Bearing witness: ethics in domestic violence research

How to Evaluate Reports of Intimate Partner Violence? Examining Interpartner Agreement in a Forensic Sample of Different-Sex Couples Where Men are Accused of Intimate Partner Violence

Research about interpartner agreement on intimate partner violence (IPV) is mainly based on community and clinical samples, with forensic or court-related samples being overlooked. This study assesses interpartner agreement on IPV reports based on the Revised Conflict Tactic Scales, aiming to explore if the proxy method would be reliable in a court-related setting. The study sample comprised 62 different-sex couples identified in the Portuguese judicial system due to an IPV-related crime perpetrated by men. Agreement was assessed based on different indexes: percent agreement and Gwet's AC1 for occurrence, and Tau-b and intraclass correlations for frequency. Men's and women's perpetration were considered. Results showed that interpartner agreement on IPV occurrence (ranging from poor-to-very good) tended to be higher and more consistent among indexes than agreement on IPV frequency (ranging from non-existent to strong). This study highlights the need to collect both partners' reports in court-related settings.

Socio-Economic Factors Influencing Intimate Partner Violence Among Adolescents and Young Women in Sub-Saharan Africa: A Scoping Review

Objective

To summarize the evidence on how socio-economic status and intimate partner violence (IPV) are interrelated among adolescents and young women (AYW) in sub-Saharan Africa (SSA).

Methods

Online databases such as MEDLINE, Embase, PsycIFO, CINAHL, Cochrane Central, Sociological Abstracts, Web of Science, and the African Index Medicus were used to identify studies published between 2015 and 2022. The reporting procedure was the Preferred Reporting Item for Systematic Reviews and Meta-Analysis (PRISMA) as a checklist extension for the scoping review.

Results

The majority of the publications, ten (62.5%) were cross-sectional studies, while four (25%) were qualitative studies and two (12.5%) were mixed methods studies. The review found that lack of financial resources exposed AYW to all forms of violence ranging from physical, sexual, emotional, psychological, and economic violence. Nonetheless, financial reliance on a partner poses a long-term threat to AYW employment and financial stability.

Conclusion

Socio-economic status influences the level of IPV experienced by AYW in many countries of SSA, while evidence of the long-term effects remains uncovered. To achieve Sustainable Development Goal (SDG) 1, which focuses on ending poverty in all forms by 2030, socio-economic inequalities caused by IPV among AYW require prompt interventions.

Uptake of gynecological consultation following domestic or sexual violence: A case-control study in the context of induced abortion

OBJECTIVE

The aim of this study was to determine the prevalence of domestic and sexual violence and to characterize the association between exposure to domestic and sexual violence and low uptake of gynecological care, in the context of induced abortion.

STUDY DESIGN

We conducted a case-control study among women seeking abortion care, in mother and child centers and sexual health centers in the Paris, France area (April 2022-March 2023).

RESULTS

A total of 103 women were included in the study during induced abortion care. Physical, psychological or sexual domestic violence was reported by 48.5 % and sexual violence, whoever the perpetrator, was reported by 23.3 %. In the bivariate analysis, a history of physical, psychological or sexual domestic violence was not associated with the absence of a gynecological consultation in the past two years, compared with no history of intimate partner violence (p = 0.09). After adjustment for regular pelvic pain, dysmenorrhea, vulvodynia and dyspareunia, there was no association between a history of sexual violence and the absence of a gynecological consultation in the past two years (OR 1.05; CI95% 0.27-4.13, p = 0.93).

CONCLUSION

Violence was a common finding among women seeking abortion care. We did not find any association between a history of sexual violence and the absence of a gynecological consultation in the past two years. We suggest investigating multiple or frequent use of gynecological care following violence. The combination of ethical, moral, and psychological constraints associated with violence screening and abortion care is a challenge to patient recruitment in future studies.

Vulnerability in research ethics: A call for assessing vulnerability and implementing protections

Ethics standards reference the need for special consideration of vulnerable populations, such as pregnant women, incarcerated individuals, and minors. The concept of vulnerability is poorly conceptualized in the medical sciences where it originated, and its application to the social sciences is even more challenging. Social science researchers may unwittingly fail to appreciate preexisting vulnerabilities and indeed may be responsible for inducing new research-related vulnerability. In this paper, we present the first comprehensive coding of country-level vulnerability designations. Specifically, we coded all 355 official documents governing social/behavioral human subjects research for the 107 countries with such regulations and identified 68 distinct vulnerability categories. The data reveal substantial regional variation, overemphasis of categories derived from medical sciences, neglect of critical categories such as displacement, and likely heterogeneity within and across groups. The article provides a conceptual framework that shifts the problem away from static, enumerated categories toward emphasis on research-induced vulnerability. Based on our conceptualization and coding, we present a framework for assessing vulnerability and implementing appropriate protections.

Navigating distress: Exploring factors affecting adolescent girls' wellbeing during and after a violence-focused survey in Maharashtra, India

BACKGROUND

Ensuring the emotional wellbeing of participants in violence-focused research is a paramount ethical requirement. While previous research suggests that most participants in violence-focused studies do not report harmful consequences, little is known about the experiences of adolescent participants in low- and middle-income countries.

OBJECTIVE

This study, conducted in Maharashtra, India, aims at assessing how participant, contextual, and interviewer characteristics affect the level of distress that adolescent girls experience after participation in a violence survey.

METHODS

A total of 3049 13-18-year-old girls were interviewed on their experiences of family and intimate partner violence. Following the interview, both girls and interviewers completed a 5-item questionnaire on perceived participant distress. Linear regression analyses were conducted to identify possible correlates of girls' distress.

RESULTS

Less than 10 % of participants reported feelings of distress upon completion of the interview. Higher levels of interviewers' empathy were significantly associated with decreased levels of participants' distress (standardised beta: -0.25, p < 0.001). Reported distress was also lower if girls had opted for an audio- and mobile-assisted self-interview (ACASI) format (standardised beta: -0.05, p < 0.01) and if the interview was conducted by someone older (standardised beta: -0.22, p < 0.001). Conversely, if interviews were conducted in participants' homes and by interviewers with higher education levels, reported distress was significantly higher (standardised beta: 0.06, p < 0.01 and 0.12, p < 0.001, respectively).

CONCLUSIONS

Our findings suggest that incorporating empathetic interviewing and trust-building techniques into interviewer training, offering ACASI interviews, and choosing interview locations that ensure confidentiality can help protect the wellbeing of participants in violence research.

Association of intimate partner violence with offspring growth in 32 low- and middle-income countries: a population-based cross-sectional study

Intimate partner violence (IPV) against women presents a major public health challenge, especially in low-income and middle-income countries (LMICs), and its relationship with poor offspring growth is emerging but remains understudied. This study aimed to explore the impact of maternal exposure to IPV on offspring growth based on different approaches in LMICs. We conducted a population-based cross-sectional study using the most recent Demographic and Health Surveys from 32 LMICs; 81,652 mother-child dyads comprising women aged from 15 to 49 years with children aged 0 to 59 months were included. We applied logistic regression models to explore the independent and cumulative relationship between IPV, including emotional, physical, and sexual IPV, with poor child growth status, including stunting and wasting; 52.6% of mothers were under the age of 30 years with a 36% prevalence of any lifetime exposure to IPV. Maternal exposure to any IPV increased the odds of stunting, but only physical and sexual IPV were independently associated with an increased risk of stunting. Three different types of IPV exhibited a cumulative effect on stunting. Maternal exposure to physical IPV was significantly associated with an increased risk of wasting. Significant associations between maternal exposure to emotional IPV with offspring stunting and physical IPV with wasting were only observed in children aged 0 to 36 months. IPV against women remains high in LMICs and has adverse effects on offspring growth. Policy and program efforts are needed to prioritize the reduction of widespread physical and sexual IPV and to mitigate the impact of such violence.

