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1.
Glob Public Health ; : 1-13, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33186501

RESUMO

ABSTRACT Intimate partner violence (IPV) is a significant global health issue. Organised diffusion has potential to influence changes in norms that perpetuate harmful practices by spreading anti-IPV messaging throughout social networks. The Change Starts at Home intervention in Nepal leverages radio programming and community mobilisation to address the perpetration of IPV. This qualitative analysis of couple interviews at the 18-month follow-up (N = 35 individuals) seeks to evaluate how the intervention messaging diffused into the community using organised diffusion as a framework, and how this influenced any changes in norms related to the perpetration of IPV. Overall, this study provides evidence that the Change at Home Intervention effectively diffused into the community and began to promote changes around IPV norms, especially among relationships that were socially and geospatially close. This analysis demonstrates the potential for organised diffusion to facilitate social norms change around IPV.

2.
BMC Health Serv Res ; 20(1): 996, 2020 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-33129317

RESUMO

BACKGROUND: Intimate partner violence (IPV) is highly prevalent in the United States and impacts the physical and mental health and social well-being of those who experience it. Healthcare settings are important intervention points for IPV screening and referral, yet there is a wide range of implementation of IPV protocols in healthcare settings in the U.S., and the evidence of the usefulness of IPV screening is mixed. This process evaluation investigates the facilitators and barriers to implementing Coordinated Care for IPV Survivors through the M Health Community Network ("M Health Network"), an intervention that aimed to standardize IPV screening and referral in a multi-specialty clinic and surgery center (CSC). Two validated IPV screens were introduced and mandated to be done by rooming staff at least once every 3 months with all clinic patients regardless of gender; the Humiliation Afraid Rape Kick (HARK) for presence of IPV and the shortened Danger Assessment (DA-5) for lethality of IPV. Upon a positive screen, the patient was offered immediate informational resources and, if willing, was referred to a social worker for care coordination with a community organization. METHODS: Semi-structured, individual and group process interviews with clinic managers and clinic staff at 8 CSC clinics (N = 24) were undertaken at 3,12, and 27 months after intervention start. Semi-structured interviews were undertaken with the research team (N = 3) post-implementation. A Consolidated Framework for Implementation Research (CFIR) codebook was used to code data in two rounds. After each round, thick description was used to write detailed and contextual descriptions of each code. Facilitators and barriers to implementation were identified during the second round of thick description. RESULTS: Facilitators to implementation were clinic staff support, dedication, and flexibility and research team engagement. Barriers were lack of prioritization, loss of intervention champions, lack of knowledge about intervention protocol and resources, staff and patient discomfort discussing IPV, and operational issues with screen technology. CONCLUSIONS: The IPV protocol was implemented, but faced common barriers. CFIR is a complex, but comprehensive, tool to guide process evaluation for IPV screening and referral interventions in health systems in the U.S.


Assuntos
Assistência Médica , Avaliação de Processos em Cuidados de Saúde , Instituições de Assistência Ambulatorial , Feminino , Programas Governamentais , Humanos , Violência por Parceiro Íntimo/prevenção & controle , Masculino , Programas de Rastreamento/métodos , Encaminhamento e Consulta , Parceiros Sexuais , Sobreviventes , Estados Unidos
3.
Glob Public Health ; : 1-13, 2020 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-33021877

RESUMO

This study examines the diffusion effects of a Social and Behaviour Change Communication intervention in Nepal targeting gender equity and violence against women. The Change trial involves weekly radio programming, listening and discussion groups (LDGs), and community engagement. This longitudinal study analyses a repeated cross-sectional two-armed, pair-matched, single blinded cluster trial of a 9-month intervention. We used probability proportionate to size methodology to identify 72 wards in the Terai region, half of which were randomly assigned to the intervention. For the community-based survey, 20 women per ward were chosen using simple random sampling (N = 1440). Ten women from each intervention ward (N = 360) were also selected to participate in radio LDGs. Injunctive norms were measured with the Partner Violence Norms Scale-PVNS. Each one person increase in diffusion was associated with a 0.04 (SE = 0.01, p-value < 0.01) higher endline norms score, adjusting for confounders. There was evidence of effect modification with a significant baseline norm by diffusion interaction term (Estimate = -0.12, p-value = 0.04). Findings demonstrated that diffusion was related to endline norms only in communities with lower baseline levels of gender equitable norms. Study findings support the importance of diffusion as a pathway to intervention scale-up and norms change.

