Impact of authentic leadership on nurses' well-being and quality of care in the acute care settings.

INTRODUCTION: Both nurses' well-being and quality of care are top priorities of the healthcare system. Yet, there is still a gap in understanding the extent and how authentic leadership influences them. This information is needed to inform the development of effective interventions, organizational practices, and policies. Thus, this study aimed to test the mechanism by which nurses' perception of their managers' authentic leadership impacts nurses' well-being and perception of quality of care, given the role of the nursing practice environment and nurses' psychological capital. DESIGN: A cross-sectional design was used. METHODS: This study recruited a random sample of 680 nurses from six hospitals in Saudi Arabia. A final sample of 415 completed the surveys, with a response rate of 61%. Structural equation modeling was performed to test the hypothesized model. RESULTS: The study showed that nurses' perceptions of authentic leadership in their managers positively and directly affect their perceptions of quality of care but do not directly affect nurses' well-being. Both the nursing practice environment and psychological capital fully mediated the relationship between authentic leadership and nurses' well-being. However, the nursing practice environment partially mediated the relationship between authentic leadership and perceptions of quality of care. CONCLUSION: The findings contribute to understanding the crucial role of authentic leaders' style in nurses' well-being and quality of care through its positive impact on the nursing practice environment and psychological capital. CLINICAL RELEVANCE: Designing interventions and policies that specifically target nursing managers' authentic leadership style has implications for enhancing nurses' well-being and the quality of patient care. Institutional measures are needed to help leaders practice an authentic leadership style to create a positive nursing practice environment and cultivate nurses' psychological capital, both of which contribute to nurses' well-being and attaining a better quality of care. Further work is required to highlight the outcomes of implementing an authentic leadership style relevant to other leadership styles.

Outcomes of adverse childhood experience during late adolescence: Evidence from college and community samples.

Scant studies have investigated adverse childhood experience (ACE) outcomes and mastery during adolescence in different cultural contexts. This cross-sectional study examines the impact of ACEs on subjective well-being, health complaints, and healthcare utilization during late adolescence, including the mediating role of the sense of mastery in the Saudi context. Adolescents (N = 396) aged 17-21 years were recruited via convenience sampling from colleges and local communities from two regions in Saudi Arabia. Data were collected using a paper-pencil anonymous survey and analyzed using path analysis. Of the sample, 85.5% experienced at least one ACE. ACEs had a direct effect on subjective well-being (p = 0.034), health complaints (p < 0.001), healthcare utilization (p < 0.001), and sense of mastery (p < 0.001). Sense of mastery had an effect on subjective well-being (p < 0.001) and health complaints (p < 0.001), but not on healthcare utilization (p = 0.436). Sense of mastery partially mediated the relationship between ACEs and subjective well-being (p = 0.034) and health complaints (p < 0.001), but not healthcare utilization (p = 0.438). ACEs have detrimental effects on adolescent health. Attention should be paid to primary prevention and early detection to avoid further harm, and interventions that address the role of the sense of mastery should be developed for adolescents.

Factors affecting family-centered care practice by nurses: A systematic review.

PURPOSE: This study presents a systematic review of the obstacles to and enablers of family-centered care (FCC) implementation by nurses. FCC, which has demonstrated beneficial outcomes, is regarded as a crucial quality measure in certain pediatric units. However, not all nurses incorporate FCC into their practice. DESIGN AND METHODS: A systematic review was conducted from January to June 2023, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Various medical subject heading keywords and terms were used to search electronic databases, with the aim of synthesizing and evaluating the results. RESULTS: Twenty-three articles were identified for review. Most of these studies were carried out in Western countries. They revealed several facilitators and obstacles to FCC implementation by nurses when caring for sick children. Some of these factors are linked to the personal attributes of the nurses, while others are associated with the characteristics of the families and the healthcare system itself. CONCLUSION: Nurses face multi-level barriers that hinder their ability to implement FCC practice. This systematic review identifies the need to leverage nurses' attributes, foster effective nurse-client relationships, and promote organizational changes. PRACTICE IMPLICATIONS: Nurses need to comprehend and work toward altering the factors that influence the delivery of FCC. The findings of this review can be used by healthcare organization leaders and policymakers to customize interventions and allocate resources to promote FCC practice. Further research in diverse cultural contexts is needed to examine the cause-and-effect relationship concerning the influence of the identified barriers and facilitators on FCC practice. In addition, experimental studies are required to evaluate the effectiveness of evidence-based interventions on FCC practice by nurses.