Improving Emotional Safety, Coping, and Resilience Among Women Conducting Research on Sexual and Domestic Violence and Abuse

Secondary trauma arises through indirect exposure to trauma through engaging with first-hand accounts and narratives of traumatic events. While a significant amount of research has explored secondary trauma experienced by professionals who work with survivors of trauma, such as clinicians and front-line service providers, there is little research exploring the experiences of secondary trauma among violence researchers who routinely engage with traumatic first-hand accounts through their work. This study qualitatively explored violence researcher's professional experiences of secondary trauma and their perceptions of what enables and constrains their own coping and resilience. Participants were recruited using purposive sampling methods. Semi-structured interviews were conducted online with seven female violence researchers from the United Kingdom. Questions explored participant's experiences of secondary trauma symptoms related to their research, perceptions of their own coping and resilience, and experiences of organizational support that have enabled or constrained their resilience. Data were analyzed thematically using a coding framework applied reflexively across interview transcripts. All participants reported experiencing symptoms of secondary trauma from their work including cognitive disturbances; altered beliefs of themselves, others or the world; and challenges connecting with others. Participants' assessment of their own expertise in violence research did not generally impact their perception of their own resilience. Organizational support for violence researchers was rarely provided and participants felt generally unsupported-left to manage any resultant distress alone. Research organizations and universities should implement trauma-informed policies which positively transform workplace culture, provide peer support spaces, and conduct effective training in order to mitigate psychological harm and promote resilience among violence researchers. Support should be tailored to the requirements of violence researchers, and institutions should develop policies that are specifically attentive to the needs of researchers who also have lived experience of violence and abuse.

A global study into Indian women's experiences of domestic violence and control: the role of patriarchal beliefs

Domestic violence (DV) is a serious and preventable human rights issue that disproportionately affects certain groups of people, including Indian women. Feminist theory suggests that patriarchal ideologies produce an entitlement in male perpetrators of DV; however, this has not been examined in the context of women from the Indian subcontinent. This study examined Indian women's experiences of abuse (physical, sexual, and psychological) and controlling behavior across 31 countries by examining the relationship between the patriarchal beliefs held by the women's partners and the women's experience of DV. This study uses an intersectional feminist framework to examine the variables. Data from an online questionnaire was collected from 825 Indian women aged between 18 and 77 years (M = 35.64, SD = 8.71) living in 31 countries across Asia (37.1%), Europe (18.3%), Oceania (23.8%), the Americas (16.1%) and Africa (3.2%) and analyzed using a hierarchical linear regression. A majority of participants (72.5%) had experienced at least one form of abuse during their relationship, and over a third (35.1%) had experienced controlling behavior. In support of the central hypotheses, after controlling for potential confounders, women whose partners showed greater endorsement of patriarchal beliefs were less likely to have access to freedom during their relationship (ß = -0.38, p < 0.001) and were more likely to have been abused by their partner or a member of his family (ß = 0.34, p < 0.001). The findings of this study highlight the need to engage with men in Indian communities through culturally-tailored intervention strategies designed to challenge the patriarchal ideologies that propagate, justify, and excuse DV.

Assessing essential service provision for prevention and management of violence against women in a remote indigenous community in Amantaní, Peru

BACKGROUND

Women living in indigenous communities in Peru currently experience extremely high rates of intimate partner violence (IPV). Over the past 10 years, there has been a large multi-sectoral initiative to establish a national network of Centros de Emergencia de la Mujer (Women's Emergency Centres) that integrate health and police services, and substantial increase in efforts from non-governmental organisations in supporting survivors of violence. However, there is currently little evidence on how existing services meet the needs of indigenous women experiencing violence in Peru.

METHODS

As part of a broader mixed-methods participatory VAWG prevention study, we assessed existing service provision for women experiencing violence in an indigenous Quechua community from Amantaní, Peru. This involved 17 key informant interviews with legal, government, police, and civil society representatives. We used the UN Women Essential Services Package for Women and Girls Subject to Violence framework to guide our analysis.

RESULTS

Participants identified major gaps in existing services for indigenous women survivors of violence in Peru. They discussed survivors and perpetrators not being identified by the health system, a lack of IPV response training for health professionals, IPV not being prioritised as a health concern, and a lack of health services that are culturally appropriate for indigenous populations. Survivors who report to police are often treated poorly and discriminated against. Legal systems were perceived as insufficient and ineffective, with inadequate legal measures for perpetrators. While legal and policy frameworks exist, they are often not applied in practice. Service provision in this region needs to adopt an intercultural, rights based, gendered approach to IPV response and prevention, considering cultural and linguistic relevance for indigenous populations.

CONCLUSION

The role of structural violence in perpetuating indigenous women's experiences of violence and undermining their access to services must be central to designing and implementing appropriate policies and services if they are to meet the needs of indigenous women in Peru.

Ethically Driven and Methodologically Tailored: Setting the Agenda for Systematic Reviews in Domestic Violence and Abuse

Purpose

Systematic reviews have an important, and growing, role to play in the global evidence eco-system of domestic violence and abuse. Alongside substantive contributions to knowledge, such reviews stimulate debates about ethical reviewing practices and the importance of tailoring methods to the nuances of the field. This paper aims to pinpoint a set of ethical and methodological priorities to guide and enhance review practices specifically in the field of domestic abuse.

Method

The five Pillars of the Research Integrity Framework (ethical guidelines for domestic abuse research) are used to interrogate the systematic review process. To do so, the Framework is retrospectively applied to a recently completed systematic review in domestic abuse. The review included a rapid systematic map and in-depth analysis of interventions aimed at creating or enhancing informal support and social networks for victim-survivors of abuse.

Results

Ethical and methodological priorities for systematic reviews in domestic abuse include (1) Safety and wellbeing: maintaining the wellbeing of researchers and stakeholders, and appraising the ethics of included studies, (2) Transparency/ accountability: transparent reporting of research funding, aims and methods together with explicit consideration of authorship of outputs, (3) Equality, human rights and social justice: developing diverse review teams/ Advisory groups, and review methods that aim to search for, and report, diverse perspectives. Considering researcher positionality/ reflexivity in the review, (4) Engagement: collaboration with non-academic stakeholders and individuals with lived experience throughout the review process, (5) Research Ethics: independent ethical scrutiny of systematic review proposals with input from researchers with expertise in systematic reviews and domestic abuse.

Conclusion

Additional research is required to comprehensively examine the ethics of each stage of the review process. In the meantime, attention should be given to the underpinning ethical framework for our systematic review practices and the wider research infrastructure that governs reviews.

Prioritising Children and Young People with Disability in Research About Domestic and Family Violence: Methodological, Ethical and Pragmatic Reflections

Purpose

The perspectives of children and young people with disability who experience domestic and family violence are under-researched, impeding the development of approaches that meet their needs. Knowledge gaps stem from the layered discursive positioning of disability, childhood/youth, or domestic and family violence in addition to the methodological, ethical and pragmatic complexity of research needed to understand their priorities and be attuned to their lived experience. This article explores methodological, ethical and practical challenges to centring their voices in research about domestic and family violence.

