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.

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.

A protocol for the safe recruitment of Indigenous and Black women experiencing intimate partner violence during the COVID-19 pandemic into a large mixed methods study: The Sisters by Choice Study.

Intimate partner violence (IPV) is a complex and pervasive public health problem disproportionately affecting Indigenous and Black women. During the COVID-19 pandemic, IPV became more complicated for advocates because social distancing, quarantine, and isolation measures further endangered women experiencing IPV. This manuscript is based on an ongoing community-engaged study in an upper Midwestern state. Our primary goal for this study is to generate urgently needed knowledge on the impact of the COVID-19 pandemic on Indigenous and Black women's help-seeking behaviours following IPV by systematically documenting barriers women faced during the pandemic. Engaging women in a large study that seeks to garner information about their experiences of violence is complex and challenging and requires significant planning, especially for ensuring participants' safety. In this write-up, we detail the safety planning protocol developed for the purposes of recruiting and engaging women in rural and urban areas in an upper Midwestern state in the United States. Our goal is to provide scholars conducting research in the area of violence with practical considerations for safely conducting a study of this nature.

Experiences of gender-based violence among Somali refugee women: a socio-ecological model approach.

Gender-based violence (GBV) is an all-encompassing term that speaks to acts or threats that may lead to physical, sexual or emotional harm to an individual based on their gender. This paper provides a scoping review of research on gender-based violence among Somali refugee women in different parts of the world. Using the socio-ecological model as a framework, we reviewed 30 empirical studies focusing on some form of GBV among Somali refugee women. We identified societal, community and individual factors contributing to the experience of GBV. We also discuss how these factors influence women's willingness to access care, especially healthcare and social services. The review reveals that oftentimes, institutions that work closely with this population have a limited understanding of how closely culture affects the willingness and ability to seek help about GBV. Based on our analysis, we suggest ways in which social institutions and healthcare providers can provide culturally-safe support to Somali refugee women who have experienced some form of GBV.

Substance Misuse Themes Among Women Living in Transitional Housing: Effects on Children, Intimate Partner Relationships, and Social Relationships.

ABSTRACT: Traditional substance misuse treatments have not always taken women or marginalized populations into consideration. A holistic approach that addresses how drugs may be used to cope with trauma caused by violence, poverty, and neglect as well as employment of engagement strategies that connect populations with culturally relevant support systems are key, especially in treating African American women. As substance misuse rates rise among African American women, characterizing how this may influence or be influenced by relationships (such as with children, intimate partners, and social relations) is especially important in the context of effective treatment. The purpose of this qualitative study was to examine the themes surrounding substance misuse and close relationships among women previously enrolled in a transitional housing treatment program grounded in social support. Many women discussed how the program itself was an impetus in addressing not only their own substance use but also intergenerational substance use within their families. Women also noted how relationships with their children were vastly different pretreatment compared with during and after treatment, specifically emphasizing a positive improvement. Regarding intimate relationships, African American women learned to establish assertiveness and navigate healthier social relationships, all while sustaining drug abstinence. It is important to acknowledge the role of the healthcare professional in ensuring effective and culturally relevant treatment for African American women; nursing curricula should include evidence-based practice education and training on mental health and substance misuse specific to marginalized communities to more deeply understand the complex intersections of substance misuse, poverty, and social relationships in the lives of women.

Barriers Faced by American Indian Women in Urban Wisconsin in Seeking Help Following an Experience of Intimate Partner Violence.

American Indian1 (AI) women experience high rates of intimate partner violence (IPV) and face many barriers when help-seeking. This study aims to understand better the context of IPV and help-seeking behaviors for urban AI women after experiences with IPV. Postcolonial and Indigenous feminist frameworks framed this critical ethnography study. Semistructured interviews with 34 AI IPV survivors2 living in Wisconsin urban areas were conducted. Our findings highlight context-specific structural barriers to help-seeking after experiences of IPV heightened by the COVID-19 pandemic. Context-specific and survivor-led interventions are necessary to address and reduce barriers that urban AI women face.

Centering Our Voices: Experiences of Violence Among Homeless African American Women.