Nurses' practices of children and family-centered care for chronically ill children: A cross-sectional study.

PURPOSE: There is limited evidence of children and family-centered care (CFCC) practice in different cultural contexts, particularly regarding the factors that predict it among nurses providing care to chronically ill children. Also, the CFCC's impact on the quality of care has not been well studied. This study aimed to test a hypothesized model in which nurses' attributes and care environments predict CFCC, thereby increasing the quality of nursing care. DESIGN AND METHODS: A multicenter cross-sectional study recruited a convenience sample of 405 nurses caring for chronically ill children in Saudi Arabia for an online survey between February 2023 and August 2023. Structural Equation Modeling evaluated the hypothesized model. RESULTS: The hypothesized model fits the data based on the fit indices. Care environment affected CFCC (ß = 0.831, p = .000), while nursing attributes only indirectly affected CFCC practices through the mediating effect of the work environment (ß = 0.553, p = .000). The CFCC practices positively affect the quality of nursing care (ß = 0.636, p = .000). CONCLUSIONS: Nursing attributes impact the work environment, which affects the practice of CFCC and enhances the quality of care for chronically ill children. Investing in nurses' attributes and a positive work environment is crucial for nursing leaders to enhance CFCC practice and the quality of care. PRACTICAL IMPLICATIONS: The findings of this study can be used to shape policies and develop interventions to improve nursing CFCC practices and promote better quality of care for chronically ill children.

Gender differences in predictors of quality of life for parents of children with Autism Spectrum disorder in Saudi Arabia.

PURPOSE: Few researchers have examined gender differences in the quality of life (QoL) of parents of children with autism spectrum disorder (ASD) in diverse cultural contexts. The purpose of this study was to identify how ASD severity, affiliate stigma, perceived social support, family functioning, and coping strategies differentially predict the QoL of mothers and fathers of children with ASD in Saudi Arabia. DESIGN AND METHODS: Based on a cross-sectional research design, data were gathered between April and July 2023 from a convenience sample of 376 parents (220 mothers and 156 fathers) of children with ASD in Saudi Arabia. Welch's t-test and regression were used to achieve the study purpose. RESULTS: Mothers of children with ASD reported lower QoL, perceived social support, and family functioning than fathers. Mothers relied on emotion-focused coping strategies, whereas fathers used problem-focused coping strategies. Furthermore, affiliate stigma, perceived social support, and family functioning significantly predicted the QoL of mothers and fathers of children with ASD. However, the severity of ASD affected only the QoL of the mothers. Problem-focused coping significantly predicted fathers' QoL but not mothers' QoL. CONCLUSIONS: The results highlight gender differences in the factors that predict the QoL of parents of children with ASD in Saudi Arabia. PRACTICE IMPLICATIONS: Healthcare professionals should consider parents' gender when providing support and interventions to improve parental QoL.

Intimate Partner Violence and School-Aged Children's Mental Health: Unpacking the Effects of Family Functioning, Mothers' Mental Health, and Social Capital.

There is a limited understanding of the pathways through which intimate partner violence (IPV) affects school-aged children's mental health. This study aims to examine a hypothesized model in which fathers' perpetration of IPV against mothers affects school-aged children's mental health through family functions, mothers' mental health, and social capital. A cross-sectional study was conducted by recruiting 513 mothers from 17 different Primary Health Care centers in Saudi Arabia. Structural equation modeling was used to test a hypothesized model, controlling the family's financial status. The model accounted for 54.2% of the variance in children's mental health problems. This study reveals that IPV issue against mothers during the last 12 months influences school-aged children's mental health directly and indirectly through the current family functioning and mothers' mental health. The impact of IPV issues on school-aged children's mental health requires particular consideration. The study findings urge attention to preventing the IPV issue against mothers, as well as improving family functioning and treating mothers' mental health to protect school-aged children from mental health problems.

Factors related to parents' adherence to childhood immunization.

