Background

Social norms and gendered power relationships contribute to the acceptability of 'wife abuse' - a common form of domestic violence globally.

Objectives

To estimate the prevalence and overlap of emotional abuse, forced heavy work, and food deprivation during pregnancy and examine their association with women's attitudes accepting of wife abuse in Nepal.

Methods

Baseline data were used from a randomized controlled trial involving pregnant women aged 18 and older attending routine antenatal care at two public hospitals in Nepal between January 2023 and March 2025. Participants completed a color-coded audio computer assisted self-interview. Attitudes toward wife abuse were assessed using 16 items drawn from three existing instruments. Exploratory factor analysis identified three distinct attitudinal factors. The dependent variable was a composite indicator of emotional abuse, forced heavy work, or food deprivation (coded as present if any were reported). Associations between the three attitudinal factors and composite outcome were analyzed using multiple logistic regression, adjusting for relevant sociodemographic variables.

Results

Emotional abuse, forced heavy work, or food deprivation was reported by 6.7% of participants. Acceptance of wife abuse for domestic shortcomings (Factor 1) was significantly associated with higher odds of experiencing abuse (aOR [1.75 (1.23-2.50)].

Conclusions

Pregnant women who endorsed attitudes accepting wife abuse - particularly for perceived domestic shortcomings - had higher odds of experiencing emotional abuse, forced heavy work, or food deprivation. These findings highlight importance of addressing harmful gender norms within households and ensuring antenatal care settings include safe opportunities to identify and support women at risk.

BackgroundIn Sweden, during the school years of 2021/22, 11,900 women and 8,100 men chose to spend a semester abroad; however, there has been little research on how they experience their time abroad and what difficulties they might face. Some studies have shown that Swedish exchange students consume alcohol to a higher degree and indulge in risky sexually behaviour while on exchange studies. Therefore, our aim was to explore Swedish exchange students' experiences from a semester abroad.MethodsA qualitative design with semi-structured interviews. Eleven students who had spent parts of their education abroad participated in the study. A qualitative content analysis was used to analyse the data.ResultsThe exchange students experienced stress due to a high workload and found that cultural differences could be both frustrating and fascinating. Some exchange students experienced minor illnesses and homesickness. The exchange students expressed a responsible view on sex and emphasized using protection against STIs while engaging in casual sex. Some enjoyed drinking alcohol to varying degrees and meeting new friends while abroad. However, they rarely engaged in excessive drinking; instead, they adopted a more spontaneous and social drinking pattern. Some experienced violence, such as robbery and harassment, and most took several safety measures, including being extra careful to lock their doors, not going out alone, and using public transport instead of taxis.ConclusionSwedish exchange students described stress and casual alcohol consumption as common experiences. They emphasized the importance of STI protection as well as safety measures to avoid exposure to violence. Reports of alcohol consumption, casual sex, violence, minor illnesses, and homesickness highlight the challenges faced during exchange studies. These findings indicate potential risks associated with being an exchange student.

Background: Domestic violence and food insecurity are significant global health challenges, particularly during pregnancy, when both can adversely affect maternal and child health. Food insecurity may occur independently or as a consequence of domestic violence, yet their relationship remains underexplored. This study aims to investigate the association between exposure to domestic violence perpetrated by intimate partners or by family members and food insecurity during pregnancy.

Methods: This cross-sectional study used baseline data from 2129 pregnant women attending routine antenatal care as part of an ongoing randomized controlled trial. Inclusion criteria were age >= 18 years, gestational age between 12 and 22 weeks, and consent to participate. Colour-Coded Audio Computer-Assisted Self-Interview method was administered via a computer tablet for data collection. Domestic violence was assessed using the Nepalese Abuse Assessment Screen and food insecurity using a modified Household Food Insecurity Access Scale.

Results: Of the participants, 12.9% reported food insecurity, and 6% reported experiencing some form of DV. Women reporting any domestic violence, domestic violence perpetrated by intimate partners only or by family members only had significantly higher odds of food insecurity after adjusting for socio-demographic, economic and obstetric factors [Adjusted Odds Ratio (95% CI): 2.5 (1.6-3.9), 3.3 (1.5-7.5) and 2.1 (1.2-3.5) respectively].

Conclusions: Domestic violence was strongly associated with food insecurity during pregnancy. Screening for domestic violence among food-insecure pregnant women and addressing underlying causes could mitigate risks to maternal and child health.

Background: Abuse of older people is common and people living with dementia are at high risk of being subjected to abuse. This study protocol describes the development and procedure to test the validity of two new screening instruments to detect abuse of people with dementia: 1) The REAGERA-S20, intended to be answered by people with dementia themselves, including questions about their abusive experiences, and 2) The REAGERA - N, intended to be answered by the next of kin of people with dementia, including questions about their own exposure to abuse, their own perpetration as well as the witnessing of abusive acts. In addition, the Risk on Elder Abuse and Mistreatment Instrument (REAMI) is translated into Swedish within the project and will be validated. Finally, qualitative interviews are conducted to explore the experiences of abuse from the perspective of both the person with dementia and the next of kin.

Method: People with mild to moderate dementia (n = 80) and their next of kin (n = 80) are recruited at health and social care facilities providing care to people with dementia. In cases of severe dementia, only next of kin is included. At the time of data collection, participants fill out the instruments and are thereafter interviewed, first separately and then jointly by researchers about their abusive experiences. The interviews are used as a gold standard for calculating the properties of the instruments, e.g., sensitivity and specificity, but will also be used for qualitative analysis concerning the experiences of abuse. Health and social care professionals that are well acquainted with the participants fill out the REAMI and results will be validated using the results of the interviews as the gold standard.

Discussion: This study protocol describes a research project that aims towards a comprehensive identification and understanding of abuse of people with dementia by including the perspective of both people with dementia themselves, their next of kin and professionals. If the instruments are found to be reliable they can be used to detect abuse in people with dementia. Also, the qualitative interviews with participants will enhance our understanding of abuse of people with dementia.

The prevalence of physical, sexual and psychological abuse against the women is very high in rural Bangladesh where social connectivity and help seeking behavior of the abused women might be a crucial factor to reduce victimization. At the same time, the pattern of women’s social connectivity and help seeking behaviour may vary from community to community. This study will explore the pattern of social connectivity and help seeking behavior among married women in ethnic minority Santal and Garo as well as mainstream Bengali communities in rural Bangladesh.

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.