Method

A conceptual framework of feminist disability theory and intersectionality informed our co-designed research, across three phases: (1) quantitative large-scale data linkage and case file analysis; (2) qualitative research with children and young people, their families and service providers and (3) stakeholder engagement workshops.

Results

We reflect on how our research was able to prioritise the contextual agency of children and young people with disability, ways it could not, and other constraints.

Conclusion

Children and young people with disability experiencing domestic and family violence hold an expert and unique vantage point on what happens to them. Amplifying their priorities for directing policy and organisational change requires more of researchers in terms of methods, but also more flexibility in how projects are funded to enable creativity and innovation. We call for collective attention to frameworks for supported decision-making and child ethics to progress inclusive research which recognises the importance of participation for children and young people with disability.

Proximity to Alcohol Sellers and Dose Response Relationship Between Alcohol Consumption With Intimate Partner Violence in Rural Southwestern Uganda

Introduction: Intimate partner violence (IPV) is associated with several adverse public health outcomes and alcohol use is one of its risk factors. Proximity to alcohol selling points could be linked with problem drinking and IPV. We aimed to determine whether proximal location to alcohol and intensity of alcohol consumption are associated with IPV in rural southwest Uganda.Methods: We conducted a cross-sectional study in rural southwest Uganda with structured interviews at household level. We used the alcohol use disorders identification test (AUDIT) and the Conflict Tactics Scale to measure past year alcohol consumption and IPV (perpetration and victimization). We estimated Euclidean distances between participants' households and nearest alcohol outlets using geographic information systems. We used generalized estimating equation models to calculate adjusted odds ratios (aOR) for the factors associated with IPV.Results: We enrolled 742 participants and median age was 41 years (inter-quartile range or IQR 32-53) and 52.2% of respondents were male. The overall prevalence of IPV in the past year was 52.2%. In a multivariable regression model, women (aOR = 2.24, 95%CI 1.28, 3.91) compared to men, those living proximal to an alcohol selling point (OR = 1.77, 95% CI 1.38, 2.27) were more likely to experience IPV. There was a dose-response relationship between alcohol consumption and IPV. With non-drinkers as the reference category, the aORs were 4.54 (95% CI 2.04, 10.08) for casual drinkers, 10.53 (95% CI 4.15, 26.77) for hazardous drinkers and 15.31 (95% CI 4.73, 49.54) for alcohol dependent drinkers.Conclusion: IPV is very common and has a dose-response relationship with alcohol consumption and drinking outlet proximity. There is an urgent need for IPV and alcohol interventions programs in these rural communities. Policy to restrict proximity of alcohol outlets to residential locations should be examined as an intervention for alcohol consumption and IPV perpetration.

Prevalence, pattern, and predictors of formal help-seeking for intimate partner violence against women: findings from India's cross-sectional National Family Health Surveys-3 (2005-2006) and 4 (2015-2016)

BACKGROUND

Help-seeking for intimate partner violence (IPV) requires women to disclose their experiences. For policymakers, low help-seeking threatens the United Nations Sustainable Development Goals (SDGs) of gender equality, good health, and wellbeing. In India, the Prevention of Domestic Violence Against Women Act (PWDVA 2005) was implemented in 2006. Using two rounds of the India National Family Health Survey (NFHS), one before and one after implementation, we examined the prevalence, pattern, and sociodemographic and socioeconomic factors associated with formal help-seeking for IPV.

METHODS

We used univariable and multivariable logistic regression models to assess the prevalence of help-seeking for IPV in the past 12 months and examined associations with different forms of IPV and sociodemographic factors.

RESULTS

The proportion of ever-married women aged 15-49 years who reported physical, sexual, or emotional IPV in the last 12 months increased from 23% in NFHS-3 (2005-2006) to 25% in NFHS-4 (2015-2016). In both surveys, few women sought help. Informal sources of help were preferred over formal sources, which declined from NFHS-3 to NFHS-4 (any help: 24.5 to 13.8%; informal help: 24.1 to 13.4%; and formal help: 1.2 to 1.1%). Women from lower castes and women with children were less likely to seek formal help. Over the two surveys, the odds of formal help-seeking for sexual IPV in the past 12 months remained similar (NFHS-3 aOR 1.9, 95% CI 1.4, 2.5. NFHS-4 aOR 1.9, 95% CI 1.4, 2.6). The odds were slightly higher for emotional IPV (NFHS-3 aOR 2.5, 95% CI 1.8, 3.3. NFHS-4 aOR 2.7, 95% CI 2.0, 3.7) and spousal control (NFHS-3 aOR 2.0, 95% CI 1.4, 3.0. NFHS-4 aOR 2.3, 95% CI: 1.4, 3.7).

CONCLUSIONS

Low disclosure and help-seeking impact a country's social, cultural, economic, and political progress. The PWDVA did not appear to result in increases in help-seeking among women in India who experienced IPV. Further work is needed to understand barriers to help-seeking in the presence of public policy efforts to support women affected by IPV. These may include poor implementation and enforcement of Policy, as well as normalization and justification of gender-based violence. We recommend a deeper understanding of help-seeking across all systems to establish a barometer of help-seeking. An increase in formal or informal help-seeking is an indicator of reduced tolerance of IPV and the enabling environment of the PWDVA 2005 for tracking progress toward the SDGs of gender equality and the eradication of all forms of gender-based violence and discrimination.

Intimate partner violence against women in Southern Punjab, Pakistan: A phenomenological study

BACKGROUND

Intimate Partner Violence (IPV) refers to behavior by an intimate partner that can cause physical, sexual, or psychological harm; is a common global public health issue requiring immediate attention. IPV is the most common form of violence in rural areas of Punjab, Pakistan.

METHODS

This qualitative phenomenological study collected 46 in-depth interviews from married women who experienced IPV in the rural areas of South Punjab. A semi-structured interview guide was used for data collection. These women were selected through a snowball sampling technique from October 2018 to March 2019. Researchers accessed the study setting with the help of gatekeepers (Lady Health Workers and Village Heads). The interviews were audio-recorded in the local language (Saraiki) and were translated into English. The data were analyzed using the thematic inductive analysis technique.

RESULTS

The study has presented multifaceted factors of IPV by using the socio-ecological framework in rural areas of South Punjab, Pakistan. The current study introduced culturally contextualized terminologies of "protection," "physical submissiveness," "mental delicacy," and "social security". For married women, culturally embedded terms became the primary cause of IPV. In addition, the study also highlighted some of the cultural terminologies (such as run-mureed, watta-satta, beghairat, izzat, etc.) that are ubiquitous in the local context that sometimes intensifies IPV in the family and community sphere. Furthermore, the study discussed how gender-based inequalities trigger a status quo that ultimately creates power discrimination between spouses, which perpetuates violence in the domestic context.

CONCLUSIONS

Gender-prejudiced roles and expectations imposed by orthodoxy, misinterpretations of Islamic teachings, and dominant patriarchy can be contested through awareness campaigns among the public, and gender sensitization drives among public institutions of police and judiciary. Education and employment-based can lead to women's empowerment and help to challenge the orthodox anti-feminist societal norms and the role of kinship-based networks in the family and community sphere.