BACKGROUND: Immunizations protect children from deadly infectious diseases. Yet, there is still insufficient understanding of the factors associated with parents' non-adherence to immunizations in contexts outside of Western countries. The aim of this study is twofold: (a) to investigate non-adherence to immunizations for children aged 6 months to 6 years in Saudi Arabia based on the number of immunizations missing or delayed by more than one month; and (b) to examine the underlying factors that predict the extent of non-adherence based on the Health Belief Model framework. METHODS: A cross-sectional study was carried out in 22 randomly selected primary health care centers. Structured interviews were also conducted to collect data using the modified Health Belief Model questionnaire. Multiple regression analysis was used to assess the predictors of the extent of non-adherence. RESULTS: Based on data from 220 participants, 51.8% of parents did not adhere with childhood immunizations. There was no significant relationship between parents' sociodemographic characteristics and the extent of their hesitancy about children's immunizations. The linear combination of perception of infectious disease severity, perception of their children's susceptibility, perception of immunization benefits, perception of fewer barriers to obtaining immunizations, cues to action related to immunizations, and self-efficacy predicted the extent of non-adherence to immunizations (F (11.220) = 2.595, p < 0.001) and explained 12% of its variance. Yet, only perceived children's susceptibility, perceived barriers, and self-efficacy independently predicted parents' non-adherence. CONCLUSION: Saudi Arabia's high proportion of non-adherence to childhood immunizations should be addressed. For instance, a health education program could be developed to increase parents' awareness that their children are susceptible to health risks. Paying a special attention to existing barriers in accessing and receiving the immunizations is crucial. In addition, building parents' self-efficacy, which is confident in making healthy decisions, such as keeping their children's immunizations up to date, is important.

Fear of contamination among older adults in the post-COVID-19 era.

This study assesses older adults' fear of contamination in the post-coronavirus disease 2019 (COVID-19) era, examining the factors associated with this fear and investigating its effects on their well-being and use of primary healthcare, considering the moderating effects of activities of daily living (ADL) and multimorbidity in these two relationships. A cross-sectional study was conducted in primary healthcare centers in three regions in Saudi Arabia with a convenience sample of 444 older adults diagnosed with chronic diseases. The results indicated that 77.9% of older adults had high contamination fear, predicted by their age, education level, gender, ADL, and previous COVID-19 infection experience. Subjective well-being and the number of primary healthcare visits in the post-COVID-19 era were negatively affected by contamination fear and both ADL and multimorbidity moderated these relationships. In conclusion, the study confirmed the need to focus on older adults' contamination fear to mitigate its negative effects on well-being and critical primary healthcare visits.

A structural equation model analysis of the association between work-related stress, burnout and job-related affective well-being among nurses in Saudi Arabia during the COVID-19 pandemic.

AIM: To test a model that examines the direct and indirect effects of work-related stress on job-related affective well-being through compassion fatigue. BACKGROUND: Despite the danger of infection, nurses' dedication to their work appears to be an innate desire to provide care for patients with COVID-19. Nonetheless, the universal effort to control the outbreak has led to extended work hours and workload, which has been defined as the primary contributor to work-related stress among nurses and might impact their job-related affective well-being. METHOD: We used a cross-sectional exploratory design. Data were collected using an online survey from 161 nurses working in the Saudi health care system. The survey included obtaining information on demographics and work-related stress using Professional Quality of Life Scale version 5 to measure compassion fatigue as well as a job-related affective well-being scale. RESULTS: Work-related stress had significant negative direct effects on job-related affective well-being and positive effects on compassion fatigue. Compassion fatigue had significantly negative direct effects on job-related affective well-being. Work-related stress exerted negative indirect effects on job-related affective well-being through compassion fatigue, which partially mediated the relationship. CONCLUSION: The findings supported the model and added to our understanding regarding the impact of work-related stress on nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Stress reduction is an important element in improving staff outcomes as well as job-related affective well-being.

Psychological elder abuse among older Saudi adults: A cross-sectional study.

The research examining elder abuse in diverse cultural contexts, such as in Saudi Arabia, remains limited. This study examined the extent of psychological elder abuse among older Saudi adults and investigated the characteristics of the victims that increase the risk of such abuse and its impact on older adults' self-rated health. Between December 2021 and April 2022, a sample of 444 older adults were recruited from 25 primary health care centers in Saudi Arabia and completed a structured interview. Of those surveyed, 88.3% reported at least one symptom or suspected symptom of psychological elder abuse. Age, gender, income, living arrangements, functioning, and social networking predicted vulnerability psychological elder abuse. Self-rated health was negatively impacted by psychological elder abuse, and this relationship is not moderated by social networking. These findings can provide insights about psychological elder abuse in Saudi Arabia and increase awareness of its impact.

