Family-Centered Care Across Thai Neonatal Intensive Care Units: A National, Cross-Sectional Survey.

BACKGROUND: Implementing family-centered care (FCC) presents challenges to parental-healthcare provider partnership and collaboration in newborn care in neonatal intensive care units (NICUs). AIMS: To explore NICU nurses' perceptions of FCC (respect, collaboration, and support) during the COVID-19 pandemic and to compare these between nurses working in secondary and tertiary/higher care settings. METHODS: A multicenter, cross-sectional exploratory online survey design study was conducted to identify Thai NICU nurses' perceptions. The online survey of the Perceptions of Family-Centered Care-Staff (PFCC-S) was distributed via a Web page and professional networks between July and September 2022. RESULTS: Of the 187 survey respondents, most NICU nurses worked in the NICU for less than 16 years and were employed in tertiary care/higher care settings in southern Thailand. There was a significant difference in perceptions of support subscale between NICU nurses in secondary (mean: 3.32, SD ± 0.53) and tertiary/higher care settings (mean: 3.17, SD ± 0.46) (P < .05). CONCLUSION: Despite the challenges of the visitation restriction of COVID-19 in Thailand, nurses' perceptions of the value of FCC were maintained. RELEVANCE TO CLINICAL PRACTICE: Further research is recommended to investigate how FCC can be implemented where there is a lack of material and infrastructure resources and staff shortage.

Self-efficacy and social support as mediators of mental health among abused women.

Supportive counseling and facilitated referrals to support organizations have shown positive effects on mental health and coping with domestic and family violence. However, the reasons why and how such effects are significant remain unknown. The current paper used data from a randomized controlled trial of a psychosocial intervention implemented in Nepal among 140 abused pregnant women. The hypothesized mediating effects of self-efficacy and social support on mental health and quality of life of abused pregnant women were tested using serial mediation analyses. Significance of parameter estimates and bias-corrected 95% confidence intervals (CIs) for the indirect effects were generated using bootstrapping. The postintervention changes in self-efficacy and social support were found to have significant mediating effects on the relationship between the intervention and changes in both mental health and quality of life of participants post intervention. The positive effects on outcomes were seen at follow-up as well, though to a lesser extent. Further interventions should focus on enhancing abused women's self-efficacy and social support to ensure their positive mental health and better lives.

Family-centred care change during COVID-19.

BACKGROUND: Family-centred care (FCC) is an approach to promote family and health care provider partnership. This has been incorporated into neonatal intensive care units (NICUs) worldwide. However, FCC in low resource health settings, such as Thailand, is challenging and further impacted by coronavirus disease 2019 (COVID-19). AIMS: To evaluate FCC innovations to improve respect, collaboration and support in a Thai NICU. STUDY DESIGN: A quasi-experimental study was conducted in an NICU in southern Thailand. Pre-implementation was prior to COVID-19, and parental and staff perceptions of FCC were measured via Perceptions of Family Centred Care-Parent (PFCC-P) and -Staff (PFCC-S) survey. The FCC innovations were developed by stakeholders based on the COVID-19 restrictions, pre-survey results, parents' and clinicians' interviews and integrative review, then implemented via a flowchart. Post-implementation evaluation was via repeated surveys. Comparisons were made pre-and post-implementation, with Mann-Whitney U-test statistics for parents and Wilcoxon's Rank Sum for staff. RESULTS: A total of 185 (85 pre; 100 post) parents and 20 (pre and post; paired group) health care professionals participated. Because of COVID-19, many planned interventions were unfeasible, however, other innovations achieved (e.g., structured telephone updates, information booklet revision). There was an increase in parents' perception of respect ([median] 2.50-3.50), collaboration (2.33-3.33) and support (2.60-3.60) domains and overall (2.50-3.43; p < .001; 95% CI: 2.93-3.11). Interdisciplinary professionals' perception of FCC did not significantly change pre-and post-implementation/COVID-19 pandemic for respect (3.00-2.92), collaboration (3.22-3.33), support (3.20-3.20) and overall (3.15-3.20; 95% CI: 3.10-3.25). CONCLUSION: Despite the challenges of COVID-19 restricting NICU access, the provision of FCC was maintained and even improved. RELEVANCE TO CLINICAL PRACTICE: Further research is necessary to develop FCC practice innovations associated with communication, across diverse health care systems and resources.