4.
Glob Public Health ; : 1-13, 2020 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-33090903

RESUMO

Intimate partner violence (IPV) impacts the physical and mental health of one in three women globally, with equally high rates in rural Nepal. The risk of physical violence, stalking, harassment, and homicide between intimate partners increases when alcohol is used by the perpetrator. This study evaluates the impact of Change Starts at Home, a nine-month intervention to prevent IPV in which 360 married couples in the Terai region of Nepal listened to a serial radio drama and engaged in Listening Group Discussions. A sub-sample of 18 couples were selected for individual in-depth interviews that were taken at the end of the intervention and 16 months later. Participants strongly and consistently associated alcohol use with IPV against women in their own and others' relationships. Husbands and wives agreed that men sustained reductions in alcohol use, conflict, and perpetration of IPV, attributed to improvements in communication, conflict resolution, and a reduction in alcohol expenditure following the intervention. The results of this study suggest that integrating programming on alcohol reduction within IPV prevention interventions in the Terai region of Nepal has benefits on couple functioning, alcohol consumption, and IPV perpetration.

5.
Psychol Trauma ; 2020 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-32853015

RESUMO

OBJECTIVE: This study is a follow-up to van der Kolk et al. (2014), a trial conducted through the Trauma Center at Justice Resource Institute, which demonstrated treatment efficacy and remains the only randomized controlled trial of trauma-sensitive yoga. The present process study extends the outcomes study by examining treatment moderators of the original trial. METHOD: Sixty-four women with childhood interpersonal trauma histories and posttraumatic stress disorder participated in the interventions: Trauma Center Trauma-Sensitive Yoga (TCTSY) versus active control (women's health education). Analyses explored if adult-onset interpersonal trauma and baseline psychological measures (clinician-rated and self-reported PTSD, dissociation, depression, psychological functioning) moderated PTSD changes. RESULTS: Three of six measures had small effects in moderating the relationship between adult-onset interpersonal trauma and TCTSY efficacy, in which TCTSY was most efficacious for those with fewer adult-onset interpersonal traumas. Within this subgroup, various levels of all baseline measures except depression indicated that TCTSY was more effective in reducing PTSD than the active control condition. CONCLUSIONS: By delineating client characteristics most associated with PTSD improvements, practitioners may best target yoga interventions to increase effectiveness. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

6.
BMC Int Health Hum Rights ; 20(1): 13, 2020 05 29.
Artigo em Inglês | MEDLINE | ID: mdl-32471424

RESUMO

BACKGROUND: Violence against women and girls (VAWG) is a human-rights violation with adverse long-term and inter-generational consequences. Redefining VAWG as legally unacceptable is one strategy for social change. The co-occurrence of national laws against VAWG is understudied, and tools to monitor the national legal environment are lacking. We developed the Laws on Violence against Women and Girls Index (LoVI) to measure global progress to develop comprehensive national legislation against child marriage, sexual harassment, domestic violence, and marital rape. METHODS: Using data from 2016 and 2018 for 189 countries from the World Bank Women, Business, and the Law database, we used factor analysis to assess the dimensionality of the LoVI. We examined the distribution of the LoVI across countries and regions, and the relationship of national rankings on the LoVI with those for other indicators from the United Nations, Demographic and Health Surveys, and World Factbook. RESULTS: A single LoVI factor showed good model fit in the factor analysis. National LoVI rankings were positively associated with gender equality in human development and economic rights-related rankings and negatively associated with rates of justifying wife beating and of lifetime and prior-year physical and/or sexual IPV. The LoVI was not associated with national indicators for human development and income inequality. CONCLUSION: The LoVI is a concise, coherent, validated index to monitor the progress of nations on adopting comprehensive legislation to advance 2030 Sustainable Development Goal 5, to eliminate VAWG.

