual level, it was found that Arab women differ in the way they deal with the abuse. For example, if an Arab woman feels ashamed to disclose the abuse, she is unlikely to visit her family physician.³⁸ Arab women who reported violence were more likely to use medical services that are unrelated to the abuse (especially gynecology), compared to Arab women who reported not having experienced violence, and compared to their Jewish counterparts.³⁹ Additionally, a recent study showed that Arab women characterized by severe emotional distress and a high level of exposure to physical, emotional, and sexual abuse demonstrated a pattern of using more services, compared to Arab women who did not have elevated levels of the aforementioned characteristics and to Jewish women.⁴⁰

Moreover, it was found that some of them are inclined to use cognitive minimization to cope with the aversive experiences. That is, viewing the incident as insignificant and thinking that suppression of it would make it vanish hinders the rate of receiving support.⁴¹ Some view the abuse as problems that must be resolved within a person, without any outside assistance.⁴² Others find it hard to identify themselves as being in a place of need and distress,⁴³ and only a handful of young Arab women seek help.⁴⁴ These findings in turn may increase their feeling of isolation, lack of support, and lack of trust in others, and shape their emotional experience.⁴⁵

These studies examined the consumption of services in part among young women who were abused in childhood, however, there is a need for a broad examination of the extent of consumption of formal and non-formal support and the young Arab women’s satisfaction with receiving such support.

4. Study Goals

The aims of the present study were to: (1) Understand the extent and patterns of support and satisfaction with the services among young Arab women in Israel. (2) Understand the barriers to consuming formal services that young Arab women experience. (3) Examine the relationships between demographic characteristics and exposure to abuse and neglect in childhood, and the use of formal and non-formal social support. (4) Examine differences in the consumption of services and the barriers to their consumption between young Arab women who were abused or neglected in childhood and those who were not. The findings of the study will contribute to expanding the knowledge in the field. In addition, this study may help in adapting outreach efforts and interventions with young Arab women, which take into account their ethnic and social context.

5. Method

5.1. Participants

Participants in this study were 482 young Arab women, aged 18–25 years (M = 20.52, SD = 2.61), recruited through snowball sampling. They were Arab citizens of Israel, and most (about 93%) were Muslim. Close to three quarters of them were single, and the rest were mainly married or engaged (Table 1). A few were mothers. Close to half lived in Arab cities, about a quarter in mixed Jewish-Arab cities, and another quarter in rural villages. About half of the participants had a matriculation certificate, and over a third had academic education. Others had lower levels of education. Close to half were studying at the time of data collection. About three quarters of the participants lived with their parents (or other relatives), and most of the rest lived in their own homes or rented apartments. Their economic status was usually evaluated by them as good or very good, and others assessed it as moderate. About half were employed.

Table 1. Demographic characteristics (N = 482).

		N	%
Marital status (n = 456)	Single	331	72.‏6
	Married, engaged	120	26.‏3
	Divorced	5	1.‏1
Children (n = 425)	Yes	28	6.‏6
Current residence (n = 453)	Arab city	215	47.‏5
	Mixed city	115	25.‏3
	Rural	123	27.‏2
Education (n = 460)	Elementary	6	1.‏3
	High school, no matriculation certificate	41	8.‏9
	High school, matriculation certificate	242	52.7
	Academic	171	37.‏1
Residence (n = 459)	With parents/relatives	351	76.5
	Rented	40	8.7
	Own place	58	12.6
	Other	10	2.2
Current economic status (n = 460)	Good/very good	283	61.‏5
	Moderate	139	30.2
	Bad/very bad	38	8.3
Currently employed (n = 465)	Yes	232	49.‏9
Currently studies (n = 461)	Yes	215	44.‏6
Past characteristics:
Father’s education (n = 455)	Elementary or none	117	25.7
	High school	243	53.4
	Non-academic professional training	33	7.2
	Academic	62	13.6
Mental disability in the family of origin (n = 457)	Yes	59	12.9
Lived outside the family during childhood (n = 453)	Yes	50	11.0
Past mental treatment (n = 456)	Yes	48	10.5
Current mental treatment (n = 455)	Yes	13	2.9

The young women grew up in families with up to 15 siblings (M = 5.76, SD = 3.33). About half of their fathers had high school education, and most of the rest had lower education levels. About one-tenth of the families of origin had some mental disability, about one-tenth of the young women spent time outside their family homes during childhood, and about one-tenth of them received some mental treatment in the past. A few were currently receiving mental treatment.