Evaluation of the Arabic version of the Chronic Pain Grade scale: Psychometric properties.

To increase our understanding of chronic pain in clinical and research contexts, an assessment of its dimensions using reliable and valid self-reported pain measures is imperative. However, well-validated Arabic chronic pain assessment scales are lacking. The Chronic Pain Grade (CPG) scale has been used worldwide, yet an Arabic version of the CPG scale has not yet been validated. Thus, we conducted this study to demonstrate the psychometric properties, including reliability, convergent validity, and construct validity of the Arabic CPG scale. A cross-sectional study was conducted in two hospitals in Saudi Arabia. Data were collected from a convenience sample of 233 chronic pain patients. The confirmatory factor analysis showed an excellent fit with the factor structure of the CPG scale and, thus, supported construct validity. The two identified subscales were pain intensity and pain disability. Convergent validity was supported by having significant correlations between the short-form McGill Pain Questionnaire and CPG subscales. Internal consistency reliability was demonstrated, as Cronbach's α was 0.916 for pain intensity and 0.815 for pain disability. This study provides evidence that the Arabic CPG scale is a reliable and valid measure of chronic pain dimensions, including pain intensity, and pain-related disability. This Arabic version of the CPG scale has the potential to expand research and clinical assessment in the Arab world. Future studies are required for further validation.

Nursing Empowerment: How Job Performance Is Affected by a Structurally Empowered Work Environment.

OBJECTIVE: The purpose of this study is to investigate the level of structural empowerment and explore its relationship with job performance among nurses. BACKGROUND: Empowered nurses display more authority and an awareness of the accomplishment of their contribution to organizational goals. METHODS: A cross-sectional study was conducted with a convenience sample of nurses in 4 hospitals in Jordan. Data were collected using a self-administered questionnaire. RESULTS: A total of 195 nurses responded to the questionnaires, including 88 males (45.1%) and 107 females (54.9%). Overall, participants perceived their work environment to be moderately empowering. There is a significant positive correlation between structural empowerment and job performance. CONCLUSIONS: Highly empowered nurses display higher performance than less empowered nurses. Nurse managers must create an empowering work environment that supports nurses' job performance positively through structural empowerment. Applying structural empowerment in the work setting is crucial for ensuring the highest quality of patient care, improving nurses' performance, and reaching the organizational goals.

Predictors of patient-centered care provision among nurses in acute care setting.

AIM: The study was conducted to assess the predictors of patient-centred care provision among nurses working in an acute care setting. We hypothesized that higher structural empowerment and compassion satisfaction and lower burnout would predict the provision of patient-centred care. BACKGROUND: Patient-centred care is a crucial aspect of quality health care and the heart of nursing care. Although previous studies have highlighted some determinants of patient-centred care provision among nurses, there remains a gap in understanding the factors that predict the provision of patient-centred care. METHODS: A cross-sectional predictive design was used. Through random sampling, 255 nurses were recruited from five hospitals providing acute care services in Saudi Arabia. RESULTS: Multiple linear regression revealed that compassion satisfaction (ß = 0.260 [95% CI: 0.201-0.645]), burnout (ß = -0.266 [95% CI: -0.998 to -0.403]) and structural empowerment (ß = 0.273 [95% CI: 0.462-1.427]) jointly explained significant variance (27.5%) in the provision of patient-centred care by nurses. CONCLUSIONS: The study findings reveal that lower burnout, higher compassion satisfaction and structural empowerment increase nurses' provision of patient-centred care. IMPLICATIONS FOR NURSING MANAGEMENT: Leadership and managerial strategies that not only address compassion satisfaction and burnout but also empower nurses are crucial for the provision of patient-centred care by nurses.

The Reliability and Validity of the Arabic Version of the Composite Abuse Scale.

Research that examines intimate partner violence (IPV) in the Arab world has been hampered by a lack of comprehensive valid and culturally appropriate measures. The purpose of this study was to test the reliability and validity of the Arabic version of the Composite Abuse Scale (CAS) in a sample of 299 Saudi women recruited from primary healthcare centers. Confirmatory factor analysis (CFA) did not support the original four-factor structure of CAS. Exploratory factor analysis revealed that the item pool reliably distinguished four different types of abuse (physical abuse, verbal abuse, sexual abuse, and control). Two items were dropped from the scale leaving a 27-item scale. The final four-factor model with 27 items was supported through further CFA, including analyses supporting the fit of the four-factor model on a higher level, second-order concept (IPV). Total and subscales CAS scores demonstrate excellent to good reliability and evidence of concurrent validity based on correlations with established measures of depression (Center for Epidemiologic Studies-Depression [CESD]) and posttraumatic stress disorder (PTSD) (PTSD Checklist-Civilian Version [PCL-C]).

