Obuvumu: Improving Health Service Uptake for Survivors of Sexual Violence

项目摘要 在乌干达，大量妇女遭受性暴力，其中包括来自亲密关系的暴力。 和非亲密伴侣对去年暴力事件的研究表明，四分之三的女性 暴露于至少一种类型的SV：四分之一的人是性胁迫的受害者，四分之一的人有 经历过强迫性行为经历SV对身心健康有有害影响，包括： 意外怀孕，身体伤害，危险行为，性冒险行为，使妇女暴露于 性传播感染、慢性压力、抑郁、自尊心低和缺乏对 生殖选择。SV的负面影响可以通过提供及时和有效的卫生服务来减轻。 针对伤害管理和心理支持的有效干预措施。然而，保健服务 在乌干达和撒哈拉以南非洲（SSA）的大部分地区，SV的受害者都没有得到充分利用， 10名患有SV的女性中有1人从未寻求护理。许多因素导致健康摄取有限 在乌干达和撒南非洲其他地方为性传播疾病幸存者提供的服务，包括心理、文化、经济和 其他因素，如恐惧和耻辱。此外，为受害者提供的保健服务往往缺乏足够合格的工作人员 和医疗用品，保密性无法得到保证。在得不到及时有效治疗的情况下， 高SV发病率在人口水平上导致严重的心理和身体后果， 影响未来社会经济发展。因此，迫切需要进行研究， 产生可用于改善SV幸存者的卫生服务利用的知识。拟议 Obuvumu（在乌干达当地语言卢甘达语中的意思是“勇气”）在乌干达的研究创新， 通过以下具体目标满足这一需求：目标1：进行形成性定性研究， 为离散选择实验（DCE）提供信息，该实验将产生关于卫生服务系统信息 乌干达SV女性幸存者的使用情况;目标2：使用DCE方法，评估 影响妇女在经历性暴力后寻求服务的决定;目标3：根据调查结果 从DCE，应用以用户为中心的设计原则，共同设计干预措施，解决障碍， 目标1和2中确定的优先事项。如有必要，R34的结果将用于通知R 01 应用程序来测试干预。最终，研究结果可能有助于为提高肥胖率的努力提供信息。 报告性传播疾病，并改善妇女的生殖健康、心理健康和相关健康结果， 乌干达，更广泛地说，在撒哈拉以南非洲的低资源国家和其他SV发病率高的地区。 与此相关，拟议研究的长期目标是为文化的未来发展提供信息， 采取适当、可行、可接受和有效的干预措施，提高妇女的卫生服务利用率 SV的幸存者

PROJECT SUMMARY High numbers of women experience sexual violence (SV) in Uganda, and this includes violence from intimate and non-intimate partners. Studies of past year violence have revealed that three out of four females were exposed to at least one type of SV: one out of four are victims of sexual coercion, and one out of four have experienced forced sex. Experiencing SV has harmful effects on physical and mental health including: unwanted pregnancy, physical injury, risky behaviors, sexual risk-taking behaviors exposing women to sexually-transmitted infections, chronic stress, depression, low self-esteem and lack of control over reproductive choices. The negative impacts of SV can be mitigated by health services providing timely and effective interventions that target injury management and psychological support. However, health services for victims of SV in Uganda, and much of sub-Saharan Africa (SSA), are vastly underutilized to the extent that nine out of 10 females who experience SV never seek care. Many factors contribute to limited uptake of health services in Uganda and elsewhere in SSA for SV survivors, including psychological, cultural, economic, and other factors, such as fear and stigma. Further, health services for victims often lack sufficiently qualified staff and medical supplies, and confidentiality cannot be ensured. In the absence of timely and effective treatment, high rates of SV result in serious psychological and physical consequences at a population level and compromise future social and economic development. Thus, there is a strong need for research that will generate knowledge that may be used to improve health service utilization for survivors of SV. The proposed Obuvumu (meaning “courage” in Luganda – a local Ugandan language) study in Uganda innovates and addresses this need through the following specific aims: Aim 1: Conduct formative qualitative research to inform a discrete choice experiment (DCE) that will generate systematic information on health service utilization for female survivors of SV in Uganda; Aim 2: Using a DCE approach, assess the factors that influence women’s decisions to seek services after experiencing SV among; and Aim 3: Based on findings from the DCE, apply user-centered design principles to co-design an intervention that addresses barriers and preferences identified in Aims 1 and 2. If warranted, findings from this R34 will be used to inform an R01 application to test the intervention. Ultimately, study findings may help inform efforts to increase rates of reporting SV, and improve reproductive health, mental health and related health outcomes for women in Uganda, and more broadly in low-resource countries in SSA and other regions where rates of SV are high. Relatedly, the long-term goal of the proposed research is to inform the future development of culturally appropriate, feasible, acceptable and effective interventions to increase health service utilization among female survivors of SV.