Introduktion: Mäns våld mot kvinnor är ett folkhälsoproblem. Våld i nära relation ger upphov till akuta och långsiktiga hälsoproblem hos offren. Syfte: Undersöka kvinnors upplevelse av bemötandet från hälso- och sjukvårdspersonal efter att ha blivit utsatta för våld i nära relation. Metod: För att besvara studiens syfte användes en deskriptiv design med en allmän litteraturstudie som metod grundad på originalartiklar med kvalitativa studier. Resultat: Resultatet delades in i två teman; positiva och negativa bemötanden. Positiva bemötanden delades in i kategorierna empati och fungerande skyddsnät. Känsla av empati skapades när bemötandet upplevdes som medkännande, när personalen tog sig tid, var stöttande och motiverande, utförde bekräftande handlingar och vid en god personal-patient relation. Känslan av att sjukvården fungerade som skyddsnät framkom när bemötandet var informativt, professionellt, när kvinnorna erhöll praktisk hjälp och när kvinnan upplevde känslan av tillit. Negativa bemötanden kategoriserades till negativa känslor, diskriminering och bristande skyddsnät. Negativa känslor uppstod när kvinnan upplevde en ej fungerande personal-patient relation och när bemötandet var nedvärderande, empatilöst, skuldbeläggande och oförstående. Diskriminering upplevdes när personalen osynliggjorde våldet eller när patienten upplevde kulturellt förtryck. Känsla av bristande skyddsnät upplevdes när kvinnorna kände sig svikna av systemet, upplevde brist på tid och information och ett icke- professionellt bemötande. Slutsats: Våldsutsatta kvinnor uppfattade bemötandet från hälso- och sjukvårdspersonal på olika sätt. Majoriteten upplevde bemötandet som negativt så vidare forskning behövs i området för att identifiera vilken kunskap och utbildning personalen behöver. Detta för att kvinnan ska få bästa möjliga förutsättningar för ett gott bemötande och bra vård efter våld i nära relation. / Introduction: Violence against women is a public health issue. Intimate partner violence generates acute and long-term health problems. Aim: Investigate women's experience of treatment received from health care professionals after being exposed to intimate partner violence. Method: A literature study with descriptive design using original articles with qualitative studies was used to answer the aim of the study. Result: The result was divided in two themes; positive and negative experiences. Positive experiences were divided into categories empathy and functioning safety net. The feeling of empathy emerged when the encounter was experienced as compassionate, the personnel took their time, was supportive and motivated, performed confirming actions and there was a satisfying professional-patient relation. The feeling of a functional safety net emerged when the encounter was informative, professional, the women obtained practical help and a feeling of trust was experienced. Negative experiences were categorized to negative emotions, discrimination and lack of safety net. Negative emotions occurred when women experienced dysfunctional professional-patient relation and the encounter was derogatory, unempathetic, blaming and the professionals did not understand the women’s situation. Discrimination was experienced when the personnel overlooked the violence or the patient experienced cultural oppression. Lack of safety net was experienced when women felt betrayed by the system, lack of time and information and not receiving a professional encounter. Conclusion: Women exposed to violence experienced treatment from healthcare professionals in different ways. The majority had negative experiences which reveals that further research is needed to identify the gaps in knowledge and to further educate personnel who are active in healthcare.

