Umeå University's logo

Background: Intimate partner violence (IPV) is a global issue, with women, especially those with disabilities, facing a higher lifetime risk than those without disabilities. Given the elevated risk factors and challenges related to having a disability, it is crucial to provide effective IPV support. The competence and expertise of service providers regarding IPV significantly influence their ability to provide adequate IPV support. Understanding service providers' self-perceived competence is essential for improving the quality of IPV support for women with disabilities.

Objective: This study assesses the self-perceived competence of service providers in supporting women with disabilities subjected to IPV in Sweden.

Methods: A cross-sectional survey was distributed to professionals in healthcare, social services, and the police, and 1,151 people participated. Descriptive statistics and linear regression analyses were performed to assess the factors influencing service providers' self-perceived competence.

Results: The findings indicate that healthcare, police, and social services professionals often encounter women with disabilities, but they rarely ask them directly about IPV. Many don't routinely inquire about IPV exposure. While institutional routines for addressing IPV exist, service providers don't consistently implement or use them. Key factors influencing self-perceived competence include receiving IPV and disability-specific training and sufficient employer support for addressing IPV among women with disabilities.

Conclusions: The findings underscore the need for a more consistent application of routines and enhanced training to strengthen the capacity of service providers to support women with disabilities subjected to IPV.

Previous studies indicate that the use of disability benefits is associated with reduced chances of having children. The current study aimed to identify the bidirectional nature of this association which has been overlooked in previous research. The longitudinal data used in this study were obtained from the Swedish national registers. It consists of 440,200 individuals born from 1968 to 1970 with a follow-up period extending up to 2010. Descriptive analysis, heat map visualization, and multinomial logistic regression were performed. The results show a complex and dynamic association between disability and parenthood. Starting on disability benefits at the age of 20–25 years was associated with a reduced chance of having children during the follow-up duration (≤42 years). Interestingly, another pattern was also revealed, and individuals who had their first child as teenagers (aged 13–19 years) were at higher odds of starting to receive disability benefits during their 30s and 40s compared to the rest of the study population. This is the first study to show evidence of a bidirectional nature of the association between age at starting to use disability benefits and the age of having a first child. Our findings demonstrate the potential of using heatmaps and multinomial regression on time-to-event data to examine bidirectional relationships between various factors investigated across several disciplines.

Background: There is a consensus among scholars, policymakers, and implementers that addressing the complex nature of intimate partner violence (IPV) requires a collaborative response. However, there is limited literature on how various professionals work collaboratively to address the needs of women with disabilities who experience IPV. This study combines the perspectives of women with disabilities and those of professionals to understand collaboration in providing IPV services to women with disabilities.

Methods: Twenty-nine in-depth interviews were conducted with 18 IPV service providers and 11 women with disabilities. The data were analyzed using reflective thematic analysis.

Results: The findings are presented under three themes: the first shows a consensus among different IPV service providers and disabled women on the importance of collaboration when supporting victims of IPV with disabilities; the second depicts the common ways in which collaboration occurs when supporting women with disabilities; and the third illuminates the critical elements that boost effective collaboration.

Conclusion: Supporting IPV victims with disabilities requires active collaboration at both an internal and external level. Strengthening collaboration among different actors requires trust, specified roles, and the allocation of adequate resources.

This study explored the experiences and perceptions of professional service providers offering services to women with disabilities exposed to intimate partner violence (IPV). Eighteen in-depth interviews were conducted with service providers working in health care, social work, the police, women’s shelters, and the Centre for Violence Against Women. Our findings suggest that providing adequate IPV services to women with disabilities requires coordination and collaboration. IPV services were organized around five overarching themes: finding services; assessing the risk; identification; protection and care; and becoming independent. This approach was helpful for women who faced disability-related challenges in accessing IPV services.

Objectives: Six million children were under-vaccinated in 2022. Our study aimed to 1) quantify the magnitude of under-vaccination variation between health facilities, 2) assess to which extent individual and health center level factors contributed to the variation, 3) identify individual and health facility factors associated with under-vaccination, and 4), explore rural vs. urban health facility variations.