5.2. Variables and Instruments

Background characteristics questionnaire. This tool was based on previous questionnaires used in child abuse studies in Arab society.⁴⁶ It included age, religion, marital status, education, current residence, economic status, and employment.

5.2.1. Formal Social Support

Formal social support was assessed based on a study conducted by⁴⁷ on the Israeli Bedouin population and adapted to the current study on the basis of qualitatively analyzed interviews with 20 young Arab women.⁴⁸ The resulting questionnaire included four parts: (a) Acquaintance with seven categories of formal social services, such as youth centers/youth-focused programs, health services, social welfare services, each rated as familiar (1) or unfamiliar (0). Good internal consistency was found (α = .84), and the total score was composed of the sum of the items, ranging between 0 and 7. (b) Current use of the seven categories of formal social services, each rated as being used (1) or not used (0). Low internal consistency was found (α = .52), and the total score was composed of the sum of the items, ranging between 0 and 7. (c) Satisfaction with the service mostly used and the service provider, 14 items rated on a 1–7 scale (1—not at all, 7—very much) so that higher scores represent greater satisfaction. High internal consistency was found (α = .93), and the total score was composed of the mean of the items. (d) Barriers to formal service use. 21 items (yes—1, no—0), α = .87. A total mean score was computed so that higher scores represent a greater extent of barriers. Sample items include: “I do not believe they will understand my culture”; “They will not understand my native language”.

5.2.2. Non-formal Social Support

Multi-dimensional Perceived Social Support (MSPSS).⁴⁹ This questionnaire was used in order to assess whether the young women received non-formal support in addition to the consumption of formal services or lack of it. This widely used questionnaire includes 12 self-report items, relating to family support, friend support, and significant other support (four items each). Items are rated on a 1–7 scale (1—very strongly disagree, 7—very strongly agree) so that higher scores represent greater social support. The scale of significant other support was used in the current study (e.g. “There is a special person who is around when I am in need”), and high internal consistency was found (α = .91).

5.2.3. Childhood Abuse and Neglect

Childhood Trauma Questionnaire–Short Form (CTQ-SF).⁵⁰ This self-report questionnaire includes 25 items, assessing childhood emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect. Items are rated on a 5-point scale from 1 (never true) to 5 (very often true), with higher scores representing greater extents of abuse and neglect. The questionnaire has known reliability and validity, with internal consistencies ranging between 0.79 and 0.94.⁵¹ Good internal consistencies were generally found in the current study: total score α = .93, physical abuse α = .90, emotional abuse α = .84, sexual abuse α = .88, emotional neglect α = .84, and physical neglect α = .49. Results pertaining to physical neglect should be regarded with great caution. Each scale is composed of five items, and total scores were computed according to the sum of the items (5–25 per scale). According to the initial classification⁵² and current studies i.e.,⁵³ cut-off scores for abuse and neglect were determined: physical abuse ≥ 8, emotional abuse ≥ 9, sexual abuse ≥ 6, emotional neglect ≥ 10, and physical neglect ≥ 8. A total cut-off for abuse or neglect was defined as scoring positive on at least one sub-scale.

