Violence Against Women in Turkey: A Social Ecological Framework of Determinants and Prevention Strategies

Emergency Nurses' Reasons for Not Recommending Their Hospital to Clinicians as a Good Place to Work

Importance

Half of emergency nurses report high burnout and intend to leave their job in the next year. Whether emergency nurses would recommend their workplace to other clinicians may be an important indicator of a hospital's ability to recruit clinicians.

Objective

To examine why emergency nurses do not recommend their hospital to other clinicians as a good place to work.

Design, Setting, and Participants

This qualitative study used directed content analysis of open-text responses (n = 142) from the RN4CAST-NY/IL survey of registered nurses licensed in New York and Illinois between April 13 and June 22, 2021. Inductive and deductive analytic approaches guided study theme development informed by the Social Ecological Model. The collected data were analyzed from April to June 2023.

Main Outcomes and Measures

Nurses who answered "probably not" or "definitely not" to the survey question, "Would you recommend your place of employment as a good place to work?" were prompted to provide a rationale in an open-text response.

Results

In this qualitative study of 142 emergency nurses (mean [SD] age, 43.5 [12.5] years; 113 [79.6%] female; mean [SD] experience, 14.0 [12.2] years), 94 (66.2%) were licensed to work in New York and the other 48 (33.8%) in Illinois. Five themes and associated subthemes emerged from the data. Themes conveyed understaffing of nurses and ancillary support (theme 1: unlimited patients with limited support); inadequate responsiveness from unit management to work environment safety concerns (theme 2: unanswered calls for help); perceptions that nurses' licenses were in jeopardy given unsafe working conditions and compromised care quality (theme 3: license always on the line); workplace violence on a patient-to-nurse, clinician-to-nurse, and systems level (theme 4: multidimensional workplace violence); and nurse reports of being undervalued by hospital management and unfulfilled at work in delivering suboptimal care to patients in unsafe working conditions (theme 5: undervalued and unfulfilled).

Conclusions and Relevance

This study found that emergency department nurses did not recommend their workplace to other clinicians as a good place to work because of poor nurse and ancillary staffing, nonresponsive hospital leadership, unsafe working conditions, workplace violence, and a lack of feeling valued. These findings inform aspects of the work environment that employers can address to improve nurse recruitment and retention.

Healing After Violence: The Effect of Perception of Social Support on Posttraumatic Growth in Female University Students

This study investigated the Turkish validity and reliability of the Healing After Gender-based Violence Scale (GBV-Heal) and the relationship between social support perception, posttraumatic growth in university students who are victims of gender-based violence. The study sample consisted of 167 female students who experienced gender-based violence. The Turkish version of GBV-Heal of Kaiser-Meyer-Olkin value was 0.892; the Bartlett Sphericity Test result was determined as χ2  =  195,053, and the obtained variables were found suitable for factor analysis. Perception of social support related to post-violence healing in female university students is effective on posttraumatic growth.

An application of the ecological model to sexual harassment in informal areas of Cairo, Egypt

Street-based sexual harassment is a prevalent but understudied form of gender-based violence that restricts women's access to public spaces. Drawing on adaptations of the ecological model that identify the root causes of gender-based violence in patriarchy, in this study, we explore the causes of street harassment in informal areas of Greater Cairo. Our analysis is based on qualitative interviews and focus groups with male and female youth aged 13-29 years, parents of youth and community leaders in two informal areas. We supplement the qualitative data with descriptive analysis of a representative, 2016 survey of youth in informal areas of Cairo that measured experiences with and attitudes toward harassment. Harassment was prevalent in the study areas, and respondents tended to place the blame for harassment at the individual level of the ecological model, particularly women's behavior. However, there were also community- and societal-level factors that contributed to the prevalence of harassment. Patriarchal norms and stigmatization of women who are harassed reinforced victim-blaming, such that most young women were afraid to report experiences of harassment due to social censure. In this context, educational or awareness raising interventions are unlikely to be effective in combating harassment, which is widely acknowledged to be a problem. Rather, interventions are needed along the different levels of the ecological model to target peer group and community norms that encourage harassment, address harassment in schools and strengthen reporting mechanisms.

