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Lopez AA, Dressel A, Luebke J, Williams J, Campbell J, Miller J, Kibicho J, Schadewald D, Abusbaitan H, Pirsch A, Gondwe KW, Schubert E, Ruiz A, Kako P, Mkandawire-Valhmu L, Egede LE. Intimate partner violence in the lives of Indigenous and Black women in the upper Midwest of the United States during the COVID-19 pandemic: A mixed-methods protocol examining help-seeking behaviours and experiences. Int J Ment Health Nurs 2024; 33:1003-1012. [PMID: 38323681 PMCID: PMC11260249 DOI: 10.1111/inm.13294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 12/29/2023] [Accepted: 01/09/2024] [Indexed: 02/08/2024]
Abstract
Violent behaviour perpetrated against women has long-lasting negative physical and mental health consequences for women, their children, their families, and their communities. Intimate partner violence (IPV) is associated with many adverse physical, psychological, and emotional consequences. Structural racism and historical trauma affect women's trust and further hinder the ability of Indigenous and Black women to seek help after experiencing IPV. The availability of IPV support services, which can include shelter, food, group therapy, legal assistance, and advocacy, can be inaccessible to women due to the inability to access often limited resources in urban environments and reasons compounded by potential geographic distance if living in rural areas or living in community. Understanding the unique reasons why Indigenous and Black women do not seek help, and the barriers they experience when seeking help after IPV, is critical. Pandemics have the potential to create further complexities on how IPV is experienced. Black and Indigenous women experiencing IPV were therefore at even greater risk for IPV-related harm because of state and local "stay at home" measures put in place to minimise the spread COVID-19. The purpose of this manuscript is to explicate the methods for a large R01 study in the Upper Midwest.
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Affiliation(s)
- Alexa A Lopez
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Anne Dressel
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Jeneile Luebke
- School of Nursing, University of Wisconsin, Madison, Wisconsin, USA
| | - Joni Williams
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jennifer Campbell
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jessica Miller
- School of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jennifer Kibicho
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Diane Schadewald
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Hanan Abusbaitan
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Anna Pirsch
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kaboni W Gondwe
- School of Nursing, University of Washington, Seattle, Washington, USA
| | - Erin Schubert
- Sojourner Family Peace Center, Milwaukee, Wisconsin, USA
| | - Ashley Ruiz
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Peninnah Kako
- University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | | | - Leonard E Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Ullman SE, Shepp V, O'Callaghan E. Survivors' Experiences of Sexual Assault by Intimate Partners: A Qualitative Study of Survivors and their Informal Supports. JOURNAL OF FAMILY VIOLENCE 2024; 39:875-887. [PMID: 39185457 PMCID: PMC11343082 DOI: 10.1007/s10896-023-00535-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 08/27/2024]
Abstract
Sexual assault occurring in the context of intimate partner violence (IPV) relationships has received much less attention in the literature on sexual assault. Studies of both survivors and their informal support network members are also lacking in both sexual assault and IPV literatures. Purpose The current study's purpose was to examine sexual assault survivors' experiences where intimate partner violence was mentioned as part of their narratives. Method Survivors and their informal support providers (SP; e.g., family, friends, romantic partners) were interviewed separately about disclosure, social reactions, and help-seeking following assault. Twenty-nine survivors and 12 informal support persons they told about their assaults mentioned survivor experiences of IPV-related sexual assault (IPVS). Results Several themes emerged from the analysis of codes related to the traumatic event of IPV: 1) Severe physical violence in an intimate partner relationship; 2) use of violence for sexual gratification; 3) connecting trauma to other behavior, 4) unwanted duty and redefining abuse, and 5) state responses to IPVS. Conclusions Implications are drawn for future research and practice on IPVS with survivors and their informal support networks.
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Klein LB, Melnik J, Curran K, Luebke J, Moore KM, Ruiz AM, Brown C, Parker D, Hernandez-White I, Walsh K. Trauma- and Violence-Informed Empowering Care for Sexual Assault Survivors. JOURNAL OF FORENSIC NURSING 2024; 20:166-173. [PMID: 38509039 PMCID: PMC11333187 DOI: 10.1097/jfn.0000000000000483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND Forensic nurse examiners, including sexual assault nurse examiners, provide care for survivors holistically through healthcare, emotional support, connection to follow-up care, safety planning, and, if desired, evidence collection to aid in the prosecution of sexual assault. There is increasing recognition that trauma-informed care must also include an understanding of the impacts of structural violence on minoritized patients to ensure health equity. AIM To help address this guidance gap, we expanded Campbell and colleagues' empowering care model using a trauma- and violence-informed care (TVIC) lens. METHODS We used an iterative discussion-based process that included five joint meetings between a seven-member transdisciplinary research team and a five-member nurse advisory board. RESULTS In a TVIC-informed empowering care model, we propose behavioral examples for forensic nurses for each of Campbell et al.'s five key domains of empowering care for forensic nurse examinations (i.e., build rapport and establish trust, show compassion, provide patient-directed care, convey professionalism, and provide resource referral and follow-up). CONCLUSIONS These behavioral examples for nurses can help guide forensic nurse training and practice to reduce disparities in treatment and follow-up support. Structures and systems are needed that enable forensic nurses to provide trauma- and violence-informed empowering care to survivors of sexual assault and, over time, increase the accessibility of forensic nurse examinations and improve patient outcomes.
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Affiliation(s)
- L B Klein
- Author Affiliations: Sandra Rosenbaum School of Social Work
| | - Jessica Melnik
- Department of Psychology, University of Wisconsin-Madison
| | | | | | | | - Ashley M Ruiz
- Edson College of Nursing and Health Innovation, Arizona State University
| | | | | | | | - Kate Walsh
- Departments of Psychology and Gender and Women's Studies, University of Wisconsin-Madison
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Recalde-Esnoz I, Prego-Meleiro P, Montalvo G, Del Castillo H. Drug-Facilitated Sexual Assault: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:1814-1825. [PMID: 37650508 DOI: 10.1177/15248380231195877] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Since the last two decades, the scientific community has made an effort to analyze drug-facilitated sexual assault (DFSA). However, a lack of understanding remains about the DFSA problem, particularly concerning the opportunistic variant. Facing this situation, a systematic review of the term DFSA is carried out from its first appearance in the scientific databases consulted (Web of Science, Scopus, and PubMed) to the current day. The search resulted in 773 publications, reduced to a final study sample composed of 19 articles. Eligible studies for this review had to meet certain inclusion criteria, in addition to providing information on DFSA prevalence, DFSA victim profile, DFSA offender profile, involved drugs, or contextual information about the assault. The results demonstrated that the assailants are men, who mostly know victims before the assault. The victims are young women under 30 years old. Alcohol is the drug involved in most DFSA cases, prevailing a voluntary use. Most assaults occur in private spaces, particularly the aggressors' own homes. Furthermore, there is a detected need for a standard definition of DFSA to allow the different actors involved in dealing with sexual violence to work effectively together, and, at the same time, it is detected that the available studies overrepresent proactive DFSA and underestimate opportunism, the most common modus operandi involved in DFSA cases.
