Washington University in St Louis George Warren Brown School of Social Work, St Louis, Missouri, USA
University of Michigan, Ann Arbor, Michigan, USA.
BMJ Open. 2024 Aug 6;14(8):e081663. doi: 10.1136/bmjopen-2023-081663.
Sexual violence is a significant public health concern with severe physical, social and psychological consequences, which can be mitigated by health service utilisation. However, in Uganda and much of sub-Saharan Africa, these services are significantly underused, with 9 out of 10 survivors not seeking care due to a range of psychological, cultural, economic and logistical factors. Thus, there is a strong need for research to improve health service utilisation for survivors of sexual violence.
The proposed study seeks to address the underutilization of health services for female survivors of sexual violence using a discrete choice experiment (DCE). The study will be conducted in the greater Masaka region of southwestern Uganda and target adult female survivors of sexual violence. We will first undertake qualitative interviews with 56 survivors of sexual violence to identify the key attributes and levels of the DCE. In order to ensure a sufficiently powered sample, 312 women who meet inclusion criteria will be interviewed. Our primary analysis will employ a mixed (random parameters) logit model. We will also model the role of individual-specific characteristics through latent class models.
The study protocol was reviewed and approved by the following ethics review boards in Uganda and the USA: the Uganda Virus Research Institute (UVRI), the Uganda National Council for Science and Technology (HS2364ES), Washington University in St Louis and the University of Michigan. Our methods conform to established guidelines for the protection of human subjects involved in research. Our dissemination plan targets a broad audience, ranging from policymakers and government agencies to healthcare providers, academic communities and survivors themselves.
性暴力是一个严重的公共卫生问题，会对身体、社会和心理造成严重影响，但可以通过利用卫生服务来减轻其影响。然而，在乌干达和撒哈拉以南非洲的大部分地区，这些服务的利用率非常低，十分之九的幸存者由于一系列心理、文化、经济和后勤因素而不寻求护理。因此，非常有必要开展研究，以提高性暴力幸存者对卫生服务的利用。
拟议的研究旨在通过离散选择实验（DCE）解决性暴力女性幸存者对卫生服务的利用不足问题。该研究将在乌干达西南部的大马萨卡地区进行，目标是性暴力的成年女性幸存者。我们将首先对 56 名性暴力幸存者进行定性访谈，以确定 DCE 的关键属性和水平。为了确保有足够的样本量，将对 312 名符合纳入标准的女性进行访谈。我们的主要分析将采用混合（随机参数）对数模型。我们还将通过潜在类别模型来模拟个体特定特征的作用。
该研究方案已在乌干达和美国的以下伦理审查委员会进行了审查和批准：乌干达病毒研究所（UVRI）、乌干达国家科学技术委员会（HS2364ES）、圣路易斯华盛顿大学和密歇根大学。我们的方法符合涉及研究对象的人类受试者保护的既定准则。我们的传播计划针对广泛的受众，包括政策制定者和政府机构、医疗保健提供者、学术团体和幸存者本身。
