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Prevention of intimate partner violence: community and healthcare workers´ perceptions in urban Tanzania
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Intimate partner violence (IPV) against women is public health and human rights concern. The studies forming this thesis seek to understand healthcare worker and community attitudes and perceptions about IPV; their role in support, care and prevention of IPV, and the feasibility of introducing routine screening for IPV among women attending healthcare.

Methods: Four interrelated studies were conducted in Temeke District, Dar es Salaam, Tanzania: 1) a content analysis of 16 in-depth interviews with healthcare workers about their experiences of meeting IPV clients, 2) a grounded theory analysis of seven focus group discussions that explore community perceptions, 3) a cross sectional study of 657 healthcare workers and students to understand their attitudes and perceptions about IPV and future roles in care and support, and 4) evaluation of a pilot intervention that introduces routine screening in an outpatient department. The pilot intervention included screening of 102 women, ten observations of healthcare worker interactions with women clients, three focus group discussions, and five narratives written by healthcare workers about their experiences with the screening tools.

Results: Gender inequalities, attitudes, and poverty intersect in the explanation of IPV. Healthcare workers view low economic status among women, rigid gender norms, and stigma that influences women to stay in violent relationships. Alcohol abuse, multiple sexual partners and low levels of income among men were cited as triggers for IPV episodes. Between 20-67% of healthcare workers and students report meeting IPV clients at work. More than 9o% observed clients with unexplained feelings of sadness and/or loss of confidence. Resource and training limitations, heavy workloads and low salaries constrain services. A strong desire to make a difference in the care and support of IPV clients was present, but violence as a hidden agenda with a client resistance to disclosure was a challenge. The community study shows a transition in gender norms is making violence against women less acceptable.

Conclusions and suggestions: Healthcare workers and the community strongly wish and are committed to support IPV prevention. Both groups understood the meaning, provocative factors and some IPV effects. This awareness contributes to their desire to be part of a change. At the central level, prevention of IPV should be on the governments’ policy agenda and should be prioritised. Education about gender-based violence must be incorporated into the curricula of healthcare workers. At community level, advocacy is necessary for changing harmful gender norms and measures to combat women’s poverty. Men should be engaged at all levels. Provision of information on the human rights perspectives of IPV should be strengthened and related to other types of violence.

Place, publisher, year, edition, pages
Umeå: Umeå university , 2011. , 54 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1460
Keyword [en]
Intimate partner violence, healthcare workers, perceptions, gender norms, social support, prevention, Tanzania
National Category
Medical and Health Sciences
Research subject
Public health
Identifiers
URN: urn:nbn:se:umu:diva-49743ISBN: 978-91-7459-321-1 (print)OAI: oai:DiVA.org:umu-49743DiVA: diva2:457041
Public defence
2011-12-02, Sal 135, Byggnad 9 A, Allmänmedicin, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2011-11-18 Created: 2011-11-16 Last updated: 2015-04-29Bibliographically approved
List of papers
1. Striving to make a difference: health care worker experiences with intimate partner violence clients in Tanzania
Open this publication in new window or tab >>Striving to make a difference: health care worker experiences with intimate partner violence clients in Tanzania
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2009 (English)In: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 30, no 1-2, 64-78 p.Article in journal (Refereed) Published
Abstract [en]

In this article we describe health care workers' (HCWs') experiences and perceptions of meeting clients exposed to intimate partner violence (IPV). Qualitative content analysis of in-depth interviews from 16 informants resulted in four main themes. The first, "internalizing women's suffering and powerlessness," describes HCWs' perceptions of violence, relating it to gender relations. The second, "caught between encouraging disclosure and lack of support tools," refers to views on possibilities for transparency and openness. The third, "Why bother? A struggle to manage with limited resources," illustrates the consequences of a heavy workload. Last; "striving to make a difference," emphasizes a desire to improve abilities to support clients and advocate for prevention.

Keyword
domestic violence; women; perceptions; prevention; midwives
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-21790 (URN)10.1080/07399330802523618 (DOI)19116822 (PubMedID)
Available from: 2009-04-20 Created: 2009-04-20 Last updated: 2017-12-13Bibliographically approved
2. Community perceptions of intimate partner violence: a qualitative study from urban Tanzania
Open this publication in new window or tab >>Community perceptions of intimate partner violence: a qualitative study from urban Tanzania
2011 (English)In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 11, 13Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Intimate partner violence against women is a prevailing public health problem in Tanzania, where four of ten women have a lifetime exposure to physical or sexual violence by their male partners. To be able to suggest relevant and feasible community and health care based interventions, we explored community members' understanding and their responses to intimate partner violence.

METHODS: A qualitative study using focus group discussions with 75 men and women was conducted in a community setting of urban Tanzania. We analysed data using a grounded theory approach and relate our findings to the ecological framework of intimate partner violence.

