Understanding the healthcare provider response to sexual violence in Ghana: A situational analysis

University Sexual and Gender-Based Violence Policies in Sub-Saharan Africa: Exploring Best Practices

AIMS

Addressing sexual and gender-based violence (SGBV) in educational settings across the globe, particularly in institutions of higher education, requires strong institutional framework and policy guidelines. Most research about university SGBV policies has focused on high-income countries with little or no recourse to universities in low- and middle-income countries. This policy analysis aims to analyze existing policies related to SGBV from select sub-Saharan African universities to provide guidance on best practices toward addressing SGBV at universities in Africa.

METHODS

Seven university policies and six national policies from six countries across sub-Saharan Africa (Ghana, Liberia, Nigeria, Rwanda, South Africa, and Zimbabwe) were reviewed using a standardized data extraction form. The policy analysis identified eight key elements of policies related to SGBV for sub-Saharan African universities, which were verified using a nominal group technique with five international experts in the field.

RESULTS

Overall, policies varied significantly in accessibility, terminology, definitions, format, and inclusivity across the sites. Some of the policies were not readily accessible, and there was limited evidence provided in some of the policy documents.

CONCLUSIONS

Policies for universities in sub-Saharan Africa should (a) be evidence based, (b) be readily available in multiple formats, (c) define key terms broadly with gendered signifiers, (d) be succinct and concise, (e) incorporate broad definitions for all university stakeholders, (f) identify who created the policy and when, (g) address prevention, and (h) address response. Evidence-based policies addressing SGBV prevention, response, and justice are sorely needed at universities across the globe.

The Development and Implementation of a Forensic Education Module for Nebraska Critical Access Providers: A Pilot Study

BACKGROUND

Sexual assault, intimate partner violence, and human trafficking are traumatic events for individuals and communities. As healthcare shortages increase, critical access hospitals must manage resources to ensure comprehensive forensic care effectively. Current literature indicates a lack of forensic healthcare education for providers within critical access hospitals. This forensic education module for critical access healthcare providers aimed to (a) increase forensic examination competencies, (b) improve forensic interviewing skills, (c) increase provider self-efficacy, and (d) show knowledge retention.

METHODS

This mixed-methods pilot study utilized a convenience sample of 45 healthcare providers in Nebraska critical access hospitals who presented for the forensic education module training. Repeated measures analysis of variance and paired t tests assessed the aims of this study. Structured surveys gathered qualitative data on three themes.

RESULTS

Implementation of the forensic education module showed a statistically significant increase in forensic interviewing skills, nonstatistically significant changes in general self-efficacy, and sustainability of knowledge and self-efficacy over 6 weeks. Analysis also showed a clinically significant increase in provider self-efficacy over 6 weeks. Structured questionnaire responses showed participants valued the content to address their perceived barriers to providing care.

CONCLUSIONS

This study validates the need for increased education in Nebraska's rural and medically underserved areas to ensure access to forensic care and provision of services. This pilot study shows the potential for forensic education interventions to increase provider competencies and improve provider self-efficacy, with evidence of retention of knowledge and skills.

College Students' Trust, Betrayal, and Needs During and After Their Worst Nonassault-Related Healthcare Experiences Differ Based on Sexual Violence Exposure

The BITTEN theoretical framework conceptually links patient's past healthcare betrayal and trauma experiences with their current and future healthcare interactions. BITTEN was used to examine whether healthcare experiences, behaviors, and needs differ between those with and without a history of sexual violence exposure. College students at two public universities in the southeastern United States (n = 1,381; 59.5% White, 61.0% women) completed measures about their self-selected worst or most frightening but nonassault-related healthcare experience. Multivariate general linear and mediation models were used to test theory-derived hypotheses. Participants exposed to sexual violence reported greater healthcare institutional betrayal, lower trust, and greater need for tangible aid and trauma-informed care during their worst nonassault-related healthcare experience. They also reported greater current healthcare avoidance alongside increased utilization of more physical and mental healthcare appointments, even after accounting for gender and race differences. These results suggest that, with minimal information about past sexual violence exposure, healthcare providers could be better poised to predict and address vulnerable patients' healthcare needs.

Formal support services and (dis)empowerment of domestic violence victims: perspectives from women survivors in Ghana

BACKGROUND

As part of efforts to prevent violence against women, several countries have institutionalized formal support services including legislations to prevent, protect victims, and deter perpetrators of domestic violence (DV). Prior research on formal support service utilization shows that DV survivors do not get the necessary services they deserve. However, much remains to be known about the experiences of women survivors of DV who accessed a range of formal support services and how their experiences (dis)empowered them. Here, we assessed the experiences of Ghanaian women survivors of DV with formal support services vis-à-vis the provisions of the Ghana DV Act and insights of subject experts.

