This study culturally adapted and validated a Nepalese version of the Abuse Assessment Screen (AAS) tool for identifying domestic violence among pregnant women in Nepal, creating the Nepalese Abuse Assessment Screen (N-AAS). International and national topic experts reviewed the initial N-AAS version using the Delphi method, and pregnant women participated in cognitive interviews, providing feedback on the N-AAS as user experts. Subsequent pre-testing of a comprehensive questionnaire, which included the translated version of the N-AAS, occurred in two tertiary care hospitals using an electronic format known as Color-Coded Audio Computer-Assisted Self-Interview (C-ACASI). The study assessed the content validity index, compared the concurrent validity of the N-AAS with the gold standard interview, estimated the prevalence of domestic violence from two hospitals, and calculated the Kappa coefficient. The reliability of the entire questionnaire was also evaluated through a test-retest analysis, with content validity rated as "good to excellent" by topic and user experts and high test-retest reliability (91.2-98.9%), indicating consistency across questionnaires completed at two different time points, with 12% of participants reporting any form of violence. The N-AAS demonstrated >= 91.7% specificity for all forms of abuse, accurately identifying non-abuse cases. In addition, moderate to excellent sensitivity was observed for emotional abuse (52.5%) and physical abuse since marriage (50%), while sensitivity for physical abuse in the past 12 months was 100%. Thus, the N-AAS demonstrated reliable test-retest results with a good Kappa coefficient and specificity, as well as showing excellent sensitivity for detecting recent physical abuse and moderate sensitivity for detecting emotional abuse and physical abuse since marriage. Because cultural context often leads women to normalize and tolerate abuse from spouses and family members and women are thus reluctant to report abuse, the results imply that the N-AAS can serve as a valuable screening tool for domestic abuse in antenatal care settings in Nepal.

Aim

To describe educators' conceptions of the pedagogical challenges involved in teaching practical topics to nursing students at clinical skills centres (CSCs).

Design

A qualitative descriptive design.

Methods

The study used a phenomenographic approach. Data were collected through individual qualitative interviews with 17 educators teaching at CSCs, between November 2020 and March 2021. The checklist called Consolidated Criteria for Reporting Qualitative Research for qualitative research was used.

Results

Three categories of description emerged regarding the educators' conceptions of the pedagogical challenges: teaching with credibility, teaching with confidence and creating a conducive learning environment. These conceptions were interrelated based on the way that the teaching was performed. Further, the results indicate that educators had to manage two different professional areas, that is, nursing and pedagogy, which both needed to be integrated in order to create the right learning environment.

Conclusion

To increase competence and confidence, it is recommended to develop educational course for the educators at the clinical skills centre where pedagogy and nursing are intertwined.

Implications for the Profession

This study indicated the need for educators to be prepared with credibility and confidence when teaching at CSCs to create a conducive learning environment. In order to develop this, it is key to provide support through formal and informal mentoring and entail the need for educators to combine the two roles of nursing and pedagogy.

Reporting Method

Consolidated criteria for reporting qualitative research (COREQ).

Public Contribution

No patient or public contribution.

Previous studies exploring the influential factors associated with attitudinal acceptance of wife abuse (AAWA) did not widely focus on the relation between women's social mobility (WSM) and different dimensions of AAWA in rural Bangladesh. This current study examined the association between WSM and different dimensions of AAWA in the context of socio-cultural differences among the Bengali, the Santal, and the Garo ethnic communities in rural Bangladesh. Adopting a cross-sectional design, 1,929 married men and women were randomly included in the study from 8 Bengali, 8 Santal, and 8 Garo villages where 50.2% were women and 49.8% were men. Of the sample, 33.2% Garo, 33.2% Santal, and 33.6% Bengali participants were included in this study. Data revealed that 45.5% of women had low social mobility and the prevalence of different dimensions of AAWA was high and varied among the study communities. We used descriptive statistics, chi-square, and binary logistic regression analysis to estimate the association. The multivariate binary logistic regression analysis results revealed that the likelihood of attitudinal acceptance of overall abuse, psychological abuse, physical abuse, abuse on disobeying family obligation, and abuse on challenging male authority were significantly lower for the respondents who belonged to families where women enjoyed high mobility compared to those who belonged to families where WSM was low. This study also showed that the Bengali and the Santal participants were more likely to accept different dimensions of AAWA compared to the Garos. This study suggests that WSM should be considered in policy-making and implementing interventions to reduce the different dimensions of AAWA in rural Bangladesh.