Women experiencing homelessness who are also survivors of violence require uniquely tailored programs to accommodate complex needs. To understand how violence shaped the lives of formerly homeless African American women, an instrumental case study design and community-based participatory research approach was utilized in this qualitative study. Focus group interviews with graduates (N = 40) from a long-term transitional housing program were conducted. Using thematic analysis, identified themes included: cycles of violence, violence in the community, relationships with children, and coping with violence. These themes illustrated survivors' growth through supportive programming and highlighted services dedicated to empowering women who have experienced violence.

A qualitative assessment of gender roles in child nutrition in Central Malawi.

BACKGROUND: Child malnutrition persists globally with men and women playing distinct roles to support children's nutrition. Women frequently carry the bulk of the workload related to food, care, and health, all of which are critical factors in child nutrition. For this reason, development efforts have emphasised women ignoring the potential role of men in supporting children's nutrition. This study sought to understand the different roles that Malawian men and women play in children's nutrition. METHODS: This qualitative was conducted in rural Central Malawi as part of a baseline study in 2017 for the CARE Southern Africa Nutrition Initiative. Seventy-six participants were interviewed, including 19 men and 57 women, using focus group discussions and in-depth interviews. We sought to understand the gender distribution of men's and women's roles and how these roles influence child nutrition. RESULTS: We found that both men and women were involved in productive, reproductive, and community work. However, consistent with the literature, women carried a disproportionate workload in supporting child nutrition compared to men. Women's heavier workloads often prevented them from being able to meet children's food needs. Nevertheless, shifts in gender roles were observed in some of the sampled communities, with men taking up responsibilities that have been typically associated with women. These changes in gender roles, however, did not necessarily increase women's power within the household. CONCLUSIONS: Traditional gender roles remain prevalent in the sampled communities. Women continue to be primarily responsible for the food, care, and health of the household. Women's heavy workloads prevent them from providing optimal care and nutrition for children. While efforts to advance gender equality by encouraging men to participate in child care and other household responsibilities appear to have had marginal success, the extent to which these efforts have successfully encouraged men to share power remains unclear. Improving gender equality and child nutrition will require efforts to redistribute gendered work and encourage men to move towards shared power with women over household decision-making and control over income.

The changing dynamics of community care and support in rural Malawi: The impact on Women's health and wellbeing at end of life.

In this critical ethnographic study, we examined women's end of life experiences in Malawi, one of the few countries in the world with a national palliative care policy. Specifically, we explored how women's and their caregivers' experiences were shaped by family and community care, and material needs. Interviews and observations with female clients of a non-governmental organization in rural Central Malawi, and with their caregivers, revealed that community-level support was both precarious and critical. We found three main themes: (1) I stay with them well, (2) we eat together, and (3) everyone is for themselves. The analysis illustrates the centrality of community care, social in/exclusion, and availability of stable food, shelter, medical, and caregiving resources on health and wellbeing at end of life. We provide recommendations to strengthen community care opportunities and women's resource bases.

Successful substance use disorder recovery in transitional housing: Perspectives from African American women.

Through the lens of Black Feminist Thought, the intersectionality of poverty, racism, and sexism in the lives of urban dwelling African American women was explored. Reflections on recovery among women previously enrolled in a transitional housing treatment program were gathered via semistructured interviews, using an instrumental case study design. Four major themes surrounding the context of recovery were identified and analyzed: Knowledge and awareness of addiction, importance of social support and support groups, peace of mind that resulted from a new lifestyle, and women's desire to maintain their recovery status. Many women did not realize that their drug use constituted an addiction prior to their enrollment in the program. Social support and support groups such as AA, NA, and AODA helped the women to maintain their recovery, and this newfound recovery resulted in additional stress relief. Finally, many women felt empowered to maintain their recovery, not only for themselves but also their children. Paradigm shifts in treatment and recovery processes are needed to better serve minority populations, specifically focusing on women and African Americans. Recovery services must shift from previously male centered, hegemonic, pathology-oriented treatment modalities to serve populations more efficiently and equitably. Furthermore, to create effective social change in recovery, programs must address the social determinants of substance misuse, addictive behaviors, and underlying structural inequalities resulting from the intersection of racism, sexism, and classism. Deeper understandings of complex social issues must be disseminated, particularly for women battling substance misuse who are homeless, racially discriminated against and marginalized. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A qualitative analysis of perceptions of and reactions to COVID-19.