Pathways to change: Three decades of feminist research and activism to end violence against women in Nicaragua

This paper presents the results of nearly three decades of partnership between feminist researchers and activists to prevent violence against women and girls (VAWG) in Nicaragua. A household survey conducted in 1995 in León, the country's second-largest city, revealed that 55 per cent of women had experienced lifetime physical intimate partner violence (IPV), and 27 per cent had experienced IPV in the last 12 months. The study results were instrumental in changing domestic violence laws in Nicaragua. A follow-up study in 2016 found a decrease of 63 per cent in lifetime physical IPV and 70 per cent in 12-month physical IPV. This paper examines possible explanations for the reduction, including the policy reforms resulting from feminist advocacy. We compare risk and protective factors for physical IPV, such as changes in women's attitudes towards violence, their use of services, and knowledge of laws, using data from both the 1995 and 2016 surveys, as well as three waves of Demographic and Health Surveys. We conclude that the decline in IPV can be partially attributed to the efforts of the Nicaraguan women's movements to reform laws, provide services for survivors, transform gender norms, and increase women's knowledge of their human rights.

"Mi Corazón se Partió en Dos": Transnational Motherhood at the Intersection of Migration and Violence

In the recent Central American migrations spurred by violence, political instability, and economic insecurity, women grapple with whether and when to bring their children with them in pursuit of safety in another country, and with fulfilling their roles as mothers from afar. Drawing from the transnational motherhood literature and critical feminist theories, this interpretive qualitative study examined transnational motherhood grounded in the lived experiences of Central American women (n = 19) over the course of their migrations to the US. Informed by the principles of grounded theory, the inductive analysis identified five processes in which migration and violence shaped meanings of motherhood: risking everything, embodying separation, braving reunification, mothering others, and experiencing motherhood due to sexual violence. The findings contribute knowledge of how violence shapes and informs women's migrations and decision-making, and the consequences women endure in taking action to mitigate threats of violence in their own and their children's lives. The analysis furthermore highlights the specific and profound effects of family separation on mothers. The voices, perspectives, and experiences of migrating mothers and the ways in which migration and violence shapes notions and lived experiences of motherhood are imperative to research, practice, and advocacy to change oppressive immigration policies.

Global measurement of intimate partner violence to monitor Sustainable Development Goal 5

BACKGROUND

One third of women experience intimate partner violence (IPV) and potential sequelae. Sustainable Development Goal (SDG) 5.2-to eliminate violence against women, including IPV-compels states to monitor such violence. We conducted the first global measurement-invariance assessment of standardised item sets for IPV.

METHODS

Demographic and Health Surveys (DHS) from 36 Lower-/Middle-Income Countries (LMICs) administering 18 IPV items during 2012-2018 were included. Analyses were performed separately for two items sets: lifetime physical IPV (seven items) and controlling behaviours (five items). We performed country-specific exploratory and confirmatory factor analyses (EFA/CFA). Datasets meeting benchmarks for acceptable item loadings and model-fit statistics were included in multiple-group CFA (MGCFA) to test for exact measurement invariance. Based on findings, alignment optimization (AO) was performed to assess approximate measurement invariance (< 25% of model parameters non-invariant). For each item set, national rankings based on AO-derived scores and on prevalence estimates were compared. AO-derived scores were correlated with type-specific IPV prevalences to assess correspondence.

RESULTS

National rates of physical IPV (5.6-50.5%) and controlling behavior (25.9-84.7%) varied. For each item set, item loadings and model-fit statistics were adequate in country-specific, unidimensional EFAs and CFAs. Both unidimensional constructs lacked exact invariance in MGCFA but achieved approximate invariance in AO analysis (12.3% of model parameters for physical IPV and 6.7% for controlling behaviour non-invariant). For both item sets, national rankings based on AO-derived scores were distributed similarly to rankings based on prevalence. However, estimates often were not significantly different cross-nationally, precluding national-level comparisons regardless of estimation strategy. Three physical-IPV items (slap, twist, choke) and two controlling-behaviour items (meet female friends; contact with family) warrant cognitive testing to improve their psychometric properties. Correlations of AO-derived scores for physical IPV (0.48-0.66) and controlling behaviours (0.49-0.87) with prevalences of lifetime physical, sexual, psychological IPV as well as controlling behaviour varied.

CONCLUSIONS

Seven DHS lifetime physical-IPV items and five DHS controlling-behaviour items were approximately invariant across 36 LMICs spanning five world regions, such that cross-national comparisons of factor means are reasonable. Measurement-invariance testing over time will inform their utility to monitor SDG5.2.1; cross-national, cross-time measurement-invariance testing of improved sexual and psychological IPV item-sets is needed.

Abuse among Portuguese older people at a time of economic crisis recovery: findings from the Harmed study

This study aimed to assess the prevalence of abuse against Portuguese older people after an economic crisis and to assess how it has influenced health. A cross-sectional study was carried out including 677 older adults (≥60 years) during 2017. Results show that overall, 23.9% of older people reported being a victim of abuse in the last 12 months. The prevalence of psychological abuse was 19.9%, financial abuse 5.8%, physical abuse 2.5% and sexual abuse 1.9%. Older people who report abuse were more likely to have perceived insufficient income and low social support. The abuse was also significantly associated with poor health status and depressive symptoms. Even in an auspicious period, more than a fifth of older people experiences abuse which is associated with social and health vulnerabilities. These results support that an investment should be made in terms of policies toward an age-friendly environment.

"Back Home You Just Go Talk to the Family": The Role of Family Among Women Who Seek Help for Intimate Partner Violence Pre- and Postresettlement to the United States

Gaps in knowledge remain regarding how and from whom women resettling to the United States as refugees seek help for intimate partner violence (IPV), and what happens when they do. This study examined ways in which women seek help for IPV across varied contexts and at different times both pre- and postresettlement. Researchers used a purposive sampling approach to recruit women who resettled to the United States as refugees (n = 35). An inductive approach to thematic analysis led to an examination of the role of family in seeking help for IPV and seeking help in the absence of family. The findings speak to the importance of applying a social support lens to theory, practice, and research concerned with women's help-seeking for IPV in the resettlement context.

Categories and health impacts of intimate partner violence in the World Health Organization multi-country study on women's health and domestic violence

BACKGROUND

Intimate partner violence (IPV) damages health and is costly to families and society. Individuals experience different forms and combinations of IPV; better understanding of the respective health effects of these can help develop differentiated responses. This study explores the associations of different categories of IPV on women's mental and physical health.

METHODS

Using data from the World Health Organization (WHO) Multi-Country Study on Women's Health and Domestic Violence, multilevel mixed effects logistic regression modelling was used to analyse associations between categories of abuse (physical IPV alone, psychological IPV alone, sexual IPV alone, combined physical and psychological IPV, and combined sexual with psychological and/or physical IPV) with measures of physical and mental health, including self-reported symptoms, suicidal thoughts and attempts, and nights in hospital.

RESULTS

Countries varied in prevalence of different categories of IPV. All categories of IPV were associated with poorer health outcomes; the two combined abuse categories were the most damaging. The most common category was combined abuse involving sexual IPV, which was associated with the poorest health [attempted suicide: odds ratio (OR): 10.78, 95% confidence interval (CI) 8.37-13.89, thoughts of suicide: 8.47, 7.03-10.02, memory loss: 2.93, 2.41-3.56]. Combined psychological and physical IPV was associated with the next poorest outcomes (attempted suicide: 5.67, 4.23-7.60, thoughts of suicide: 4.41, 3.63-5.37, memory loss: 2.33, 1.88-2.87-).