Syftet med vår studie har varit att undersöka och analysera olika förebyggande program på området våld i ungas relationer. Utgångspunkterna har varit gemensamma fokusområden mellan programmens grundläggande idéer, programmens utfall samt potentiella utvecklingsområden. Vi har valt en kvalitativ textanalys som metod där vi har använt oss av 15 stycken vetenskapliga artiklar med internationell forskning. För att undersöka och analysera vårt material har vi använts oss av tematisk analys och kodning. De teoretiska utgångspunkter vi tillämpat är Aaron Antonovskys teori om känsla av sammanhang, intersektionalitet och genusperspektiv. Resultat tyder på att programmen har flertalet gemensamma fokusområden. De fokusområden vi belyser är bland annat medvetenhet om våld, våld som lösning samt träning, färdigheter och kunskap. Samtliga förebyggande program visar på förbättringar i relation till fokusområdet, men belyser även det som programmen inte lyckats med. Slutligen framförs utvecklingsmöjligheter inför framtida förebyggande program utifrån programmens resultat. / The aim of this study has been to examine and analyze various preventive programs related to intimate partner violence among young people. The starting points have been common areas of focus between the basic ideas of the programs, the outcomes of the programs and potential areas of development. We have chosen a qualitative text analysis as a method where we have used 15 scientific articles with international research. We used thematic analysis and coding as a method to investigate and analyze our material. The theory that has been used in the study are Aaron Antonovsky’s theory about sense of coherence, intersectionality and gender perspective. Results indicate that the program has several common focus areas. The focus areas we highlight include awareness of violence, violence as a solution as well as training, skills and knowledge. All prevention programs show improvements in relation to the focus area, but also highlight what the program has not succeeded in. Finally, development opportunities for future prevention programs are presented based on the results of the programs.

Bakgrund: Våld i nära relationer är ett globalt folkhälsoproblem. Våldet kan uttrycka sig på flera olika sätt och leda till omfattande hälsoproblem. Hälso- och sjukvården har en viktig roll i att screena, identifiera och stödja våldsutsatta kvinnor. Det är avgörande att hälso- och sjukvårdspersonal skapar en trygg miljö för patienterna. Syfte: Syftet var att synliggöra hinder för sjuksköterskor att identifiera mäns våld mot kvinnor i nära relationer. Metod: En litteraturöversikt baserad på fyra kvalitativa, fyra kvantitativa och fyra mixade originalartiklar hämtade från databaserna CINAHL och PubMed. Resultat: Resultatet är strukturerat utifrån tre huvudteman: Kunskap- och utbildningsbrist, Organisatoriska hinder samt Känslomässiga hinder. Sjuksköterskor vittnar om kunskapsluckor, bristande rutiner, knappa resurser, utmaningar i arbetsmiljön, tidsbrist, attityder och rädslor. Slutsats: Sjuksköterskor möter hinder vid identifiering av våld i nära relation. Fördjupad kunskap, större organisatoriskt stöd och ökad medvetenhet är viktigt för att förbättra arbetet med våldsutsatta kvinnor. / Background: Intimate partner violence is a global public health problem, manifesting in various forms and causing significant health problems. Healthcare plays an important role in screening, identifying, and supporting battered women. It's essential that healthcare professionals create a safe environment for patients. Aim: The purpose was to highlight barriers for nurses in identifying men's violence against women in partner relationships. Method: A literature review based on four qualitative, four quantitative and four mixed-methods original articles retrieved from the databases CINAHL and PubMed. Results: The results are structured around three main themes: Lack of knowledge and education, Organizational barriers and Emotional barriers. Nurses report about knowledge gaps, lacking protocols, resource limitations, work environment challenges, time constraints, attitudes and fears. Conclusions: Nurses encounter barriers in identifying intimate partner violence. Enhanced knowledge, greater organizational support, and increased awareness are important for improving work with battered women.