BackgroundDomestic violence (DV) prior to, and during pregnancy is associated with increased risks for morbidity and mortality. As pregnant women routinely attend antenatal care this environment can be used to offer support to women experiencing DV. We have developed a video intervention that focuses on the use of behavioral coping strategies, particularly regarding disclosure of DV experiences. The effectiveness of this intervention will be evaluated through a randomized controlled trial (RCT) and a concurrent process evaluation.MethodsAll pregnant women between 12-22 weeks of gestation attending routine antenatal care at two tertiary level hospitals in Nepal are invited to participate. DV is measured using the Nepalese version of the Abuse Assessment Screen (N-AAS). Additionally, we measure participants' mental health, use of coping strategies, physical activity, and food security through a Color-coded Audio Computer Assisted Self Interview (C-ACASI). Irrespective of DV status, women are randomized into the intervention or control arm using a computer-generated randomization program. The intervention arm views a short video providing information on DV, safety improving actions women can take with an emphasis on disclosing the violence to a trusted person along with utilizing helplines available in Nepal. The control group watches a video on maintaining a healthy pregnancy and when to seek healthcare. The primary outcome is the proportion of women disclosing their DV status to someone. Secondary outcomes are symptoms of anxiety and depression, coping strategies, the use of safety measures and attitudes towards acceptance of abuse. Follow-up is conducted after 32 weeks of gestation, where both the intervention and control group participants view the intervention video after completing the follow-up questionnaire. Additionally, a mixed methods process evaluation of the intervention will be carried out to explore factors influencing the acceptability of the intervention and the disclosure of DV, including a review of project documents, individual interviews, and focus group discussions with members of the research team, healthcare providers, and participants.DiscussionThis study will provide evidence on whether pregnant women attending regular antenatal visits can enhance their safety by disclosing their experiences of violence to a trusted person after receiving a video intervention.Trial registrationThe study is registered in ClinicalTrial.gov with identifier NCT05199935.

Previous studies on intimate partner violence (IPV) against women in Bangladesh rarely focused on the effectiveness of primary prevention strategies like legal remedies. There is also a lack of studies on the issues among the ethnic minority communities in the country. This study examines the awareness of laws on IPV (such as recognizing the abusive acts and knowing the sanctions) among the ethnic Garo and Santal and mainstream Bengali communities in rural Bangladesh. The study randomly included 1929 married women and men from 24 villages. It appeared that the respondents were not adequately aware of the relevant legal provisions. There were also gender and ethnic differences in the issues. On average, the respondents maintained a low score on recognizing abusive acts. The awareness was further lower among the women compared to the men. In addition, multivariate analysis indicated that the Bengali women had relatively a better understanding of the issues than the Garo and Santal women. However, the Garo men showed poorer awareness of recognizing the abusive acts than the Bengali and Santal men. On the other hand, the respondents also maintained a very insufficient knowledge of the sanctions against such abusive acts, whereas women also showed a lower awareness compared to their male counterparts. Data further revealed that the Santal women had a more inadequate understanding of the issues than the Bengali and Garo women. However, the Garo men had more awareness of the sanctions than the Bengali and Santal men. The study reveals that people are unfamiliar with the laws governing IPV. It shows that understanding legal issues is another field of gender and ethnic inequality in the country. We suggest that there should be intervention to make aware the citizen, mainly women of all ethnicities, to ensure the efficacy of the laws.

Aim: Our aim was to investigate potential differences in mental health, self-rated health, risky sexual behaviour, alcohol use, and drug use between (1) Prospective exchange students and campus students separated by sex, and (2) male and female students as a group. Method: Comparative cross-sectional design using an online survey containing the following instruments: Knowledge, Attitudes, and Sexual Behaviour in Young People in Sweden; Self-Rated Health Questionnaire; and General Health Questionnaire 12. One-hundred and fourteen prospective exchange students and 451 campus students participated in the study. Results: Male prospective exchange students rated their mental health as being better and had used cannabis more often compared with female prospective exchange students. Male prospective exchange students also rated their mental health as being better than male campus students. Female students, in general, rated their mental health as worse than male students. A larger proportion of male prospective exchange students had sex together with alcohol compared with male campus students, and a larger proportion of female prospective exchange students had sex with a new partner and drank more alcohol compared to female campus students. Conclusion: The result shows that risky alcohol use and sexually risky behaviour is prominent amongst prospective exchange students. It is possible that they will continue, and even increase their risky behaviour whilst abroad as they find themselves in a new social context, and free from influence of the rules and restrictions that they might have at home. With limited knowledge of the local culture, native language, and in an unfamiliar environment, it is possible that the risks will be enhanced and possibly decrease their health. This highlights the need for proactive interventions, conceivably with some variations in content between sexes.