CONCLUSIONS

Understanding the prevalence and health impact of different forms and categories of IPV is crucial to risk assessment, tailoring responses to individuals and planning services. Previous analyses that focused on singular forms of IPV likely underestimated the more harmful impacts of combined forms of abuse.

Emotional distress among frontline research staff

Public health research frequently deals with sensitive topics. A growing body of evidence suggests that frontline researchers who elicit or process participant's traumatic experiences are themselves at risk of developing emotional distress or secondary trauma from daily immersion in these data. This both threatens a study's data quality and calls into question how the harms and benefits of conducting research are distributed across a study team. The objective of this study was to explore how frontline research staff in Eswatini experience and process emotional distress as part of their daily work and to describe potential strategies for resilience and coping using qualitative research methods. We conducted 21 in-depth interviews with informants who had worked in data collection, data entry, and transcription on a number of sensitive topics, including HIV, sex work, and LGBT health. We found that emotional distress is a salient experience among frontline research staff working in Eswatini. This distress stems from conducting research against a generalized backdrop of high rates of HIV, violence, and poverty, particularly since research staff are drawn from affected communities and have their own firsthand knowledge of the phenomena they are studying. Moreover, the qualities study staff are often hired for - empathy, compassion, and emotional intelligence - are also traits that may increase their likelihood of feeling distressed by the narratives they encounter in their work. The workplace can serve as a prism, exacerbating or potentially mitigating these risks into harm at the individual, interpersonal, and community level. While not all study teams may have access to formal mental health services, several informants recommended incorporating regular meetings with a trained counselor as part of the overall project. Others recommended building time for team-building or debriefing conversations into the normal workweek, a strategy that would address both the issue of workload and could bolster the already existent strategy of relying on team members for mental health support.

Decolonising violence against women research: a study design for co-developing violence prevention interventions with communities in low and middle income countries (LMICs)

BACKGROUND

There has been substantial progress in research on preventing violence against women and girls (VAWG) in the last 20 years. While the evidence suggests the potential of well-designed curriculum-based interventions that target known risk factors of violence at the community level, this has certain limitations for working in partnership with communities in low- and middle-income (LMIC) countries, particularly when it comes to addressing the power dynamics embedded within north-south research relationships.

METHODS

As an alternative approach, we outline the study design for the EVE Project: a formative research project implemented in partnership with community-based researchers in Samoa and Amantaní (Peru) using a participatory co-design approach to VAWG prevention research. We detail the methods we will use to overcome the power dynamics that have been historically embedded in Western research practices, including: collaboratively defining and agreeing research guidelines before the start of the project, co-creating theories of change with community stakeholders, identifying local understandings of violence to inform the selection and measurement of potential outcomes, and co-designing VAWG prevention interventions with communities.

DISCUSSION

Indigenous knowledge and ways of thinking have often been undermined historically by Western research practices, contributing to repeated calls for better recognition of Southern epistemologies. The EVE Project design outlines our collective thinking on how to address this gap and to further VAWG prevention through the meaningful participation of communities affected by violence in the research and design of their own interventions. We also discuss the significant impact of the COVID-19 pandemic on the project in ways that have both disrupted and expanded the potential for a better transfer of power to the communities involved. This article offers specific strategies for integrating Southern epistemologies into VAWG research practices in four domains: ethics, theories of change, measurement, and intervention design. Our aim is to create new spaces for engagement between indigenous ways of thinking and the evidence that has been established from the past two decades of VAWG prevention research and practice.

Influences of Extended Family on Intimate Partner Violence: Perceptions of Pakistanis in Pakistan and the United Kingdom

Limited research has been undertaken on the role of extended family members in Intimate Partner Violence (IPV). This study uniquely explores the perspective of Pakistani men and women about the role of a husband and wife's families in relation to marital conflict and IPV. For this qualitative study, data were collected through 41 individual interviews, including 20 from Pakistan and 21 from the United Kingdom. The findings are presented in four themes, including "privacy and personal space," "interference and instigation of problems," "conflicting and uncommunicated expectations," and "adjustment facilitation." A lack of privacy and personal space within a family home shared with extended family on the husband's side, interference in terms of mothers-in-law and sisters-in-law making complaints about the wife, and the couple's differing expectations of the husband's responsibility for his extended family could cause tension and conflict that could lead to IPV. The husband's family could also have a positive effect by minimizing conflict through offering the couple personal time and helping the wife to adjust to her new family. The wife's family was perceived as having a much more passive role in terms of not interfering, but instead allowing her to adjust to her new extended family. In conclusion, the husband's extended family can have a considerable impact on conflict within couples. Public health prevention initiatives for IPV in Pakistani people should address the role of the husband's extended family. The findings of the study are not only important for the population studied, which is part of an international diaspora, but also for other communities worldwide that value close family structure due to cultural and religious preferences.

Examining the Risks of Engaging in Population-based Surveys on Violence: Follow-up Study of the Individual Deprivation Measure in South Africa

In the South African Individual Deprivation Measure, the individual survey, included questions about two potentially highly sensitive topics-individuals' experience of violence and their control over personal decision making. In-depth follow-up interviews were conducted with 105 consenting survey participants to determine whether participating in the survey resulted in negative impacts for individuals, particularly in relation to these two topics. Several participants found that being asked about their experiences resurfaced painful memories, but we did not find any evidence that the approach of surveying every eligible individual in the dwelling resulted in any form of harm for the survey participants.

The Challenges of Conducting Qualitative Research on "couples" in Abusive Intimate Partner Relationships Involving Substance Use

Undertaking qualitative dyad or couple interviews involving intimate partner abuse and substance use presents considerable ethical, safeguarding, and theoretical challenges throughout the research process from recruitment to conducting interviews and analysis. These challenges and how they were managed are outlined using the experience from a qualitative study of 14 heterosexual "couples" that explored the complex interplay between intimate partner abuse and substance use. Managing these challenges for participants, their families, and researchers included the use of safeguarding protocols and procedures to manage risk and the provision of clinical support for experienced researchers. Researchers often felt drawn into the conflicts and complex dynamics of opposing accounts from the male and females' relationship which could be emotionally and methodologically taxing. Researchers discussing their analysis and felt experiences with each other provided a reflexive space to manage emotions and stay close to the theoretical underpinnings.

Prevalence and determinants of intimate partner violence against mothers of children under-five years in Central Malawi

BACKGROUND

Intimate partner violence (IPV) against women is a global human rights violation and a public health problem. The phenomenon is linked to adverse health effects for women and children. Mothers of young children in Malawi can be particularly at risk because of gender-based power imbalances. The objectives of this study were to examine the prevalence and the risk factors of IPV against mothers of children under-five years of age in rural Malawi.

METHODS

A multistage, cross-sectional study design was used. A sample of 538 mothers of young children was randomly selected from postnatal clinics in Dowa district. The WHO's Violence against women screening instrument was used to collect data. Logistic regressions were used to determine risk factors that were associated with IPV against mothers.