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Affiliation(s)
| | - Pablo Prego-Meleiro
- Universidad Complutense de Madrid, Spain
- Universidad de Alcalá, Alcalá de Henares, Spain
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Depireux A, Glowacz F. Intimate Partner Sexual Violence in Emerging Adulthood: Exploring Sexual Consent Attitudes as a Target for Sexual Coercion Prevention. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:2689-2710. [PMID: 38902488 DOI: 10.1007/s10508-024-02890-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 06/22/2024]
Abstract
While intimate partner violence is now recognized as a major societal and international issue, sexual violence between partners remains understudied despite its significant prevalence rates and the specific contexts in which it occurs. The aim of this study was to analyze the links between different dimensions of sexual consent and sexual coercion experienced within intimate relationships in order to identify targets for prevention campaigns. The study was carried out during a time of transition in the sociopolitical and legislative context in Belgium linked to the implementation of a reform to the sexual criminal law, which has made the expression of sexual consent central to the qualification of sexual offenses. A total of 431 young adults (88.40% female; Mage = 22.19 years; SDage = 1.79) were recruited from the general population through an online survey to analyze the links between attitudes and beliefs toward sexual consent, attachment style, mental health, and sexual victimization between partners. Results showed that a lack of perceived behavioral control over establishing sexual consent, as well as the avoidance of intimacy, predicted sexual victimization. The clinical implications of these findings are discussed and potential public policy responses for prevention and awareness are suggested. Future research should further investigate and conceptualize sexual consent as it relates to sexual coercion in a more representative sample from an intersectional perspective.
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Affiliation(s)
- Anthony Depireux
- Department of Psychology, Adaptation, Resilience, and Change Research Unit, University of Liège, Place des Orateurs 1, 4000, Liège, Belgium.
| | - Fabienne Glowacz
- Department of Psychology, Adaptation, Resilience, and Change Research Unit, University of Liège, Place des Orateurs 1, 4000, Liège, Belgium
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Sutherland MA, Hutchinson MK, Si B, Ding Y, Liebermann E, Connolly SL, Saint-Eloi Cadely H, Hayes JF, Mueller SD. Health screenings in college health centers: Variations in practice. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-8. [PMID: 38905516 DOI: 10.1080/07448481.2024.2361307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 05/19/2024] [Indexed: 06/23/2024]
Abstract
Objective: The purpose of this study was to examine the routine screening of female students in college health centers for six priority health-related behaviors and experiences (tobacco use, alcohol use, eating disorders [EDs], obesity, anxiety and depression, intimate partner violence/sexual violence [IPV/SV]), and to identify variations in practice. Participants: A nationally representative sample of 1,221 healthcare providers (HCPs), including nurse practitioners, physicians, and physician assistants, from 471 U.S. college health centers. Methods: HCPs completed surveys (on-line or paper) and reported on routine screening of female college students. Results: HCPs reported consistently high rates (75-85%) of screening for tobacco use, alcohol use, and anxiety/depression. Rates of screening for IPV/SV, obesity and EDs were much lower. Nurse practitioners reported the highest IPV/SV screening rates. Conclusions: College health centers present unique opportunities for screening, case-finding and intervening to reduce long-term sequelae. Providers are well-positioned to lead initiatives to improve screening practices.
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Affiliation(s)
| | | | - Bing Si
- Systems Science and Industrial Engineering, Binghamton University, Binghamton, New York, USA
| | - Yu Ding
- Systems Science and Industrial Engineering, Binghamton University, Binghamton, New York, USA
| | - Erica Liebermann
- College of Nursing, University of Rhode Island, Kingston, Rhode Island, USA
| | - Somatra L Connolly
- University of Rhode Island College of Nursing, RINEC, Providence, Rhode Island, USA
| | - Hans Saint-Eloi Cadely
- Developmental Science Graduate Program Director, Department of Human Development and Family Science, University of Rhode Island, Kingston, Rhode Island, USA
| | - Jacqueline F Hayes
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Brown Medical School, Providence, Rhode Island, USA
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Lucea MB, Ramirez A, Martino N. Barriers to Seeking Healthcare Services After Sexual Assault: A Scoping Review. JOURNAL OF FORENSIC NURSING 2024:01263942-990000000-00093. [PMID: 38912876 DOI: 10.1097/jfn.0000000000000493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
BACKGROUND Sexual violence by an intimate partner or by a stranger remains highly prevalent in the United States. Yet, the use of post-sexual-assault health care is still underutilized. Persons in vulnerable populations such as immigrants, LGBTQIA+, and Black women may experience additional barriers to care. OBJECTIVE We sought to determine the extant research in this area, the methodologies used, and whether specific barriers exist for seeking sexual assault services. We sought to understand if barriers differed for vulnerable populations. INCLUSION CRITERIA Peer-reviewed literature published before September 2023, written in English, conducted in the United States, and that included survivors of sexual violence and explored barriers to seeking care postassault (i.e., sexual assault nurse examiners) were included in the review. METHODS Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews protocols were followed. PubMed, Scopus, CINAHL, PsycINFO, and PTSDpubs databases were used to identify literature that met the inclusion criteria, from which we selected 14 publications. RESULTS Much of the literature employed qualitative or mixed methods designs. Several studies focused on underserved minority groups, including immigrant women, Black women, and homeless youth. Common barriers existed on the intrapersonal, interpersonal, organizational, community, and societal levels. CONCLUSION The literature provided substantive context for the multilevel barriers, all contributing to survivors remaining silent rather than seeking much-needed help. Although there is a need for additional research on barriers to sexual assault services specifically, the extant research supports strengthening multilevel, alternative approaches to deliver much-needed services.
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Affiliation(s)
- Marguerite B Lucea
- Author Affiliations:Department of Nursing, College of Health Professions, Towson University
| | - Andrea Ramirez
- Department of Forensic Science, Fischer College of Math and Sciences, Towson University
| | - Natalie Martino
- Department of Audiology, College of Health Professions, Towson University
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Baeza MJ, De Santis JP, Cianelli R, Metheny N, Villegas N. Bearing (Aguantando) With Intimate Partner Violence: A Grounded Theory Study of Self-Silencing Among Hispanic Women Who Experienced Intimate Partner Violence. QUALITATIVE HEALTH RESEARCH 2024; 34:662-675. [PMID: 38236009 DOI: 10.1177/10497323231225144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Hispanic women who experience intimate partner violence (IPV) face unique disparities. They have poorer health outcomes and are less likely to seek help than their non-Hispanic counterparts. When women remain in relationships where IPV occurs and refuse to disclose or seek treatment, they may resort to self-silencing, which can also worsen health outcomes. The purpose of this study was to develop a theory that explains how self-silencing evolves among Hispanic women who experience IPV. Participants were recruited from two research studies focused on Hispanic women's health, and from snowball sampling, which involved referrals by previously registered participants. Data were collected via Zoom® and included individual interviews. A total of 25 women participated in this study. Analysis followed constructive grounded theory levels of analysis described by Charmaz and constant comparative methods described by Glaser and Strauss. A grounded theory entitled Bearing (Aguantando) With Intimate Partner Violence emerged from the data. The theory explains the main strategy Hispanic women use to deal with violence while remaining in a relationship where IPV occurs. The theory is constructed of four categories with subcategories. The results of this study provide an initial framework to understand the self-silencing process among Hispanic women who experience IPV. In addition, this study identifies different levels of interventions that can be useful for researchers and healthcare providers to promote Hispanic women's ability to become empowered, use their voices, and seek help.
