The prevalence of violence among female health worker of Jeddah’s General Ministry of Health Hospital

i THE PREVALENCE OF VIOLENCE AMONG FEMALE HEALTH WORKER OF JEDDAH’S GENERAL MINISTRY OF HEALTH HOSPITAL DR HALA HATIM ALNOAMAN Mas e 's Disse a ion o ob ain he Mas e 's Deg ee in P ima y Ca e Men al Heal h NOVA Medical School | Faculdade de CiênciasMédicas No embe 2020 ii THE PREVALENCE OF VIOLENCE AMONG FEMALE HEALTH WORKER OF JEDDAH’S GENERAL MINISTRY OF HEALTH HOSPITAL S uden name: D Hala Ha im Alnoaman Supe iso s :P o esso Ben W igh P o esso Migue Xa ie Mas e 's Disse a ion o ob ain he Mas e 's Deg ee in P ima y Ca e Men al Heal h No embe 2020 iii The p e alence o Violence Among Female Heal h Wo ke o Jeddah's Gene al Minis y o Heal h Hospi al Copy igh ©DR HALA HATIM ALNOAMAN, Faculdade de Ciências e Tecnologia, Uni e si- dade No a de Lisboa A Faculdade de Ciências e Tecnologia e a Uni e sidade No a de Lisboa êm o di ei o, pe pé uo e sem limi es geog á icos, de a qui a e publica es a disse ação a a és de exempla es imp essos ep oduzidos em papel ou de o ma digi al, ou po qualque ou o meio conhecido ou que enha a se in en ado, e de a di ulga a a és de eposi ó ios cien í icos e de admi i a sua cópia e dis ibuição com objec i os educacionais ou de in es igação, não come ciais, desde que seja dado c édi o ao au o e edi o i DEDICATION I would like o dedica e his piece o wo k o all women who we e abused by hei pa ne . I is also dedica ed o my pa en s, my child en and husband o hei mo i a ion, encou agemen , lo e and suppo . ACKNOWLEDGEMENTS I am ex emely g a e ul o ALLAH almigh y he mos me ci ul, he mos g acious o gi ing me he s eng h o comple e his s udy success ully. Thanks o my supe iso P o esso Ben W igh and P o esso Miguel Xa ie o hei aluable ad ice and guidance h oughou he esea ch. I especially hank my pa en s, husband and my child en o hei suppo and help. i ABSTRACT This is a communi y-based c oss-sec ional s udy whe e he p e alence o domes ic iolence and i s associa ed ac o s we e de e mined. The aim o he s udy was o de e mine p e alence and epidemiology o domes ic iolence among emale heal h wo ke o Gene al Minis y o Heal h (MOH) Hospi al in Jeddah, Kingdom o Saudi A abia. A sel -adminis e ed ques ionnai e was he ool o he s udy. Simple andom sampling echnique was used o selec emale heal h wo ke s. All emale heal h wo ke s including physicians, nu ses, pha macis s, physio he apis s and lab echnicians om gene al MOH hospi als pa icipa ed in he s udy. The p e alence o iolence was 45.3 % among emale heal h wo ke s o gene al MOH hospi als. The Saudi na ionali y, di o ce, highe mon hly income, suppo ing hei amilies inancially, sha ing child en expendi u e wi h hei pa ne s and using polygamy we e ound o be associa ed wi h domes ic iolence. The s udy concluded ha domes ic iolence was ound o be high in he s udy popula ion and was associa ed wi h se e al ac o s. Key wo d:Domes ic Violence ,Female Heal h wo ke ,Epidemology,polygamy ii CONTENTS Subjec Page No Acknowledgmen …………………………………………………. Abs ac …………………………………………………............... i Con en s……………………………………………………………... ii Lis o igu es………………………………………………………. xi Lis o Tables………………………………………………………. xii Lis o abb e ia ions………………………………………………… x i CAHPTER 1: INTRODUCTION ………………………………….. 1 1.1 BACKGROUND……………………………………………… 1 1.2 Ra ionale………………………………………………………. 4 1.3 Aim o he s udy……………………………………………….. 4 1.4 Objec i es………………………………………………………. 4 CHAPTER 2 :Li e a u e e iew…………………………………… 5 2.1 INTRODUCTION…………………………………………….. 5 2.2 De ini ions…………………………………………………… 5 2.3 P e alence…………………………………………………… 6 2.3.1 In e na ional iew……………………………………… 6 2.3.2 Regional s udies………………………………………… 10 2.3.3 Local s udies…………………………………………… 12 CHAPTER 3: Me hodology……………………………………… 14 iii 3.1 S udy a ea…………………………………………………. 