Vård av kvinnor utsatta för våld i nära relationer är en komplex och krävande del av sjuksköterskors arbete. Våldet är vanligen förenat med fysiska, psykiska såväl som sociala utmaningar och kräver kunskapsbaserad vård. Trots ökad medvetenhet om våld i nära relation finns det fortsatta brister i förståelsen av sjuksköterskors upplevelser och hantering av vården på våldsutsatta kvinnor. Syftet är att belysa sjuksköterskors upplevelser av att vårda kvinnor utsatta för våld i nära relation inom somatisk vård. Genom att få insikt i deras perspektiv kan eventuella brister i vården identifieras och förbättringar föreslås för att öka effektiviteten och stödet för både sjuksköterskor och patienter. En integrerad sammanställning av kvalitativ forskning inspirerad av metasyntes utfördes. Genom att systematiskt granska och syntetisera befintliga kvalitativa forskningsstudier kring sjuksköterskors upplevelser av att vårda kvinnor utsatta för våld i nära relationer, identifierades olika teman. Sjuksköterskor beskrev svårigheter att vårda dessa kvinnor och betonade utmaningarna med att identifiera och stödja dessa patienter. Det framgick även hur arbetet kan innebära en känslomässig påverkan på sjuksköterskan. Resultaten sammanställdes och visade på behovet av ökad utbildning och bättre samarbete mellan olika vårdinstanser. Denna metod möjliggjorde en djupare förståelse för sjuksköterskors upplevelser genom en sammanvägning av flera studiers resultat. Litteraturstudien betonar behovet av stöd och förbättringar i utbildning och samarbete mellan vårdgivare för att bättre tillgodose behoven hos sjuksköterskor såväl som för våldsutsatta kvinnor. / The care of women exposed to intimate partner violence is a complex and demanding aspect of nurses' work. Violence is often associated with physical, psychological, and social challenges, requiring knowledge-based care. Despite increased awareness of intimate partner violence, there are continued gaps in understanding nurses' experiences and management of care for abused women. The aim is to highlight nurses' experiences in caring for women exposed to intimate partner violence within somatic healthcare. By gaining insight into their perspectives, any deficiencies in care can be identified, and improvements suggested to enhance effectiveness and support for both nurses and patients. An integrated compilation of qualitative research inspired by metasynthesis was conducted. By systematically reviewing and synthesizing existing qualitative research studies on nurses' experiences in caring for women exposed to intimate partner violence, different themes were identified. Nurses described difficulties in caring for these women and emphasized the challenges in identifying and supporting these patients. It also emerged how the work could have an emotional impact on the nurse. The results were compiled, indicating the need for increased education and better collaboration between different healthcare entities to enhance care. This method allowed a deeper understanding of nurses' experiences by combining results from several studies. The literature-based study emphasizes the need for support and improvements in education and collaboration among healthcare providers to better meet the needs of both nurses and abused women.

Background: There is a strong association between exposure to intimate partner violence (IPV) and the development of negative mental health (MH) outcomes among women and their children. Given the high prevalence of IPV in low and lower-middle income countries (LLMICs) and its relationship with varying MH issues, it is essential to identify evidence-based interventions that reduce MH challenges, including interventions that remain effective under LLMIC resource, implementation, and scalability constraints. Objective: The proposed study involves a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating psychosocial interventions compared to a) no intervention, b) alternatively specified interventions, or c) waitlisted services to reduce MH impairment among women and children with IPV exposure and who live in LLMICs relative to those living in high income countries (HICs). Methods: Our methods and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We systematically searched eight electronic databases for RCTs reporting the effects of psychosocial interventions on the well-being of women, and/or their children, who were exposed to IPV and who were living in LLMICs or HICs. Searches were completed on April 10, 2022. We implemented forward citation searching on February 19th, 2023, of