Submit to survive: an exploration of sexual cleansing as an act of violence against widows in the Luo community of Kenya

In this paper, the sexual 'cleansing' of widows and subsequent inheritance is assessed for its socio-cultural significance. Although the practice has been well studied in the context of HIV in Sub-Saharan Africa, it has not been widely examined as an act of sexual violence against women. To address this gap, in-depth interviews were conducted with 27 widows aged 29 to 90 years in Siaya County in Southwest Kenya. A majority of participants stated the cleansing ritual was forcefully initiated, violently fulfilled, and frequently seen as rape. Findings from this study necessitate the identification of the cultural practice of widow cleansing as an act of violence against women. Doing so will facilitate the creation of a legal framework with which to act to eliminate the practice.

Investigating public awareness, prevailing attitudes and perceptions towards domestic violence and abuse in the United Kingdom: a qualitative study

Background

Reported cases of Domestic Violence and Abuse (DVA) have increased since the advent of the COVID-19 pandemic and ensuing lockdowns. Understanding the general public’s view about DVA is vital, as it would help develop targeted interventions and effective public policies to tackle this rising problem in society. Our qualitative study investigated the public awareness, attitudes and perceptions towards DVA, and explored mechanisms to tackle DVA in the community setting in the UK.

Methods

The research team conducted personal interviews with 29 community dwelling adults who responded to study invitations and adverts on social media. We used a topic guide to ensure consistency across the interviews, which were audio-recorded, transcribed and analysed thematically to detect emergent themes concerning DVA.

Results

All respondents were aware of the concept of abuse. Thirty-eight percent declared either having experienced DVA directly or that they knew someone close to being abused. More than half of the respondents were not aware of existing DVA supportive services in the UK. Overarching themes generated from the contextual analysis included contributing factors for DVA, challenges and barriers facing victims and proposals for future interventions.

Conclusions

Community dwelling adults have a good understanding of the impacts of DVA, but many fail to recognise specific instances or events in their daily lives contributing to DVA. Raising public awareness, particularly in children through the school curriculum, highlighting existing support services and introducing the routine use of short screening tools for DVA in health and social care settings can increase awareness, early identification and signposting to effective interventions. Sustained, multi-level community facing interventions are recommended to reduce stigma and fear associated with DVA.

Multilevel analysis of factors associated with perinatal intimate partner violence among postpartum population in Southern Ethiopia

Violence around pregnancy is critical in nature and major public health problem worldwide. Thus, the present study aims to determine the extent of perinatal partner violence and to identify its individual and community-level factors among postpartum women in Southern Ethiopia. A total of 1342 postpartum women nested in 38 'Kebles' (clusters) were enumerated using multistage-clustered sampling techniques for multilevel analysis. Different parameters were computed for model comparison and model fitness. The overall prevalence of intimate partner violence before, during, and/or after pregnancy was estimated to be 39.9% [95% CI 36.9-44.5]. About 18% of women reported continuous abuse over the perinatal period. Postpartum women who live in rural areas [adjusted odds ratio (AOR) = 2.46; 95% CI 1.21-5.01], or in neighborhoods with high IPV favoring norms [AOR = 1.49; 95%CI 1.01-2.20], high female literacy [AOR = 2.84; 95%CI 1.62-5.01], high female autonomy [AOR = 2.06; 95%CI 1.36-3.12], or in neighborhoods with lower wealth status [AOR = 1.74; 95%CI 1.14-2.66] were more likely to encounter PIPV. The complex patterns of interplaying factors operating at different levels could put pregnant or postpartum women at higher risk of IPV victimization. Therefore, policies that prioritize the improvement of contextual factors, particularly norms toward IPV and women's empowerment are likely to be the most effective interventions.

Association between poor food production and intimate partner violence among smallholder farmers in northwestern Benin

Rates of intimate partner violence (IPV) remain concerningly high in Benin, particularly in the predominantly rural region of Atacora in the northwest. In the context of increasing food insecurity, concerns have been raised regarding the role that lack of food in the household may be playing in increasing the rate of IPV in this context. This study aims to investigate the association between household food production and IPV in Atacora, Benin. Using a social ecological model and drawing from family stress theory, we analysed data from a cross-sectional survey of 300 women in the study region. Logistic regression and sequential modelling results show that after controlling for individual, household and community level factors, insufficient food production is positively associated with women's likelihood of experiencing physical (adjusted OR=6.50 [2.48, 17.04], p < .01) and sexual violence (adjusted OR=4.49 [1.68, 11.99], p < .01). We conclude that production-oriented interventions in rural farming communities may reduce women's risk of IPV by increasing households' access to food and reducing family stress. Long term interventions would do well to focus on improving women's access to land and building capacity in the management of marital conflict without violence.