RESULTS

Overall prevalence of all four forms of IPV against mothers of under-five children was 60.2%. The prevalence of IPV controlling behavior, psychological, physical, and sexual violence were 74.7, 49.4, 43.7 and 73.2% respectively. In multivariate analyses, mothers whose partners had extra marital affairs were more likely to experience controlling behavior (AOR: 4.97, 95% CI: 2.59-8.55, P = 0.001), psychological (AOR: 2.14, 95% CI: 1.486-3.472, P = 0.001) and physical (AOR: 2.29, 95% CI: 1.48-3.94, P = 0.001) violence than mothers whose partners did not have extra marital affairs. Mothers whose partners consume alcohol were more likely to experience sexual violence (AOR: 2.00, 95% CI: 1.17-3.41, P = 0.001) than mothers whose partners did not drink. Finally, mothers who spent more than 30 min drawing water were at greater risk of experiencing IPV than mothers who spent less than 30 min.

CONCLUSION

This study found a significantly higher prevalence of IPV against mothers of under-five children in rural Malawi compared to women in the general population. Micro and macro-level programs aimed at mitigating the partners' potential risk behaviors identified in this study are suggested. Public health programs that support increased household access to safe water are also recommended to help undermine IPV against mothers.

Prevalence and determinants of malaria infection among children of local farmers in Central Malawi

Background

Malaria is a leading cause of morbidity and mortality among children under 5 years in Malawi, and especially among those from rural areas of central Malawi. The goal of this study was to examine the prevalence and determinants of malaria infection among children in rural areas of Dowa district in central Malawi.

Methods

A multistage, cross-sectional study design was used to systematically sample 523 child-mother dyads from postnatal clinics. A survey was administered to mothers and a rapid malaria infection diagnostic test was administered to children. The main outcome was positive malaria diagnostic tests in children. Logistic regressions were used to determine risk factors associated with malaria among children aged 2 to 59 months.

Results

The prevalence of malaria among children under 5 years was 35.4%. Results suggest that children of mothers who experienced recent intimate partner violence (IPV) were more likely to be diagnosed with malaria (AOR: 1.88, 95% CI 1.19–2.97; P = 0.007) than children of mothers who did not. Children of mothers who had no formal education were more likely to be diagnosed with malaria (AOR: 2.77, 95% CI 1.24–6.19; P = 0.013) than children of mothers who had received secondary education. Children aged 2 to 5 months and 6 to 11 months were less likely to be diagnosed with malaria (AOR: 0.21, 95% CI 0.10–0.46; P = 0.000 and AOR: 0.43; 95% CI 0.22–0.85; P = 0.016, respectively) than children aged 24 to 59 months.

Conclusion

The prevalence of malaria infection among children in the study area was comparable to the national level. In addition to available malaria control programmes, further attention should be paid to children whose mothers have no formal education, children aged 24 to 59 months, and children of mothers that are exposed to IPV in the area.

Long-term change in the prevalence of intimate partner violence: a 20-year follow-up study in León, Nicaragua, 1995-2016

Introduction

Although intimate partner violence (IPV) affects an estimated one out of three women globally, evidence on violence prevention is still scarce. No studies have measured long-term change in larger populations over a prolonged period.

Methods

The aim of this study was to measure changes in the prevalence of IPV in León, Nicaragua, between 1995 and 2016. The 2016 study interviewed 846 ever-partnered women aged 15 to 49 regarding experiences of physical, sexual and emotional IPV. These findings were analysed together with comparable data collected from 354 women in 1995. Multivariate logistic regression modelling was carried out on a pooled data set to identify differences between the two studies while controlling for potential confounding factors.

Results

Lifetime physical IPV decreased from 54.8 to 27.6 per cent (adjusted OR (AOR) 0.37; 95% CI 0.28 to 0.49) and 12-month prevalence of physical IPV decreased from 28.2 to 8.3 per cent (AOR 0.29; 95% CI 0.20 to 0.42), respectively. Similar decreases were found in lifetime and 12-month emotional IPV. No significant difference was found in the prevalence of lifetime sexual violence between the two time periods.

Conclusions

The results suggest that the reduction in IPV was not due to demographic shifts, such as increased education or age, but reflects a true decrease in the prevalence of IPV. The decrease is not likely to have occurred on its own, and may be attributable to multisectoral efforts by the Nicaraguan government, international donors and the Nicaraguan women’s movement to increase women’s knowledge of their rights, as well as access to justice and services for survivors during this time period.

Researching violence against women and girls in South Sudan: ethical and safety considerations and strategies

Background

Globally, it is estimated that at least one out of every three women experiences violence by an intimate partner and/or non-partner throughout their lifetime. Women and girls are at even higher risk of violence in conflict and humanitarian crises. Although effort has expanded to build rigorous evidence and research on violence against women and girls (VAWG) among conflict-affected populations, methodological and ethical challenges remain. Basic ethical research practices are more challenging in conflict-affected populations and therefore require supplementary protections. While it is important to follow international ethical guidelines, in practice it is sometimes difficult depending on the setting. The aim of this paper is to present the main ethical challenges that occur when conducting research on VAWG in conflict and humanitarian settings, as well as potential strategies to address these challenges, based on a recent study carried out in South Sudan in 2016.

Case presentation

This paper provides an analysis utilizing the World Health Organization guidelines on doing research on VAWG and in conflict and humanitarian settings. The paper analyses four main components: the first component is a risk-benefit assessment, which includes identifying the research gap and evaluating feasibility with local stakeholders. The second component is a methodological and conceptual approach, which involves both local stakeholders and external experts in order to develop flexible methods that can be used in a volatile conflict setting. The third component is safety considerations, which emphasizes the importance of collaborating with a partner with strong local networks. The last component is analysis and research uptake. This component describes the importance of developing different research products, and disseminating them in a way to ensure they would be relevant and minimize any risks to the participants.

Conclusions

The study in South Sudan provided an excellent opportunity to put into practice the international ethical guidelines to carry out research on VAWG in conflict and humanitarian settings. The study enabled the research team to reflect on the guidelines and develop strategies to cope with new methodological and ethical challenges that arose in this complex setting, adapting the guidelines, as necessary. It demonstrated the necessity of developing a strong yet adaptable methodology with multiple alternative plans to solve any safety or ethical issues that occur throughout the entirety of the study. It also revealed the importance of collaborating with an implementing partner and gathering input from both local and international stakeholders on research design, analysis and uptake. Most importantly, the study in South Sudan emphasized that this type of complex research requires significant planning, in addition to substantial financial and human resources. Donor buy-in and flexibility is therefore essential.

Not Managing Expectations: A Grounded Theory of Intimate Partner Violence From the Perspective of Pakistani People

Intimate partner violence (IPV) is a major social and public health problem affecting people from different cultures and societies. Much research has been undertaken to understand the phenomenon, its determinants, and its consequences in numerous countries. However, there is a paucity of research on IPV in many areas of the world including Pakistan. The present study aimed to develop a theory of the meaning and process of IPV from the perspective of Pakistani men and women living in and outside Pakistan.

Maternal exposure to intimate partner violence and breastfeeding practices in 51 low-income and middle-income countries: A population-based cross-sectional study

BACKGROUND

Intimate partner violence (IPV) against women is a major global health issue, particularly in low- and middle-income countries (LMICs), that is associated with poor physical and mental health, but its association with breastfeeding practices is understudied. Both the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) recommend that children initiate breastfeeding within the first hour of birth and be exclusively breastfed for the first 6 months of life. Breastfeeding within the first hour of birth is critical to newborn survival, and exclusive breastfeeding for 6 months is recognised to offer significant health benefits to mothers and their infants. We examined the association of maternal exposure to IPV with early initiation of breastfeeding (within 1 hour of birth) and exclusive breastfeeding in the first 6 months.