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Affiliation(s)
- María José Baeza
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
- Escuela de Enfermería, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Joseph P De Santis
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Rosina Cianelli
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
- Escuela de Enfermería, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicholas Metheny
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Natalia Villegas
- The University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA
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Szyfer Lipinsky A, Goldner L, Hadar D, Saint-Arnault D. Predicting Recovery Pathways in Jewish Ultra-Orthodox Intimate Partner Violence Survivors: A Structural Equation Modeling Approach. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241255738. [PMID: 38819011 DOI: 10.1177/08862605241255738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Cultural and religious norms, as well as trauma-related cognitions and recovery actions, are known to impact the well-being of survivors of intimate partner violence (IPV). Although acknowledged as a key component, there is scant research on the recovery trajectories of women who have experienced IPV, in particular on survivors from collectivistic societies such as the Jewish Ultra-Orthodox (JUO) community in Israel. A mediation model examined the recovery process of 261 Israeli JUO survivors. In particular, it tested whether the normalization of violence and women's endorsement of Jewish religious norms that justify violence would be directly and negatively associated with women's well-being and positively associated with psychopathology. Additionally, it examined whether women's normalization of violence and support of religious norms would positively predict women's negative trauma-related cognitions. In turn, these cognitions were expected to negatively predict women's engagement in recovery actions, help-seeking behaviors, and faith-based responses but positively predict disengagement responses. The model further posited that women's engagement in steps toward recovery, help-seeking behaviors, and faith-based responses would positively predict women's well-being and negatively predict psychopathology. In contrast, women's disengagement responses would negatively predict women's well-being and positively predict their psychopathology. Bootstrap results indicated that supporting religious norms positively predicted women's trauma-related cognitions, which then negatively predicted women's recovery actions, help-seeking behaviors, and faith-based responses but positively predicted women's disengagement responses. Women's recovery actions and faith-based responses positively predicted women's well-being, while disengagement responses positively predicted women's psychopathology. Contrary to expectations, help-seeking behaviors positively predicted psychopathology.
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Salvador-Oscco E, Santander-Cahuantico AC, Fernandez-Guzman D, Bendezu-Quispe G. Factors associated with non-help-seeking among women victims of physical or sexual intimate partner violence in Peru: Findings from the National Demographic and Family Health Survey, 2017 to 2019. Int J Soc Psychiatry 2024; 70:470-481. [PMID: 38149362 DOI: 10.1177/00207640231216357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
OBJECTIVE To evaluate the factors associated with non-help-seeking in victims of physical or sexual intimate partner violence (IPV) in Peru. METHODS This was an analytical cross-sectional study of 3-year data from the Peruvian Demographic and Health Survey. The sample comprised women aged 18 to 49 who had experienced physical or sexual IPV at some time in their lives. The dependent variable was non-help-seeking after suffering physical or sexual IPV. Adjusted prevalence ratios (aPR) with their 95% confidence interval (CI) were calculated to assess the factors associated with non-help-seeking. In addition, a sensitivity analysis was carried out in which only women who suffered physical or sexual IPV in the last year were considered. RESULTS Data from 15,265 female victims of physical or sexual IPV were analyzed. It was found that 57.4% did not seek help after suffering physical or sexual IPV. The main reasons for non-help-seeking included thinking it was unnecessary (42.3%) and embarrassment (14.9%). Age between 30 and 49 years old (PRa:1.15; 95%CI [1.06, 1.25]) and residing in a rural area (PRa:1.07; 95%CI [1.00, 1.13]) were associated with a higher probability of non-help-seeking. On the other hand, having a secondary education level (PRa:0.91; 95% CI [0.86, 0.97]) or higher (PRa:0.90; 95%CI [0.82, 0.99]), having a partner who drinks alcohol (PRa:0.94; 95%CI [0.89, 0.99]), having experienced physical or sexual IPV during a pregnancy (PRa:0.87; 95%CI [0.80, 0.94]), and having experienced moderate (PRa:0.81; 95%CI [0.76, 0.86]), or severe physical or sexual IPV (PRa:0.74; 95%CI [0.67, 0.82]), were associated with a lower probability of non-help-seeking. These associations were consistent in the sensitivity analysis. CONCLUSION Half of the women who experience physical or sexual IPV do not seek help. There are sociodemographic factors related to this non-seeking of help that are useful for identifying and prioritizing interventions to reduce IPV and improve the health status of women.
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Affiliation(s)
- Edison Salvador-Oscco
- Facultad de Medicina, Universidad Nacional de San Agustín de Arequipa, Arequipa, Peru
| | | | | | - Guido Bendezu-Quispe
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
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Zhang B, Wong A, Constantino RE, Hui V. The association between psychological distress, abusive experiences, and help-seeking among people with intimate partner violence. BMC Public Health 2024; 24:1060. [PMID: 38627699 PMCID: PMC11020675 DOI: 10.1186/s12889-024-18350-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/13/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is a serious public health problem associated with countless adverse physical and mental health outcomes. It places an enormous economic and public health burden on communities. The aim of this study was to examine the associations between psychological states (such as depression or hopeless) and help-seeking experiences of IPV survivors after experiencing IPV, based on the Allegheny County Health Survey (ACHS). METHODS Data from 2015 to 2016 Allegheny County Health Survey with N = 8,012 adults were analyzed. The 6-item version of the Kessler Psychological Stress Scale, located in Module 11 of the ACHS questionnaire, was used to measure psychological stress in participants. Module 12 of the ACHS questionnaire collected information on participants' experiences of intimate partner violence and help-seeking in the past 12 months. Descriptive statistical analysis, Pearson's chi-square or two sample independent t-tests statistical analysis, and multivariate binary logistic regression models were used to analyze the relationship between IPV experience and psychological distress. RESULTS A total of 212 of the 8,012 participants had IPV experience, with age, marital status, education, income, and race significantly different from those without IPV experience. The psychological stress of participants feeling hopeless (OR = 2.02, 95% CI = 1.37-2.99), restless or fidgety (OR = 1.83, 95% CI = 1.27-2.65), perceiving everything was an effort (OR = 1.55, 95% CI = 1.08-2.22) and worthless (OR = 1.49, 95% CI = 1.01-2.20) was associated with the IPV experience. Help-seeking behaviors of IPV survivors were associated with psychological distress, such as hopelessness (OR = 6.71, 95% CI = 1.38-32.60). CONCLUSIONS This study explored the association between IPV experience, help-seeking and psychological distress, and the need to expand community support. It is necessary to implement targeted interventions, enhance training of professionals, and promote the identification of early IPV cases as well as collaboration between healthcare and social support departments to reduce the occurrence of IPV or psychological distress following IPV.
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Affiliation(s)
- Bohan Zhang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Arkers Wong
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Rose E Constantino
- Health and Community Systems, School of Nursing, University of Pittsburgh, Pennsylvania, PA, USA
| | - Vivian Hui
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China.
- Health and Community Systems, School of Nursing, University of Pittsburgh, Pennsylvania, PA, USA.
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Murvartian L, Matías-García JA, Saavedra-Macías FJ, Crowe A. A Systematic Review of Public Stigmatization Toward Women Victims of Intimate Partner Violence in Low- and Middle-Income Countries. TRAUMA, VIOLENCE & ABUSE 2024; 25:1349-1364. [PMID: 37309621 DOI: 10.1177/15248380231178756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Public stigmatization of women victims of intimate partner violence (IPV) has begun to be studied because of its negative impact on recovery from violence. This systematic review aimed to analyze such stigmatization in low- and middle-income countries (LAMIC) by identifying social norms and perceptions linked to public stigmatizing responses, such responses, negative consequences of those responses on victims, and other factors associated with public stigma. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, five databases were searched using "stigma" and multiple synonyms of IPV as keywords. Selected articles were empirical, written in English, published in peer-reviewed journals, and reported findings on public stigma toward women victims of IPV that had occurred in LAMIC. Nineteen articles met the inclusion criteria. Patriarchal gender roles, normalization of IPV and the consideration of violence as a private matter were the most prevalent social norms among the studies. These led to blaming, isolating, and discriminating against the victim, making her feel ashamed, considering her less valuable than before suffering IPV, and dismissing or denying the abuse. Many negative consequences were identified. Anticipated public stigma, associated with not disclosing the abuse and not seeking help, was the most popular. Public stigmatization was stronger when other public stigmas intersected and in the case of disadvantaged social circumstances. Consequences were diminished by protective factors such as informal support and gender-based violence support services. This review provides a global vision for future research in each specific sociocultural context and is a first step in the design of anti-stigma programs in LAMIC.
