Enabling factors that facilitate recovery among survivors of gender-based violence.

WHAT IS KNOWN ON THE SUBJECT?: Gender-based violence (GBV) has long-term devastating effects on psychological health, resulting in depression, anxiety and posttraumatic stress disorder. Beyond physical and mental health symptoms, GBV can affect survivors on many personal, social, and spiritual levels, impacting their ability to connect to themselves, others, and the world around them. While most research on recovery following GBV has focused on recognizing factors associated with distress or adverse outcomes, there is limited information about how they recover. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We know little about the internal characteristics that enable or support the healing journey (factors) or what the survivors do to build capacity or support for health and change (strategies). Therefore, this study discovered the main factors or strategies that GBV survivors used throughout their recovery process which included; social connection, self-care, self-understanding and spiritual connection. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses always encounter and deal with the GBV survivors as they always suffer from mental health issues related to their trauma. Therefore, mental health nurses can utilize our research findings to establish nursing interventions or psychoeducational programs with the aim of facilitating trauma recovery among the survivors. ABSTRACT: INTRODUCTION: Gender-based violence (GBV) is a severe worldwide phenomenon mainly affecting women. Little studies focus on the details of the recovery process that survivors of GBV go through. AIM: To identify the enabling factors that facilitate recovery among survivors of GBV. METHOD: We used the thematic qualitative analysis approach to analyse 20 interviews with the women survivors of GBV. RESULTS: Our study resulted in four factors that survivors used in their recovery process (social connection, self-care, self-understanding and spiritual connection). DISCUSSION: Recovering from an abusive relationship is a social, spiritual, cultural and psychological process. Current study confirmed the positive impact of our identified enabling factors in the recovery process of GBV survivors. IMPLICATIONS FOR PRACTICE: The current study illustrates findings that provide a deeper understanding of the journey to recovery following GBV, which can be helpful when guiding and supporting women who have suffered GBV to start and pursue their journey toward recovery.

Coping strategies among women exposed to Gender-Based violence in Turkey.

AIM: To understand coping strategies used by women experiencing gender-based violence and living in Turkey. Coping is a cognitive and behavioural strategy that individuals develop to manage stress, generally categorized as emotion-focused or problem-focused coping. Women exposed to gender-based violence develop various coping strategies to manage stress and its adverse mental and physical health effects. DESIGN: Qualitative study using the phenomenological approach. METHODS: Data were collected in Turkey by using the snowball technique (n = 17) between September 2019 and September 2020. The Clinical Ethnographic Narrative Interview is the source of the qualitative data for this study. Data were coded manually and utilized the RADAR technique. RESULTS: Seventeen women aged 25-40 were included in this analysis. Women stated that they were exposed to more than one type of gender-based violence according to their lived experiences. Analysis of the nature of coping strategies revealed five main themes. The themes were self-competence, separation from others/isolation, getting professional help, having faith and social support. CONCLUSION: Breaking the silence and listening to gender-based violence experiences from survivors' voices contribute significantly to literature. There was a dearth of research on Turkish women's gender-based violence survivors; the research intended to address that gap. The participants highlighted that they would like to receive more attention and felt relief in sharing their experiences. IMPACT: The Clinical Ethnographic Narrative Interview is a great tool to explore narratives of gender-based violence and coping skills of women. The study explored coping strategies of Turkish women's gender-based violence survivors. The participants indicated their emotion-focused and problem-solving coping strategies and shared their stories. This study will enhance efforts to concentrate on gender-based violence among Turkish women and inspire other researchers, practitioners and policymakers to change and provide more opportunities for the benefit and well-being of these women.

Trauma Recovery Rubric: A Mixed-Method Analysis of Trauma Recovery Pathways in Four Countries.

Research is beginning to examine gender-based violence (GBV) survivors' recovery, but little is known about diverse recovery trajectories or their relationships with other distress and recovery variables. This interdisciplinary, international multisite mixed-method study developed and used the TRR to identify and classify survivors' trauma pathways. This study describes the phases of the initial development of the preliminary TRR (Phase 1), refines and calibrates the TRR (Phase 2), and then integrates the TRR into quantitative data from four countries (Phase 3). Seven recovery pathways with six domains emerged: normalizing, minimizing, consumed/trapped; shutdown or frozen, surviving, seeking and fighting for integration; finding integration/equanimity. Depression scores were related to most recovery domains, and TRR scores had large effect sizes. At the same time, PTSD was not statistically related to TRR scores, but TRR had a medium effect size. Our study found that the TRR can be implemented in diverse cultural settings and promises a reliable cross-cultural tool. The TRR is a survivor-centered, trauma-informed way to understand different survivorship pathways and how different pathways impact health outcomes. Overall, this rubric provides a foundation for future study on differences in survivor healing and the drivers of these differences. This tool can potentially improve survivor care delivery and our understanding of how to meet best the needs of the survivor populations we intend to serve.