METHODS AND FINDINGS

We assessed population-based cross-sectional Demographic and Health Surveys (DHS) from 51 LMICs. Data from the most recent DHS in each country (conducted between January 2000 and January 2019) with data available on IPV and breastfeeding practices were used. By WHO region, 52.9% (27/51) were from Africa, 11.8% (6/51) from the Americas, 7.8% (4/51) from the Eastern Mediterranean, 11.8% (6/51) from Europe, 11.8% (6/51) from South-East Asia, and 3.9% (2/51) from the Western Pacific. We estimated multilevel logistic regression models for any IPV and each type of IPV separately (physical violence, sexual violence, and emotional violence), accounting for demographic and socioeconomic factors. Depending on specification, the sample size varied between 95,320 and 102,318 mother-infant dyads. The mean age of mothers was 27.5 years, and the prevalence of any lifetime exposure to IPV among mothers was 33.3% (27.6% for physical violence, 8.4% for sexual violence, and 16.4% for emotional violence). Mothers exposed to any IPV were less likely to initiate breastfeeding early (adjusted odds ratio [AOR]: 0.88 [95% CI 0.85-0.97], p < 0.001) and breastfeed exclusively in the first 6 months (AOR: 0.87 [95% CI 0.82-0.92], p < 0.001). The associations were similar for each type of IPV and were overall consistent across infant's sex and WHO regions. After simultaneously adjusting for all 3 types of IPV, all 3 types of IPV were independently associated with decreased likelihood of early breastfeeding initiation, but only exposure to physical violence was independently associated with a decreased likelihood of exclusively breastfeeding in the first 6 months. The main limitations of this study included the use of cross-sectional datasets, the possibility of residual confounding of the observed associations by household wealth, and the possibility of underreporting of IPV experiences attenuating the magnitude of observed associations.

CONCLUSIONS

Our study indicates that mothers exposed to any form of IPV (physical, sexual, or emotional violence) were less likely to initiate breastfeeding early and breastfeed exclusively in the first 6 months. These findings may inform the argument for antenatal screening for IPV in LMICs and the provision of services to not only improve mothers' safety and well-being, but also support them in adopting recommended breastfeeding practices.

The MuSeS project: a mixed methods study to increase understanding of the role of settlement and multicultural services in supporting migrant and refugee women experiencing violence in Australia

Background

Violence against women is a major human rights and public health issue globally. The experience of violence affects women across Australia, including the large number of migrant and refugee women who permanently or temporarily resettle in the country. Many women who experience violence find it difficult to access support, and evidence suggests women who have resettled in Australia face additional barriers to violence-specific services. Previous research, however, indicates many migrant and refugee women experiencing violence have contact with, and may disclose violence to, settlement and multicultural services. There has been limited research documenting current knowledge of, and practices by, settlement and multicultural services in relation to violence. The MuSeS project will address this knowledge gap and identify strategies settlement and multicultural services can use to better support women experiencing violence.

Methods

This mixed methods research project will be conducted in six geographic communities across three Australian states: South Australia, Tasmania and Victoria. The different migration and resettlement patterns seen in these jurisdictions will enable generation of data relevant to settings across the country. The project has been designed in consultation with partner organisations from the settlement and multicultural service sector to ensure the research addresses their concerns and priorities. A mix of quantitative and qualitative methods will be used to generate rich data to inform strategies for settlement and multicultural services to better support women experiencing violence. These methods include an anonymous online survey of settlement and multicultural service providers to assess current knowledge, practices and professional development needs; in-depth interviews with settlement, multicultural and specialist (refugee) mental health service providers; in-depth interviews with refugee women; and focus group discussions with frontline workers and volunteers working with settlement and multicultural services.

Discussion

Findings from this two-year research project will generate an in-depth understanding of the current and potential role of Australian settlement and multicultural services in supporting migrant and refugee women experiencing violence, and inform strategies to strengthen services’ capacity to appropriately respond. Given the prevalence of violence against women globally, findings will be useful for services engaging with migrant and refugee populations around the world.

Conducting evaluation research with children exposed to violence: How technological innovations in methodologies and data collection may enhance the process

Research and program evaluation processes that engage children and youth are becoming much more common due to influences from children's rights and the acknowledgement that children have the capacity to contribute to research, both as participants and co-researchers (Roberts, 2017). Recent technological advances in the form of tablet and internet-based applications have provided researchers with additional methodological tools to better capture the voices and experiences of children and their caregivers (Livingstone & Blum-Ross, 2017). However, little has been written on the ways in which these new technological advances can improve research experiences for children who have been exposed to intimate partner and family violence, as well as other forms of traumatic experiences. This paper provides a review of current literature and a case study example of how one children's mental health agency has implemented tablet-based data collection procedures.

“Salía de uno y me metí en otro”: Exploring the Migration-Violence Nexus Among Central American Women

Increasing numbers of Central American women cross the U.S.–Mexico border, prompting social service providers, advocates, and policy makers to investigate motivations and appropriate responses. Drawing from a constructivist grounded theory study and in-depth qualitative interviews, this article explores women’s experiences of domestic and sexual violence in relation to migration. Findings reveal interconnections across multiple and interconnecting categories of violence as precipitating factors for migration, during border-crossing, and following arrival in the United States. This study fills gaps in our understanding of the violence-migration nexus and provides direction for policy, practice, and advocacy, in the context of shifting political landscapes and migration trends.

Perceived Risks and Benefits in IPV and HIV Research: Listening to the Voices of HIV-Positive African American Women

African American women living with HIV were asked to reflect on the perceived risks and benefits of research participation after completing a study examining socially sensitive issues in their lives, including intimate partner violence (IPV) and HIV. Administration of standardized quantitative instruments yielded positive responses to the research experience. However, qualitative assessments of perceived risks and benefits revealed more nuanced responses. For example, confidentiality concerns were more prominent in open-ended responses as was participants' positive attitudes toward monetary compensation. In addition, some women reported that study participation provided them with new insights about their experiences with IPV. Findings suggest that empirical studies on research protections involving potentially distressing and socially sensitive experiences with vulnerable populations require both quantitative and qualitative assessments of perceived risks and benefits. We discuss implications of our findings for ethics practices in trauma-related research among populations with multiple social vulnerabilities.

Unraveling the Mobilization of Memory in Research With Refugees

In this article, we explore how narrative accounts of trauma are co-constructed through the interaction between researcher and participant. Using a narrative multiple-case study with Kurdish refugee families, we address how this process takes place, investigating how researcher and participants were engaged in relational, moral, collective, and sociopolitical dimensions of remembering, and how this led to the emergence of particular ethical questions. Case examples indicate that acknowledging the multilayered co-construction of remembering in the research relationship profoundly complicates existing deontological guidelines that predominantly emphasize the researcher's responsibility in sensitively dealing with participants' alleged autobiographical trauma narratives. Instead, our analysis invites qualitative researchers to engage in a continued, context-specific ethical reflection on the potential risks and benefits that are invoked in studies with survivors of collective violence.