the included studies to capture any missed or recently published papers. Title, abstract, full-text screening, and data extraction were completed independently, using Covidence. Primary and secondary outcome data extracted and analyzed from the included studies were: (a) MH disorder (depressive disorder, anxiety disorder, post-traumatic stress disorder (PTSD)), (b) clinical symptoms of mental illness (stress, emotion dysregulation, self-efficacy, self-esteem, externalizing symptoms, and suicidal thoughts and ideation) and (c) parent and child relationship and quality of life. Pooled effect estimates of the outcomes were synthesized on Comprehensive Meta-Analysis (CMA) and were reported using Hedge’s g. Risk of bias was also assessed, in duplicate, using the Clarity Risk of Bias Tool and the certainty of the available evidence was classified according to the Grading of Recommendations Assessment, Development and Evaluation Tool (GRADE). Where at least five studies were available for an outcome, three a priori subgroup analyses were completed for women and children on the basis of : 1) psychosocial intervention type (empowerment and advocacy, trauma-focused therapy, non-trauma focused therapy, counselling, and cognitive behavioural therapy (CBT), and parenting), income setting (LLMIC and HIC), and 3) length of follow-up (post-intervention, < 12-months follow-up, and ≥ 12-months follow-up). Lastly, sensitivity analyses explored the impact of the following on the outcomes (1) high-risk of bias ratings; (2) missing data, and (3) reporting on feasibility and pilot data. Results: A total of 33,257 articles were identified via database searches; 12,057 were removed using deduplication, resulting in 21, 200 articles for title and abstract screening. A total of 581 articles underwent full-text screening, of which 55 unique studies were included in the review. Across the included studies, enough data was available to analyze seven outcomes within the meta-analysis; this included the primary outcomes of depressive disorder, anxiety disorder, PTSD, and the secondary outcomes, stress, self-esteem, self-efficacy, and quality of life. Thirteen studies were completed in LLMIC settings, with 42 studies focused on HICs. Ten studies focused on women and children exposed to IPV, 43 studies focused strictly on women, and two studies focused strictly on children. With respect to the outcomes, the majority of studies examined intervention impacts on depression (k = 33, 60%), anxiety (k = 11, 20%), and PTSD (k = 26, 47%). After performing the meta-analyses, very uncertain evidence suggests that psychosocial interventions may lead to reductions in maternal depression (g = -0.222; 95% CI -0.353 to -0.090) maternal anxiety (g = -0.541; 95% CI -0.953 to -0.129), and child PTSD (g = -0.314; 95% CI -0.602 to -0.026). Additionally, very uncertain evidence suggests that psychosocial interventions may have little to no effect on child depression (g = 0.085; 95% CI -0.519 to 0.690), maternal PTSD (g = -0.193; 95% CI -0.339 to -0.047), maternal stress (g = -0.188; 95% CI -0.454 to 0.078), and maternal self-efficacy (g = 0.187; 95% CI -0.096, 0.469). As well, moderate certainty of evidence indicates that psychosocial interventions are likely to result in little to no difference in self-esteem (g = 0.196; 95% CI -0.009 to 0.401), and a low certainty of evidence indicates that psychosocial interventions may result in little to no difference in maternal quality of life (g = 0.121; 95% CI -0.090, 0.332), relative to controls. However, when considering these outcomes, trauma-focused therapy showed significant improvements in maternal depression in HICs and LLMICs, while maternal anxiety and PTSD showed significant improvements in LLMICs. Non-trauma focused therapy resulted in significant improvements in maternal stress specifically in LLMICs. Parenting psychosocial interventions were also effective in significantly improving child PTSD in LLMICs. Conclusion: The systematic review and meta-analysis found that psychosocial interventions may not be more beneficial compared to control groups for addressing MH outcomes amongst women and children exposed to IPV within LLMICs and HICs. While trauma-focused therapy, non-trauma focused therapy, and parenting interventions demonstrated significant positive impacts for maternal depression, anxiety, PTSD, stress and child PTSD, the evidence available was deemed to be uncertain. This review underscores the importance of equal resource distribution, fair research practices, investing in longer follow-up studies, comprehensive