Antenatal-Based Pilot Psychosocial Intervention to Enhance Mental Health of Pregnant Women Experiencing Domestic and Family Violence in Nepal.

Survivors of domestic and family violence (DFV) report poorer quality of life and worsening mental health. This study evaluated the effect of a counseling and education intervention on the mental health and help-seeking behaviors among pregnant women living with DFV. A parallel pilot randomized controlled trial was performed among 140 pregnant women attending an antenatal clinic of a tertiary hospital of Nepal. Using computer-generated random numbers, participants were randomized to the intervention group (a counseling session, an information booklet about DFV, and contact details of the counselor) or a control group (usual care plus a booklet containing contact details of local DFV support services). Outcome measures included mental health, quality of life (QOL), self-efficacy, social support, and safety planning behaviors. Analyses followed intention-to-treat, using the generalized estimating equation model. Intervention participants showed significant improvements in anxiety (ß = -3.24, p < .001) and depression (ß = -3.16, p < .001) at postintervention. Such improvements were also sustained at follow-up assessment (p < .001). Significant group and time interaction for QOL, social support, use of safety behaviors, and self-efficacy (p < .05) revealed a greater increase in these outcome measures among intervention participants at both follow-up assessments compared with the control group. This pilot integrated intervention showed promising outcomes in improving the mental health, social support, and the use of safety behaviors among women with DFV. This intervention could be incorporated into regular antenatal care as a strategy to identify and support victims of DFV. Larger controlled trials with longer follow-up are needed to support and expand on the current findings regarding the effectiveness of a psychosocial intervention targeting victims of DFV in resource-constrained settings.

Associations between health behaviors and mental health in Australian nursing students.

AIM: Nursing students experience high levels of stress, anxiety and depression. This study examined associations between health behaviors and stress, anxiety and depression in Australian nursing students. DESIGN: this was a cross-sectional study. METHODS: Participants completed an online survey providing demographic information and responses to the 21-item Depression Anxiety Stress Scale, Fagerström Test for Nicotine Dependence, short Food Frequency Questionnaire, Alcohol Use Disorders Identification Test, International Physical Activity Questionnaire and Workforce Sitting Questionnaire. Associations were evaluated using multivariate linear regression. RESULTS: Mild to extremely severe stress (46.6%), anxiety (52.8%) and depression (42.2%) were prevalent. Intake of snack-foods was associated with higher depression (ß = 8.66, p < 0.05) and stress (ß = 3.92, p = 0.055) scores. More time spent sitting was associated with higher depression (ß = 0.48, p < 0.001) and stress (ß = 0.28, p < 0.05) scores. Skipping meals correlated with higher stress, anxiety and depression scores. CONCLUSION: More support must be provided to nursing students to manage psychological distress and mental health during university study.

Domestic and Family Violence and its Association with Mental Health Among Pregnant Women Attending Antenatal Care in a Tertiary Hospital of Eastern Nepal.

BACKGROUND: Pregnancy has been identified as a vulnerable period for both the initiation and escalation in severity of domestic and family violence. There is a significant dearth of scholarly literature documenting the relationship of domestic and family violence with the mental health and quality of life among pregnant women of Nepal. METHODS: Baseline data of 140 women enrolled in a trial of a psychosocial intervention for abused pregnant women were analysed. Face-to-face interviews were conducted using standardised scales. Prevalence of domestic and family violence and mental health conditions were estimated and inferential statistics were used to assess the association of domestic and family violence with mental health, quality of life, social support, and use of safety behaviours. RESULTS: The lifetime prevalence of domestic and family violence was found to be 27.7% (n = 173), followed by 17.1% of women (n = 107) fearing someone in their family. Domestic and family violence in the last 12 months was significantly associated with anxiety (p = 0.001), depression (p = 0.005), quality of life (p < 0.05), and perceived social support (p = 0.001). Use of safety behaviours (p = 0.037) was significantly low among women reporting domestic and family violence in the past year as well as during the current pregnancy (p = 0.017). CONCLUSIONS: There exists a high psychological morbidity among pregnant women exposed to domestic and family violence. The findings support the need of implementing a screening and support intervention for abused women seeking antenatal services.