The Post-Traumatic Growth Journey of Women Who Have Survived Intimate Partner Violence: A Synthesized Theory Emphasizing Obstacles and Facilitating Factors.

Suffering intimate partner violence (IPV) is a devastating personal experience and post-traumatic growth (PTG) is a positive, psychological change in a person, following trauma such as IPV. There is a gap in the literature when it comes to theories on PTG after surviving IPV. The aim of this theory development was to synthesize an approach to understanding the PTG journey of female IPV survivors. According to our theory, their PTG journey includes eight main components: 1. The women's early experience of trauma, 2. The consequences of that trauma, 3. Their experiences of IPV, 4. The consequences of IPV, 5. The facilitating factors to PTG, 6. The hindering factors to PTG, 7. Their experience of PTG, and 8. The lingering effects of IPV. According to our findings, PTG is a real possibility for female IPV survivors, and it is likely to improve their mental health, well-being, and quality of life, as well as that of their children, loved ones, and communities, thereby decreasing the damaging effects of IPV. The theory can be useful for professionals when guiding female survivors of IPV to promote their recovery and healing. Due to the lack of research in this field, additional research is needed to further develop this theory.

Trauma History as a Significant Predictor of Posttraumatic Growth Beyond Mental Health Symptoms in Women-Identifying Survivors of Undergraduate Non-Consensual Sexual Experiences.

There is little data on what influences posttraumatic growth for women who experienced non-consensual sexual contact (NCSC) as an undergraduate college student. The purpose of this study is to garner a better understanding of posttraumatic growth among women-identifying survivors of undergraduate NCSC by addressing the following aims: 1) evaluate the mediating role of NCSC-related shame on the relationship between perceived peer rape myth acceptance and posttraumatic growth (n = 174); and 2) evaluate the shared and independent variance contributions of mental health symptoms and trauma history clusters on posttraumatic growth (n = 151).NCSC-related shame did not mediate the relationship between perceived peer rape myth acceptance and posttraumatic growth. Mental health symptoms and trauma history significantly contributed to 35.27% of posttraumatic growth variance, with the trauma history cluster significantly influencing posttraumatic growth scores beyond mental health symptoms. Based on these findings, it is important that clinicians assess for a history of trauma and the impact of that trauma in addition to mental health symptoms when trying to understand posttraumatic growth after campus sexual violence.

Psychometric Evaluation of the Healing After Gender-Based Violence Scale: An Instrument for Cross-Sectional and Longitudinal Assessment of Recovery Progress for Women-Identifying Survivors.

Purpose: The Healing after Gender-based Violence Scale (GBV-Heal) was developed to measure the holistic recovery processes of woman-identifying survivors of gender-based violence (GBV). The GBV-Heal asks survivors to evaluate a series of statements based on perceptions of one's lowest point and how they currently feel. These scale response options create lowest point, current feelings, and difference scores to evaluate the healing outcome cross-sectionally. This manuscript aims to evaluate the psychometric properties of the GBV-Heal to understand its usefulness for research and practice. Method: Instrument evaluation consisted of two phases analyzing online survey data from two GBV survivor samples recruited from online health research portals in the United States. In Phase One (N = 236), we conducted factor analyses and evaluated convergent/discriminant validity using depression, anxiety, posttraumatic stress, posttraumatic growth, and wellbeing measures. In Phase Two (N = 47), we evaluated GBV-Heal response consistency via test-retest within two weeks. Results: Results showed that the scale's final model included 4 components with 18 items, explaining 61.2% and 65% of the overall scale variances for "at my lowest point" and "my current feelings," respectively. The GBV-Heal difference score showed a weak positive correlation with wellbeing and posttraumatic growth scores and a weak negative correlation with depression, anxiety, and PTSD scores. Test-retest revealed Pearson r correlations of 0.82, 0.82, and 0.69 for the lowest point, current feelings, and difference scores respectively. Conclusion: These findings substantiate the reliability and validity of our instrument as an outcome measure that can be used both cross-sectionally and longitudinally with survivors of GBV.

The Diné (Navajo) Hózhó Lifeway: A Focused Ethnography on Intergenerational Understanding of American Indian Cultural Wisdom.