METHODS

From May to August 2018, we recruited a total of 28 participants: 21 women survivors of DV in Weija-Gbawe Municipality of Ghana, and 7 experts from the police, human rights, and health professions. We used two sets of in-depth interview guides: one to collect data on survivors' experiences, and the second for the insights of experts. We performed summary descriptive statistics on survivors' sociodemographic characteristics and used thematic analysis to assess their experiences of DV; and access to, patronage, and response of formal support services.

RESULTS

Of 21 DV survivors, 19 (90.1%) were aware of the existence of the DV law, however none was well informed of their entitlements. DV survivors have low formal education and are not economically empowered. Some DV survivors are revictimized in the process of accessing formal services. DV survivors expect the government to provide them with shelter, upkeep, medical, and legal aid. All the 21 survivors had at least one contact with a women's rights organization and were knowledgeable of their supporting services namely legal services, temporary shelter, and psychosocial support.

CONCLUSIONS

The experiences of DV survivors do not reflect the legal provisions of Ghana's DV Act. Government under funding of formal services and negative gender norms are disempowering to survivors. NGOs are popular among women survivors of DV in Ghana for the education, legal, and material support they provide. A close collaboration between the government and NGOs could better mitigate DV in Ghana.

Attitudes of health professionals towards violence and their tendency to report spousal violence

The aim of this study is to determine the attitudes of primary care providers, physicians, nurses and midwives towards domestic violence and their tendencies to report violence against women and the affecting factors. The population of this study was 294 health professionals. The mean score on the Domestic Violence was 19.23 ± 4.28 and on the Scale of Health Professionals' Intentions/Behaviors Regarding Reporting Intimate Partner Violence was 124.24 ± 20.41. While the health professionals' attitudes towards domestic violence were more negative in our study, attitudes towards reporting violence against women were more positive. Also, health professionals faced ethical problems related to the principles of privacy and confidentiality.

Assessing the care of doctors, nurses, and nursing technicians for people in situations of sexual violence in Brazil

This study aimed to assess the quality of care for people in situations of sexual violence in health services, identifying positive and negative indicators, and suggest solutions. This is a cross-sectional study with a quantitative approach and convenience sampling. The sample consisted of 134 professionals (doctors, nurses, and nursing technicians) working in public health services. Three instruments were used, namely, a structure evaluation form, a questionnaire, and a process evaluation form. The results revealed eight positive indicators (adequate infrastructure; rooms for patient assistance; gynecological bed; visual and auditory privacy; waiting rooms; a professional team comprising physicians, nurses, nursing technicians, and receptionists; adequate training of staff to provide health services to people in situations of sexual violence; and most healthcare professionals asking their patients about possible sexual violence situations) and nine negative indicators (reduced number of rooms for patient assistance with toilets; absence of protocols to identify and assist people in situations of sexual violence; absence of leaflets, posters, and other materials on sexual violence; absence of a referral flow chart (specific for people in situations of sexual violence) to specialized services; reduced number of consultations with suspected and/or confirmed cases of sexual violence; non-use of specific protocols; not referral of these patients to the specialized care network; most professionals consider the health unit where they work as unable to help people in situations of sexual violence; a decrease in attendance at health facilities that do not have a protocol for assisting people in situations of sexual violence), making clear the interventions necessary to promote the provision of quality health services that meet the specific needs of people in situations of sexual violence. These indicators are expected to provide subsidies for the improvement of public policies aimed at listening, welcoming, identifying, and treating people in situations of sexual violence.

Clinical Care of Victims of Interpersonal Violence and Rape in Tanzania: A Qualitative Investigation

Introduction

Africa has high rates of interpersonal violence and rape, although little is known about how these cases are handled in the clinical setting.

Methods

We enrolled 121 health care professionals and students in Tanzania from the fields of midwifery, nursing and medicine, and conducted 18 focus group discussions stratified by both professional and clinical experience. Two clinical scenarios were presented across all groups and participants were asked to give their opinions on how the hospital they worked in would manage the cases. Case 1 focused on how to address a case of an injured woman beaten by her husband (and whether the perpetrator would be reported to the police). Case 2 focused on how to handle a rape victim who is brought to the hospital by the police.

Results

Participants considered both cases as emergencies. There was a similarity in the clinical care procedures across both scenarios. This included building rapport with the patient, prioritization of the medical care, history taking, and referring to other specialties for follow-up. Participants differed in how they would handle the legal aspects of both cases, including whether and how to best follow mandated reporting policies. Providers wondered if they should report the husband in case study 1, the criteria for reporting, and where to report. Providers displayed a lack of knowledge about resources needed for sexual violence victim and the availability of resources.

Conclusion

These findings indicate that cases of intimate partner violence and rape are likely to be under-reported within hospitals and clinics in Tanzania. Health care providers lack training in their required obligations and procedures that need to be followed to ensure victim’s safety. The findings confirm that there is a need for health care students in Tanzania (and possibly Africa) to receive comprehensive training in how to handle such cases.