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Kieran K. Truth in myth: Ancient Stories' windows on treating modern trauma. J Adv Nurs 2024; 80:971-976. [PMID: 37788046 DOI: 10.1111/jan.15892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/31/2023] [Accepted: 09/20/2023] [Indexed: 10/04/2023]
Abstract
AIM Examine frameworks of myth in the theory and treatment of sequalae of intimate and interpersonal traumas, often seen and experienced by practicing nurses. DESIGN A discursive narrative review using a trauma-informed lens. METHODS Review of existing frameworks using myth to understand or treat trauma. Due to limited literature from 1945 to 2023, a strategy akin to snowball sampling was used: exploration of source references, an unstructured interview, and a synthesis of existing approaches to interpersonal and intimate trauma. RESULTS Effective treatments for post-traumatic stress disorder exist, but reach is limited. Nursing is under-represented in the existing literature on myth and trauma, which does not sufficiently include intimate and interpersonal traumas. CONCLUSION Encounters with myths encourage healing from interpersonal violence by making clear connections to universal themes while engaging intellect and emotions. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Encounters with myths could help to mitigate trauma sequalae. Nurses are positioned to develop and test evidence-based, highly flexible, patient-centred interventions using myth. IMPACT Identified gap: research using myth to address intimate and interpersonal violence. Under-studied intervention: a few works suggest myth encounters benefit combat trauma survivors. All nurses encounter individuals with trauma histories. Myths may build empathy and efficacy. REPORTING METHOD No EQUATOR guidelines were discovered for the paper format. PATIENT/PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Kathryn Kieran
- Department of Nursing, MGH Institute of Health Professions, Boston, Massachusetts, USA
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14
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Waltzman D, Daugherty J, Haarbauer-Krupa J, Zheng X, Jorge C, Basile KC. Association Between Lifetime Sexual Violence and Recent Traumatic Brain Injury Among Adults: 2017 Connecticut Behavioral Risk Factor Surveillance System. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:1351-1367. [PMID: 37804158 PMCID: PMC10962142 DOI: 10.1177/08862605231203962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
Sexual violence (SV) is a critical public health problem that is associated with numerous negative health consequences, including immediate- and long-term physical and mental health conditions and health-risk behaviors. Some of these health-risk behaviors (e.g., substance use, unsafe driving practices, poor mental health, lower impulse control, and abnormal brain circuitry) might increase the risk for sustaining a traumatic brain injury (TBI). A TBI causes neurological or neuropsychological changes and may also lead to various symptoms that affect a person's cognition, mobility, behavior, and mental health. Determining if those who have experienced SV are at increased risk of sustaining a TBI in their lifetime is critical given the high prevalence and health impacts of SV, the potential vulnerability to TBI after SV, and the known detrimental effects of TBI. This exploratory study examined data from the 2017 Connecticut behavioral risk factor surveillance system and found that lifetime SV victimization (controlling for age and sex) was associated with increased odds of reporting a recent TBI in the past 12 months (adjusted odds ratio [AOR] = 2.1; 95% confidence interval [CI] [1.03, 4.21]). Further research is needed to better understand how SV history is related to the risk of sustaining a TBI. Healthcare professionals can support patients who experience SV by providing resources to help reduce associated physical and mental health conditions and health-risk behaviors.
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Affiliation(s)
- Dana Waltzman
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jill Daugherty
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Juliet Haarbauer-Krupa
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Xi Zheng
- Connecticut Department of Public Health, Hartford, CT, USA
| | - Celeste Jorge
- Connecticut Department of Public Health, Hartford, CT, USA
| | - Kathleen C. Basile
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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15
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Peeren S, McLindon E, Tarzia L. "Counteract the gaslighting" - a thematic analysis of open-ended responses about what women survivors of intimate partner sexual violence need from service providers. BMC Womens Health 2024; 24:110. [PMID: 38336660 PMCID: PMC10858602 DOI: 10.1186/s12905-024-02943-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Intimate partner sexual violence (IPSV) is a prevalent but misunderstood form of gender-based violence with significant impacts women's health and well-being. Research suggests that IPSV has a specific context and unique impacts, but little is known about how to tailor service responses. To address this gap, we explored help-seeking experiences and needs among IPSV survivors after disclosure. METHODS This study draws on qualitative data from a subsample of women who participated in a cross-sectional survey about the service needs of intimate partner violence survivors. Women who reported IPSV and provided information about IPSV-specific help-seeking needs after disclosure were included in the analysis. Open-ended text responses of 37 IPSV survivors were analysed using thematic analysis. RESULTS IPSV was invisible and silenced in service responses. Three themes suggest potential ways forward. In the first theme, 'Don't dismiss it', women needed providers to take their disclosures seriously and listen to the significant impacts of IPSV on their well-being and safety. In the second theme, 'See the bigger picture', women needed service providers to understand that IPSV fits into broader patterns of abuse, and that psychological abuse and coercive control impacts women's ability to consent. In the third theme, 'counteract the gaslighting', women needed providers to educate them about the continuum of IPSV and help them label IPSV as a form of violence. CONCLUSIONS Our exploratory findings extend the limited evidence base on IPSV and highlight a need for further in-depth research to explore a tailored approach to supporting IPSV survivors. To avoid contributing to the silencing of IPSV survivors, service responses should recognise the harmful and sexualised nature of IPSV, challenge cultural stereotypes that minimise IPSV, and understand that co-occurring psychological abuse may exacerbate shame and prevent women from articulating the source of their distress.
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Affiliation(s)
- Síofra Peeren
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- Service User Research Enterprise, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK.
| | - Elizabeth McLindon
- Department of General Practice, The University of Melbourne, Melbourne, VIC, Australia
- Centre for Family Violence Prevention, The Royal Women's Hospital, Parkville, VIC, Australia
| | - Laura Tarzia
- Department of General Practice, The University of Melbourne, Melbourne, VIC, Australia
- Centre for Family Violence Prevention, The Royal Women's Hospital, Parkville, VIC, Australia
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16
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Fekih-Romdhane F, Boukadida Y, Abassi B, Chaibi LS, Conus P, Krebs MO, Thornicroft G, Cheour M, Jahrami HA. French validation of the barriers to access to care evaluation (BACE-3) scale. L'ENCEPHALE 2024:S0013-7006(24)00010-1. [PMID: 38311478 DOI: 10.1016/j.encep.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 11/03/2023] [Accepted: 11/08/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND The aim of this study was to develop and evaluate a French version of the Barriers to Access to Care Evaluation (BACE-3) scale that is tailored to the socio-cultural and language setting of the study. METHODS The translation of the BACE-3 into French and its validation were the two key components of this psychometric investigation. An online survey was created and circulated to French-speaking participants who volunteered to participate in the study. RESULTS For all translated questions, the reliability analysis key results (Cronbach's alpha and McDonald's Omega) were both>0.95, which is an excellent reliability value. The BACE-3 items were shown to be positively related to one another, implying excellent validity. Results of exploratory and confirmatory factor analyses showed that all stigma-related items were loaded under the same factor. CONCLUSIONS The BACE-3 has been validated in French, and its psychometric qualities have been thoroughly evaluated and found to be excellent.