data analysis, and clear reporting. Future research should prioritize well-designed trials to understand the effects of specific psychosocial interventions. / Thesis / Master of Science (MSc) / Women's exposure to intimate partner violence (IPV) is a serious public health problem that often occurs in the presence of children and is linked to poor mental health; this is especially true among women and children living in low and lower-middle income countries (LLMIC) (Barada et al., 2021; García-Moreno et al., 2013; Silva et al., 2019). Given that intervening early can help reduce the mental health (MH) impacts of IPV exposure, there is an urgency to identify and disseminate evidence-based interventions in LLMIC settings. Here, we systematically review the literature evaluating psychosocial interventions that aim to reduce MH impairment among women and children exposed to IPV in LLMIC settings and examine how these findings compare to psychosocial interventions that reduce MH impairment among those living in high-income country (HIC) settings. In total, 55 unique studies were included in the systematic review. Findings are varied; however, overall, trauma-focused therapy, non-trauma focused therapy, and parenting psychosocial interventions significantly improved specific mental health outcomes within specific settings. In HICs, trauma-focused therapy demonstrated improvements in maternal depression. In LLMICs, trauma-focused therapy was effective in reducing maternal depression, anxiety, and post-traumatic stress disorder (PTSD). In addition, in LLMICs, only, non-trauma focused therapy improved maternal stress and parenting interventions improved child PTSD. We also narratively and statistically discuss factors specific to the psychosocial interventions that may improve MH following IPV exposure. Intervention factors include mechanism, type, delivery, setting, and modality, which should be targets for future evaluation. In sum, our review emphasizes the importance of tailoring interventions to address the unique needs of survivors in particular settings and calls for balanced, larger, and well-designed trials to better understand the effects of psychosocial interventions within and across contexts.

Syftet med denna studie är att undersöka hur kvinnor som utsatts för våld i nära relationer beskriver våldet i sina egna självbiografier samt vilka copingstrategier som kan identifieras i deras berättelser. Med hjälp av fyra självbiografier skrivna av kvinnor som under många år levt med en våldsutövande man ska deras beskrivning av våldet belysas. Empirin kommer med hjälp av teorier så som normaliseringsprocessen och teorier om copingstrategier att analyseras. Våldet som belyses är fysiskt, psykiskt, sexuellt och ekonomiskt. Resultaten visar att kvinnorna beskriver liknande tillvägagångssätt och händelser kring alla de olika våldsformerna. Männens kontroll och isolering dominerar kvinnornas liv och leder till en känsla av förlorad verklighetsuppfattning. Copingstrategierna som identifierades delades upp i emotionell och problemfokuserad coping. Emotionellt fokuserad coping identifierades som bland annat att ventilera, hitta stöd, religion samt förnekelse av sin situation. Den problemfokuserade copingstrategier identifierades som informationssamlande, anpassade beteende och sökandet efter sin nya roll. / The purpose of this study is to examine how women who have been subjected to intimate partner violence describe the violence in their own autobiographies, as well as which coping strategies can be identified in their stories. With the help of four autobiographies written by women who lived with a violent man for many years, their description of the violence will be highlighted. The experience will be analyzed with the help of theories such as the normalization process and theories of coping strategies. The coping strategies are divided into emotional and problem-focused coping. The violence highlighted is physical, psychological, sexual and financial violence. The results show that the women describe similar approaches and events around all  different forms of violence. Men's control and isolation dominate women's lives and lead to a sense of lost perception of reality.The coping strategies identified were divided into emotional and problem-focused. Emotionally focused coping was identified as, among other things, ventilating, turning to one's religion for support and denial of one's situation. The problem-focused coping strategies are identified as information gathering, adapted behavior and the search for one's new role.