6. Procedure

This study is part of a broader study in which the data collection process included a pilot from February 2018 to March 2019, in which data were collected about 680 young Arab women. Participants with missing information (198) were excluded from the study. The pilot for collecting quantitative data included disseminating a questionnaire link through dedicated Facebook groups, mailing lists, and dissemination by research assistants (young Arab women themselves) through their own social network. Recruitment using this method was slow and yielded poor results: 74 young Arab women clicked the link, 53 of whom filled out the questionnaire only partially. In light of this, we moved to a data collection method that relies on personal communication between the research assistants and the participants. Research assistants, Arab women with training in the help professions, were employed nationwide in order to cover the research population as much as possible. Data collection after the pilot lasted from June 2018 to March 2019. Research participants were located in public settings and in frameworks belonging to the third sector as follows: (a) Written application to welfare department managers who provide service to young Arab women, in Arab cities and towns and mixed cities. (b) Personal contact with the social workers who work with the young women in the designated centers (for example, Yated, Warm Homes, Afikim Program) in order to encourage the recruitment of participants for the study. (c) Applying to associations and frameworks in the third sector that work with young women (for example, Ajik, Naamat, community centers, The Women's Courtyard).

Questionnaires were filled out in three ways: by an interview (n = 247), by telephone (n = 165), by internet (n = 70). No differences were generally found in the study variables by the manner of filling out the questionnaire: Extent of non-formal social support (F(2, 478) = 0.20, p = .823, η² = .001), barriers to formal social support (F(2, 398) = 1.09, p = .336, η² = .005), and child abuse and neglect (F(2, 479) = 0.65, p = .524, η² = .003). Differences were found regarding formal service use (χ²(2) = 26.69, p < .001) with online participants reporting lower service use (65.5%) than others (via interview: 88.6%, via telephone: 92.2%). Satisfaction with formal social support (F(2, 362) = 12.09, p < .001, η² = .063) was lower among online participants (M = 4.81, SD = 1.62) than others (via interview M = 5.27, SD = 1.09, via telephone M = 5.74, SD = 1.05). That is, online participants reported lower formal support consumption than others, yet they were a minority (15%) of the sample.

7. Data Analysis

Data were analyzed with SPSS ver. 27. Variables were defined with items means/summary scores, and non-normal distributions were log- or exponentially transformed, as required. The frequency of childhood abuse and neglect was defined according to scale norms. Variables were described with means and standard deviations, as well as frequencies and percentages. Pearson correlations were calculated between formal and non-formal social support and childhood abuse and neglect, and independent t-tests were calculated for formal and non-formal social support by the classification of the women into those abused/neglected in childhood versus those who were not. Spearman correlations were calculated between formal and non-formal social support, and various demographic characteristics. Multiple regression analyses were calculated to assess the relationships between the formal and non-formal social support and the demographic variables, and childhood abuse and neglect, found significant in the earlier bi-variate analyses.

7.1. Adherence to Ethical Guidelines

The study was approved by the Institutional Review Board of Ruppin academic center. In addition, each participant expressed her written consent to participate in the study by signing a participation form. It was clarified to each participant that participation was not mandatory, and that she could stop filling out the questionnaire at any stage. At the same time, the study participants were given the telephone numbers of the research assistants to contact them in case of emotional distress following the completion of the questionnaire. No reports of emotional distress were reported from study participants. In light of the sensitive issues that emerged from the study, the research assistants underwent pre-training as well as standard training to maintain their personal well-being as well as participants’ well-being, in accordance with the World Health Organization guidelines on exposure to gender-based violence.⁵⁴

8. Results

8.1. Descriptive Results

Participants were asked about their acquaintance with various formal services (Table 2). On average, they were familiar with about four of seven services (SD = 2.41), such that about half of them were familiar with up to four services (none or one service: n = 94, 20.3%, two to four services: n = 137, 29.5%), and another half were familiar with at least five of the seven services (five or six services: n = 115, 24.8%, all seven services: n = 118, 25.4%, not in table). Mean service use was rather low, yet with a moderate-high level of satisfaction. Barriers to formal support consumption were moderate-low on average. The extent of non-formal social support consumption was rather high.

Table 2. Means and standard deviations for the study variables (N = 482).