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Affiliation(s)
- Feten Fekih-Romdhane
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia; The Tunisian Center of Early Intervention is Psychiatry, Department of psychiatry "Ibn Omrane", Razi Hospital, 1, rue des orangers, 2010 Manouba, Tunisia.
| | - Youssef Boukadida
- The Tunisian Center of Early Intervention is Psychiatry, Department of psychiatry "Ibn Omrane", Razi Hospital, 1, rue des orangers, 2010 Manouba, Tunisia
| | - Bouthaina Abassi
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia; The Tunisian Center of Early Intervention is Psychiatry, Department of psychiatry "Ibn Omrane", Razi Hospital, 1, rue des orangers, 2010 Manouba, Tunisia
| | - Leila Sarra Chaibi
- The Tunisian Center of Early Intervention is Psychiatry, Department of psychiatry "Ibn Omrane", Razi Hospital, 1, rue des orangers, 2010 Manouba, Tunisia
| | - Philippe Conus
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marie-Odile Krebs
- Laboratoire de physiopathologie des maladies psychiatriques, UMR_S1266 institut de psychiatrie et neurosciences de Paris, université Paris Descartes, Inserm, Paris, France; Institut de psychiatrie (CNRS GDR 3557), Paris, France; Service hospitalo universitaire, faculté de médecine Paris Descartes, centre hospitalier Sainte-Anne, université Paris Descartes, Paris, France
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Majda Cheour
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia; The Tunisian Center of Early Intervention is Psychiatry, Department of psychiatry "Ibn Omrane", Razi Hospital, 1, rue des orangers, 2010 Manouba, Tunisia
| | - Haitham A Jahrami
- Ministry of Health, Manama, Bahrain; Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
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17
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Scott SE, Lavage DR, Risser L, Gonzalez Bockinski S, Miller E, Ragavan MI. Economic Abuse and Help-Seeking Intentions Among Adolescents. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:107-132. [PMID: 37599430 DOI: 10.1177/08862605231194640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Economic adolescent relationship abuse (ARA) includes coercive behaviors leading to interference with education, employment, and finances. To date, no study has examined help seeking among adolescents and young adults if they were to experience economic ARA. The goals of this article include examining: (a) help-seeking intentions of adolescents regarding economic ARA; (b) help-seeking sources and reasons for not seeking help; and (c) differences in help-seeking intentions based on age, race/ethnicity, gender identity, and experiences of economic ARA. We conducted a cross-sectional survey of adolescents ages 13-19 focused on economic ARA experiences and help seeking. We performed descriptive statistics of help-seeking intentions, sources, and barriers. We utilized logistic regression, adjusted for age, race/ethnicity, and gender identity, to explore associations between economic ARA victimization and help-seeking intentions. Of 2,852 participants, 56% said they would seek help for economic ARA. Adolescents with positive help-seeking intentions shared that they would seek help from their parents (43%) or friends (35%). Those less likely to seek help were concerned about others finding out (32%), not being believed (31%), or authority figures being notified (31%). Help-seeking intentions were lower among Black/African American adolescents (aOR = 0.55, CI [0.43, 0.70]) and Multiracial adolescents (aOR = 0.26, CI [0.16, 0.42]) compared to White adolescents. Help-seeking intentions were higher among gender diverse adolescents (aOR = 5.78, CI [2.98, 11.22]) and those ages 15-17 years (aOR = 1.84, CI [1.36, 2.47]) compared to those identifying as female and ages 18-19 years. Help-seeking intentions were lower among adolescents who experienced economic ARA (aOR = 0.61, CI [0.51, 0.72]). While the majority of adolescents reported that they would seek help if they experienced economic ARA, those who had experienced economic ARA were less likely to report intentions to seek help. Supportive interventions for adolescents experiencing economic ARA are needed.
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Affiliation(s)
- Sarah E Scott
- University of Pittsburgh School of Medicine, PA, USA
| | | | - Lauren Risser
- University of Pittsburgh School of Medicine, PA, USA
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18
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Lagdon S, Anyadike-Danes N, Reynolds M, Flack WF, Armour C. Intimate Partner Sexual Violence, Gender, and Psychological Distress Among Northern Irish University Students. VIOLENCE AND VICTIMS 2023; 38:910-928. [PMID: 37989531 DOI: 10.1891/vv-2022-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
While substantial prevalence rates of intimate partner sexual violence (IPSV) have been found among university students for decades in North America, there is a specific gap in published studies on this issue in the United Kingdom and Ireland. The present analysis used data from a larger survey study of students in one Northern Irish university. The analyses reported here were used to examine relationships among IPSV victims, gender (males and females only), unhealthy alcohol use, and psychological distress among university students (n = 654) since the age of 16 and during the previous year. The results of this study are consistent with previous research indicating that women (n = 248) experience IPSV more often than men (n = 37; 50% vs. 23%, respectively). Nonetheless, IPSV is experienced by both men and women with statistically significant associations with alcohol use, posttraumatic stress, depression, and generalized anxiety compared with those who did not report any IPSV experience.
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Affiliation(s)
- Susan Lagdon
- School of Psychology, Ulster University, Coleraine, Londonderry, Northern Ireland
| | - Ngozi Anyadike-Danes
- School of Psychology, Ulster University, Coleraine, Londonderry, Northern Ireland
| | - Megan Reynolds
- DCU Anti-Bullying Centre, Dublin City University, Dublin, Ireland
| | - William F Flack
- Department of Psychology, Bucknell University, Lewisburg, Pennsylvania, USA
| | - Cherie Armour
- School of Psychology, Queens University Belfast, Belfast, Northern Ireland
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19
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Nobels A, Meersman C, Lemmens G, Keygnaert I. "Just something that happened?": Mental health impact of disclosure and framing of sexual violence in older victims. Int J Geriatr Psychiatry 2023; 38:e6036. [PMID: 38088814 DOI: 10.1002/gps.6036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION Despite the important impact of sexual violence (SV) on mental health, few victims disclose their experiences. Although research in adult victims suggests that SV disclosure could protect against long-term mental health problems, studies in older adults are lacking. OBJECTIVES To establish the prevalence of depression, anxiety, posttraumatic stress disorder (PTSD), suicide attempts, and self-harm, their association with SV disclosure, and the moderating effect of sociodemographic characteristics and SV framing in the relation between SV disclosure and the different mental health outcomes in older SV victims. METHODS Data on sexual victimisation, mental health, SV framing, and disclosure were collected through structured face-to-face interviews with 171 randomly selected sexually victimised adults of 70 years and older living in Belgium. SV was measured using behaviourally specific questions based on a broad definition. Mental health outcomes were measured using validated scales. RESULTS Depression, anxiety and PTSD were reported by 34%, 33% and 9% of participants respectively, 5% had attempted suicide and 1% reported self-harm during lifetime. SV framing was associated with the kind of help victims consulted. SV disclosure was not linked with depression and anxiety, but was associated with an increase of PTSD symptoms in older victims with care dependency (p = 0.004) or a chronic illness and/or disability (p = 0.025). CONCLUSIONS SV disclosure in itself does not protect against adverse mental health outcomes in old age. Capacity building of professionals trough training and development of clinical guidelines and care procedures may increase appropriate response to SV disclosure by older victims.
