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

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.

Readiness to Screen for Domestic Violence against Women in Healthcare Uganda: Associations with Demographic, Professional and Work Environmental Factors

Aim: We assessed demographic, professional and work environmental determinants of readiness to screen for Intimate Partner Violence among healthcare practitioners in healthcare Uganda. Methods: The Domestic Violence Healthcare Provider Survey Scale and the Demand-Control-Support questionnaire was administered to a random sample of 376 health care providers (n = 279 valid responses) from Gulu, Anaka, Lacor and Iganga hospital situated in northern and eastern Uganda. Correlation tests, t-tests, ANOVA and Multiple Linear regression were used to analyse the data. Results: Male care providers were more likely than female peers to blame the victim for the occurrence of Intimate Partner Violence in a relationship. Participants from Lacorhospital graded a lower self-efficacy and a poorer support network with regard to screening for Intimate partner violence, and a higher propensity to blame the victim when contrasted with other hospitals. Doctors experienced a lower self-efficacy with regard to IPV screening than other professions. Blaming the victim for abuse was associated with a high work load and low support at work. In addition, with increasing work control and support, participants’ appraisal of system support and self-efficacy increased. Conclusion: Gender, profession, facility of work, work demand, control and support are important determinants of the readiness to screen for IPV in healthcare Uganda, and should inform strategy for the introduction and implementation of routine IPV inquiry in healthcare Uganda.

Communities and service providers address access to perinatal care in postconflict Northern Uganda:socialising evidence for participatory action

Objectives Describe participatory codesign of interventions to improve access to perinatal care services in Northern Uganda.Study design Mixed-methods participatory research to codesign increased access to perinatal care.Fuzzy cognitive mapping,focus groups and a household survey identified and documented the extent of obstructions to access.Deliberative dialogue focused stakeholder discussions of this evidence to address the obstacles to access.Most significant change stories explored the participant experience of this process.Setting Three parishes in Nwoya district in the Gulu region,Northern Uganda.Participants Purposively sampled groups of women,men,female youth,male youth,community health workers,traditional midwives and service providers.Each of seven stakeholder categories included 5-8 participants in each of three parishes.Results Stakeholders identified several obstructions to accessing perinatal care:lack of savings in preparation for childbirth in facility costs,lack of male support and poor service provider attitudes.They suggested joining saving groups,practising saving money and income generation to address the short-term financial shortfall.They recommended increasing spousal awareness of perinatal care and they proposed improving service provider attitudes.Participants described their own improved care-seeking behaviour and patient-provider relationships as short-term gains of the codesign.Conclusion Participatory service improvement is feasible and acceptable in postconflict settings like Northern Uganda.Engaging communities in identifying perinatal service delivery issues and reflecting on local evidence about these issues generate workable community-led solutions and increases trust between community members and service providers.