OBJECTIVE: To understand communities' perceptions, beliefs, and health-related behavior choices related to COVID-19 in order to guide public health nursing communication and interaction with patients and the community. DESIGN: A qualitative study, guided by the Health Belief Model (HBM), strove to comprehend the perceptions and reactions to COVID-19 among Wisconsinites. SAMPLE: Twenty-five diverse Wisconsin residents aged 18 or older. MEASUREMENTS: Semi-structured interviews provided information about individuals' attitudes, perceptions, and reactions to COVID-19. Interviews were audio-recorded, transcribed, and thematic analysis was conducted to identify themes. RESULTS: We identified three major themes: (1) "health care starts way before you ever enter the doors of a healthcare facility"; (2) "to live in a society is to help each other"; and (3) mental health as impacted by COVID-19. CONCLUSIONS: This study demonstrated the need for greater public health support, as well as the role of Social Determinants of Health. Understanding perceptions and reactions to COVID-19 can help public health nurses understand and better respond to future pandemics.

Pediatric tuberculosis in India: Justice and human rights.

Tuberculosis (TB) is the deadliest infectious disease across the world, with the greatest burden occurring in India. Pregnant women and children are especially vulnerable to adverse effects from infection, and they tend to have diminished ability to protect themselves. Malnutrition, HIV, and other causes of immune suppression such as exposure to air pollution make one more prone to serious illness or death from TB infection. Risk factors are influenced by maternal education, access to health care, poverty, nutrition, healthcare stigma, and sanitation, among others. Current literature is heavily clinical, lacking focus on upstream factors, with a skew toward secondary and tertiary prevention strategies (i.e., case finding and treatment), and less emphasis on primary prevention (e.g., wealth equity and environmental regulation). Given concerns with extremely drug resistant TB and because infectious diseases can permeate National borders, public health nurses, and other healthcare professionals must educate themselves and advocate on behalf of vulnerable populations such as children in India. Improved sanitation, air quality monitoring, women's education, and increased access to health care are cost-effective and evidence-based strategies to address pediatric TB in India, a challenge which is grounded in human rights and justice.

'I was broken in so many different ways': The intersection of complex factors impacting homeless and at-risk African American women's mental health and well-being.

African American women are at higher risk of poor mental ill health compared with other racial and ethnic groups in the United States. For low-income and homeless African American populations, the risk of poor mental ill health is even higher. The purpose of our study was to learn what programmes at a long-term transitional living centre helped at-risk and homeless African American mothers to succeed on their own, in accordance with self-identified goals. We conducted ten focus group interviews with 39 graduates of a long-term transitional living centre located in a Midwestern city, and an individual interview with the founder of that centre (N = 40). Our study was informed by Black Feminist Thought, Life Course Theory, and an instrumental case study design. Thematic analysis was used to identify patterns in the qualitative data collected. Findings pertaining to mental health included impacts of adverse childhood experiences, lack of social networks, child placement in foster care, and implications on self-esteem and self-worth. Our findings demonstrate the need for healthcare providers to take into account the intersecting factors facing African American women experiencing homelessness undergirded by systemic racism, which impacts their mental health and well-being.

Adverse childhood experiences among previously homeless African American women.

OBJECTIVE: To learn how adverse childhood experiences (ACEs) impacted the life course trajectory of formerly homeless and at-risk African American women. DESIGN: Intersectionality and life course theory informed this qualitative pilot study, based on an instrumental case study design. SAMPLE: Forty previously homeless and at-risk African American women, who were graduates from a long-term transitional living facility in Milwaukee, Wisconsin. MEASUREMENTS: Focus group interviews and one individual interview provided data about participants' life experiences prior to, during, and following their time at the transitional living facility, which provided supportive wrap-around services. Interviews were audiotaped, transcribed, and line-by-line thematic analysis was conducted to identify themes. Fifteen focus group participants also completed ACE questionnaires. RESULTS: Participants reported a high prevalence of multiple ACEs, and three themes were identified: childhood experiences with family conflict, childhood experiences of abuse, and negative coping mechanisms. One-hundred percent of women had experienced at least one ACE, based on ACE questionnaire responses. CONCLUSIONS: ACEs affect various parts of patient's lives as adults. For nurses and other healthcare professionals, connecting with community resources provides the opportunity to strategically approach health improvement with wrap-around resources to improve health outcomes.