Determining mental health literacy of undergraduate nursing students to inform learning and teaching strategies.

There is limited research on mental health literacy among undergraduate nursing students in Australia. Overseas studies indicate significant gaps in students' knowledge and practice. The aims of this study were to (1) assess mental health literacy knowledge in undergraduate nursing students and compare these across year levels, and to (2) identify students' learning needs about mental health literacy in practice. A convenience sample of 114 Bachelor of Nursing students studying at one Australian University completed the online survey. Results showed that third-year students reported higher levels of mental health literacy compared to first- and second-year students. Almost 40% of students felt they did not have sufficient understanding of mental health literacy for practice. Most respondents (66.7%) wanted more information on different types of mental illnesses, treatments, how to reduce mental health stigma, and how to care for and communicate with people with mental illness. Students identified that mental health first aid training should be compulsory for all nursing students. Mental health literacy is a crucial area to be addressed in undergraduate nursing education. Explicit content and skill development are required to improve students' awareness of health literacy and inform their practice.

The modules of mental health programs implemented in schools in low- and middle-income countries: findings from a systematic literature review.

BACKGROUND: Secondary schools in low- and middle-income countries (LMICs) provide health promotion, preventive, and early intervention services. Nevertheless, literature indicates that the modules of these services are either adapted or modified from existing mental health programs in developed countries. The literature also highlights the provision of non-comprehensive services (mental health promotion, prevention, and early intervention), in LMICs. These findings inform the need for undertaking this systematic literature review. The aim of this review was thus to identify the modules of school-based mental health programs (SBMHP) that have been implemented in LMICs to guide the development of a culturally sensitive comprehensive mental health program for adolescents in a LMIC country. METHODS: The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was used to guide this review. The following databases were searched in September 2018, to identify the relevant literature: PubMed, CINAHL, Scopus, Web of Science, PsycINFO, and ERIC. The search was conducted by the first author and reviewed by the authors. RESULTS: Following the screening process, a total of 11 papers were identified and reviewed for quality. The systematic review highlighted that the mental health programs provided in schools included: an introduction module, a communication and relationship module, a psychoeducation module, a cognitive skills module, a behavioral skills module, establishing social networks for recovery and help seeking behavioral activities and a summary/conclusion module. CONCLUSION: This review sheds light on the characteristics of the programs in LMICs. Two programs were found to be universal in nature. Five programs were directed at key risk factors or at-risk groups, and four were early intervention programs. The review also revealed that only one program out of the 11 programs included modules for parents. The synthesis indicated that all the identified programs were adapted or modified from existing programs. The dearth of comprehensive programs in LMICs was also revealed. Lastly, the review revealed seven modules that can be useful for developing a SBMHP.

'We don't see because we don't ask': Qualitative exploration of service users' and health professionals' views regarding a psychosocial intervention targeting pregnant women experiencing domestic and family violence.

INTRODUCTION: Given the relative recency of Domestic and Family Violence (DFV) management as a field of endeavour, it is not surprising that interventions for addressing DFV is still in its infancy in developing countries. In order to maximise the success of an intervention, it is important to know which aspects of the intervention are considered important and helpful by service providers and service users. This study, therefore, examined the acceptability of an antenatal-based psychosocial intervention targeting DFV in Nepal and explored suggestions for improving the program in future. MATERIALS AND METHODS: Intervention participants and health care providers (HCPs) were interviewed using semi-structured interviews. Data were audio-recorded and thematic analysis was used to analyse the data. Final codes and themes were identified using an iterative review process among the research team. RESULTS: Themes emerging from the data were grouped into domains including perceptions towards DFV, impact of the intervention on women's lives and recommendations for improving the program. DFV was recognised as a significant problem requiring urgent attention for its prevention and control. Intervention participants expressed that they felt safe to share their feelings during the counselling session and got opportunity to learn new skills to cope with DFV. The majority of the participants recommended multiple counselling sessions and a continued provision of the service ensuring the intervention's accessibility by a large number of women. DISCUSSION: This is the first study to document the perspectives of women and HCPs regarding an antenatal-based intervention targeting psychosocial consequences of DFV in Nepal. There was a clear consensus around the need to engage, support and empower victims of DFV and the intervention was well received by the participants. Ensuring good mental health and wellbeing among victims of DFV requires work across individual, organisational and community levels.