Help-Seeking Behavior Among Moroccan, Romanian, and Ecuadorian Women Experiencing Intimate Partner Violence in Spain

This study aims to identify different types of response to intimate partner violence (IPV) and help-related seeking behavior among Spain's most numerous immigrant groups-Moroccans, Romanians, and Ecuadorians. Women reporting physical, sexual and/or psychological violence by a current or former intimate partner (n = 194) were selected from a cross-sectional study based on 1,607 surveys (2011). There are 84% of surveyed battered women who reported seeking help through informal and/or formal channels. The most frequently reported informal help-seeking behavior was talking with the abusive partner (from 63% to 83%). Moroccans identified social services (29.6%) and health care (25.9%) professionals as their most frequently used formal resources when seeking help. Approximately 32% of Ecuadorians and Romanians declared having reported their partners to the police. Among all of the women, seeking help through formal channels was more probable in cases where the severity of IPV was high (adjusted odds ratio = 5.69, 95% confidence interval [2.29, 14.12]). It is needed to increase professionals' opportunities to intervene in cases of IPV before they become severe.

Methodological and Ethical Challenges in a Web-Based Randomized Controlled Trial of a Domestic Violence Intervention

The use of Web-based methods to deliver and evaluate interventions is growing in popularity, particularly in a health care context. They have shown particular promise in responding to sensitive or stigmatized issues such as mental health and sexually transmitted infections. In the field of domestic violence (DV), however, the idea of delivering and evaluating interventions via the Web is still relatively new. Little is known about how to successfully navigate several challenges encountered by the researchers while working in this area. This paper uses the case study of I-DECIDE, a Web-based healthy relationship tool and safety decision aid for women experiencing DV, developed in Australia. The I-DECIDE website has recently been evaluated through a randomized controlled trial, and we outline some of the methodological and ethical challenges encountered during recruitment, retention, and evaluation. We suggest that with careful consideration of these issues, randomized controlled trials can be safely conducted via the Web in this sensitive area.

'I Know it was Every Week, but I Can't be Sure if it was Every Day: Domestic Violence and Women with Learning Disabilities

BACKGROUND

Domestic violence against women is well researched in the general population, but much less so in relation to women with learning disabilities. This qualitative research study interviewed 15 women with learning disabilities who had experienced domestic violence about their experiences, the impact of the violence on them and their children, their coping strategies and help seeking behaviour.

MATERIALS AND METHODS

Semistructured in-depth interviews were conducted. Data were analysed using Inter-pretive Phenomenological Analysis. A service user advisory group helped at particular stages, notably at the formative stage and with dissemination, especially the production of accessible materials, including a DVD.

RESULTS

The violence experienced by many of the women was severe and frequent. It impacted negatively on their physical and psychological well-being. The women's awareness of refuges and others sources of help was generally low.

CONCLUSIONS

Healthcare and social care professionals have a clear remit to help women with learning disabilities to avoid and escape violent relationships.

The ethics of researching intimate partner violence in global health: A case study from global health research

There has been an increase in attention to intimate partner violence (IPV) as a health issue that contributes to the spread of HIV, physical and emotional stress, depression, substance use, serious injuries, and higher rates of mortality in low-income settings. This paper explores the ethical implications raised by research on IPV by global health scholars. Drawing on Hedgecoe's work on critical bioethics to analyse a qualitative study of IPV in Rwanda, this paper discusses the risks and benefits of conducting research on IPV as part of the global health agenda. We discuss ethical issues that have become evident through our work in this area, including: raising IPV as an issue of concern in women's lives in settings where economic support for women experiencing IPV may not exist; recording interviews and focus group discussions in contexts with significant government surveillance; ethical tensions in appropriating local voices in ways that position women as 'victims' of violence; and the risks associated with framing IPV as a global health issue separate from feminist advocacy. We recommend more tailored approaches to ethics in IPV research, which considers the specificity of the social, cultural and economic context.

Abused women's experiences of a primary care identification and referral intervention: a case study analysis

AIMS

The aim of this study was to report the findings of a qualitative case study that investigated abused women's experiences of an identification and referral intervention and to discuss the implications for nurses, specifically those working in primary and community care.

BACKGROUND

Domestic violence and abuse is a significant public health issue globally but it is a hidden problem that is under-reported. In the UK, Identification and Referral to Improve Safety is a primary care-based intervention that has been found to increase referral rates of abused women to support and safety services. This paper reports on the findings of an evaluation study of two sites in England.

DESIGN

Qualitative study with a case study design.

METHODS

In line with case study design, the entire evaluation study employed multiple data collection methods. We report on the qualitative interviews with women referred through the programme. The aim was to elicit their experiences of the three aspects of the intervention: identification; referral; safety. Data collection took place March 2016.

FINDINGS

Ten women took part. Eight had exited the abusive relationship but two remained with the partner who had perpetrated the abuse. Women were overwhelmingly positive about the programme and irrespective of whether they had remained or exited the relationship all reported perceptions of increased safety and improved health.

CONCLUSION

Nurses have an important role to play in identifying domestic violence and abuse and in referral and safety planning. As part of a portfolio of domestic violence and abuse interventions, those that empower women to take control of their safety (such as Identification and Referral to Improve Safety) are important.

'They just walk away' - women's perception of being silenced by antenatal health workers: a qualitative study on women survivors of domestic violence in Nepal

Background

Domestic violence during pregnancy has detrimental effects on the health of the mother and the newborn. Antenatal care provides a ‘window of opportunity’ to identify and assist victims of domestic violence during pregnancy. Little is known about the experience, needs, and expectations from the women's perspective in relation to domestic violence in Nepal.

Objective

Our study aims to explore how women who have experienced domestic violence evaluate their antenatal care and their expectations and needs from health centers.

Design

Twelve in-depth interviews were conducted among women who had experienced domestic violence during pregnancy and utilized antenatal care. The women were recruited from two different organizations in Nepal.

Results

Women in our study concealed their experience of domestic violence due to fear of being insulted, discriminated, and negative attitudes of the health care providers. The women wished that the health care providers were compassionate and asked them about their experience, ensured confidentiality and privacy, and referred them to services that is free of cost.

Conclusions

Findings from our study may help the health care providers to change their attitudes toward women survivors of domestic violence. Identifying and assisting these women through antenatal care could result in improved services for them and their newborns.

Vocational Research for the Liberation of Battered Women

Domestic violence interferes with women’s exploration of career interests, pursuit of career goals, and attainment of economic independence. Vocational research may contribute significantly to preventive-intervention efforts against domestic violence and to the liberation of battered women by increasing their economic stability and strengthening their support network. In this article, the authors’ aim is to inspire vocational research with battered women. We use Prilleltensky’s emancipatory communitarian approach to outline a vocational research agenda with battered women and to describe research practices that facilitate collaboration among researchers and community stake-holders and that increase battered women’s self-determination and contribution to their communities. We discuss general research and specific vocational research practices to assist researchers with building research partnerships, recruiting and retaining participants, and disseminating vocational research results to effect social change.

Interviewer Training in the WHO Multi-Country Study on Women’s Health and Domestic Violence

The importance of a sound research strategy for measuring and understanding violence against women cross-culturally is well recognized. However, the value of specialized interviewer training to attain these data is not always fully appreciated. This article describes interviewer selection and training in the World Health Organization (WHO) Multi-Country Study on Women’s Health and Domestic Violence and highlights their importance. Such training ensures high-quality data and cross-country comparability, protects the safety of respondents and interviewers, and increases the impact of the study. Moreover, women are not only willing to share experiences with trained and empathetic interviewers but also find the interview a positive experience.