Preventing violence against women in high-prevalence settings: A multidisciplinary approach from psychology, political science and global health

根据世界卫生组织（世卫组织，2013年），暴力侵害妇女行为在世界许多地方是一种流行病，对妇女的身心健康造成严重影响。在世界上发病率最高的环境中，十分之八的妇女在其一生中会遭受亲密伴侣或陌生人的身体暴力或性暴力（世卫组织，2005年，2013年）。这是一个巨大的健康和人权问题，但我们对如何解决这个问题知之甚少。拟议的研究方案借鉴了我在预防暴力侵害妇女行为的最高流行率设置的专业知识，通过30多个同行评审的出版物和越来越大的赠款在阿富汗，伊拉克，卢旺达和亚马逊地区的项目开发。高流行率环境（超过50%的妇女遭受暴力）对预防暴力提出了独特的挑战：暴力被广泛认为是正常的男人和女人（Tran等人，2016年），寻求帮助的人经常经历耻辱，歧视和来自家庭，社区成员，警察和卫生专业人员的进一步暴力（Odero等人，2014年），卫生系统对暴力侵害妇女问题的应对措施基本上不存在（Garcia-Moreno等人，2015年）。该研究方案与萨摩亚和秘鲁的土著社区合作，为如何在高发生率环境中预防暴力建立证据基础。通过与当地组织建立良好的伙伴关系，我将与这两种环境中的社区成员、领导人和当地代表合作，调整衡量暴力侵害妇女行为的创新工具，并为如何适当和敏感地研究暴力行为制定道德准则。然后，我将创建一个关于如何让高流行率社区参与减少暴力侵害妇女行为的变革理论。研究的这些初始阶段最终导致与当地社区合作，利用变革理论和道德准则，共同制定预防暴力侵害妇女行为的干预措施，然后使用最高标准的评价方法测试干预措施的有效性，以便有可能在世界各地其他高发社区推广干预措施。这是一个真正的多学科项目，需要整合来自心理学，政治学和全球卫生流行病学的技能和方法才能有效。为了实现这一目标，我将利用我在性别社会学（博士），社区心理学，（硕士，博士后），人文（BA），并补充这与指导从世界领先的专家在过程跟踪方法从政治学（杰里米·希夫曼教授，JHU），暴力侵害妇女预防干预措施（教授大卫奥斯林，伦敦大学学院），并在全球卫生社区干预措施的评估（安德鲁科帕斯博士，伦敦大学学院）在流行病学，统计学和研究领导的培训。研究的每个阶段都将包括秘鲁和萨摩亚之间的知识交流活动，以建设当地的研究能力，并与亚洲、南美洲和联合王国从事高发生率环境下预防暴力工作的学者建立联系。知识交流活动、国际咨询委员会和公众参与将提供一种手段，将当地行为者与我过去合作过的全球组织联系起来，包括性暴力研究倡议（SVRI）、南非MRC的性别和健康研究单位、联合国妇女署和世界银行。在短期内，这项研究有可能通过减少萨摩亚和秘鲁妇女遭受的暴力行为来改善她们的生活。从长远来看，开发新的工具、理论框架和干预措施，以防止在高发生率环境中暴力侵害妇女行为，有可能改善世界各地类似环境中妇女的生活。

According to the World Health Organisation (WHO, 2013), violence against women (VAW) is a pandemic in many parts of the world with severe implications for women's physical and mental health. In the world's highest prevalence settings, eight out of ten women will experience physical or sexual violence from an intimate partner or stranger in their lifetime (WHO 2005, 2013). This is an enormous health and human rights issue, and yet we know very little about how it should be addressed. The proposed research programme draws on my specialisation in preventing violence against women for the highest prevalence settings, developed through over 30 peer-reviewed publications and increasingly large grants for projects in Afghanistan, Iraq, Rwanda, and the Amazon. High prevalence settings (where over 50% of women experience violence) present unique challenges for violence prevention: violence is widely accepted as normal by both men and women (Tran et al. 2016), those seeking help frequently experience stigma, discrimination, and further violence from family, community members, police and health professionals (Odero et al. 2014), and evidence of health system responses to VAW are largely non-existent (Garcia-Moreno et al., 2015). This research programme works in partnership with indigenous communities in Samoa and Peru to build an evidence base for how to prevent violence in high prevalence settings. Through well-established partnerships with local organisations, I will work with community members, leaders and local representatives in both settings to adapt innovative tools for measuring violence against women and establish ethical guidelines for how to research violence appropriately and sensitively. I will then create a theory of change for how to engage high-prevalence communities in reducing violence against women. These initial stages of the research culminate in the co-creation of an intervention to prevent violence against women in partnership with local communities that draws on the theory of change and ethical guidelines, followed by testing the effectiveness of the intervention using the highest standards of evaluation methodologies so that the intervention can potentially be rolled out in other high-prevalence communities around the world. This is a truly multidisciplinary project that requires an integration of skills and methods from across psychology, political science and global health epidemiology to be effective. To achieve this, I will draw on my unique background in the sociology of gender (PhD), community psychology (MSc, post-doc), and humanities (BA), and complement this with mentoring from the world's leading experts in process tracing methods from political science (Prof Jeremy Shiffman, JHU), VAW prevention interventions (Prof David Osrin, UCL), and the evaluation of community interventions in global health (Dr Andrew Copas, UCL) alongside training in epidemiology, statistics, and research leadership. Each stage of the research will include a knowledge-exchange activity between Peru and Samoa to build local research capacity and establish connections with scholars working on violence prevention in high-prevalence settings across Asia, South America and in the UK. Knowledge-exchange activities, an international advisory committee and public enagement will provide a means of linking local actors with global organisations I have worked with in the past including the Sexual Violence Research Initiative (SVRI), the South African MRC's Gender and Health Research Unit, UN Women, and the World Bank. In the short-term, the research has the potential to improve women's lives in Samoa and Peru by reducing the violence they experience. For the longer-term future, the development of new tools, theoretical frameworks and an intervention to prevent violence against women in high-prevalence settings has the potential to improve women's lives in similar settings all over the world.