Development and Validation of an Information Booklet Aimed at Promoting Mental Health for Pregnant Women with a History of Abuse.

BACKGROUND: Mental health needs of victims of domestic and family violence are often overlooked. A booklet was designed to help women update their knowledge and skills in effective coping with domestic and family violence and support them in developing effective stress reduction and problem management techniques. In addition, this booklet is believed to serve as a reference for further use. This paper describes the development process and validation of the information booklet. This booklet was used during an intervention trial conducted in Nepal to educate abused pregnant women. METHODS: This methodological study involved three stages: bibliographical survey, development of the booklet, and validation by specialists in the relevant fields and representatives of the target audiences. A total of eight experts, currently working in the field of domestic violence and/or midwifery, and 15 representatives of the target participants were involved in the validation process. A minimum Content Validity Index of 0.78 was considered for content validation, and minimum agreement of 75% for face validation. RESULTS: The booklet presented a global Content Validity Index of 0.92. The overall level of agreement within the target participants was 86.3%, which was higher than the minimum recommended level. Both subject experts and participants positively evaluated the adequacy, coverage and readability of contents of the booklet. CONCLUSIONS: The booklet was validated using content and face validity. This validated booklet is expected to be an effective tool for communication that would help pregnant women cope better with domestic and family violence and adopt strategies to remain emotionally healthy.

Association between dietary patterns and sociodemographics: A cross-sectional study of Australian nursing students.

Lack of time, financial issues, and stressful clinical and educational environments in nursing studies promote higher intakes of convenience and fast foods loaded with fat and sugar, which are linked to reduced mental and physical health. In this study, we examined the dietary patterns of nursing students and their associated sociodemographic factors to inform the development of future health-promotion interventions. A total of 548 Bachelor of Nursing students were invited to complete a survey. Associations were explored using χ2 and logistic regression. Three dietary patterns were identified: healthy (fruit, vegetables, and legumes), Western (loaded with fat, sugar, and salt), and unbalanced. Only 21% of participants were classified as following a healthy dietary pattern, and more likely to be older (>35 years old) and have a personal annual income between $AUD20 000-$59 999 and $60 000-$99 999. Students with one to two and three or more children were more likely to follow a Western dietary pattern. There is a need to develop interventions to improve the dietary behaviors of nursing students by health-promoting activities and the provision of online health resources.

Interventions for reducing and/or controlling domestic violence among pregnant women in low- and middle-income countries: a systematic review.

BACKGROUND: Domestic violence (DV) during pregnancy is recognized as a global health problem associated with serious health consequences for both the mother and her baby. Several interventions aimed at addressing DV around the time of pregnancy have been developed in the last decade, but they are primarily from developed countries. Low- and middle-income countries (LMICs) are facing both a mounting burden of DV as well as severe resource constraints that keep them from emulating some of the effective interventions implemented in developed settings. A systematic review was conducted to examine the approaches and effects of interventions designed for reducing or controlling DV among pregnant women in LMICs. METHODS: Electronic databases were systematically searched, and the search was augmented by bibliographic reviews and expert consultations. Two reviewers assessed eligibility and quality of the studies and extracted data independently. The third reviewer was involved to resolve any discrepancies between the reviewers. Due to the limited number of studies and varied outcomes, a meta-analysis was not possible. Primary outcomes of this review included frequency and/or severity of DV and secondary outcomes included mental health, safety behaviours, and use of community resources. In addition, findings from the critical appraisal of studies were utilised to inform the initial draft of Theory of Change (ToC). RESULTS: Only five studies (two randomized trials and three non-randomized trials) met the eligibility criteria. The interventions consisting of supportive counselling demonstrated a reduction in DV and an improvement in use of safety behaviours. One study has embedded the DV intervention into an existing program on human immunodeficiency virus (HIV). Limited evidence could be drawn for outcomes such as quality of life and the use of community resources. DISCUSSION: This review attempted to address the knowledge gap by collating evidence on interventions aimed at addressing DV among pregnant women in LMICs. The development of a ToC was critical in understanding how certain activities led to the desired outcomes. This ToC can guide the design of future research and development of practice guidelines. The participatory involvement of the stakeholders is recommended to refine the current ToC to support its further development for practice. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42017073938.