Measuring Violence Against Women: A Global Index

Violence against women (VaW) is a widespread crime and violation of the rights of women. It is present in every country without exception and crosses boundaries of culture, class, education, income, and race. Despite the magnitude of the literature and the abundance of publications on this problem, the field lacks a comprehensive and homogeneous way to measure and compare the extent of VaW across countries. Proper quantification of this problem is needed to develop preventive policies and strategies to reduce it. This article develops an index of VaW (VAWI) with global scope and multidimensional approach for 102 countries. It is an original index that calculates the total level of VaW by capturing information from the main VaW types (physical, sexual, psychological, and economic violence) in a single value between 0 and 1, where 0 denotes complete absence of violence and 1 the highest level of violence in a country. The proposed index is easy to compute and is comparable across countries. Our main results show that the nations with the highest levels of global VaW are Yemen, Senegal, Oman, Cameroon, and Uganda. The countries with the lowest levels are the Northern European Countries, Canada, and Malta. This VAWI makes a novel and important contribution to the study of gender issues. It can be used not only to monitor the statistics on VaW data within countries over time but also to make comparisons among countries. Further, it could be useful in designing new policy initiatives to reduce VaW.

The Experience of Disgust in Women Exposed to Domestic Violence in Turkey

In trauma, fear as a basic emotion that evokes avoidance after exposure to a traumatic event is important for posttraumatic process. Another emotion causing avoidance is disgust. Despite the fact that disgust also plays an important role in trauma, there is limited information about how it is experienced during and after exposure to the traumatic event. In this study, the aim was to understand how women experience disgust during and after domestic violence, as a prolonged and repeated traumatic experience, and how they try to cope with disgust evoking situations in this process. For this aim, qualitative methodology was used. With purposive sampling, six women exposed to domestic violence including physical, verbal and sexual abuse were interviewed. With each woman, approximately seven semi-structured interviews were completed. Forty-one interviews were audio recorded and transcribed. Data was analyzed by Interpretative Phenomenological Analysis. At the end of the analysis, three superordinate themes, namely, experience of perpetrator-directed disgust with gustatory expressions of moral disgust and association of disgust in domestic abuse to daily life experiences; experience of self-disgust with two themes of internalization of assault without awareness and contamination by sexual abuse; coping with disgust in domestic violence with four subthemes, namely, avoidance from perpetrator, reidentification of the perpetrator with substitutive identity, alienation from self, reidentification of self with new relationships were constructed. Results showed that disgust is experienced in a repressed way as a result of the aversive nature of traumatic experience. The results were evaluated in psychological, social and cultural contexts. Their implications for understanding disgust in domestic violence were discussed.

Effects of the COVID-19 Pandemic on the Lives of Women with Different Socioeconomic Backgrounds and Victimization Experiences in Portugal

The heavy economic, social, and psychological toll of pandemic lockdowns around the world and their disproportionate effect on women are widely acknowledged, but different socioeconomic backgrounds and contexts may influence the degree to which stay-at-home measures impact their lives. Additionally, knowing that violence against women tends to increase during times of crisis, we are testing if the additional burden of victimization represents an added load to the perceived social impacts of the lockdown. Using 2021 survey data from a random sample of 1541 Portuguese women, the paper explores, through logistic regression models, the social impact of the lockdown on the lives of women, its socioeconomic determinants, and the role played by violence against women during the pandemic. The results show that the COVID-19 pandemic lockdown did not equally affect all facets of women’s social lives, and women with higher education status and that experienced income reductions due to the measures taken to control the pandemic are more prone to experience a more severe negative impact of the lockdown on the various facets of their lives. Additionally, having been a victim during the pandemic partially mediates the effect of education and income reduction on the social outcomes of the lockdown.