RESULTS: The analysis resulted in one core category, "Moving from frustration to questioning traditional gender norms", that denoted a community in transition where the effects of intimate partner violence had started to fuel a wish for change. At the societal level, the category "Justified as part of male prestige" illustrates how masculinity prevails to justify violence. At the community level, the category "Viewed as discreditable and unfair" indicates community recognition of intimate partner violence as a human rights concern. At the relationship level, the category "Results in emotional entrapment" shows the shame and self-blame that is often the result of a violent relationship. At the individual level, the risk factors for intimate partner violence were primarily associated with male characteristics; the category "Fed up with passivity" emerged as an indication that community members also acknowledge their own responsibility for change in actions.

CONCLUSIONS: Prevailing gender norms in Tanzania accept women's subordination and justify male violence towards women. At the individual level, an increasing openness makes it possible for women to report, ask for help, and become proactive in suggesting preventive measures. At the community level, there is an increased willingness to intervene but further consciousness-raising of the human rights perspective of violence, as well as actively engaging men. At the macro level, preventive efforts must be prioritized through re-enforcement of legal rights, and provision of adequate medical and social welfare services for both survivors and perpetrators.

Place, publisher, year, edition, pages
BioMed Central, 2011
National Category
Public Health, Global Health, Social Medicine and Epidemiology Obstetrics, Gynecology and Reproductive Medicine Gender Studies
Identifiers
urn:nbn:se:umu:diva-49723 (URN)10.1186/1472-6874-11-13 (DOI)000208607800013 ()21501506 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2006-1512
Note

This study was performed with support from the Swedish Agency for Research Cooperation, Sida/SAREC. The authors acknowledge the very important administrative support from Umea University and Muhimbili University of Health and Allied Sciences, as well as community groups in Temeke District, Dar es Salaam, Tanzania. We also appreciate the support from the Centre for Global Health at Umea University, FAS and the Swedish Council for Working Life and Social Research ( grant number. 2006-1512).

Available from: 2011-11-16 Created: 2011-11-16 Last updated: 2017-12-08Bibliographically approved
3. Health care workers' attitudes and perceptions on intimate partner violence and their views in care and prevention: a cross-sectional survey from Tanzania
Open this publication in new window or tab >>Health care workers' attitudes and perceptions on intimate partner violence and their views in care and prevention: a cross-sectional survey from Tanzania
(English)In: Article in journal (Refereed) Submitted
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-49725 (URN)
Available from: 2011-11-16 Created: 2011-11-16 Last updated: 2015-04-29Bibliographically approved
4. Screening of women for intimate partner violence: a pilot intervention at an outpatient department in Tanzania
Open this publication in new window or tab >>Screening of women for intimate partner violence: a pilot intervention at an outpatient department in Tanzania
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2011 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 4, Article nr 7288- p.Article in journal (Refereed) Published
Abstract [en]

Intimate partner violence (IPV) is a public health problem in Tanzania with limited health care interventions.

OBJECTIVES: To study the feasibility of using an abuse screening tool for women attending an outpatient department, and describe how health care workers perceived its benefits and challenges.

METHODS: Prior to screening, 39 health care workers attended training on gender-based violence and the suggested screening procedures. Seven health care workers were arranged to implement screening in 3 weeks, during March-April 2010. For screening evaluation, health care workers were observed for their interaction with clients. Thereafter, focus group discussions (FGDs) were conducted with 21 health care workers among those who had participated in the training and screening. Five health care workers wrote narratives. Women's responses to screening questions were analyzed with descriptive statistics, whereas qualitative content analysis guided analysis of qualitative data.

RESULTS: Of the 102 women screened, 78% had experienced emotional, physical, or sexual violence. Among them, 62% had experienced IPV, while 22% were subjected to violence by a relative, and 9.2% by a work mate. Two-thirds (64%) had been abused more than once; 14% several times. Almost one-quarter (23%) had experienced sexual violence. Six of the health care workers interacted well with clients but three had difficulties to follow counseling guidelines. FGDs and narratives generated three categories Just asking feels good implied a blessing of the tool; what next? indicated ethical dilemmas; and fear of becoming a 'women hospital' only indicated a concern that abused men would be neglected.

CONCLUSIONS: Screening for IPV is feasible. Overall, the health care workers perceived the tool to be advantageous. Training on gender-based violence and adjustment of the tool to suit local structures are important. Further studies are needed to explore the implications of including abuse against men and children in future screening.

Place, publisher, year, edition, pages
CoAction Publishing, 2011
Keyword
intimate partner violence, health care workers, abuse screening, Tanzania
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-49724 (URN)10.3402/gha.v4i0.7288 (DOI)000299012700009 ()22028679 (PubMedID)
Funder
FAS, Swedish Council for Working Life and Social Research, 2006-1512
Note

Forskningsfinansiär/funding agency: Swedish Agency for Research Cooperation, SAREC.

Available from: 2011-11-16 Created: 2011-11-16 Last updated: 2017-12-08Bibliographically approved

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