A Multi-Site Analysis of the Prevalence of Food Insecurity in the United States, before and during the COVID-19 Pandemic.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic profoundly affected food systems including food security. Understanding how the COVID-19 pandemic impacted food security is important to provide support and identify long-term impacts and needs. OBJECTIVE: The National Food Access and COVID research Team (NFACT) was formed to assess food security over different US study sites throughout the pandemic, using common instruments and measurements. This study presents results from 18 study sites across 15 states and nationally over the first year of the COVID-19 pandemic. METHODS: A validated survey instrument was developed and implemented in whole or part through an online survey of adults across the sites throughout the first year of the pandemic, representing 22 separate surveys. Sampling methods for each study site were convenience, representative, or high-risk targeted. Food security was measured using the USDA 6-item module. Food security prevalence was analyzed using ANOVA by sampling method to assess statistically significant differences. RESULTS: Respondents (n = 27,168) indicate higher prevalence of food insecurity (low or very low food security) since the COVID-19 pandemic, compared with before the pandemic. In nearly all study sites, there is a higher prevalence of food insecurity among Black, Indigenous, and People of Color (BIPOC), households with children, and those with job disruptions. The findings demonstrate lingering food insecurity, with high prevalence over time in sites with repeat cross-sectional surveys. There are no statistically significant differences between convenience and representative surveys, but a statistically higher prevalence of food insecurity among high-risk compared with convenience surveys. CONCLUSIONS: This comprehensive study demonstrates a higher prevalence of food insecurity in the first year of the COVID-19 pandemic. These impacts were prevalent for certain demographic groups, and most pronounced for surveys targeting high-risk populations. Results especially document the continued high levels of food insecurity, as well as the variability in estimates due to the survey implementation method.

The built environment and perceived HIV risk among young women living in the peri-urban slum of Kibra, Nairobi, Kenya.

This study reports on the lived experiences of young women living in a peri-urban slum in Kenya and its impact on perceived HIV risk and prevention needs. Guided by the theory of gender and power and postcolonial theory, 73 women 15-24 years of age participated in individual and focus group interviews. Results revealed that the built environment inside and outside the home such as inadequate physical space and lack of security impacted perceived HIV risk. To have meaningful and sustainable change, HIV prevention efforts must address social structures that impact daily lived experiences of young women.

A black dog enters the home: hunger and malnutrition in Malawi.

Hunger and inadequate nutrition are ongoing concerns in rural Malawi and are exemplified in traditional proverbs. Traditional proverbs and common expressions offer insight into commonly held truths across societies throughout sub-Saharan Africa. Strong oral traditions allow community beliefs embodied in proverbs to be passed down from generation to generation. In our qualitative study, we conducted 8 individual and 12 focus group interviews with a total of 83 participants across two districts in rural central Malawi with the aim of soliciting context-specific details on men and women's knowledge, attitudes and practices related to nutrition, gender equality and women's empowerment. Each interview began by asking participants to share common proverbs related to nutrition. Our qualitative analysis, informed by an indigenous-based theoretical framework that recognises and centres African indigenous knowledge production, yielded six themes: 'a black dog enters the home', 'don't stay with your hands hanging', 'a man is at the stomach', 'showers have fallen', 'we lack peace in our hearts' and 'the hunger season'. Traditional proverbs can provide insight into the underlying causes of hunger and malnutrition. Physicians, nurses and other allied health professionals around the world have a role to play in addressing hunger and malnutrition, which have been exacerbated by climate change. We have an ethical duty to educate ourselves and others, and change our behaviours, to mitigate the root causes of climate change, which are contributing to food insecurity and resultant poor health outcomes in countries like Malawi.

An integrative literature review and critical reflection of intersectionality theory.