Atenção às mulheres em situação de violência: construção de modelo de educação permanente em saúde

RESUMO Objetivo: Propor um Modelo de Educação Permanente em Saúde com estratégias vinculadas ao referencial das Cinco Disciplinas para o desenvolvimento de competências dos profissionais que atuam na atenção direta às mulheres em situação de violência. Método: Pesquisa qualitativa realizada pela técnica de grupo focal, com 16 profissionais que integram uma rede intersetorial em Curitiba-PR, de agosto a outubro de 2019. Dados analisados por análise de conteúdo na modalidade temática, à luz do referencial teórico das Cinco Disciplinas: domínio pessoal; modelo mental; visão compartilhada; aprendizagem em equipe; e, pensamento sistêmico. Resultados: As Cinco Disciplinas foram evidenciadas nas categorias, bem como estratégias a serem utilizadas para desenvolvimento de competências. Utilizou-se uma representação diagramática a ser percorrida durante processo de aprendizagem. Conclusão: As estratégias sugeridas pelos profissionais que atuam na atenção às mulheres em situação de violência apoiaram a proposição de um Modelo de Educação Permanente em Saúde baseado no referencial teórico adotado.

Care for women in situations of violence: construction of a model of permanent health education

ABSTRACT Objective: To propose a Permanent Health Education Model with strategies linked to the Five Disciplines framework for the development of competencies of professionals who work in direct care for women in situations of violence. Method: A qualitative research carried out by the focus group technique, with professionals who are part of an intersectoral network in Curitiba-PR, from August to October 2019. Data analyzed by content analysis in the thematic modality, in the light of the theoretical framework of the Five Disciplines: personal mastery; mental model; shared vision; team learning and systems thinking. Results: The Five Disciplines were evidenced in the categories, as well as strategies to be used for competence development. A diagrammatic representation was used to be covered during the learning process. Conclusion: The strategies suggested by professionals who work in the care for women in situations of violence supported the proposition of a Permanent Health Education Model based on the adopted theoretical framework.

Association between intimate partner psychological violence and psychological distress among nurses: The role of personality traits and social support

AIM

This study proposes investigating the risk and protective factors of intimate partner (IP) psychological violence and psychological distress to better promote psychological wellbeing for nurses and health outcomes for patients.

DESIGN

A cross-sectional study.

METHOD

This cross-sectional study was carried out chiefly in Guangdong, Hunan, and Shaanxi provinces, in the east, central, and west of the Chinese economic areas, respectively. It was conducted in October 2021 using convenience sampling. A total of 843 nurses were eligible for the final analysis. Single-factor linear regression models were used to identify potential factors associated with IP psychological violence and psychological distress. In addition, the structural equation model was used to explore the role of personality traits and social support in the association between IP psychological violence and psychological distress.

RESULTS

The predictors for the score of IP psychological violence among nurses were participants' married status, contact frequency with a partner, perceived past-year psychological and physical violence experience, the alcohol consumption of partners, and personality traits and social support of partners. Moreover, the alcohol consumption of participants, the past-year experience of IP psychological violence, the score of psychological violence, personality traits, social support, and the personality traits of partners were associated factors affecting the psychological distress of nurses. In the structural model, the personality trait of partners had a direct pathway to psychological violence and social support. The results demonstrated that psychological violence significantly increased psychological distress.

CONCLUSION

Personality traits and social support are essential factors influencing the relationship between IP psychological violence and psychological distress.

IMPACT

The findings of this study emphasize the possibility and importance of identification and intervention for reducing IP psychological violence based on personality traits and social support.

'My story is like a magic wand': a qualitative study of personal storytelling and activism to stop violence against women in Turkey

Background: Telling personal stories of violence has been central to recent advocacy efforts to prevent violence against women around the world. In this paper, we explore the use of personal storytelling as a form of activism to prevent femicide in Turkey. This study is part of a broader storytelling initiative called SHAER (Storytelling for Health: Acknowledgement, Expression and Recovery) to alleviate the psychological and emotional suffering of women who have experienced gender-based violence in high-prevalence settings.

Objectives: We conceptually explore personal stories of violence as a form of both distributed agency and activism. This conceptual framework is used to answer the following research question in the Turkish context: How do women use their personal stories of interpersonal violence for their own benefit (support) and that of others (activism)?

