Healthcare providers’ perceptions on screening for Intimate Partner Violence in healthcare: A qualitative study of four health centres in Uganda

Stephen Lawoko, Gloria K. Seruwagi, Iryne Marunga, Milton Mutto, Emmanuel Ochola, Geoffrey Oloya, Joyce Piloya, Muhamadi Lubega

Anaka Hospital, Gulu, Uganda.
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Gulu Referral Hospital, Gulu, Uganda.
Iganga Hospital, Iganga, Uganda.
Lacor Hospital, Gulu, Uganda.
Pincer Group International, Kampala, Uganda.
Victoria University, Kampala, Uganda.

DOI: 10.4236/ojpm.2013.31001                

Abstract

The current qualitative study explored the perceptions of healthcare providers on screening for Intimate Partner Violence (IPV) in healthcare in Uganda, to develop a conceptual framework for factors likely to hinder/promote IPV screening in the country. Using purposive sampling, the study enlisted 54 healthcare workers (doctors and nurses) from four hospitals (i.e. Gulu referral hospital, Iganga referral hospital, Lacor hospital, Anaka hospital) to participate in eight focus group discussions. Data was thematically analysed using Template Analysis. The study found support for an ecological framework suggesting a complex interaction of factors at the individual (e.g. poor skills in detection of IPV by health workers and unwillingness to disclose abuse by patients), organisational (e.g. understaffing and lack of protocols for IPV screening) and societal (e.g. societal acceptance of abuse of women and poor policy on IPV management) levels as potential barriers to the practice of IPV screening in healthcare Uganda. These findings have important implications on further training of healthcare workers to adequately screen for IPV, re-organisation of the healthcare system so that it is fully-fledged to accommodate IPV screening and improved collaboration between the health sector and other community advocates in IPV management. These initiatives should run concurrently with a concerted community sensitization effort aimed at modifying attitudes towards IPV among care providers and recipients a like, as well as preparing the general population to will-fully disclose IPV to healthworkers. Study limitations and implications for further research are discussed.