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Affiliation(s)
- Anne Nobels
- Department of Psychiatry, Ghent University Hospital, Ghent, Belgium
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | | | - Gilbert Lemmens
- Department of Psychiatry, Ghent University Hospital, Ghent, Belgium
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium
| | - Ines Keygnaert
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Women's Clinic, Ghent University Hospital, Ghent, Belgium
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20
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Dams-O'Connor K, Bulas A, Haag H(L, Spielman LA, Fernandez A, Frederick-Hawley L, Hoffman JM, Goldin Frazier Y. Screening for Brain Injury Sustained in the Context of Intimate Partner Violence (IPV): Measure Development and Preliminary Utility of the Brain Injury Screening Questionnaire IPV Module. J Neurotrauma 2023; 40:2087-2099. [PMID: 36879469 PMCID: PMC10623077 DOI: 10.1089/neu.2022.0357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Abstract Intimate partner violence (IPV) is associated with risk for multi-etiology brain injury (BI), including repetitive head impacts, isolated traumatic brain injuries (TBI), and anoxic/hypoxic injury secondary to nonfatal strangulation (NFS). IPV-related injuries are often unreported, but evidence suggests that survivors are more likely to report when asked directly. There are currently no validated tools for screening of brain injury related to IPV that meet World Health Organization guidelines for this population. Here, we describe measure development methods and preliminary utility of the Brain Injury Screening Questionnaire IPV (BISQ-IPV) module. We culled items from existing IPV and TBI screening tools and sought two rounds of stakeholder feedback regarding content coverage, terminology, and safety of administration. The resulting stakeholder-informed BISQ-IPV module is a seven-item self-report measure that uses contextual cues (e.g., being shoved, shaken, strangled) to query lifetime history of IPV-related head/neck injury. We introduced the BISQ-IPV module into the Late Effects of TBI (LETBI) study to investigate rates of violent and IPV-specific head/neck injury reporting in a TBI sample. Among those who completed the BISQ-IPV module (n = 142), 8% of the sample (and 20% of women) reported IPV-related TBI, and 15% of the sample (34% of women) reported IPV-related head or neck injury events that did not result in loss or alteration of consciousness. No men reported NFS; one woman reported inferred BI secondary to NFS, and 6% of women reported NFS events. Those who endorsed IPV-BI were all women, many were highly educated, and many reported low incomes. We then compared reporting of violent TBIs and head/neck injury events among individuals who completed the core BISQ wherein IPV is not specifically queried (administered from 2015-2018; n = 156) to that of individuals who completed the core BISQ preceded by the BISQ-IPV module (BISQ+IPV, administered from 2019-2021; n = 142). We found that 9% of those who completed the core BISQ reported violent TBI (e.g., abuse, assault), whereas 19% of those who completed the BISQ+IPV immediately preceding the core BISQ reported non-IPV-related violent TBI on the core BISQ. These findings suggest that standard TBI screening tools are inadequate for identifying IPV-BI and structured cueing of IPV-related contexts yields greater reporting of both IPV- and non-IPV-related violent BI. When not queried directly, IPV-BI remains a hidden variable in TBI research studies.
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Affiliation(s)
- Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ashlyn Bulas
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Halina (Lin) Haag
- Department of Social Work, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Lisa A. Spielman
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Angela Fernandez
- Department of OBGYN and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lynn Frederick-Hawley
- Department of OBGYN and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeanne M. Hoffman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Yelena Goldin Frazier
- Yelena Goldin Frazier Curect Neuropsychology of New York, East Rockaway, New York, USA
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21
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Saberi E, Hutchinson M, Hurley J. Implementing intimate partner violence (IPV) screening within emergency departments - Barriers, challenges and enablers experienced by intimate partner violence practice change champions. Int Emerg Nurs 2023; 69:101311. [PMID: 37348236 DOI: 10.1016/j.ienj.2023.101311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/05/2023] [Accepted: 05/19/2023] [Indexed: 06/24/2023]
Abstract
AIM To identify the barriers, challenges, and enablers that clinical champions experience whilst implementing Intimate Partner Violence (IPV) screening within Emergency Departments (EDs). BACKGROUND Champions support the introduction of IPV screening within EDs. This paper shares new knowledge about IPV practice change champions: barriers, challenges and enablers they experienced in their efforts. DESIGN Between 2017-2019, semi structured qualitative interviews were conducted with 23 individuals who identified as champions, working to introduce routine IPV in two rural tertiary hospital Emergency Departments. An interpretive framework and process of constant comparison was used to thematically analyse data from transcribed interviews. RESULTS Champions identified barriers, challenges, and enablers that they experienced. Enablers included: support for the work of champions; champion leadership and collegiality; and training for the champion role. Challenges and Barriers included: resistance to a change in the focus of practice; and workflow and workload. CONCLUSIONS AND IMPLICATIONS Nurse champions can effectively support IPV practice change but face certain barriers, challenges and enablers. Nurse managers can use this information to support champions to undertake their role effectively in order to better meet the needs of individuals experiencing IPV.
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Affiliation(s)
- Elham Saberi
- Southern Cross University, School of Health and Human Sciences, Lismore, NSW 2480, Australia.
| | - Marie Hutchinson
- Southern Cross University, School of Health and Human Sciences, Coffs Harbour, NSW 2450, Australia.
| | - John Hurley
- Southern Cross University, School of Health and Human Sciences, Coffs Harbour, NSW 2450, Australia.
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22
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Baert S, De Buyser S, Van Belle S, Gemmel P, Rousseau C, Roelens K, Keygnaert I. Factors Related to Police Reporting in Sexual Assault Care Centers: Are We Underestimating the Role of Support Persons? Violence Against Women 2023:10778012231183659. [PMID: 37365905 DOI: 10.1177/10778012231183659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Few victims of sexual assault (SA) report to the police. Research on the role of support persons in victims' reporting is sparse. We address this gap by examining the association of victim, assailant, victimization incident, and support characteristics with reporting rates among victims attending sexual assault care centers (SACCs). Logistic regression results show that type of SA, delay between SA and presentation at SACC, and presence of an informal support person at SACC and SACC site are significantly associated with police reporting. These findings reveal the importance of targeting victims' support persons to alter reporting behavior among SA victims.
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Affiliation(s)
- Saar Baert
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Stefanie De Buyser
- Biostatistics Unit, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sara Van Belle
- Health Systems and Health Policy Research Group, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Paul Gemmel
- Department of Marketing, Innovation and Organization, Ghent University, Ghent, Belgium
| | - Charlotte Rousseau
- Centre de Prise en Charge des Violences Sexuelles Bruxelles, Saint-Pierre University Hospital, Brussels, Belgium
| | - Kristien Roelens
- Department of Human Structure and Repair, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Ines Keygnaert
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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23
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Stockman D, Haney L, Uzieblo K, Littleton H, Keygnaert I, Lemmens G, Verhofstadt L. An ecological approach to understanding the impact of sexual violence: a systematic meta-review. Front Psychol 2023; 14:1032408. [PMID: 37292501 PMCID: PMC10244654 DOI: 10.3389/fpsyg.2023.1032408] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 05/08/2023] [Indexed: 06/10/2023] Open
Abstract
Aim A systematic meta-review was conducted to examine (1) the broad range of negative and positive individual and interpersonal changes following adult sexual violence, as well as (2) the risk/protective factors at multiple levels of the social ecology (e.g., individual, assault, and micro/meso/exo/macro/chronosystem factors)-influencing the impact of sexual violence. Methods Searches of Web of Science, Pubmed, and ProQuest resulted in inclusion of 46 systematic reviews or meta-analyses. Review findings were extracted for summary and a deductive thematic analysis was conducted. Results Experiencing sexual violence is associated with many negative individual and sexual difficulties as well as revictimization risk. Only a limited number of reviews reported on interpersonal and positive changes. Factors at multiple levels of the social ecology play a role in the intensity of these changes. Reviews including macrolevel factors were non-existent, however. Conclusion Reviews on sexual violence are fragmented in nature. Although the use of an ecological approach is often lacking, adopting such a perspective in research is necessary for a fuller understanding of the multiple influences on survivor outcomes. Future research should evaluate the occurrence of social and positive changes following sexual violence, as well as the role of macrolevel factors in influencing post-assault outcomes.