	N	M	SD
Formal social support (range 1–7):
Acquaintance with formal services	464	4.17	2.41
Formal service use	367	1.34	1.30
Satisfaction with service use	365	5.41	1.17
Barriers to formal support (range 0–1)	401	0.35	0.24
Non-formal social support (range 1–7):
Extent of support	481	1.56	5.59
Childhood abuse and neglect (range1–5):
Total score	482	1.58	0.68
Physical abuse	482	1.38	0.83
Emotional abuse	482	1.71	0.93
Sexual abuse	482	1.33	0.75
Physical neglect	482	1.57	0.64
Emotional neglect	482	1.93	0.99

Note. M = mean, SD = standard deviation.

Means for child abuse and neglect were moderate-low to low (Table 2), with the highest among them concerning emotional neglect, and the lowest concerning physical and sexual abuse. However, looking at the percentage of participants who were positive to childhood abuse and neglect, according to the cutoff points, revealed that close to 70% of the participants reported exposure to at least one type of abuse or neglect in childhood (n = 331, 68.7%, not in table). About 40% reported physical or emotional neglect (physical neglect: n = 208, 43.2%; emotional neglect: n = 192, 39.8%), about a third reported emotional abuse (n = 164, 34.0%), about 30% noted sexual abuse (n = 142, 298.5%), and about 20% mentioned physical abuse (n = 95, 19.7%, not in table).

A further examination of acquaintance with and consumption of formal services shows that acquaintance was consistently higher than consumption (Table 3). Close to 70% of the participants mentioned being acquainted with youth centers and various youth-focused programs, health services, and employment-focused services. About 27% to 37% reported using these services. Social welfare services and mental health services were known to about 60–65% of the participants and were used by about one-tenth of them. Emergency shelters and telephone support services were known to about 40–45% of the participants and were used by about 5% of them.

Table 3. Distribution of acquaintance with and consumption of formal services.

	Acquaintance with service (n = 464)		Service use (n = 367)
	n	%	n	%
Youth centers, youth-focused programs	318	318	135	36.8
Health services	315	315	130	35.4
Employment-focused services	318	318	101	27.5
Social welfare services	299	299	58	15.8
Mental health services	276	276	29	7.9
Emergency shelters	217	217	16	4.4
Telephone support	190	40.9	21	5.7

Moreover, the participants were asked about the service they used the most, to which 263 participants responded (55%). About a third of them (n = 87, 33.1%) mentioned the youth centers or youth-focused programs, close to one fifth mentioned the health services (n = 49, 18.6%) and the employment-focused services (n = 45, 17.1%), about one-tenth mentioned social welfare services (n = 26, 9.9%), and others mentioned mental health services (n = 10, 3.8%) and emergency shelters (n = 5, 1.9%). Other women mentioned various service combinations (n = 41, 15.6%). Frequency of service use was seldom (38%), often (25%), or very often (37%).

As noted earlier, the barriers to formal support questionnaire included 21 items, to which 401 participants responded (83%, not in table). Most of them noted that they believed they were capable of managing on their own (81%) or with the help of family or friends (74%), and thus did not use formal services. About 35–40% of the respondents indicated barriers to service use, including distrust in the ability of the services to assist them, cultural misunderstanding, preference of external non-communal or anonymously provided services, and too much bureaucracy. About 25–30% of the respondents marked lack of knowledge regarding where to go, fear of the consequences of such a request for help, inability to reach the service, distrust of the service providers’ ability to listen, understand, or help, ethnic or gender-based discrimination, and lack of confidentiality. About 15–20% of the young women indicated that their families prevented them from asking for help, or they knew they would be in danger if they asked for help. Others were doubtful that service providers would believe their story.