Bakgrund  År 2021 miste minst 19 personer i Sverige livet på grund av våld i en nära relation. Drygt 200 kvinnor om dagen utsätts för denna typ av våld i Sverige, och var tredje kvinna världen över har erfarenheter av våld i nära relation.  Syfte  Syftet var att belysa barriärer i vårdmötet som kan försvåra sjuksköterskans möjlighet att identifiera våld i nära relationer.  Metod  Metoden som användes var en icke-systematisk litteraturöversikt baserad på 13 artiklar med kvalitativ och kvantitativ ansats. Artiklarna som användes hämtades från PubMed och CINAHL. En integrerad innehållsanalys gjordes av artiklar med hög eller medelhög kvalitet enligt Sophiahemmet högskolas granskningsmall.  Resultat  Två huvudkategorier identifierades: “Förutsättningar” och “Yrkesmässigt ansvar”. “Förutsättningar” hade två underkategorier: “Tidsbrist &amp; Screening” samt “Farhågor” och huvudkategorin “Yrkesmässigt ansvar” två underkategorier: “Riktlinjer, styrdokument” och “Utbildning”. Resultatet speglar de barriärer som vårdpersonal upplever när det kommer till att ställa frågor angående våld i nära relationer och sammanfattas som följer: tidsbrist, brist på utbildning, brist på riktlinjer, rädsla för personlig säkerhet, ”victim blaming”, genans, och osäkerhet. Barriärerna resulterar ofta i tillitsbrist från våldsutsatta.  Genom sitt beteende riskerar vårdpersonalen att normalisera det våld som patienten utsatts för. Sjuksköterskan har jämfört med andra professioner en unik förutsättning att nå ut till våldsutsatta.  Slutsats  Ett halvt sekel har gått sedan forskning om våld i nära relationer initierades. Lika länge har sjukvårdspersonal upplevt barriärer som hindrar dem från att identifiera och hjälpa våldsutsatta. Framtida forskning bör fokusera på interventioner med syfte att förändra identifierade problem. / Background  In the year of 2021, 19 people in Sweden lost their lives owing to domestic violence. Over 200 women are subjected daily to this type of violence in Sweden, and every third woman in the world has had experiences of domestic violence.  Aim  The aim was to illustrate barriers in health care encounters which could obstruct nurses’ ability to identify domestic violence.  Method  The method used was a non-systematic literature review based on 13 articles including qualitative and quantitative approaches. Articles were collected from PubMed and CINAHL. An integrated content analysis comprised of the articles scoring high to medium quality according to Sophiahemmet högskolas review template.  Results  In compiling the results, two main categories were identified: “Prerequisites” and “Professional responsibilities”. “Prerequisites” had two subcategories: “Lack of time &amp; Screening” and “Fears” and “Professional responsibility” had two subcategories: “Guidelines, governing documents” and “Education”. The results mirror the barriers health care professionals experience in order to ask questions about domestic violence and can be summarized as follows: Lack of time, education, guidelines &amp; governing documents; victim blaming; disconcertion; and uncertainties. These barriers often result in a lack of trust in health care professionals.  By their actions, health care professionals are risking a normalization of the violence the patient is subjected to. Compared to other professionals, nurses have a unique possibility to reach individuals exposed to domestic violence.  Conclusions  Half a decade has passed since the research of domestic violence initiated. For just as long, health care professionals have experienced barriers preventing them from identifying and treating individuals exposed to domestic violence. Future research should focus on intervention studies, targeting identified problems.