7.
SSM Popul Health ; 10: 100530, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31890850

RESUMO

Intimate partner violence (IPV) affects 1 in 3 women worldwide. Research in low- and middle-income countries suggests that multicomponent interventions incorporating media, group work, and community mobilization may be effective at changing social norms that enable such violence. Our study aimed to evaluate the impact of a radio programme plus community engagement versus radio programming alone on the 12-month prevalence of IPV. Using a cluster randomized, repeat cross-sectional, single-blinded approach, thirty-six village communities were pair-matched within three districts in Nepal and randomly assigned to either control or intervention. Both groups were exposed to social behaviour change communication through radio programming. In addition, weekly listening and discussion groups (LDGs) were formed in intervention communities to meet and discuss radio programming over the 40-week intervention period. Participants were also exposed to other community mobilization activities such as street theatre and messaging from local leaders who were engaged in intervention programming. IPV was measured at baseline, 12 months post-baseline at program conclusion, and 28 months post-baseline using a simple random sample of 40 married women per cluster (n = approximately 1440 at each time point) along with 382 women who participated in the LDGs. Although control and intervention groups were demographically similar, baseline rates of IPV were higher in control areas. The trend in IPV for both groups was nonlinear, largely declining at midline (control condition) and rising again at endline (control and intervention conditions), possibly reflecting greater reporting due to awareness-raising activities. Significant differences between the two groups were largely absent at endline. Higher LDG attendance was associated with decreases in several forms of IPV, some of which persisted to endline. These findings suggest that intensive community engagement over longer timespans or social network measurement may be necessary to detect significant changes at the community level (NCT02942433).

8.
Glob Public Health ; 15(6): 852-864, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31869280

RESUMO

Women comprise two-thirds of the global-health (GH) workforce but are underrepresented in leadership. GH departments are platforms to advance gender equality in GH leadership. Using a survey of graduates from one GH department, we compared women's and men's post-training career agency and GH employment and assessed whether gender gaps in training accounted for gender gaps in career outcomes. Master-of-Public-Health (MPH) and mid-career-fellow alumni since 2010 received a 31-question online survey. Forty-four per cent of MPH alum and 24% of fellows responded. Using logistic regression, we tested gender gaps in training satisfaction, career agency, and GH employment, unadjusted and adjusted for training received. Women (N = 293) reported lower satisfaction with training (M7.6 vs 8.2) and career agency (leadership ability: M6.3 vs 7.4) than men (N = 60). Women more often than men acquired methods-related skills (95% vs 78%), employment recommendations (42% vs 18%), and group membership. Men more often than women acquired leadership training (43% vs 23%), award recommendations (53% vs 17%), and conference support (65% vs 35%). Women and men had similar odds of GH employment. Accounting for confounders and gender-gaps in training eliminated gender gaps in five of six career-agency outcomes. Panel studies of women's and men's career trajectories in GH are needed.

9.
J Interpers Violence ; 35(23-24): 5877-5888, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29294868

RESUMO

Health care providers who screen for intimate partner violence (IPV) and counsel patients can reduce victimization and positively impact women's health and well-being; yet only 2% to 50% of medical professionals report routinely screening female patients. The purpose of this study was to identify current practices, policies, barriers, and opportunities for a coordinated and routinized response to IPV in an outpatient academic primary care clinic. Data were collected through interviews and the Physician Readiness to Manage Intimate Partner Violence questionnaire. Data on IPV screening practices over a 5-month period were also available through the electronic health record. Study participants expressed that there was no uniform method of documenting screening results and great variability in the patient populations and circumstances that prompted screening. Over two thirds of the survey respondents reported either a lack of IPV protocol or a lack of knowledge about one if it existed. Providers and staff who participated believed it was within their scope of work to screen for IPV and recognized IPV as a serious health threat; however, they cited an absence of patient education resources, a lack of staff training and awareness, and no established IPV referral network as barriers to screening for IPV. The results of the pilot are in line with existing research highlighting a general lack of screening, variability in process, and the absence of systems-level policies and protocols and linkages to community resources. Pilot findings have been used to initiate a project which encompasses routinized screening, documentation, and care coordination between providers and community organizations to improve patient well-being.