Aims: To follow up on exchange students' alcohol use, drug use, mental health, self-rated health, and risky sexual behaviour after a semester abroad and to compare them with students who remained on campus. Methods: The study design was a follow-up study based on a previous baseline survey of 114 prospective exchange students and 451 campus students. Of the original 565 students, 48 (42.1%) prospective exchange students and 209 (43.3%) campus students responded to the follow-up. Both the baseline survey and the follow-up survey included the General Health Questionnaire 12, one single item from Self-Rated Health, and nine items from Knowledge, Attitudes and Sexual Behaviour in Young People in Sweden. Results: We found a statistically significant increase in the weekly consumption of alcohol among exchange students after their semester abroad. A larger proportion of exchange students had sex with a new partner and sex with more than three partners during their semester abroad compared to follow-up campus students. Conclusions: Our findings indicate that exchange students consume alcohol more frequently during their semester abroad and indulge in sexually risky behaviour. Exchange students' use of alcohol and sexually risky behaviour could be associated with even greater risks due to them being in an unknown environment, unfamiliar culture, and with limited support from family and friends. This highlights the need for further research on exchange students' experiences, especially concerning alcohol use and sex while abroad.

Background Gender inequality and violence are not mutually exclusive phenomena but complex loops affecting each other. Women in Nepal face several inequalities and violence. The causes are diverse, but most of these results are due to socially assigned lower positioning of women. The hierarchies based on power make women face subordination and violence in Nepal. The study aims to explore participants' understanding and experience to identify the status of inequality for women and how violence emerges as one of its consequences. Furthermore, it explores the causes of sex trafficking as an example of an outcome of inequality and violence. Method The study formulated separate male and female groups using a purposive sampling method. The study used a multistage focus group discussion, where the same groups met at different intervals. Six focus group discussions, three times each with male and female groups, were conducted in a year. Thirty-six individuals, including sixteen males and twenty females, were involved in the discussions. The study used constructivist grounded theory for the data analysis. Results The study participants identify that a power play between men and women reinforce inequality and increases the likelihood of violence for women. The findings suggest that the subjugation of women occurs due to practices based on gender differences, constricted life opportunities, and internalization of constructed differences among women. The study identifies that interpersonal and socio-cultural violence can result due to established differences between men and women. Sex trafficking, as an example of the outcome of inequality and violence, occurs due to the disadvantageous position of women compounded by poverty and illiteracy. The study has developed a concept of power-play which is identified as a cause and consequence of women's subordination and violence. This power play is found operative at various levels with social approval for men to use violence and maintain/produce inequality. Conclusion The theoretical concept of power play shows that there are inequitable power relations between men and women. The male-centric socio-cultural norms and practices have endowed men with privilege, power, and an opportunity to exploit women. This lowers the status of women and the power-play help to produce and sustain inequality. The power-play exposes women to violence and manifests itself as one of the worst expressions used by men.

Recommendations to routinely question patients about violence victimization have been around for many years; nonetheless, many patients suffering in the aftermath of violence go unnoticed in health care. The main aim of this study was to explore characteristics associated with being asked about experiences of violence in health care and thereby making visible victims that go unnoticed. In this study, we used cross-sectional survey data from 754 men (response rate 35%) and 749 women (response rate 38%) collected at random from the Swedish population, age 25–85. Questions were asked about experiences of emotional, physical, and sexual violence from both family, partner, and other perpetrators. Only 13.1% of those reporting some form of victimization reported ever being asked about experiences of violence in health care. Low subjective social status was associated with being asked questions (adj OR 2.23) but not with victimization, possibly indicating prejudice believes among providers concerning who can be a victim of violence. Other factors associated with increased odds of being asked questions were: being a woman (adj OR 2.09), young age (24–44 years, adj OR 6.90), having been treated for depression (adj OR 2.45) or depression and anxiety (adj OR 2.19) as well as reporting physical violence (adj OR 2.74) or polyvictimization (adj OR 2.85). The main finding of the study was that only few victims had been asked questions. For example, among those reporting ≥4 visits to a primary care physician during the past 12 months, 43% reported some form of victimization but only 6% had been asked questions. Our findings underline the importance of continuing to improve the health care response offered to victims of violence.

Gender inequality and violence against women are present in every society and culture around the world. The intensities vary, however, based on the local guiding norms and established belief systems. The society of Nepal is centered on traditional belief systems of gender roles and responsibilities, providing greater male supremacy and subordination for the females. This has led to the development and extensive practices of social gender hierarchal systems, producing several inequalities and violence toward women. This study has utilized Forum Theater interventions as a method of raising awareness in 10 villages in eastern Nepal. The study aimed to understand the perception and changes in the community and individuals from the interactive Forum Theater performances on pertinent local gender issues. We conducted 6 focus group discussions and 30 individual interviews with male and female participants exposed to the interventions. The data analysis utilized the constructivist grounded theory methodology. The study finds that exposure and interactive participation in the Forum Theater provide the audience with knowledge, develop empathy toward the victim, and motivate them to change the situation of inequality, abuse, and violence using dialogues and negotiations. The study describes how participation in Forum Theater has increased individual’s ability for negotiating changes. The engagement by the audience in community discussions and replication of efforts in one of the intervention sites show the level of preparedness and ownership among the targeted communities. The study shows the methodological aspects of the planning and performance of the Forum Theater and recommends further exploration of the use of Forum Theater in raising awareness.