Counselling-based psychosocial intervention to improve the mental health of abused pregnant women: a protocol for randomised controlled feasibility trial in a tertiary hospital in eastern Nepal.

INTRODUCTION: The strong correlation between domestic and family violence (DFV) and mental health has been well documented in studies. Pregnancy is a period when both DFV and mental distress tend to occur and/or accentuate. Although limited, available evidence from developed countries has shown continual support and education as psychological first aid that can reduce DFV and improve mental health. However, there is significantly less number of studies from resource-constrained countries; thus, there continues to be a substantial gap in knowledge and awareness regarding effective interventions for DFV. METHODS AND ANALYSIS: A two-arm randomised trial with a nested qualitative study has been planned to assess feasibility and treatment effect estimates of a counselling-based psychosocial intervention among pregnant women with a history of abuse. A total of 140 pregnant women who meet the inclusion criteria will be recruited into the study. Block randomisation will be used to allocate women equally into two groups. The intervention group will receive a counselling session, an information booklet and continuous support by a researcher, while women in the control group will receive contact information of local support services. Feasibility measures, such as rates of recruitment, consent and retention, will be calculated. Qualitative interviews with participants and healthcare providers will explore the acceptability and usability of the intervention. Outcome measures, such as psychological distress, quality of life, social support and self-efficacy, will be measured at baseline, 4 weeks postintervention and 6 weeks postpartum. ETHICS AND DISSEMINATION: This study has obtained ethical approval from the Griffith University Human Research Ethics Committee, the Nepal Health Research Council and the Institutional Review Board of a tertiary hospital in Dharan, Nepal. The findings will be disseminated via peer-reviewed publications and conference presentations and will be used to inform a future multicentre trial. TRIAL REGISTRATION NUMBER: 12618000307202; Pre-results.

Longitudinal evaluation of a training program to promote routine antenatal enquiry for domestic violence by midwives.

BACKGROUND: Routine enquiry about domestic violence during pregnancy is accepted best practice. Training is essential to improve knowledge and practice. Few studies have undertaken a comprehensive evaluation of training impact over time. AIM: To evaluate the longitudinal impact of a domestic violence training and support program to promote midwives' routine antenatal enquiry for domestic violence using a mixed methods design. METHOD: Data sources included (1) surveys of midwives at 6 months post-training, (2) interviews with key stakeholders at 12 months, (3) chart audit data of screening, risk, and disclosure rates (for 16 months). Measures included midwives' knowledge, preparation for routine enquiry, knowledge of domestic violence and perceptions of impact of the training and support for practice change. FINDINGS: Forty (out of 83) participant surveys could be matched and responses compared to baseline and post-training scores. Wilcoxon signed-rank test identified that all 6-month follow-up scores were significantly higher than those at baseline. Level of preparedness increased from 42.3 to 51.05 (Z=4.88, p<.001); and knowledge scores increased from a mean of 21.15 to 24.65 (Z=4.9, p<.001). Most participants (>90%) reported improved confidence to undertake routine inquiry. A chart audit of screening rates revealed that of the 6671 women presenting for antenatal care, nearly 90% were screened. Disclosure of domestic violence was low (<2%) with most women at risk or experiencing violence declining referral. CONCLUSIONS: Training, support processes, and referral pathways, contributed to midwives' sustained preparedness and knowledge to conduct routine enquiry and support women disclosing domestic violence.