Globally, an estimated one in four women have experienced intimate partner violence (IPV) in their lifetimes. IPV has enormous physical, mental, and social consequences across ecological levels of human experience. These consequences extend to the children of adult women survivors of IPV and are worsened by intersecting experiences of racism, classism, sexism, and xenophobia. Service systems purporting to help, such as child protective services (CPS) and health service systems, can either create additional harm for women and their children or offer services that women may have difficulty accessing due to cost, isolation, and other factors. These harms can be especially pronounced among (a) Black women who have used drugs, who have children, and who are in community supervision programs (CSPs) in the U.S. and (b) Syrian refugee women with children living outside camps in Jordan. These populations of women face particular challenges getting basic needs met while navigating safety for themselves and their children – both due to IPV and from systems themselves (e.g., risk of losing custody of their children, sociocultural risk of interference in family life). Yet, limited research exists on the relationship between experiencing IPV and service involvement within these two populations. The following dissertation aims to address these research gaps in three papers, using descriptive and bivariate data as well as logistic regression analyses of E-WORTH and Women ASPIRE studies, as informed by ecological theory. The first paper (E-WORTH), guided by ecological theory, aims to determine the prevalence of and test hypothesized associations between psychological, physical, and sexual IPV and CPS involvement among Black women who have used drugs, who ever had children, and who are in CSPs in New York City (N=247). I hypothesized that women who ever had children, were in CSPs, and had ever experienced psychological, physical, and/or sexual IPV by male partners would have higher odds of being involved with CPS in their lifetime than women who ever had children, were in CSPs, and had not experienced IPV by male partners. Using self-reported data from Black women who have used drugs and were recruited from CSPs in New York City, I found that 70.85% of women who ever had children and who were in CSPs reported ever experiencing psychological IPV by a male partner, 70.04% reported ever experiencing physical IPV by a male partner, 48.58% reported ever experiencing sexual IPV by a male partner, and 40.89% reported ever experiencing psychological, physical, and sexual IPV by a male partner. Further, I found that 55.87% of women reported ever having had an open case with CPS. Multivariable logistic regression analyses revealed that women who had experienced lifetime sexual IPV had significantly higher odds of ever being involved with CPS than women in the study who had never experienced sexual IPV (OR: 1.81; 95% CI: 1.09, 3.01). Similarly, women who experienced multiple forms of IPV (psychological, physical, and sexual) also had significantly higher odds of being involved with CPS (OR: 1.81; 95% CI: 1.07, 3.04). However, these associations did not hold in adjusted models. Paper 2 (Women ASPIRE) aims to (1) compare the prevalence of mental health symptomology (anxiety, depression, and PTSD) among Syrian refugee women with children under age 18 living outside camps in Jordan who have and who have not experienced physical and/or sexual IPV in the past year; and (2) examine the relationship between IPV and mental health symptomology among Syrian refugee women with children living outside camps in Jordan. Based on ecological theory as my conceptual framework, I hypothesized that Syrian refugee women with children who had experienced IPV in the past year would have significantly higher odds of meeting screening criteria for anxiety, depression, and PTSD as compared to Syrian refugee women with children who had not experienced IPV in the past year. I found high rates of IPV, anxiety, depression, and PTSD among women in the sample (N=412). Furthermore, using multivariable logistic regression models from the Women ASPIRE dataset, I found that women with children who had experienced physical and/or sexual IPV in the past year had significantly higher odds of meeting screening criteria for all three mental health conditions – anxiety (aOR: 3.68, CI: 2.28-5.94, p<0.001), depression (aOR: 3.03, CI: 1.83-4.99, p<0.001), and PTSD (aOR: 6.94, CI: 3.75-12.84, p<0.001) – than women with children who had not experienced IPV in the past year. Despite these findings, at least one-fifth of women with children reported an unmet need for mental health or protective services, and less than one-third of women were aware of the availability of these services in their local communities. The third paper (Women ASPIRE) aims to (a) examine the prevalence of physical and sexual IPV among health service-seeking Syrian refugee women with children in non-camp settings in Jordan and (b) compare the differences in health service use between women with children who had and who had not experienced IPV (N=412). Informed by experiences across levels of ecological theory, I hypothesized that women with children who had ever experienced IPV would have lower odds of using each type of health service (i.e., general, specialist, reproductive, mental health, and emergency health services) – and would have higher odds of using limited numbers of services – than women with children who had never experienced IPV. I tested my hypothesis using binary logistic regression models and an independent samples t-test. I found that nearly 60% of Syrian refugee women with children living outside camps in Jordan had ever experienced physical and/or sexual IPV by their current or most recent husband. Contrary to my hypotheses, I found that women with children who had ever experienced IPV had over three times the odds of using mental health services and were significantly more likely to use a greater variety of health services (including mental health services) than women who had not experienced IPV (aOR: 3.10, 95% CI: 1.92-5.00, p<0.001; mean 3.26 vs. 2.84 types of services respectively, t [410] = 03.71, p<0.001). Findings affirm that IPV is a serious public health issue among the affected populations and that access to needed services remains crucial to affected populations. Results fill gaps in existing literature by confirming that women with children in each study population have high odds of system involvement, particularly with CPS and mental health service systems, thereby offering social workers within those systems opportunities to intervene effectively. Thus, this dissertation can help social work practitioners and clinicians offer more responsive, accessible, and relevant services to clients within the study populations. Policymakers and administrators can fund development and testing of interventions across multiple ecological levels to promote the safety, health, and well-being of women and their children. Researchers can build on these findings through quantitative and qualitative studies on intervention effectiveness and accessibility among women engaged with system.