8.2. Service Consumption, Social Support, and Childhood Abuse and Neglect

The relationships between service consumption, social support, and childhood abuse and neglect were assessed with Pearson correlations, as well as with t-tests for the extent of support by the classification of the total score of childhood abuse and neglect into those abused or neglected versus those who were not (Table 4). Our results show that the various aspects of childhood abuse and neglect were unrelated with the extent of acquaintance with formal services. Yet, overall, those who were classified as abused or neglected were familiar with a lower number of services than those who were not classified as abused or neglected. One low correlation was found between aspects of childhood abuse and neglect and the extent of service consumption, and overall, no difference in service consumption was found by the classification of childhood abuse and neglect. Low negative correlations were found between aspects of childhood abuse and neglect and satisfaction with service use, and accordingly, a lower mean satisfaction level was found among those who were classified as abused or neglected, compared with those who were not. Low to moderate positive correlations were found between aspects of childhood abuse and neglect and barriers to formal support, and similarly, a higher mean level of barriers was reported by those who were classified as abused or neglected, versus those who were not. Finally, low to moderate negative correlations were found between aspects of childhood abuse and neglect and non-formal social support, with the latter being indeed higher among those not abused or neglected in childhood.

Table 4. Pearson Correlations and t-tests for Service Consumption and Social Support, by Childhood Abuse and Neglect (N = 370–476).

	Correlations						t-tests
	Total score	Physical abuse	Emotional abuse	Sexual abuse	Physical neglect	Emotional neglect	Abused/neglected M (SD)	t(df) (p)	Not abused/neglected M (SD)
Formal social support:
Acquaintance with formal services	.01	.03	.08	.07	−.03	−.08	3.97 (2.40)	4.61 (2.36)	t(462) = 2.66 (p = .008)
Formal service use	.10	.18***	.12	.10	.09	.09	0.88 (0.32)	0.84 (0.37)	t(232.8)^a = −1.24 (p = .216)
Satisfaction with service use	−.23***	−.18***	−.18***	−.09	−.21***	−.23***	5.24 (1.22)	5.78 (0.95)	t(270.3)^a = 4.54 (p < .001)
Barriers to formal support consumption	.35***	.27***	.34***	.25***	.22***	.29***	0.39 (0.25)	0.27 (0.20)	t(270.7)^a = −5.38 (p < .001)
Non-formal social support:
Extent of support	−.37***	−.20***	−.31***	−.18***	−.31***	−.40***	5.25 (1.66)	6.33 (0.97)	t(479) = 7.39 (p < .001)

**p < .01, ***p < .001.

Note. Abused/neglected or not: by the classification of the total score.

^a t for unequal variances.

8.3. Service Consumption, Social Support, and Demographic Variables

Spearman correlations were examined between service consumption and social support, and various demographic characteristics. Several low to moderate correlations were found significant. Acquaintance with formal services was positively related with past mental treatment (r = .14, p = .003); formal service use was negatively related with the participant’s and her father’s levels of education (r = −.33, p < .001 and r = −.16, p = .003, respectively); satisfaction with service use was negatively related with the number of siblings (r = −.15, p = .006); and barriers to formal support consumption were negatively related with current economic status (r = −.33, p < .001), and positively related with mental illness in the family and past mental treatment (r = .14, p = .004 and r = .13, p = .008, respectively). Finally, the extent of non-formal social support was negatively related with out-of-home care during childhood (r = −.13, p = .007), and positively related with current economic status and the father’s level of education (r = .14, p = .003 and r = .28, p < .001, respectively). Other demographic characteristics were either unrelated with service consumption and social support (such as age, marital status, or employment status), or had low variance (such as religion, having children, or current mental treatment).

These abovementioned demographic characteristics, as well as the total score for childhood abuse and neglect, were used in multiple regressions to assess their relationships with service consumption and social support. In light of the correlations presented above, the demographic variables that were used were: number of siblings, out of home care during childhood (1—yes, 0—no), the participant’s level of education (1—elementary, to 5—academic), the father’s level of education (0—none, to 5—academic), current economic status (1—very bad, to 5—very good), mental illness in the family (1—yes, 0—no), and past mental treatment (1—yes, 0—no). It should be noted that some of these demographic variables are ordinal, yet as they have at least five categories, and their skewness values range between −0.97 (SE = 0.11) and 0.50 (SE = 0.11), they were regarded as continuous. Other demographic variables are either continuous or dichotomous. Inter-correlations among the independent variables ranged between r = −.22 and r = .33 (p < .001), and the highest VIF value was 1.47.