Effectiveness of training to promote routine enquiry for domestic violence by midwives and nurses: A pre-post evaluation study.

BACKGROUND: Asking women about experiences of domestic violence in the perinatal period is accepted best practice. However, midwives and nurses may be reluctant to engage with, or effectively respond to disclosures of domestic violence due a lack of knowledge and skills. AIM: To evaluate the impact of training on knowledge and preparedness of midwives and nurses to conduct routine enquiry about domestic violence with women during the perinatal period. METHOD: A pre-post intervention design was used. Midwives and nurses (n=154) attended a full day workshop. Of these, 149 completed pre-post workshop measures of knowledge and preparedness. Additional questions at post-training explored participants' perceptions of organisational barriers to routine enquiry, as well as anticipated impact of training on their practice. Training occurred between July 2015 and October 2016. FINDINGS: Using the Wilcoxon signed-rank test, all post intervention scores were significantly higher than pre intervention scores. Knowledge scores increased from a pre-training mean of 21.5-25.6 (Z=-9.56, p<0.001) and level of preparedness increased from 40.8 to 53.2 (Z=-10.12, p<0.001). Most participants (93%) reported improved preparedness to undertake routine enquiry after training. Only a quarter (24.9%) felt their workplace allowed adequate time to respond to disclosures of DV. CONCLUSIONS: Brief training can improve knowledge, preparedness, and confidence of midwives and nurses to conduct routine enquiry and support women during the perinatal period. Training can assist midwives and nurses to recognise signs of DV, ask women about what would be helpful to them, and address perceived organisational barriers to routine enquiry. Practice guidelines and clear referral pathways following DV disclosure need to be implemented to support gains made through training.

Interventions for domestic violence among pregnant women in low- and middle-income countries: a systematic review protocol.

BACKGROUND: Violence during pregnancy is a global problem, associated with serious health risks for both the mother and baby. Evaluation of interventions targeted for reducing or controlling domestic violence (DV) is still in its infancy, and the majority of findings are primarily from high-income countries (HICs). Therefore, there is an urgent need for generating evidence of DV interventions among pregnant women in low- and middle-income countries (LMICs). METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines will be employed to structure the review. A comprehensive search will be carried out via electronic databases including MEDLINE, CINAHL, Scopus, Embase, Web of Science, PsycINFO, and The Cochrane library. Gray literature will also be scrutinized for potential articles. An optimal search strategy has been developed following consultations with subject-matter experts and librarians. This search strategy will be adapted to the different databases. Experimental studies evaluating DV interventions among pregnant women from LMICs will be included in the review. The review will only include literature written in English. Two reviewers will independently screen and assess studies for inclusion in the review. A third author will resolve any discrepancies between the reviewers. Risk of bias will be assessed based on the Cochrane risk of bias assessment tool, and overall quality of the evidence will be judged using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. Findings will be presented with the narrative synthesis, and if applicable, they will be further quantified using random-effects meta-analysis. Effect size, risk ratio for dichotomous variables, and standardized mean differences for continuous variables will be calculated for each outcome using Review Manager 5.3. DISCUSSION: Systematic reviews to evaluate the efficacy of interventions to address DV within the perinatal context have been limited. Hence, no one intervention has emerged as substantially effective towards addressing perinatal DV and associated health consequences. The evidence generated from this systematic review will inform researchers and policy makers about the effectiveness of existing DV interventions among pregnant women in LMICs and provide recommendations for future research in this area. This in turn will contribute towards violence prevention in LMICs. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017073938.

Midwives' experiences of routine enquiry for intimate partner violence in pregnancy.