Purpose: Hózhó is the cultural wisdom that guides the Diné lifeway. This study examines understanding of cultural wisdom (CW) across three generations: elders, adults, and adolescents. Method: A focused ethnography was conducted on the Navajo Nation. Twenty-two Diné (Navajo) were recruited through convenience sampling. Data were collected via two semistructured interviews and photovoice methods. Data were analyzed using content analysis, thematic analysis, and participatory visual analysis of photos. Results: The Diné elders embodied the greatest in-depth understanding of CW followed by the adolescents. An unexpected finding was the scarcity of understanding of CW among the adults. Conclusion: The Diné understanding of CW is transferred through discussion with elders, listening to and speaking traditional language, cultural preservation activities, and participation in cultural practices. The Diné believe cultural wisdom is a health sustaining protective factor, therefore strategies to restore, promote, and support the intergenerational transfer of cultural wisdom remains a tribal priority.

Defining and Theorizing About Culture: The Evolution of the Cultural Determinants of Help-Seeking, Revised.

BACKGROUND: The recent interest in defining and theorizing about social determinants of health has illuminated the importance of culture as a central phenomenon of interest. However, cultural processes appear in multiple places in social determinants of health models, and their specifics are not delineated or operationalized. OBJECTIVES: This theory development article describes the complexity of defining cultural variables and uses medical anthropology to show how cultural domains, constructs, and variables can be defined. METHODS: Using cultural anthropology theory, empirical work, and a literature synthesis as a starting point, the evolution of the cultural determinants of help-seeking theory is explored and the revision of the theory is highlighted. RESULTS: The expanded theory include structural concepts as control variables, reframes illness as "suffering," and adds concepts of course, cure, manageability, meaning in life, functioning, social negativity, and perceived need. DISCUSSION: Strategies for and benefits of isolating and operationalizing cultural variables for middle-range theory development and testing are discussed.

RO1 Funding for Mixed Methods Research: Lessons learned from the Mixed-Method Analysis of Japanese Depression Project.

Mixed methods research has made significant in-roads in the effort to examine complex health related phenomenon. However, little has been published on the funding of mixed methods research projects. This paper addresses that gap by presenting an example of an NIMH funded project using a mixed methods QUAL-QUAN triangulation design entitled "The Mixed-Method Analysis of Japanese Depression." We present the Cultural Determinants of Health Seeking model that framed the study, the specific aims, the quantitative and qualitative data sources informing the study, and overview of the mixing of the two studies. Finally, we examine reviewer's comments and our insights related to writing mixed method proposal successful for achieving RO1 level funding.

Somatic and depressive symptoms in female Japanese and American students: a preliminary investigation.

The present study examined the relationship between common somatic symptoms and depression in samples of Japanese and American college students. Fifty Japanese and 44 American women completed the Beck Depression Inventory (BDI) and rated 56 somatic-distress items for 7 days. Japanese had higher levels of somatic distress than Americans. ANOVA of somatic distress by BDI-level revealed that the High BDI Japanese group reported 26 somatic symptoms (including stomach ache, dizziness, and shoulder pain) with significantly higher means when compared with the low BDI group. High BDI Americans had a significantly higher mean for joint pain compared to the Low BDI group. The importance of the body in transcultural psychiatry is explored, and implications for primary and mental health care are discussed.

A CROSS-CULTURAL STUDY OF THE EXPERIENTIAL STRUCTURE OF EMOTIONS OF DISTRESS: PRELIMINARY FINDINGS IN A SAMPLE OF FEMALE JAPANESE AND AMERICAN COLLEGE STUDENTS.

Negative emotions such as anger, sadness and fear are universal; however, there is cultural variability in the ways that specific emotions cluster together. This Experience Sampling Method study collected daily life emotions of distress for 44 American and 50 Japanese college students. These women reported their experiences of 37 distresses once a day for seven days. Cluster Analysis revealed that Americans had upset, depression, hostility and dependency clusters. The Japanese had depression, sad/angry, gloomy, hate and interpersonal clusters. Cultural analysis of idioms of distress and clinical implications are discussed.

Help-seeking and social support in Japanese sojourners.

Research shows that social support is essential for healthy psychological functioning. Help seeking and social support are soc ial processes shaped by cultural understandings about how need should be expressed, to whom, and in what circumstances. This study used grounded theory methodology to examine how cultural factors regulate help seeking and social support in a sample of 25 Japanese sojourners' wives living in America. Culturally based social edicts such as mutual responsibility and in-group solidarity were found to promote help seeking and social support. In contrast, culturally specific factors such as enryo (polite deference) hierarchy, and the cultural rules governing reciprocity inhibited these behaviors. From these data, a cultural model of social exchange allowing for cultural diversity, is proposed. This model can increase the effectiveness of nursing interventions aimed at community-based health promotion.