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Affiliation(s)
- Dagmar Stockman
- Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Laura Haney
- Department of Psychology, East Carolina University, Greenville, NC, United States
| | - Kasia Uzieblo
- Department of Criminology, Vrije Universiteit Brussel, Brussel, Belgium
- Forensic Care Specialists, Van der Hoeven Clinic, Utrecht, Netherlands
| | - Heather Littleton
- Lyda Hill Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, CO, United States
| | - Ines Keygnaert
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Gilbert Lemmens
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Lesley Verhofstadt
- Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
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24
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Isaac S, McLindon E, Hegarty K, Tarzia L. Women's Experiences Accessing Mental Health Care in Australia After Sexual Violence in Adulthood. Violence Against Women 2023:10778012231176198. [PMID: 37203171 DOI: 10.1177/10778012231176198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
In Australia, at least one in every five women has experienced sexual violence since age 15. Research consistently links sexual violence with poor mental health, persisting long after the crisis period. Trauma-informed mental health support is therefore critical. This article draws on interviews with 29 women who had experienced sexual violence to understand their experiences accessing mental health services in Australia. Our findings suggest that, constrained by a biomedical model of care, mental health practitioners' understanding of trauma generally, and sexual violence particularly, may be lacking. Further, women struggle to navigate a "maze" of services.
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Affiliation(s)
- Sandra Isaac
- The University of Melbourne, Victoria, Australia
| | - Elizabeth McLindon
- The University of Melbourne, Victoria, Australia
- The Royal Women's Hospital, Victoria, Australia
| | - Kelsey Hegarty
- The University of Melbourne, Victoria, Australia
- The Royal Women's Hospital, Victoria, Australia
| | - Laura Tarzia
- The University of Melbourne, Victoria, Australia
- The Royal Women's Hospital, Victoria, Australia
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Scheer JR, Lawlace M, Cascalheira CJ, Newcomb ME, Whitton SW. Help-Seeking for Severe Intimate Partner Violence Among Sexual and Gender Minority Adolescents and Young Adults Assigned Female at birth: A Latent Class Analysis. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:6723-6750. [PMID: 36472356 PMCID: PMC10050117 DOI: 10.1177/08862605221137711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Sexual and gender minority adolescents and young adults assigned female at birth (SGM-AFAB) report high rates of intimate partner violence (IPV) victimization. Despite adverse health outcomes of IPV, many survivors, particularly SGM-AFAB, do not seek help. This study (1) examined the proportion of SGM-AFAB who reported severe IPV victimization who sought help; (2) elucidated patterns of help-seeking facilitators and barriers; and (3) identified associations between sociodemographic characteristics, IPV victimization types, and minority stressors and latent classes of help-seeking facilitators and barriers. Participants included 193 SGM-AFAB (Mage = 20.6, SD = 3.4; 65.8% non-monosexual; 73.1% cisgender; 72.5% racial/ethnic minority; 16.6% annual household income $20,000 or less). Most participants who experienced severe IPV did not seek help (62.2%). Having a person or provider who was aware of the participant's abusive relationship was the most common reason for seeking help (50; 68.5%). Minimizing IPV was the most common reason for not seeking help (103; 87.3%). Fewer than 5% of SGM-AFAB who experienced severe IPV and who did not seek help reported SGM-specific help-seeking barriers, including not wanting to contribute to negative perceptions of the LGBTQ community, not disclosing their SGM status, and perceiving a lack of tailored services. Help-seeking facilitators and barriers varied by sociodemographic characteristics. Three classes of help-seeking facilitators and two classes of help-seeking barriers emerged. SGM-AFAB subgroups based on sexual and gender identity, recent coercive control, and identity as IPV victims differed in latent classes. This study's findings confirm SGM-AFAB IPV survivors' low likelihood of seeking help. Our results also underscore the importance of continuing to bolster SGM-AFAB survivors' access to trauma-informed, culturally sensitive, and affirming support. Further, multilevel prevention and intervention efforts are needed to reduce minimization of abuse and anticipatory judgment and blame among SGM-AFAB who hold multiple marginalized identities, experience coercive control, and identify as IPV victims.
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Li Y, Zhou K, Tang S, Chen J. Intimate Partner Violence Screening Instruments: A Protocol for a COSMIN-Based Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1541. [PMID: 36674295 PMCID: PMC9861910 DOI: 10.3390/ijerph20021541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
Intimate partner violence (IPV) is a major public health problem resulting in a significant impediment to equal participation, quality of life, and personal, social, and economic development. At present, a variety of screening instruments for IPV have emerged in developed countries, and some of them have been adapted to the language and culture of different countries, such as Hurt, Insult, Threaten, Scream (HITS) and the Abuse Assessment Screen (AAS). The selection of the most appropriate IPV screening instrument for the target population and context from among those instruments has become difficult for researchers when intending to start screening. Therefore, a systemic review of IPV screening instruments is needed. This protocol describes a COSMIN-based systematic review of the measurement properties of these instruments. The aims of the systematic review are to (1) evaluate the methodological quality of studies on the measurement properties including the validity, reliability, and internal consistency of these IPV screening instruments, and (2) provide suggestions for relevant researchers in their local context for using the IPV screening instruments.
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Affiliation(s)
- Yanjia Li
- Xiangya School of Nursing, Central South University, Changsha 410013, China
| | - Keyi Zhou
- Xiangya School of Nursing, Central South University, Changsha 410013, China
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, Changsha 410013, China
- Xiangya Center for Evidence-Based Nursing Practice & Healthcare Innovation: A JBI Affiliated Group, Changsha 410008, China
| | - Jiarui Chen
- Xiangya School of Nursing, Central South University, Changsha 410013, China
- Xiangya Center for Evidence-Based Nursing Practice & Healthcare Innovation: A JBI Affiliated Group, Changsha 410008, China
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27
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Tarzia L, Hegarty K. "He'd Tell Me I was Frigid and Ugly and Force me to Have Sex with Him Anyway": Women's Experiences of Co-Occurring Sexual Violence and Psychological Abuse in Heterosexual Relationships. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:NP1299-NP1319. [PMID: 35440224 DOI: 10.1177/08862605221090563] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Intimate partner sexual violence (IPSV) is a common yet hidden form of violence. It is primarily perpetrated against women by their male partners and is associated with a range of serious mental and physical health outcomes. Despite these harms, it is chronically under-researched. In particular, the overlaps between IPSV and psychological abuse in relationships are poorly understood. Extant literature has focused primarily on the relationship between IPSV and physical violence, neglecting the fact that IPSV often involves verbal or emotional coercion, threats or blackmail rather than the use of 'force'. In this paper, we draw on reflexive thematic analysis of qualitative interviews with n = 38 victim/survivors of IPSV to explore how they understood the relationship between sexual and psychological abuse in their heterosexual relationships. Four themes were developed from this analysis: 1. I felt like I couldn't say Nno'; 2. I felt degraded and worthless; 3. Letting me know who's boss; and 4. Making me feel crazy. These themes broadly correspond to four distinct patterns or interactions between IPSV and psychological abuse. Our findings strongly suggest that the relationship between sexual and psychological abuse in relationships is far more complex than previous research would indicate. Psychological abuse is not simply a tool to obtain sex and sexual violence is not only used as a mechanism of psychological control. Instead, the two forms of abuse interact in ways that can be unidirectional, bi-directional or simultaneous to develop and maintain an environment of fear and control and erode women's self-worth.