Our results show that most regression models are significant with 7% to 17% of explained variance (Table 5). The model for acquaintance with formal services is not significant, yet past mental treatment was positively related with acquaintance with a higher number of formal services. The models for formal service use and satisfaction with service use have low values of explained variance. Higher service use was related with lower levels of education of the participant and her father, while higher satisfaction with service use was related with having a smaller family of origin and experiencing less childhood abuse and neglect. Higher levels of experienced barriers to service use were related with lower current economic status and with experiencing higher levels of childhood abuse and neglect. Similarly, higher levels of received non-formal support were related with higher economic status and with experiencing lower childhood abuse and neglect.

Table 5. Multiple regressions for service consumption and social support, with demographic variables and childhood abuse and neglect (β values).

	Formal Social Support				Non-formal Social Support
	Acquaintance with formal services (n = 409)	Formal service use (n = 331)	Satisfaction with service use (n = 321)	Barriers to formal support (n = 355)	Extent of support (n = 419)
Number of siblings	−.03	−.07	−.13*	.01	.03
Out of home care during childhood	.04	.01	−.05	−.06	−.02
Participant’s level of education	.03	−.26***	−.09	−.01	.05
Father’s level of education	.05	−.14*	.03	−.04	.08
Current economic status	.03	.01	.06	−.23***	.17***
Mental illness in the family	.03	.01	−.02	−.01	.07
Past mental treatment	.17**	.01	.04	−.02	.06
Childhood abuse and neglect	−.04	.04	−.20**	.32***	−.35***
Adj.R^2	.02	.07	.07	.17	.17
F(df)	F (8,400) = 1.91	F (8,322) = 4.08	F (8,312) = 4.02	F (8,346) = 10.13	F (8,410) = 11.95
1. (p)	(p = .057)	(p < .001)	(p < .001)	(p < .001)	(p < .001)

*p < .05, **p < .01, ***p < .001.

9. Discussion

Our findings show that the extent of non-formal social support and satisfaction with it was quite high, in accordance with previous studies.⁵⁵ The current study also found that the degree of familiarity with the various formal services was higher than the degree of their use, which was quite low. This finding contradicts previous studies, which have shown that many women do not know where to look or who to turn to for help.⁵⁶ Although referring to the context of young Arab women in Israel, it can be concluded that women make a conscious choice not to seek formal services despite their familiarity with these services. These findings correspond with previous findings in which avoidance of seeking formal assistance stems from unwillingness to experience double victimization by the treatment system.⁵⁷ The findings regarding the distribution of barriers to the consumption of services show that young Arab women prefer to manage on their own or with the help of family and friends. About 35–40% of the respondents mentioned distrust in the ability of the services to assist them, cultural misunderstanding, preference of external non-communal or anonymously provided services, and too much bureaucracy as barriers to service use.

Our findings show differences between young Arab women who were abused in childhood and those who were not regarding the patterns of use of services and barriers to service consumption. Specifically, the greater the abuse and neglect in childhood, the lower the satisfaction with the use of services. Furthermore, the greater the abuse in childhood, the more barriers to service consumption were experienced. This finding corresponds with other findings.⁵⁸ In her study, Nadera Kevorkian argues that abused women refuse to seek formal or non-formal assistance due to the insistence of the family to keep the matter private and avoid exposure of the abuser’s identity.⁵⁹ An alternative explanation is losing of family and social support and social respect,⁶⁰ avoidance reactions that are perceived as non-supportive, such as discrediting gossip, physical punishment, and blaming them.⁶¹

The findings further show that young women who have experienced child abuse or neglect were less familiar with the formal services, and if they were familiar with the services and used them, their satisfaction with the service and the caregiver was lower. In addition, they experienced more barriers to service consumption. These findings correspond with previous studies.⁶²