Methods: We used data from 61,839 children from The Gambia national routine vaccination register. We cross tabulated under-vaccination status across study variables and fitted two-level random intercept multilevel logistic regression models to measure variance, contribution to the variance, and factors associated with the variance and under-vaccination.

Results: We found that 7% of the prevalence of under-vaccination was due to variation between health facilities. Thirty-seven percent of the variation was explained by individual and health center variables. The variables explained 36% of the variance in urban and 19% in rural areas. Children who were not vaccinated at 4 months or with delayed history, due for vaccination in the rainy season, and health facilities with very small or large population to health worker ratios had higher under-vaccination odds.

Conclusion: Our study indicates that one of the pathways to improving vaccination coverage is addressing factors driving under-vaccination inequities between health facilities through urban-rural differentiated strategies.

Background: Current data suggests a high prevalence of intimate partner violence (IPV) among women withdisabilities (WWDs), yet there is still scanty research on the experiences of this population regarding access andutilization of IPV services.

Methods: Using qualitative in-depth data obtained from WWDs, our current study sought to identify factors thathinder WWDs from accessing and utilizing IPV services.

Results: This study showed that WWDs exposed to IPV encountered multilevel barriers nested at differentsocietal levels as they attempted to access violence-rated services. At the individual level, the identity category ofdisability, not knowing about certain forms of violence, and being better off silent were the main explanations fornot using IPV services. The role of personal connections was the main factor that influenced the utilization ofIPV services, at the interpersonal level while at the organizational level, a lack of effective communication, powerimbalances, inadequate resources, and failures to follow response standards were identified as the major barriers tousing IPV services. Societal incompetence, as exemplified by treating violence as a taboo and the lack ofregulations criminalizing psychological violence, was the main barrier at the societal level.

Conclusions: Our findings suggest that regarding WWDs, improving their access and utilization of IPV servicesrequires interventions that address barriers at societal multiple levels including the individual, interpersonal,organizational, and societal levels. This should include early interventions and programs that not only targetWWDs but also include other key players such as service providers on violence recognition and improve thequality of services. There is a need to also review laws and regulations regarding psychological violence and thenature of interventions in place for this type of violence. 

Introduction: The Hepatitis B virus that can cause liver cancer is highly prevalent in the Gambia, with one in ten babies at risk of infection from their mothers. Timely hepatitis B birth dose administration to protect babies is very low in The Gambia. Our study assessed whether 1) a timeliness monitoring intervention resulted in hepatitis B birth dose timeliness improvements overall, and 2) the intervention impacted differentially among health facilities with different pre-intervention performances.

Methods: We used a controlled interrupted time series design including 16 intervention health facilities and 13 matched controls monitored from February 2019 to December 2020. The intervention comprised a monthly hepatitis B timeliness performance indicator sent to health workers via SMS and subsequent performance plotting on a chart. Analysis was done on the total sample and stratified by pre-intervention performance trend.

Results: Overall, birth dose timeliness improved in the intervention compared to control health facilities. This intervention impact was, however, dependent on pre-intervention health facility performance, with large impact among poorly performing facilities, and with uncertain moderate and weak impacts among moderately and strongly performing facilities, respectively.

Conclusion: The implementation of a novel hepatitis B vaccination timeliness monitoring system in health facilities led to overall improvements in both immediate timeliness rate and trend, and was especially helpful in poorly performing health facilities. These findings highlight the overall effectiveness of the intervention in a low-income setting, and also its usefulness to aid facilities in greatest need of improvement.

Background: Over the past decades the number of young people using disability pensions (DP) has gradually increased in Europe but the reasons for this change are poorly understood. We hypothesize that teenage parenthood could be associated with an increased risk of receiving early DP. The aim of this study was to examine the association between having a first child at age 13-19 and receiving DP at age 20-42 (here called early DP).

Methods: A longitudinal cohort study was undertaken based on national register data obtained from 410,172 individuals born in Sweden in 1968, 1969, and 1970. Teenage mothers and fathers were followed until age 42 and compared to non-teenage parent counterparts to examine their early receipt of DP. Descriptive analysis, Kaplan-Meier curves, and Cox regression analyses were performed.