The work for female empowerment is prominent on the Unguja island of Zanzibar. Governmental support and local and international organizations are investing in women to achieve gender equality. The government of Tanzania has added changes to the law to protect women and prevent gender-based violence, as well as strategic measures to assist the stakeholders of the Zanzibarian society. Simultaneously, the reports of gender-based violence (GBV) are increasing on the islands according to the Zanzibar Female Lawyer Association. The study explores the measures taken by the government to eliminate violence against women with a focus on the role of the man in these structural social and legal changes. The study also shows the challenges that the added laws have faced in practice, and the balance between culture and legal system in a society, when a change is to take place.

Syftet med studien är att få en förståelse för socialarbetares arbete med våldsutövare samt hur de beskriver och bemöter våldsutövare som målgrupp. Studien utgår från en kvalitativ inriktning där semistrukturerade intervjuer genomfördes för att kunna besvara forskningens syfte. Det insamlade datamaterialet analyserades tematiskt och identifierade följande teman; våldsutövarens förutsättningar till förändring, utvecklingsområden i arbetet med våldsutövare, kartläggning av arbete med våldsutövare, nätverksarbete och riskfaktorer hos våldsutövaren. Resultatet analyserades i samband med tio vetenskapliga artiklar och fyra teoretiska ramverk; makt, handlingsutrymme, mentalisering och stigma. Det framträdande resultatet pekar på att våldsutövare uppvisar en bristande insikt och självreglering av känslor till våldet och att socialarbetarens bemötande blir väsentlig och avgörande för behandlingsarbetets utveckling. Utgångspunkten i arbetet grundar sig i våldsutövares enskilda problematiker som behöver beaktas där socialarbetaren anpassar arbetsmetoden efter den genom sina kunskaper och kompetenser. Utöver det har arbetet ett stort fokus på partnerkontakten med den våldsutsatta för att motivera och uppmuntra till stöd under våldsutövarens behandling. Det framgår även att socialarbetare samverkar med andra verksamheter som kan påträffa våldsutövare men att det behöver vidareutvecklas för att möjliggöra ett utökat kunskapsutbyte och uppfångande av våldsutövare. Vidare påvisar resultatet att tidigare utsatthet i barndomen är ett företrädande mönster hos flera våldsutövare. / The purpose of this study is to gain an understanding of social workers intervention programs and how they approach perpetrators of intimate partner violence. The study is based on a qualitative methodology using semi-structured interviews to answer the studies aim. The data gathered through interviews were thematically analysed where the following themes emerged; perpetrators prerequisites for change, intervention programs development areas, mapping the treatment, networking and the perpetrators risk factors. The results were analyzed by scientific articles and theoretical frameworks: power, room for maneuver, mentalization and stigma. Our findings from the data indicate that perpetrators have a lack of insight and emotional management to violence where the social workers approach becomes essential for perpetrators progress. The interventions programs foundation is based on the perpetrators individual problem areas where the social worker adapts the treatment utilizing their own knowledge and expertise. Intervention treatment places a large emphasis on partner contact to motivate and support them during the perpetrators treatment. There is a cooperation with other authorities that needs further development to enable an increased exchange of knowledge and extended reach of perpetrators. The results also show that previous exposure in childhood is a predominant pattern to perpetrators alongside other problems.