We also examined how the demographic variables affect the patterns of service consumption and barriers to service consumption. Our findings show that the better the young woman's financial situation, the greater the non-formal support. These findings show that the young Arab women's natural initial choice is non-formal support, especially among those whose financial situation is better and enables them to seek formal support for a fee. This choice stems, to our understanding, from trust in their natural social system: their peer group, family, and other non-formal agents.⁶³ An additional explanation is that requesting assistance from formal services often requires dealing with cumbersome bureaucratic systems that are unfamiliar and can be experienced as intimidating.⁶⁴ It was further found that the worse the economic situation was perceived, the more barriers were perceived. This finding reinforces previous findings that highlighted social exclusion, inequality, and multiple marginalities of young Arab women in Israel, which are a major barrier to seeking support.⁶⁵

Our findings show that 70% of the young Arab women reported some form of abuse in childhood. The extent of physical abuse and emotional neglect in the study (43%, 40%, respectively) was higher than the extent of emotional, sexual, and physical abuse (34%, 30%, 20%, respectively). These findings point to two aspects. The first aspect is the relatively high level of physical and emotional neglect, which shows that young Arab women in Israel come from poor families, with low socio-economic status and living conditions in a poor society. These conditions can harm their ability to deal with the abuse.⁶⁶ The second aspect relates to the low extent of abuse, which shows that most of the positive reports tended to be less abundant. These findings correspond with other findings,⁶⁷ which were explained as an under-reporting to the social workers about abuse, due to cultural barriers. Thus, given that this is such a widespread social problem among young Arab women and given that we see that they have poor familiarity with the services, and more barriers to the consumption of services, it is important to locate them and adapt the services to make them more accessible to them.

The choice of keeping the abuse secret in order to cope with the situation derives from the collectivist orientation of Palestinian society and reflects acceptance of this orientation and identification with it.⁶⁸ This explanation has been supported by other findings,⁶⁹ who argue that members of collectivist societies derive their identity from the collective and believe that the good reputation and status of their family carries over to their own reputation as individuals. Moreover, young Arab women who report cases of abuse against them may be accused of the violence and be denied support, help, or treatment. Furthermore, the abuse is silenced as an internal problem to avoid harming the social status and dignity of other family members, and the identity of the perpetrator is covered.⁷⁰

10. Limitations of the Study

The present study has a number of limitations, in light of which the findings should be examined. First, the use of the “snowball” sampling method rather than random sampling limits the generalizability of the findings to broader contexts. For example, the sample has small variability in terms of participants’ religion and is composed mostly of young Muslim women. This is an inherent limitation in studies in which the population is vulnerable (hard to reach populations). We strived to obtain as wide and representative a sample as possible while being ethically sensitive to the population and the sensitive research topic.

11. Contribution and Implications of the Study

The study sought to provide an understanding of the patterns of use of services, the degree of satisfaction with them, and the barriers to the consumption of services among young Arab women in Israel. Emphasis was placed on the differences between young Arab women who were abused in childhood and young women who did not experience abuse in childhood. Moreover, the study sought to shed light on demographic variables that explain the pattern of use of services and barriers to service consumption among young Arab women. It is important to gain a better understanding of the subject using integrated research methods, qualitative and quantitative. Further research should include other research populations such as professionals treating young Arab women and policy makers in the field, and examine other variables, such as social exclusion variables, perceived discrimination, and more.

12. Conclusion

Our findings regarding the patterns of seeking non-formal support and barriers to the consumption of services have implications for social work practice. On a practical level, despite the familiarity with and knowledge about the services, the young women experience barriers to contacting these services and receiving formal support. It is recommended that professionals at the micro-level and policymakers at the macro level, in collaboration with the young women, attempt to make cultural and gender adjustment of the services offered to young women. Such an adjustment may increase the young women’s wish to receive assistance and initiative in doing so.

