Health System Response to Domestic Violence

: Evaluation of an Outreach Centre Intervention in Nepal

Abstract

Background: The health sector has a unique opportunity to help women experiencing domestic violence. The Healthcare Responding to violence and Abuse project developed and implemented a complex intervention for healthcare providers in Nepali outreach centres for identifying and responding to affected women.
Objective: To adapt a survey, Provide Intervention Measure (PIM), which measures healthcare providers’ (HCPs) readiness and practice for addressing domestic violence for Nepali context, to explore the individual and organisational readiness and practice to address domestic violence in the outreach centres and to investigate post-intervention changes in HCPs’ readiness and practice.
Methods: Cross-cultural adaptation and six cognitive interviews were conducted with HCPs to adapt the survey. The study employed a mixed-methods approach in both formative and evaluation phases, integrating quantitative surveys using the adapted PIM with HCPs (n=44 pre-intervention and n=36 post-intervention) in 10 outreach centres and qualitative interviews with nine HCPs and eight key informants pre-intervention and seven HCPs post-intervention. Formative findings informed the intervention: a provider-led first-line response training. Qualitative analysis was thematic; quantitative analysis was descriptive. Findings were integrated and structured according to the health system readiness framework.
Results: The survey required modifications to use in the formative phase. Pre-intervention, there was minimal readiness: HCPs were primarily aware of physical forms of domestic violence; few asked women about violence and responded in their own ways without any training in domestic violence response. Facilities lacked clear guidelines and training opportunities. Post-intervention, providers showed improved readiness and practice with enhanced awareness of domestic violence forms and support services. However, workload and privacy challenges at facility-level and COVID-related restrictions limited practice improvements.
Conclusion: The tailored intervention improved individual providers’ readiness and practice, despite ongoing facility-level challenges. Clear guidelines and regular training opportunities are crucial to improve readiness and response to domestic violence in Nepal.

Date of Award	10 Dec 2024
Original language	English
Awarding Institution	University of Bristol
Supervisor	Gene S Feder (Supervisor), Sandi Dheensa (Supervisor), Manuela Colombini (Supervisor) & Poonam Rishal (Supervisor)