Intersectionality theory has been used by nursing scholars to offer insight into how multiple systems of oppression mutually interact to impact health and to examine how multiple social modes of existence shape individual and group experiences of health inequality. The application of intersectionality theory, however, requires a reflexive critical lens to more effectively inform nursing science and practice. We draw on a comprehensive integrative literature review to offer a critical reflection by considering the semantic and structural consistency, generalizability, simplicity and complexity, and the utility and value of intersectionality theory to nursing science and practice. If nurses are to effectively utilize intersectionality theory, it is essential that we are able to analyze and speak to the multiple modes of existence based on historical, social, economic, and political processes that impact the health of those we serve. Critical examination of intersectionality enables nurses to further consider its value and usefulness when applied to nursing science and practice, particularly when addressing health and social inequalities.

Sustaining peer support groups: Insights from women living with HIV in rural Kenya.

OBJECTIVE: As HIV transitions to a chronic disease, measures that foster continued health are critical. Peer support groups can help in reducing stigma and ensuring wellbeing for those living with HIV. The purpose of our study was to gain an understanding of the ways in which women living with HIV in rural areas sustain peer support groups. DESIGN AND SAMPLE: For this descriptive qualitative study, 20 women living with HIV participated in the study. Women were randomly divided into two peer support groups of ten women each; the groups met over a 12-month period. monthly for the first two months and then every three months for the remainder of the year. RESULTS: Discussion themes indicated women found ways to sustain the groups by using them as a platform for engaging in income generation; starting and participating in table banking; addressing food security; and finding financial and moral support. Problem-solving challenges of sustaining peer support groups was also a major theme. CONCLUSION: As people live longer with HIV, long-term peer support will be needed to maintain wellbeing. Community-based peer support groups can be sustained by engaging women in common income-generation activities.

The Utility of Postcolonial and Indigenous Feminist Frameworks in Guiding Nursing Research and Practice About Intimate Partner Violence in the Lives of American Indian Women.

The purpose of this theoretical article is to analyze the utility of postcolonial and Indigenous feminist frameworks in informing nursing research and practice specific to addressing intimate partner violence (IPV) in the lives of Indigenous women. Prevailing feminist narratives of the 20th century focused overwhelmingly on patriarchy as the sole source of oppression against women and root cause of IPV. These narratives failed to consider the complex historical ways in which patriarchy intersected with colonialism and racism to produce violence, affecting the contemporary realities of Indigenous women. In contrast, postcolonial and Indigenous feminist frameworks consider the colonial history that has disempowered Indigenous women and their nations over centuries of settler occupation. Situating IPV within historical, legal, social, and political contexts can unmask how current research and health care discourses may continue to constrain, rather than improve, access, care, and services for Indigenous victims of IPV.

Promoting the health of refugee women: a scoping literature review incorporating the social ecological model.

The health of refugee women after settlement in a new country, can be adversely or positively affected by individual, interpersonal, community, and organizational factors. While much of the previous literature highlights these factors individually, there is a lack of comprehensive synthesis regarding how the factors interact to influence the health of refugee women. We conducted a thematic analysis in our literature review to elucidate how providers can work with refugee women to prevent adverse health outcomes and intervene at multiple levels to improve their health outcomes after resettlement. We reviewed peer-reviewed literature from 2009 to 2019 from Google Scholar, JSTOR, Global Health, PubMed, CINAHL, Sociological Abstracts, and Social Service Abstracts, and also used citation chaining, to identify relevant information pertaining to refugee women's health. The key terms used for our literature review were, health care, violence, social support, and mental health. In total, we included 52 articles, 3 books, and 8 other sources. We found that refugee women are vulnerable to violence during migration and typically have high rates of post-traumatic stress disorder. There were also concerns of secondary victimization by providers after resettlement. We also found that social support is an important factor for reducing isolation, and improving access to health care, as well as improving mental health outcomes. However, social support was often difficult to maintain, and was moderated by factors such as English language fluency. Health care was influenced by health literacy, cultural difference, communication concerns, and access issues. The findings suggest that at the individual and interpersonal levels there is a need to address language barriers, improve provider-patient communication, and provide appropriate medical and mental health screenings. At the organizational level, inter-organizational communication and awareness are vital. At the community level, providers can work with community leaders, to educate, create dialogue and collaboration, to help facilitate understanding and bolster community social support. Improved communication and knowledge about the unique needs and concerns of refugee women through an integrated, multi-system approach is necessary to improve their health outcomes.