10.
J Interpers Violence ; : 886260519867705, 2019 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-31402775

RESUMO

Screening rates for intimate partner violence (IPV) among most health care providers are low; yet, positive interactions with providers can benefit people who experience IPV, with respect to increased safety, support, and self-efficacy. Missing is a broad assessment and comparison of knowledge, attitudes, and behavior across the range of providers who are likely to be involved in a response to IPV disclosure. The purpose of our study was to assess health care providers' IPV preparation, knowledge, opinions, and practices and examine differences across three types of health care providers (medical providers, nursing staff, and social/behavioral health providers). We used an anonymous online survey to gather self-reported information on preparation, knowledge, opinions, and practices around IPV. A random sample of 402 providers was drawn from 13 clinics in a large multispecialty outpatient practice setting. The respondents (N = 204) consisted of medical providers (n = 70), nursing staff (n = 107), and social/behavioral health providers (n = 27). Data analyses consisted of univariate, bivariate, and multivariate analyses. Social/behavioral health providers reported more preparation, knowledge, victim understanding, and less job-related constraints, yet they reported lower screening rates than medical providers and nursing staff. Overall, no provider group seemed well-equipped to work with patients who disclose IPV. Our findings identify unmet needs within our health system to better train health care providers and restructure care models to support IPV identification and response. A focus on interprofessional training and care collaboration would bolster competency and reduce constraints felt by the health care workforce.

11.
BMC Health Serv Res ; 19(1): 479, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299953

RESUMO

BACKGROUND: Intimate partner violence (IPV) is associated with adverse health effects and increased healthcare utilization. Systems-level interventions have been shown to be effective in identifying and referring survivors but little is known about how these strategies impact future utilization. The objective of this study is to examine the impact of a systems-level response on healthcare utilization among patients screening positive for IPV from November 2016 to February 2019 in a large multi-specialty outpatient health system in the Midwest. METHODS: Using electronic health record (EHR) data, we identified patients who screened positive for IPV (N = 756) and categorized their response as accepted printed material (N = 116), accepted direct referrals (N = 85), declined both (N = 271), or missing (N = 255). We used negative binomial models to model post-period utilization as a function of decision group, pre-period utilization, and clinical and demographic factors. RESULTS: After controlling for demographic characteristics and baseline utilization, the printed materials and direct referral groups had higher utilization rates than those who declined printed materials and direct referral during the post-period for every type of service. However, these differences were only statistically significant for outpatient, behavioral health, and social work services. Specifically, the visit rate for patients receiving printed materials was two times higher (rate ratio: 2.18; 95% CI: 1.21, 3.94) for behavioral health services and three times higher (rate ratio: 3.33; 95% CI: 1.3, 8.52) for social work services compared to those who refused printed material and direct referral. For those opting for a direct referral, the visit rate was two times higher for outpatient services (rate ratio: 1.97; 95% CI: 1.13, 3.42) compared to those who refused. CONCLUSIONS: Patients receiving printed materials or direct referrals had more social work and behavioral health visits, highlighting an important outcome of the protocol. However, higher utilization rates among outpatient services and a trend toward higher utilization of other services, including the emergency department, suggest greater health service utilization is not diminished by the systems level response-at least not within a two-year time frame.


Assuntos
Redes Comunitárias/organização & administração , Violência por Parceiro Íntimo , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Sobreviventes/psicologia , Adulto , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Meios de Comunicação de Massa/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Serviço Social/estatística & dados numéricos , Sobreviventes/estatística & dados numéricos
12.
Trials ; 20(1): 329, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31171041