Results: The proportion of teenage parents was more than twice higher in the group that received early DP (16%) compared to the group that did not receive early DP (6%) during the study duration. A higher proportion of teenage mothers and fathers started to receive DP at 20-42 years old compared to non-teenage parents, and the difference between the two groups increased during the observation period. A strong association was observed between being a teenage parent and receiving early DP, significant both independently and after adjusting for the year of birth and the father's level of education. From the age of 30 to 42 years, teenage mothers used early DP more often than teenage fathers or non-teenage parents, and this difference also increased during the follow-up period.

Conclusion: A strong association was found between teenage parenthood and the use of DP between 20 and 42 years of age. Teenage mothers used DP more than teenage fathers and non-teenage parents.

Introduction: Identifying actionable targets is crucial to improve overall and equity in vaccination coverage, and in line with the global Immunization Agenda 2030. Therefore, this study seeks to assess the prevalence of missed opportunities for simultaneous vaccination (MOSVs) and their impact on vaccination coverage and urban-rural inequity in The Gambia.

Methods: We used data of children aged 12-23 months from The Gambia 2019/2020 demographic and health survey (weighted n = 1355) with seen vaccination cards. We analyzed: the frequency of MOSVs; percentage point coverage reduction attributable to MOSVs for 18 vaccine doses and full basic vaccination; and MOSVs' contribution to urban-rural coverage inequity through Blinder-Oaxaca decomposition.

Results: Sixty percent of children experienced MOSVs, in both urban and rural areas, but urban MOSVs were more seldom corrected (35.9 % vs 45.3 %). All eighteen vaccine doses assessed could have achieved between one to eleven percentage points higher coverage if MOSVs had been avoided, with full basic vaccination gaining even more. While MOSV correction did not impact overall urban-rural coverage inequity, it did exacerbate (explained coefficient = -0.1007; P = 0.002) inequities among children who experienced MOSVs, explaining 95 % of the observed difference.

Conclusion: Our study highlights the prevalence and negative impact of MOSVs on overall vaccination coverage. Although MOSVs did not contribute significantly to the total urban-rural inequity in coverage, they have detrimental effects on vaccination coverage and urban-rural inequity among children who had experienced MOSVs. Addressing MOSVs, can enhance coverage and reduce the risk of under-vaccination, aligning with global initiatives.

Background: Over the past years, Mozambique has implemented several initiatives to ensure equitable coverage to health care services. While there have been some achievements in health care coverage at the population level, the effects of these initiatives on social inequalities have not been analysed.

Objective: The present study aimed to assess changes in socioeconomic and geographical inequalities (education, wealth, region, place of residence) in health care coverage between 2015 and 2018 in Mozambique.

Methods: The study was based on repeated cross-sectional surveys from nationally representative samples: the Survey of Indicators on Immunisation, Malaria and HIV/AIDS in Mozambique (IMASIDA) 2015 and the 2018 Malaria Indicator survey. Data from women of reproductive age (15 to 49 years) were analysed to evaluate health care coverage of three indicators: insecticide-treated net use, fever treatment of children, and use of Fansidar malaria prophylaxis for pregnant women. Absolute risk differences and the slope index of inequality (SII) were calculated for the 2015 survey period and the 2018 survey period, respectively. An interaction term between the socioeconomic and geographical variables and the period was included to assess inequality changes between 2015 and 2018.

Results: The non-use of insecticide-treated nets dropped, whereas the proportion of women with children who were not treated for fever and the prevalence of women who did not take the full Fansidar dose during pregnancy decreased between 2015 and 2018. Significant reductions in the inequality related to insecticide-treated net use were observed for all socioeconomic variables. Concerning fever treatment, some reductions in socioeconomic inequalities were observed, though not statistically significant. For malaria prophylaxis, the SII was significant for education, wealth, and residence in both periods, but no significant inequality reductions were observed in any of these variables over time.

Conclusions: We observed significant reductions of socioeconomic inequalities in insecticide-treated net use, but not in fever treatment of children and Fansidar prophylaxis for pregnant women. Decision-makers should target underserved populations, specifically the non-educated, poor, and rural women, to address inequalities in health care coverage.