Keywords

Intimate Partner Violence; Screening; Healthcare; Perceptions; Uganda

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	World Health Organization (2002) World report on violence and health. WHO, Geneva.
[2]	Mwenesi, B.K., Buluma, R.C.B., Kong’ani, R.U. and Nyarunda, V.M. (2003) Gender violence. Kenya Demographic and Health Survey, Final Report.
[3]	Gage, A. (2005) Women’s experience of Intimate Partner Violence in Haiti. Social Science & Medicine, 61, 343-364. doi:10.1016/j.socscimed.2004.11.078
[4]	Koenig, M.A., Lutalo, T., Zhao, F., Nalugoda, F., Wabwire-Mangen, F., Ki-wanuka N., et al. (2003) Domestic violence in rural Uganda: Evidence from a community-based study. Bulletin of the World Health Organization, 81, 53-60.
[5]	Campbell, J. (2002) Health consequences of Intimate Partner Violence. Lancet, 359, 1331-1336. doi:10.1016/S0140-6736(02)08336-8
[6]	Emenike, E., La-woko, S. and Dalal, K. (2008) Intimate Partner Violence and Reproductive health of women in Kenya. International Nursing Review, 55, 97-102. doi:10.1111/j.1466-7657.2007.00580.x
[7]	Koenig, M.A., Lutalo, T., Zhao, F., Nalugoda, F., Wabwire-Mangen, F., Ki-wanuka N., et al. (2003) Domestic violence in rural Uganda: Evidence from a community-based study. Bulletin of the World Health Organization, 81, 53-60.
[8]	Garcia-Morena, C., Jansen, H., Ellsberg, M., Heise L. and Watts, C. (2005) WHO Multi-country study on women’s health and domestic violence against women: Initial results prevalence, health outcomes and women’s responses. WHO, Geneva.
[9]	Emenike, E, Lawoko, S. and Dalal, K. (2008) Intimate Partner Violence and Reproductive health of women in Kenya. International Nursing Review, 55, 97-102. doi:10.1111/j.1466-7657.2007.00580.x
[10]	Plichta, S.B. (2004) Intimate Partner Violence and physical health consequences: Policy and practice implications. Journal of Interpersonal Violence, 19, 1296-323. doi:10.1177/0886260504269685
[11]	(1992) American Medical Association diagnostic and treatment guidelines on domestic violence. Archives of Family Medicine, 1, 39-47
[12]	Furniss, K., McCaffrey, M., Parnell, V. and Rovi, S. (2007) Nurses and barriers to screening for Intimate Partner Violence. MCN: The American Journal of Maternal/Child Nursing, 32, 238-243. doi:10.1097/01.NMC.0000281964.45905.89
[13]	John, I.A., Lawoko, S. and Oluwatosin, A. (2011) Acceptance of screening for Intimate Partner Violence, actual screening and satisfaction with care amongst female clients visiting a health facility in Kano, Nigeria. African Journal of Primary Health Care & Family Medicine, 3, 6 pages. doi:10.4102/phcfm.v3i1.174
[14]	Erikson, M.J., Hill, T.D. and Siegal, R.M. (2001) Barriers to domestic Violence screening in the Padiatric setting. Pediatrics, 108, 98-102. doi:10.1542/peds.108.1.98
[15]	Roelens, K., Verstraelen, H., Van Egmond, K. and Temmerman, M. (2006) A knowledge, attitudes and practice survey among obstetrician-gynaecologists on Intimate Partner Violence in Flanders, Belgium. BMC Public Health, 6, 238. doi:10.1186/1471-2458-6-238
[16]	Abbott, J., Johnson, R., Koziol-McLain, J., et al. (1995) Domestic violence against women: Incidence and prevalence in an emergency department population. Journal of the American Medical Association, 273, 1763-1767. doi:10.1001/jama.1995.03520460045033
[17]	Thomas, P. and Lowitt, N.R. (1995) Clinical problem solving: A traumatic e-perience. The New England Journal of Medicine, 333, 307-310. doi:10.1056/NEJM199508033330509
[18]	Synder, J.A. (1994) Emergency department protocols for domestic violence. Journal of Emergency Nursing, 20, 65-68.
[19]	Krug, E.G., et al. (2002) World report on violence and health. World Health Organization, Geneva.
[20]	Campbell, J. (2002) Health consequences of Intimate Partner Violence. Lancet, 359, 1331-1336. doi:10.1016/S0140-6736(02)08336-8
[21]	Okenwa, L., La-woko, S. and Jansson, B. (2009) Factors associated with disclosure of Intimate Partner Violence among Women in Lagos Nigeria. International Journal of Injury and Violence Research, 1, 37-47. doi:10.5249/jivr.v1i1.15
[22]	Petersen, R., Gazmararian, J. and Clark, K. (2001) Partner violence. Implications for health and community settings. Women’s Health Issues, 11, 116-125. doi:10.1016/S1049-3867(00)00093-1