RESUMO

BACKGROUND: Randomised controlled trials (RCTs) are widely used for establishing evidence of the effectiveness of interventions, yet public health interventions are often complex, posing specific challenges for RCTs. Although there is increasing recognition that qualitative methods can and should be integrated into RCTs, few frameworks and practical guidance highlight which qualitative methods should be integrated and for what purposes. As a result, qualitative methods are often poorly or haphazardly integrated into existing trials, and researchers rely heavily on interviews and focus group discussions. To improve current practice, we propose a framework for innovative qualitative research methods that can help address the challenges of RCTs for complex public health interventions. METHODS: We used a stepped approach to develop a practical framework for researchers. This consisted of (1) a systematic review of the innovative qualitative methods mentioned in the health literature, (2) in-depth interviews with 23 academics from different methodological backgrounds working on RCTs of public health interventions in 11 different countries, and (3) a framework development and group consensus-building process. RESULTS: The findings are presented in accordance with the CONSORT (Consolidated Standards of Reporting Trials) Statement categories for ease of use. We identify the main challenges of RCTs for public health interventions alongside each of the CONSORT categories, and potential innovative qualitative methods that overcome each challenge are listed as part of a Framework for the Integration of Innovative Qualitative Methods into RCTs of Complex Health Interventions. Innovative qualitative methods described in the interviews include rapid ethnographic appraisals, document analysis, diary methods, interactive voice responses and short message service, community mapping, spiral walks, pair interviews and visual participatory analysis. CONCLUSIONS: The findings of this study point to the usefulness of observational and participatory methods for trials of complex public health interventions, offering a novel contribution to the broader literature about the need for mixed methods approaches. Integrating a diverse toolkit of qualitative methods can enable appropriate adjustments to the intervention or process (or both) of data collection during RCTs, which in turn can create more sustainable and effective interventions. However, such integration will require a cultural shift towards the adoption of method-neutral research approaches, transdisciplinary collaborations, and publishing regimes.


Assuntos
Saúde Pública , Pesquisa Qualitativa , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Projetos de Pesquisa , Consenso , Difusão de Inovações , Grupos Focais , Humanos , Entrevistas como Assunto , Saúde Pública/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Projetos de Pesquisa/normas
14.
J Interpers Violence ; : 886260519839422, 2019 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-30917734

RESUMO

Approximately 54% of women in rural Nepal report lifetime physical or sexual violence. The Change Starts at Home project is a primary prevention strategy to reduce and prevent marital intimate partner violence (IPV). This study analyzed in-depth interviews with 17 married couples ( n = 34 individuals) at intervention midline and end line. Case-based analysis and thematic summaries were used to assess change, couple concordance, and gendered reporting patterns at midline. Individual changes included husband's alcohol use and roaming tendencies. Relationship-level changes comprised labor roles, communication, decision making, conflict resolution, and experience of IPV. End line interviews were analyzed to understand sustenance of change within these same individual and relationship dynamics. Results indicate promising shifts in men's individual behavior and marital dynamics, which underpin IPV risk.

15.
Prev Sci ; 20(6): 936-946, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30747395

RESUMO

Some harmful practices are sustained by social norms-collective beliefs about what people expect from each other. Practitioners and researchers alike have been investigating the potential of social norms theory to inform the design of effective interventions addressing these practices in low- and middle-income countries. One approach commonly used to facilitate social norms change is community-based dialogs and trainings. This approach has often been criticized for not being cost-effective, as it usually includes a relatively small number of direct participants and does not allow for scaling-up strategies. In spite of some evidence (as for instance, the SASA! Program) that community dialogs can achieve social norms change, little exists in the literature about how exactly participants in community dialogs engage others in their networks to achieve change. In this paper, we look at the potential of "organized diffusion" as a cost-effective strategy to expand the positive effects of community-based interventions to participants' networks, achieving sustainable normative shifts. We provide quantitative evidence from three case studies-Community Empowerment Program in Mali, Change Starts at Home in Nepal, and Voices for Change in Nigeria-showing that participants in community-based interventions can be effectively empowered to share their new knowledge and understandings systematically with others in their networks, eventually facilitating social norms change. Future community-based interventions intending to achieve social norms change would benefit from integrating ways to help participants engage others in their network in transformative conversations. Doing so has the potential to generate additional impact with little additional investment.


