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Since the 1990s, the international humanitarian system has developed approaches, tools, and standards for addressing gender-based violence (GBV) in emergencies premised on the survivor-centered approach (SCA). Utilizing critical discourse analysis, we explore how articulation of SCA within humanitarian discourse aligns with its stated intent to return control to survivors. The analysis reveals that humanitarian system power dynamics distort the application of SCA, leaving humanitarian service providers in charge of assessing the best course of action or severely limiting survivors' choices. We propose a survivor led approach as more aligned with the feminist and transformative goals of humanitarian action against GBV.
RESUMEN
BACKGROUND: Intimate partner violence (IPV) remains a pervasive form of gender-based violence (GBV) that is largely undisclosed, especially among women seeking healthcare services in Uganda. Prioritizing survivor needs may improve IPV disclosure. This study explores healthcare worker experiences from provider-patient interactions with survivors seeking antenatal care services (ANC) in Uganda. METHODS: In-depth interviews were conducted among twenty-eight experienced healthcare providers in a rural and an urban-based ANC clinic in Eastern and Central Uganda. Providers were asked what they viewed as the needs and fears of women identified as having experienced any form of IPV. Iterative, inductive/deductive thematic analysis was conducted to discover themes regarding perceived needs, fears, and normalizing violence experienced by IPV survivors. RESULTS: According to healthcare providers, IPV survivors are unaware of available support services, and have need for support services. Providers reported that some survivors were afraid of the consequences of IPV disclosure namely, community stigma, worries about personal and their children's safety, retaliatory abuse, fear of losing their marriage, and partners' financial support. Women survivors also blamed themselves for IPV. Contextual factors underlying survivor concerns included the socio-economic environment that 'normalizes' violence, namely, some cultural norms condoning violence, and survivors' unawareness of their human rights due to self-blame and shame for abuse. CONCLUSIONS: We underscore a need to empower IPV survivors by prioritizing their needs. Results highlight opportunities to create a responsive healthcare environment that fosters IPV disclosure while addressing survivors' immediate medical and psychosocial needs, and safety concerns. Our findings will inform GBV prevention and response strategies that integrate survivor-centered approaches in Uganda.
Asunto(s)
Violencia de Pareja , Sobrevivientes , Niño , Femenino , Humanos , Embarazo , Instituciones de Atención Ambulatoria , Violencia de Pareja/psicología , Atención Prenatal , Sobrevivientes/psicología , Violencia , Personal de Salud , Investigación CualitativaRESUMEN
Despite the high prevalence of adverse health and trauma-related outcomes associated with intimate partner violence (IPV), help-seeking and service utilization among survivors is low. This study is part of a larger mixed-methods and survivor-centered validation study on the Icelandic Barriers to Help-Seeking for Trauma (BHS-TR) scale, a new barriers measure focused on trauma recovery. A mixed-methods legitimation strategy of integration was employed to evaluate the BHS-TR structure in samples of IPV survivors. The merging of qualitative (n = 17) and quantitative (n = 137) data through a joint display analysis revealed mainly complementarity findings, strengthening the scale's overall trustworthiness and validity evidence. Divergent findings involved items about mistrust, perceived rejection, stigmatization, fearing vulnerability, and safeguarding efforts that were significant help-seeking barriers in the survivors' narratives, whereas factor analysis indicated their removal. These BHS-TR items were critically evaluated in an iterative spiraling process that supported the barriers' influence, illuminated core issues, and guided potential refinements. This work contributes to the growing field of mixed methods instrument validation placing equal status on qualitative and quantitative methods and emphasizing integration to provide more complete insights. Moreover, the study's findings highlight the added value of further exploring divergence between two sets of data and the importance of giving attention to the voices of the target population throughout the validation process.
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Violencia de Pareja , Miedo , Humanos , Prevalencia , Estereotipo , SobrevivientesRESUMEN
There is little research on virtual service models like chat and text services in agencies that work with survivors of intimate partner violence (IPV) and sexual assault (SA). This study fills a gap in the research by exploring how chat and text services are provided in one IPV and SA-focused community organization. We analyzed chat and text transcripts (n = 392) from a large multiservice, multivictimization focused agency, and conducted interviews with 11 advocates providing chat and text services through the agency hotline. Staff interviews were analyzed using grounded theory and transcripts were analyzed using content analysis. Results indicate chat/text services provide a space for connection, resource provision, education, and access to resource gain in a timely, concise, and survivor-centered way. The five major goals for chat/text advocacy models include the following: (1) rapid access to support and connection; (2) identification of options and needs for each service user; (3) increased access to resources and supports; (4) expanded understanding of violence, abuse, and harm; and (5) improvement of survivor safety. The research team identified 15 general advocacy skills and 4 chat and text specific skills used by chat/text advocates to reach program goals. Findings highlight the utility of chat/text services for increasing access to support services for survivors of violence, particularly adolescents, emerging adults, those living with an abusive individual, and during times of emergency. Future research should continue to explore the promising practice modality of chat/text services for providing advocacy to underserved and hard-to-reach populations.
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Violencia de Pareja , Sobrevivientes , Adolescente , Adulto , HumanosRESUMEN
Intimate partner violence (IPV) against women is a global human rights violation of vast proportions and a severe public health problem. Despite high rates of adverse outcomes related to IPV, help-seeking and service utilization among survivors is low. This exploratory sequential mixed-methods study using a combined etic-emic approach describes the validation of the Icelandic Barriers to Help-Seeking for Trauma (BHS-TR) scale. The qualitative phase involved developing new items based on the experiences of 17 Icelandic IPV survivors, identifying barriers including beliefs that help-seeking is a sign of weakness, and the desire to safeguard oneself from re-traumatization. The quantitative phase examined the psychometrics of the BHS-TR in a sample of 137 IPV survivors in Iceland. Results supported an eight-factor structure (Financial Concerns; Unavailable/Not Helpful; External Constraints; Inconvenience; Weakness/Vulnerability; Problem Management Beliefs; Frozen/Confused; and Shame), which when grouped comprised two indices of Structural and Internal Barriers. The scale's internal consistency was high (α = 0.87), and the results provided evidence of convergent, discriminant, and known-group validity. This study adds to the growing literature supporting the advantages of applying mixed methods for instrument development and validation, and its results highlight the significance of giving rise to the voices of survivors. The BHS-TR is the first trauma-specific and survivor-centered measure of help-seeking barriers available in Iceland. It can be used to provide valuable information that may guide the development of evidence-based interventions to break down barriers and help survivors find ways to trauma recovery.