Methods: Our study is based on 20 in-depth semi-structured interviews with women who have experienced violence and were purposefully recruited by the ‘We Will End Femicide’ Platform in Istanbul. Interviews were conducted between March and August 2019. We used inductive and deductive thematic analysis to identify instances of personal storytelling at three levels: intrapersonal, relational and collective.

Results: Our results show how the use of personal storytelling can provide a means of healing from experiences of violence. However, this process is not linear and is often influenced by the surrounding context including: the listener of the story, their reaction, and what social networks the woman has to support her. In supportive social contexts, personal storytelling can be an effective support for activism against violence: personal stories can provide opportunities for individuals to shape broader discourses about violence against women and the right of women to share their stories.

Conclusions: Telling one’s personal story of violence can both support women’s agency and contribute to the collective struggle against violence against women more broadly.

Ambivalent sexism of nursing students in Turkey and South Korea: A cross-cultural comparison study

Culture has become increasingly important concepts in nursing in the era of globalization. Nurses' cultural biases and prejudices are huge obstacles to their caring for patients from diverse cultural backgrounds. Therefore, this study examined sexism among nursing students from two patriarchal societies: Turkey influenced by Islam, and South Korea influenced by Confucianism. For this comparative study, we used the survey data from the sample of 560 nursing students, 309 from Turkey and 251 from South Korea. The findings showed that both samples showed high levels of sexism, both hostile and benevolent. When comparing the two samples, Turkish nursing students showed significantly higher sexism than did Korean students. Additionally, in both countries, male participants showed higher scores on sexism, especially hostile sexism. In terms of age, older students in Turkey showed lower levels of benevolent sexism. We hope the findings of this study can provide evidence to develop customized transcultural nursing education content in the context of different ethnicities and to help nurses and nursing students from specific cultural backgrounds in becoming aware of their own cultures.

Intimate partner violence management and referral practices of primary care workers in a selected population in Turkey

Background:

Violence against women is a significant public health problem and primary care workers (PCWs) have a crucial role in managing violence against women. However, though intimate partner violence (IPV) is frequently seen in primary care, most cases remain unreported.

Aims:

This study aims to investigate family physicians’ (FPs’) and co-working midwifes/nurses’ (M/Ns’) explanations about their responses to women disclosing IPV and the reasons for their actions.

Methods:

We conducted a cross-sectional survey via a face-to-face administered questionnaire interview involving 266 PCWs in a selected area in Turkey. We questioned the reasoning behind inappropriate responses such as not examining the patient and document findings, not recording a code of violence, and not notifying the police in the case of a disclosure of IPV.

Results:

We surveyed 129 FPs and 137 M/Ns. We found that the disclosure of IPV in primary care is very high, but more than one-third of physicians and half of M/Ns respond inappropriately. Reasons for inappropriate response varied. The majority believed that the victim would continue to live with her batterer, making any report ineffective. Some expressed concern for the women’s and their own personal safety, citing an increase in assault cases by perpetrators in the last few years. Many indicated a lack of knowledge about management of violence cases.

Conclusion:

Multiple barriers challenge PCWs in helping abused women. Common behaviours, safety concerns, and a lack of knowledge seem to be the major barriers to responding appropriately to IPV. To address this issue appropriately, protective measures for both parties – PCWs and violence victims – need to be enacted and a supportive constitutional and societal organization is required. Screening and identification should lead to interventions that benefit the victims rather than harming them.

Learn to live with it: Lived experience of Palestinian women suffering from intimate partner violence

Background and Aim:

Intimate partner violence has become a growing concern all over the world and causes numerous consequences and provokes various reactions among women. The present study was aimed to understand the lived experience of Palestinian women who suffered domestic violence by an intimate partner.

Methods:

In this hermeneutic phenomenological study, van Manen's methodical steps were used to conduct the study. An in-depth face-to-face semi-structured interview was conducted to 11 survivors of intimate partner violence. Data were analyzed by thematic analysis method.

Results:

“learn to live with it” was the core theme, which extracted from four subthemes including “failure to change for better,” “failure to gain support,” “failure to enjoy sexual life,” and “failure to make decisions.” Learn to live with it refers to participants’ acceptance to their unpleasant situation because they could not change it.

Conclusion:

Palestinian women who suffer from violence fail to cope with appropriately due to traditional culture and lack of familial and economic dependence.