Assuntos
Empoderamento , Promoção da Saúde , Características de Residência , Normas Sociais , Adolescente , Adulto , Comunicação , Países em Desenvolvimento , Feminino , Humanos , Mali , Nepal , Nigéria , Adulto Jovem
16.
BMC Womens Health ; 19(1): 20, 2019 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-30691430

RESUMO

BACKGROUND: Intimate partner violence (IPV) is a significant public health issue that affects one in three women globally and a similarly large number of women in Nepal. Although important policy and programmatic steps have been taken to address violence against women in Nepal over the past decade, there is still a gap on IPV research in Nepal, particularly with regard to social norms. METHODS: This mixed-methods study used in-depth interviews with women and their husbands as well as baseline survey data from a cluster randomized trial testing a primary prevention intervention for IPV to examine the prevalence and risk factors for IPV. Baseline survey data included 1800 women from Nawalparasi, Chitwan, and Kapilvastu districts in Nepal. Multivariate regression was used to identify risk and protective factors for exposure to physical and / or sexual IPV in the prior 12 months. Case-based analysis was used to analyze one of 18 pairs of in-depth interviews to examine risk and protective factors within marriages. RESULTS: Of 1800 eligible participants, 455 (25.28%) were exposed to IPV. In multivariate analyses, low caste, wife employment, income stress, poor marital communication, quarrelling, husband drunkenness, exposure to IPV as a child, in-law violence, and gender inequitable normative expectations were associated with IPV. The selected case interview represented common themes identified in the analysis including the wife's exposure to violence as a child, husband alcohol use, and marital quarrelling. CONCLUSIONS: Gender inequitable norms in the community and the intergenerational transmission of attitudes and behaviors supportive of IPV are important to address in intervention measures.


Assuntos
Mulheres Maltratadas/estatística & dados numéricos , Violência por Parceiro Íntimo/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Maus-Tratos Conjugais/estatística & dados numéricos , Adulto , Mulheres Maltratadas/psicologia , Feminino , Humanos , Renda/estatística & dados numéricos , Violência por Parceiro Íntimo/prevenção & controle , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Nepal , Prevalência , Fatores de Proteção , Fatores de Risco , Maus-Tratos Conjugais/prevenção & controle , Inquéritos e Questionários , Adulto Jovem
17.
SSM Popul Health ; 9: 100377, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31993478

RESUMO

Psychological abuse within intimate relationships is linked to negative health outcomes among women and is frequently identified as more wounding than physical or sexual violence. There is little agreement, however, on how to conceptualize or measure the phenomenon, despite measurement being necessary to estimate the prevalence of psychological abuse, establish its interaction with physical and sexual violence, assess its health impacts, and monitor progress towards global Sustainable Development Goals. To address this gap, we used latent class analysis (LCA), psychometric testing, and logistic regression to evaluate the construct and content validity of alternative methods for deriving a measure of psychological partner abuse, using pooled data from the first 10 countries and 15 sites of the World Health Organization Multi-Country Study on Domestic Violence and Women's Health (WHO MCS). Our analysis finds that psychological abuse is highly prevalent, ranging from 12% to 58% across countries. A three-class solution was supported for coding psychological abuse: none, moderate-intensity abuse, and high-intensity abuse. This three-level categorization, which can be coded without LCA, demonstrates a clear graded relationship with controlling behaviors and all measured health outcomes except physical pain. Factor analysis confirms that psychological abuse and male controlling behaviors are separate constructs as measured in the WHO MCS and the Demographic and Health Surveys and should not be combined. We conclude that this is a simple way to code psychological abuse for cross-country comparison. Its use could support urgently needed research into psychological abuse across settings and identify an appropriate threshold for defining psychological violence for surveys globally.