BACKGROUND: Reducing violence against women is a national public health priority in Australia. Routine antenatal intimate partner violence screening by a skilled midwife is essential for assessment, support and appropriate referral, but can be challenging to implement. AIM: To explore midwives' experiences of routine enquiry, perceptions of facilitators and barriers, and suggested strategies to improve practice. METHOD: A qualitative descriptive design was used. Participants were recruited from an e-mail bulletin by the Australian College of Midwives. In-depth telephone interviews were conducted with 21 midwives. Data were analysed using an inductive thematic analysis approach. FINDINGS: Three themes were identified: The first theme; Asking the Question incorporated the belief that whilst asking women about intimate partner violence were within the role of the midwife, participants felt unsupported and unprepared. The second theme; The big fear factor represented concerns around positive disclosures of intimate partner violence, including a sense of responsibility, worries about encouraging women to disclose without clear processes and resources to support them. The third theme; Building a relationship incorporated the importance of continuity of care, trust and rapport-building. Continuity of care was identified as a positive enabler for routine enquiry. A perceived lack of support, time pressures, and presence of a partner at appointments were all considered barriers to routine enquiry. CONCLUSION: Routine enquiry about IPV is a valuable and important midwifery role. Midwives described frustration and fear when women disclosed violence. The perceived level of support from health services varied according to practice contexts and needs to be improved.

An exploration of Australian midwives' knowledge of intimate partner violence against women during pregnancy.

BACKGROUND: Intimate partner violence is recognised as a global public health issue. Living with intimate partner violence results in poorer health status with reduced quality of life and higher utilisation of health services. Increased awareness, education and training, and an understanding of multi-agency collaboration are vital in order for health practitioners to respond to women experiencing partner violence and abuse. Midwives are well placed to identify, provide immediate support, and refer women onto appropriate support agencies but may lack appropriate education, training or support. AIM: To investigate midwives' knowledge of intimate partner violence against women during pregnancy. METHODS: An online survey link was distributed through the Australian College of Midwives. The survey included personal, professional and practice details, and 25 questions that tested knowledge about intimate partner violence. FINDINGS: 152 midwives completed the online questionnaire. Knowledge scores ranged from 27 to 48 (out of a possible 50), with the mean total score of 42.8 (SD=3.3). Although 60% of participants scored 48, two-thirds did not know about the risks and signs of intimate partner violence. One-third of the midwives did not know about age risks associated with intimate partner violence. Around 25% incorrectly believed that perpetrators are violent because of alcohol or drug use. Nearly 90% (88%) of participants had some education or training about intimate partner violence. Those with some training achieved higher knowledge scores than those with no formal training (Mann-Whitney U=1272, p=0.003). CONCLUSION: Participating midwives generally reported a high level of knowledge about intimate partner violence but held misconceptions about risks and characteristics of perpetrators of violence. These knowledge gaps may adversely affect their ability to identify women at risk of violence. Education about intimate partner violence was associated with improved knowledge. Future training and education on intimate partner violence should target identified knowledge gaps.

Effect of intimate partner violence on antenatal functional health status of childbearing women in Northeastern Thailand.

We investigated the effects of physical, psychological, and sexual violence on the health status of women attending antenatal clinics at two tertiary hospitals in rural Thailand. We asked 421 pregnant women at 32 weeks gestation or later to complete a survey questionnaire. Participants reported high rates of psychological abuse (53.7%); threats, acts of physical abuse, or both (26.6%); and sexual violence (19.2%). Women abused during pregnancy had poorer health compared with nonabused women, in role emotional functioning, vitality, bodily pain, mental health, and social functioning. Given the high prevalence of violence and poor health status, routine screenings by maternity services is urgently required.

Effect of intimate partner violence on postpartum women's health in northeastern Thailand.

In the present study, we investigated the prevalence of psychological, physical, and sexual violence perpetrated by an intimate partner, and the effects on health status of postpartum women who gave birth at two tertiary hospitals in northeastern Thailand. Participants were recruited during pregnancy and interviewed at 6 weeks' postpartum. Measures included the Short Form 12-Item Health Survey, Psychological Maltreatment of Women Inventory, and Severity of Violence against Women scale. Participants reported high rates of psychological abuse, threats and/or acts of physical abuse, and sexual violence. Abused postpartum women had lower well-being than non-abused women on all Short Form 12-Item Health Survey subscales, except the general health subscale. These women also had significant poorer health compared to non-abused women, in social functioning and mental health. The study findings suggest that routine screening for intimate partner violence by maternity services is urgently needed.