Factors mediating the impacts of child abuse and intimate partner violence on chronic pain: a cross-sectional study.

BACKGROUND: Most research on the health impacts of intimate partner violence (IPV) and child abuse has been conducted in Western countries and may not be generalizable to women living in different contexts, such as Saudi Arabia. Chronic pain, a disabling health issue associated with experiences of both child abuse and IPV among women, negatively impacts women's well-being, quality of life, and level of functioning. Yet, the psychosocial mechanisms that explain how abuse relates to chronic pain are poorly understood. We developed and tested a theoretical model that explains how both IPV and child abuse are related to chronic pain. METHODS: We recruited a convenience sample of 299 Saudi women, who had experienced IPV in the past 12 months, from nine primary health care centers in Saudi Arabia between June and August 2015. Women completed a structured interview comprised of self-report measures of IPV, child abuse, PTSD, depressive symptoms, chronic pain, and social support. Using Structural equation modeling (SEM), we analyzed the proposed model twice with different mental health indicators as mediators: PTSD symptoms (Model 1) and depressive symptoms (Model 2). RESULTS: Both models were found to fit the data, accounting for 31.6% (Model 1) and 32.4% (Model 2) of the variance in chronic pain severity. In both models, mental health problems (PTSD and depressive symptoms) fully mediated the relationship between severity of IPV and child abuse and chronic pain severity. Perceived family support partially mediated the relationship between abuse severity and depressive symptoms. CONCLUSIONS: These results underscore the significance of considering lifetime abuse, women's mental health (depressive and PTSD symptoms) and their social resources in chronic pain management and treatment.

Obesity in women who have experienced intimate partner violence.

AIMS: The aim of this study was to examine the pathway through which intimate partner violence (IPV) severity and child abuse severity influence obesity among women who have experienced IPV. BACKGROUND: Intimate partner violence is a public health issue that is found to be related to obesity. Yet, little is known about the pathways that link both IPV and child abuse experiences to obesity. The roles of posttraumatic stress disorder and depressive symptoms in the relations between IPV and obesity are still not well known. DESIGN: A cross-sectional study of 299 women who have experienced IPV. METHODS: A convenience sample of abused women was recruited from nine primary healthcare centres in Saudi Arabia. Data were collected in 2015, using self-report questionnaires and physical measures for obesity. Non-parametric analysis of variance was conducted to explore group differences. Structural equation modelling was used to examine the hypothesized model. RESULTS: Among the sample, 52.5% was classified as obese based on body mass index. Obese women had significantly higher levels of IPV, physical child abuse, depressive symptoms and posttraumatic stress disorder symptoms. The study showed that both IPV severity and child abuse severity indirectly influenced obesity through depressive symptoms. CONCLUSION: The alarming rate of obesity among abused women suggests that these women are at great risk for obesity, which necessitates clinical consideration. The study findings highlight the need to treat depressive symptoms to manage and prevent obesity among IPV and child abuse survivors. Specifically, nurses should tailor interventions that address mental health outcomes of abuse in managing obesity.

Reliability and validity of the Arabic PTSD Checklist Civilian Version (PCL-C) in women survivors of intimate partner violence.

Although intimate partner violence (IPV) survivors are at high risk for developing posttraumatic stress disorder (PTSD), PTSD has been considered a disorder specific to Western culture. There is a lack of reliable and valid measures of PTSD symptomology available in the Arab world, and there is still no clear evidence about the underlying factor structure of PTSD symptomology in the context of IPV. Thus, in the present study we investigated the construct validity (factor structure), internal consistency, and concurrent validity of a translated version of the PTSD Checklist Civilian Version (PCL-C) in a sample of 299 Saudi women who had experienced IPV. Four competing models (DSM-IV, Emotional Numbing, Dysphoria, and Dysphoric Arousal) were specified and estimated using confirmatory factor analysis (CFA). The five-factor Dysphoric Arousal model provided superior fit with the data compared to the alternative models, supporting construct validity of the Arabic PCL-C. The factor loadings for the five-factor Dysphoric Arousal model ranged from .31 to .83. A relatively high correlation between the Arabic PCL-C and Arabic Center for Epidemiologic Studies-Depression (CES-D) Scale (r = .78, p < .05) provided evidence of concurrent validity. The total scale also demonstrated internal consistency reliability (α = .89). Overall, the study supports the Dysphoric Arousal model in representing PTSD symptoms among IPV survivors, the reliability and validity of the Arabic version of PCL-C, and the cross-cultural applicability of PTSD symptoms.