[23]	World Health Organisation (2005) WHO multi-country study on women’s Health and domestic violence against women. WHO, Geneva.
[24]	Brottsf?rebygande R?det (BR?) (2009) V?ld mot kvinnor och m?n i n?ra relationer: V?ldets karakt?r och offrets erfarenhet av kontakter och r?ttsv?sendet (In Swedish). BR? Rapport, 12.
[25]	Ramsey, J., Richardson, J., Carter, Y.H., Davidson, L. and Feder, G. (2002) Should health professionals screen women for domestic violence? Systematic review. British Medical Journal, 2, 314.
[26]	Lawoko S. (2006) Factors associated with attitudes towards violence: A study of women in Zambia. Victoria Silvstedt, 21, 645-656.
[27]	Uthman, O.A., Lawoko, S. and Moradi, T. (2009) Factors associated with attitudes towards Intimate Partner Violence against women: A comparative analysis of 17 sub-Saharan countries. BMC International Health and Human Rights, 9, 14. doi:10.1186/1472-698X-9-14
[28]	Erikson, M.J., Hill, T.D. and Siegal, R.M. (2001) Barriers to domestic violence screening in the Padiatric setting. Pediatrics, 108, 98-102. doi:10.1542/peds.108.1.98
[29]	Roelens, K., Verstraelen, H., Van Egmond, K. and Temmerman, M. (2006) A knowledge, attitudes and practice survey among obstetrician-gynaecologists on intimate partner violence in Flanders, Belgium. BMC Public Health, 6, 238. doi:10.1186/1471-2458-6-238
[30]	Waalen, J., Goodwin, M., Alison, M., Spitz, M.S., Petersen, R. and Saltzman, L.E. (2000) Screening for Intimate Partner Violence by health care providers: Barriers and interventions. American Journal of Preventive Medicine, 19, 230-237. doi:10.1016/S0749-3797(00)00229-4
[31]	Maiuro, R.D., Vitaliano, P.P., Sugg, N.K., Thompson, D.C., Rivara, F.P. and Thompson, R.S. (2000) Development of a health care provider survey for domestic violence: Psychometric properties. American Journal of Preventive Medicine, 19, 245-252. doi:10.1016/S0749-3797(00)00230-0
[32]	John, I., Lawoko, S. and Svanstrom, L. (2011) Screening for Intimate Partner Violence in healthcare in Kano, Nigeria: Extent and determinants. Journal of Family Violence, 26, 109-116. doi:10.1007/s10896-010-9348-y
[33]	South Eastern Sydney Area Health Service (SESAHS) (1997) Domestic violence policy and protocol. SESAHS, Caringbah. http://www.ciap.health.nsw.gov.au/hospolic/domviol/domesticviolence. html
[34]	Gerbert, B., Abercrombie, P., Caspers, N., Lowe, C. and Bronstone, A. (1999) How health care providers help battered women: The survivor’s perspective. Women & Health, 29, 115-135. doi:10.1300/J013v29n03_08
[35]	Lawoko, S., Sanz, S, Helstrom, L. and Castren, M. (2011) Screening for Intimate Partner Violence against women in healthcare Sweden: Prevalence and determinants. ISRN Nursing, 2011, Article ID 510692, 7 Pages. doi:10.5402/2011/510692
[36]	Green, J. and Thorogood, N. (2004) Qualitative methods for health research. SAGE, Lon-don.
[37]	Denzin, N.K. and Lincoln, Y.S, (1994) Handbook of qualitative research. SAGE, London, ix.
[38]	King, N. (2004) Using templates in the thematic analysis of text. In: Cassels, C. and Symon, G, Eds., Essential Guide to Qualitative Methods in Organizational Research, Sage, London, 256-270.
[39]	Cassels, C. and Symon, G. (2004), Essential guide to qualitative methods in organizational research. Sage, London, 256-270.
[40]	Ochen, E.A. (2011) Life beyond the bush: Examining the challenges and opportunities for reintegration of formerly abducted child mothers in northern Uganda. PhD Thesis, University of Huddersfield, Queensgate.
[41]	Troung, Y. and Simmons, G. (2010) Perceived intrusiveness in digital advertising: Strategic marketing implications. Journal of Strategic Marketing, 18, 239-256. doi:10.1080/09652540903511308
[42]	Dries, N. and Pepermans, R. (2008) “Real” high potential careers. Personnel Review, 37, 85-108. doi:10.1108/00483480810839987
[43]	Wainright, D.W. and Waring, T.S. (2007) The application and adaptation of a diffusion of innovation framework for information systems research in NHS general medical practice. Journal of Information Technology, 22, 44-58. doi:10.1057/palgrave.jit.2000093
[44]	Wolf, D.A. and Jaffe, P.G. (1999) Emerging strategies in the prevention of domestic violence. Domestic Violence and Children, 9, 133-144.