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Affiliation(s)
- Laura Tarzia
- Department of General Practice, 2281The University of Melbourne, VIC, Australia
- Centre for Family Violence Prevention, The Royal Women's Hospital, Parkville, VIC, Australia
| | - Kelsey Hegarty
- Department of General Practice, 2281The University of Melbourne, VIC, Australia
- Centre for Family Violence Prevention, The Royal Women's Hospital, Parkville, VIC, Australia
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Hegarty KL, Andrews S, Tarzia L. Transforming health settings to address gender‐based violence in Australia. Med J Aust 2022; 217:159-166. [PMID: 35796723 PMCID: PMC9546247 DOI: 10.5694/mja2.51638] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 12/02/2022]
Abstract
Gender‐based violence includes intimate partner violence, sexual violence and other harmful acts directed at people based on their gender. It is common in Australia and causes great ill health, especially for women victims/survivors, with Indigenous women particularly affected. Health services are an opportune place for early intervention for victims/survivors of gender‐based violence as they attend frequently. Interventions that are evidence‐based and respond to consensus from victim/survivor voices include universal education, screening in antenatal care, first line supportive care, and referral for advocacy and psychological interventions, including mother–child work. Health care staff require training, protocols, scripts, referral pathways, understanding of cultural safety and antiracist practice in service delivery, and leadership support to undertake this sensitive work, including support, if needed, for their own experiences of gender‐based violence. Using a trauma‐, violence‐ and gender‐informed approach across health systems, taking into account structural inequities, is essential to sustain the gender‐based violence work in health services. Gender‐based violence experienced by Indigenous women is distinct and of urgent concern as rates rapidly increase. Inequities across the health system are pronounced for Indigenous women.
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Affiliation(s)
- Kelsey L Hegarty
- Safer Families Centre University of Melbourne Melbourne VIC
- Centre for Family Violence Prevention, Royal Women’s Hospital Melbourne VIC
| | - Shawana Andrews
- Safer Families Centre University of Melbourne Melbourne VIC
- Melbourne Poche Centre for Indigenous Health University of Melbourne Melbourne VIC
| | - Laura Tarzia
- Safer Families Centre University of Melbourne Melbourne VIC
- Centre for Family Violence Prevention, Royal Women’s Hospital Melbourne VIC
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Signorelli MC, Costa da Silva VL, Evans DP, Prado SM, Glass N. Feasibility of an Online-Based Safety Decision Aid for Brazilian Women Living with Intimate Partner Violence: Findings from Participatory-Action Research in a One Stop Center. JOURNAL OF FAMILY VIOLENCE 2022; 38:433-446. [PMID: 35601758 PMCID: PMC9113623 DOI: 10.1007/s10896-022-00409-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 06/15/2023]
Abstract
Intimate partner violence (IPV) is a challenge in Brazil; the country is ranked 6th globally for femicide and one in four women experience physical and/or sexual IPV in their lifetimes. Safety decision aids (SDA) are tools for women experiencing IPV. Building upon previously developed and tested online SDA tools, we intend to adapt an SDA tool for use in Brazil. The purpose of this study was to examine the feasibility of a technology-based SDA to support Brazilian women living with IPV, tailored for the Brazilian context. Our participatory-action research approach built upon research between 2018 and 2019 at the House of the Brazilian Woman (HBW) of Curitiba, Brazil, a cross-sectoral one-stop center (OSC) providing comprehensive care for IPV survivors. Field research included observation, field notes, and in-depth interviews with twenty-eight (n = 28) participants (HBW staff and survivors). The results were grouped into four main thematic categories: advantages; uncertainties; barriers; and suggestions. The triangulated results showed that the majority of participants considered the SDA feasible, highlighting flexibility and confidentiality; information about IPV; and access to resources for formal help-seeking as advantages of the tool. Participants also expressed uncertainties about SDA's ability to increase women's safety and its accessibility for the most vulnerable. They made suggestions for improvement to meet the unique needs of Brazilian women. This study provided evidence on the potential of an SDA tailored for use within a comprehensive program of women survivors in Brazil. This step was crucial to inform the future implementation and evaluation.
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Affiliation(s)
- Marcos Claudio Signorelli
- Chamber of Public Health, Federal University of Paraná, Rua Jaguariaíva, 512, Matinhos, PR 83260-000 Brazil
| | - Vera Lucia Costa da Silva
- Post-Graduation in Sustainable Territorial Development, Federal University of Paraná, Rua Jaguariaíva, 512, Matinhos, PR 83260-000 Brazil
| | - Dabney P. Evans
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Sandra Marques Prado
- House of the Brazilian Woman of Curitiba, Av. Paraná, 870, Curitiba, PR 80035-130 Brazil
| | - Nancy Glass
- Johns Hopkins Center for Global Health, Johns Hopkins University, 415 N Washington St, Baltimore, MD 21205 USA
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Handebo S, Kassie A, Nigusie A. Help-seeking behaviour and associated factors among women who experienced physical and sexual violence in Ethiopia: evidence from the 2016 Ethiopia Demographic and Health Survey. BMC Womens Health 2021; 21:427. [PMID: 34953493 PMCID: PMC8710004 DOI: 10.1186/s12905-021-01574-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Violence against women remains devastatingly pervasive and remained unchanged over the past decade. Violence against women is preventable and help-seeking of women subjected to violence is an entry point. So, this study assessed help-seeking behaviour and associated factors among women who experienced physical and sexual violence in Ethiopia. METHOD Using the 2016 Ethiopia Demographic and Health Surveys (EDHS), this paper analyzes the determinants of help-seeking behavior of women subjected to violence in Ethiopia. EDHS used a two-stage stratified cluster sampling technique. From 642 communities, a total of 1540 (weighted) reproductive age women were included in the analysis. Simple descriptive, bivariable and multivariable logistic regression analysis were employed. Statistical significance was set at a p-value of less than 0.05. RESULTS Only 22.5% of the women who experienced violence sought help. Being aged 30 and above, working in sales, or an agricultural job, being in the richest wealth quintile, and experiencing severe violence were associated with increased help-seeking behaviour. Living in a rural area, having a husband who attended primary, secondary, and higher education, having a husband working in a professional job and agriculture were factors associated with lower odds of help-seeking behaviour. CONCLUSION In Ethiopia below one-fourth of women who were subject to violence sought help. Socio-demographic factors and severity of the violence were associated with help-seeking. Preventing child marriages and reducing poverty as well as increased employment and education for women enhance help-seeking behaviour by the women. Interventions could include creating awareness, law enforcement, and support for victims.
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Affiliation(s)
- Simegnew Handebo
- School of Public Health, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Ayenew Kassie
- Department of Health Education and Behavioural Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adane Nigusie
- Department of Health Education and Behavioural Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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