18.
SSM Popul Health ; 9: 100481, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31993482

RESUMO

Existing data suggest that there are distinct patterns (or classes) of intimate partner violence (IPV) experience that depart from dichotomous categorizations used to monitor progress toward Sustainable Development Goal 5.2. Less is known about the patterning of IPV in non-Western settings. This study estimates distinct classes of IPV experience in Nepal and examines potential community-level variability in these classes and in the association between IPV class and depressive symptoms. This study used data collected in 2016 from a random sample of Nepalese married women of reproductive age (N = 1440) living in 72 communities in three districts (Nawalparasi, Chitwan, and Kapilvastu). We used fixed effects and random effects latent class models of 2 through 6 classes. We fit a negative binomial regression model adjusted for relevant confounders to examine the relationship of the latent IPV classes with depressive symptoms. A four-class model was the best fitting. It included a "low exposure" class (77.36% of the sample) characterized by a low probability of experiencing any form of IPV, a "sexual violence" class (9.03% of the sample) characterized by a high probability of experiencing a form of sexual violence, a "moderate violence" class (6.60% of the sample) characterized by modest probabilities of experiencing less severe emotional and physical IPV, and a "systematic violence" class (7.01% of the sample) characterized by a high probability of being exposed to all forms of IPV. Adding random effects did not improve model fit, suggesting no community-level variations in classes. Relative to membership in the low exposure class, membership in all other classes was associated with a higher count of depressive symptoms. Those in the systematic class had a mean weighted symptom count 2.29 times that of the low exposure group. Classes of IPV exposure must be identified to ensure that surveillance and programming are attuned to women's experiences of violence.

19.
BMJ Glob Health ; 3(5): e000934, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30483407

RESUMO

Introduction: Women living with disabilities are disproportionately vulnerable to intimate partner violence (IPV). Existing research on the topic largely takes place in high-income settings and treats disability as a dichotomous experience-an individual either has a disability or does not. Disability experiences, however, are diverse such that some individuals face minimal impairment, while for others impairment can be severe. With this spectrum in mind, this study sought to examine the associations between severity of disability impairment, past-year IPV, past-year in-law violence and perceived social support among married women in Nepal. Methods: Baseline data (2016) from a randomised controlled trial aiming to reduce IPV among women aged 18-49 (n=1800) were analysed using generalised estimating equations logistic regressions to assess associations. Results: Women with severe impairment reported higher levels of physical and/or sexual, emotional, economic and in-law violence than women without a disability (adjusted OR (AOR)=1.68, 95% CI 1.04 to 2.72; AOR=1.65, 95% CI 1.03 to 2.65; AOR=1.75, 95% CI 1.02 to 3.02; AOR=2.80, 95% CI 2.53 to 5.11, respectively). Differences in IPV between women reporting some impairment versus no disability were observed for economic (AOR=1.47, 95% CI 1.11 to 1.94) and in-law violence (AOR=1.50, 95% CI 1.07 to 2.10). Women with severe or some impairment versus no disability were less likely to perceive their in-laws as supportive. Conclusion: Disability status was associated with increased vulnerability to IPV. A gradient was observed; the highest levels of IPV were experienced by women with severe impairment, followed by some impairment. Future research should examine the mechanisms driving such observations.

20.
Artigo em Inglês | MEDLINE | ID: mdl-30266716

RESUMO

INTRODUCTION: Emerging research has linked women's sanitation and menstrual hygiene experiences with increased vulnerability to violence outside the home. Few studies, however, have investigated the relationship between menstruation and violence perpetrated by family members. This type of violence may be linked specifically to restrictions placed on women during menstruation, which are common in some regions of Nepal owing to shared power differentials that disfavour women, and societal norms that stigmatise menstruation. OBJECTIVE: To record the prevalence of menstrual restrictions experienced by married women and examine potential associations between intimate partner violence (IPV) in the past year and menstrual restrictions imposed by husbands and/or in-laws among women in three districts of Nepal: Nawalparasi, Kapilvastu and Chitwan. METHODS: Baseline data from a larger randomised control trial aiming to reduce IPV in three districts of the Terai region of Nepal (n=1800) were used to assess the prevalence of menstrual restrictions and the association with IPV. RESULTS: Nearlythree out of four women (72.3%) reported experiencing high menstrual restriction, or two or more types of menstrual restriction. When controlling for demographic variables and IPV, no type of IPV was associated with high menstrual restrictions. CONCLUSION: The experience of menstrual restriction was widespread in this sample of women in Nepal. Future research should seek to identify how best to capture menstrual stigma and deviations around such norms. The global health and development community should prioritise integration with existing water and sanitation programmes to reduce stigma and ensure the well-being of menstruating women and girls. TRIAL REGISTRATION NUMBER: NCT02942433.

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