Relationship Between Violence Against Women, Social Support, Self-Esteem, and Mental Health in Riyadh, Saudi Arabia.

The objectives of this study were to measure the prevalence of mental distress and to explore the relationship between violence against women (VAW), social support, self-esteem, and mental distress in women in Riyadh, Saudi Arabia. A questionnaire-guided, cross-sectional, interview-based study was conducted with 1,932 women, in primary healthcare centers. Around 29% reported moderate to severe distress levels, whereas 40% of women reported lifetime exposure to at least one type of violence. Linear regression analysis found that VAW was positively associated with mental distress with a unit increase associated with a 0.13 (0.58, 1.15) increase in distress level, whereas, for both social support and self-esteem, a unit increase in violence was associated with -0.23 (-0.47, -0.32) and -0.22 (-0.49, -0.33) unit decrease in the mental distress. Structural equation modeling found that violence had direct significant negative effects on social support (ß = -.156, p < .001) and self-esteem (ß = -.135, p < .001). Both social support (ß = -.266, p < .001) and self-esteem (ß = -.183, p < .001) had direct significant negative effects on distress. VAW exerted a direct significant positive effect on distress (ß = .171, p < .001) as well as an indirect effect (ß = .068, p < .001). Both social support (ß = .044, p < .001) and self-esteem (ß = .025, p < .001) were significant mediators of the effect of violence on mental distress. VAW can lead to mental distress and low self-esteem. Identification, counseling, and social support for women are important to improve their self-confidence and reduce the adverse effects of violence.

The Effect of Health Literacy on Health-Related Quality of Life Among Saudi Women With Chronic Diseases.

BACKGROUND: Women have unique health concerns in the context of chronic illness. Although health literacy has been linked to health-related quality of life, the pathway by which some factors mediate this relationship has not been well examined among Saudi women with chronic disease. PURPOSE: This study was designed to examine the relationship between health literacy and health-related quality of life and determine the mediating roles of healthy lifestyle and patient-centered care in explaining this relationship. METHODS: A cross-sectional study was used. A random sample of 20 primary healthcare centers in Saudi Arabia was selected. A convenience sample of 300 women diagnosed with a chronic illness was recruited from these centers. Structural equation modeling was used to test the proposed relationships. RESULTS: Controlling for women's age and education, the hypothesized model adequately fit the data. Health literacy and its dimensions were found to positively and directly affect both patient-centered care (ß = 0.614, B = 0.189, p < .001) and healthy lifestyle behaviors (ß = 0.550, B = 1.211, p < .001). Furthermore, both patient-centered care (ß = 0.390, B = 1.301, p < .001) and healthy lifestyle behaviors (ß = 0.322, B = 0.150, p < .001) were found to positively and directly affect health-related quality of life, whereas health literacy had significant, direct (ß = 0.285, B = 0.292, p < .001) and indirect (ß = 0.417, B = 0.428, p < .001) effects on health-related quality of life through patient-centered care and healthy lifestyle behaviors. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Special consideration should be given to health literacy, patient-centered care, and healthy lifestyle behaviors to enhance health-related quality of life in women with chronic illness. Gender-specific health services and interventions are needed to improve women's health literacy.

Identifying factors that predict women's inability to maintain separation from an abusive partner.

In this study, the extent to which nine indicators of intrusion (i.e., unwanted interference in everyday life) predicted the odds of women maintaining separation from an abusive partner was examined using data from a community sample of 286 Canadian women. Higher levels of depression and PTSD symptoms significantly and independently increased women's risk of being unable to maintain separation from a former or new abusive partner over a 12-month period (Odds Ratios 4.6 and 2.7, respectively). These finding underscore the importance of supporting women to identify and manage mental health problems as a means of enhancing their safety.