At the same time, in light of the findings about the clear and positive link between the poor economic situation and the perceived barriers, the economic independence of young Arab women should be promoted. This can be achieved through improved access to academic education and employment. Economic independence, in our opinion, may increase the decision-making ability of young women and contacting support agencies, regardless of family or social factors.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Raghda Alnabilsy

Raghda Alnabilsy is researcher at the Department of Social Work at Ruppin Academic Center. She studies ethnic minorities, women, girlhood, the Palestinian family in Israel, the sociopolitical-sociocultural context of Palestinian girls and women victims of violence, children and adolescents exposed to abuse, cultural and gender-based sensitivity in theory and practice of social work, adaptation of culturally diverse students. She has published articles in reputed journals and contributed chapters in book—Intimate Partner Violence Against Palestinian Women in Israel (2019); The self-Identity Construction of Arab Young Women Who were Abused in Childhood Within a Complex Cultural and Socio-Political Context (2022).

Haneen Elias

Haneen Elias is a Palestinian researcher at the Department of Social Work, Ruppin Academic Center in Israel. Her studies focus on ethnic, and gender marginalized and excluded minorities, such as young Palestinian women who were abused in childhood. She has published articles in reputed journals and contributed chapters in book—Child abuse and Neglect in Palestinian Society in Israel (2019); Barriers to Receiving Support Among Young Arab Women in Israel Who Have Been Abused In Childhood (2019); Promoting Context-Informed Perspective Among Social Workers Treating Young Arab Women Abused in Childhood (2022); Leaving the Margins: Promoting a Context-Informed Perspective in Social Work Education Among Palestinian Female Students in Israeli Academia (2022). E-mail: [email protected].

Shira Pagorek-Eshel

Shira Pagorek-Eshel is researcher at the Department of Social Work at the Ruppin Academic Center Israel. Her studies focus on trauma in various life contexts, mainly political violence. She has been awarded several research grants for studying the Palestinian society in Israel. She has published articles in reputed journals—Young Arab Women’s Processes Of Coping with Girl Abuse: Intersection of Patriarchal Oppression and Being a National Minority in Israel (2020); The Association of Social Factors and COVID-19-related Resource Loss with Depression and Anxiety Among Arabs in Israel (2021).

Notes

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38 Nihaya Daoud, et al., “Patterns of Healthcare Services Utilization”, op. cit.

39 Ibid.

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58 Nadera Shalhoub Kevorkian, “The Politics of Disclosing Female Sexual Abuse: A Case Study of Palestinian Society”, Child Abuse and Neglect, Vol. 23, No. 12, 1999, pp. 1275–1293.

59 Ibid.

60 Pooja Sawrikar and Ilan Katz, “Barriers to Disclosing Child Sexual Abuse (CSA) in Ethnic Minority Communities: A Review of the Literature and Implications for Practice in Australia”, Children and Youth Services Review, Vol. 83, No. August, 2017, pp. 302–315. doi:10.1016/j.childyouth.2017.11.011.

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64 Sulimani-Aidan, “In between Formal and Informal”, op. cit.

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66 Muhammad M. Haj-Yahia, “Wife Abuse and Battering in the Sociocultural Context of Arab Society”, Family Process, Vol. 39, no. 2, 2000, pp. 237–255. doi: 10.1111/j.1545-5300.2000.39207.x.

67 Paula Kahan-Strawczynski, Viacheslav Konstantinov, and Sharon Amiel, “Status of Young Adults in Israel in Key Areas of Life”, https://brookdale.jdc.org.il/en/publication/status-young-adults-israel-key-areas-life/.

68 Elias and Raghda, “Child Abuse and Neglect in Palestinian Society in Israel”.

69 Muhammad M. Haj-Yahia and Elisheva Sadan, “Issues in Intervention with Battered Women in Collectivist Societies”, Journal of Marital and Family Therapy, Vol. 34, No.1, 2008, pp. 1–13 . doi:10.1111/j.1752-0606.2008.00049.x.

70 Nadera Shalhoub-Kevorkian, “The Politics of Disclosing Female Sexual Abuse”, op. cit.