14 3.2 S udy Desc ip ion………………………………………….. 15 3.2.1 S udy design……………………………………………… 15 3.2.2 S udy popula ion…………………………………………… 15 3.2.3 Inclusion c i e ia & Exclusion c i e ia…………………….. 15 3.2.4 Va iables…………………………………………………… 15 3.2.5 Sampling…………………………………………………… 16 3.2.5.1 Sample size………………………………………… 16 3.2.5.2 Sampling echniques…………………………………… 16 3.3. Me hod o da a collec ion…………………………………… 17 3.3.1 Da a collec ion ool and echnique………………………… 17 3.3.2 Da a en y and analysis………………………………… 19 3.4 Pilo s udy…………………………………………………… 19 3.5 E hical conside a ion……………………………………….. 20 CHAPTER 4: RESULTS ………………….………………………… 21 4.1. RESPONSE RATE…………………………………………… .21 4.1.1. Cha ac e is ics o he s udy g oup………………………………22 4.2. P e lence o exposu e o domes ic iolence abuse:…………………………………………………………… 25 4.2.1. PREVALENCE OF ABUSIVE VIOLENCE IN FEMALE HEALTH WORKERS………………………………………………………… 25 ix 4.2.2. Exposu e o domes ic iolence abuse……………………………. 26 4.3. Fac o s associa ed wi h domes ic iolence o emale heal h wo ke s ………………………………………………………………………..… 45 4.3.1. P e alence o domes ic iolence by emale heal h wo ke ’s age….45 4.3.2. P e alence o domes ic iolence by emale heal h wo ke ’s na ionali y……………………………………………………….. ………45 4.3.3. P e alence o domes ic iolence by pa ne ’s age………………. ..47 4.3.4. P e alence o domes ic iolence by pa ne ’s na ionali y………….47 4.4. Epidemiology o domes ic iolence ………………………….……..49 4.4.1. Ma i al s a us……………………………………………………….49 4.4.2. Female heal h wo k’s educa ion…………………………………...53 4.4.3. Financial s a us……………………………………………………54 4.4.3.1. FHW income…………………………………………………….54 4.4.3.2. FHW and suppo ing hei amilies inancially…………………56 4.4.3.3. FHW and sha ing pa ne in house and child en expendi u e….58 4.4.3.4. Pa ne income………………………………………………….60 4.4.4. Polygamy…………………………………………………………61 4.4.5. Rela ionship be ween domes ic iolence and smoking pa ne ….62 4.4.6. Rela ionship be ween domes ic iolence and use o d ug………63 CHAPTER 5 : CONCLUSION AND RECOMMENDATION………...65 5.1 CONCLUSION…………………………………………………….65 2 incidence and p e alence. UILNo socie y can claim o be ee o such iolence, he only a ia ion is in he pa e ns and ends ha exis in coun ies and egions (3). Women a e much mo e likely han men o be ic imized by a cu en o o me in ima e pa ne . In 2008 he Cen e s o Disease Con ol and P e en ion published da a collec ed in 2005 and epo ed ha women expe ience wo million inju ies om in ima e pa ne iolence each yea (4). The Uni ed Na ions De elopmen Fund (UNDF) o Women es ima es ha a leas one in h ee women globally will be bea en, aped o o he wise abused du ing he li e ime. In mos cases, he abuse is a membe o he own amily (5). On a e age mo e han h ee women a day a e mu de ed by hei husbands o boy iends in he Uni ed S a es. In 2005, 1,181 women we e mu de ed by an in ima e pa ne (6). A 2005 Wo ld Heal h O ganiza ion (WHO) s udy ound ha o 15 si es in en coun ies – ep esen ing di e se cul u al se ings – he p opo ion o e e -pa ne ed women who had expe ienced physical o sexual in ima e pa ne iolence in hei li e imes anged om 15 pe cen in Japan o 71 pe cen in E hiopia (7). The Uni ed Na ions (UN) de ines iolence agains women as any ac o gende -based iolence ha esul s in, o is likely o esul in physical, sexual o men al ha m o su e ing o women, including h ea s o such ac s, coe cion o a bi a y dep i a ion o libe y, whe he occu ing in public o in p i a e li e (2). Heal h consequences can esul di ec ly om iolen ac s o om he long- e m e ec s o iolence. 3 Inju ies: Physical and sexual abuse by a pa ne a e closely associa ed wi h inju ies. Violence by an in ima e pa ne is he leading cause o non- a al inju ies o women in he USA. Dea hs om iolence agains women include hono killings (by amilies o cul u al easons); suicide; emale in an icide (mu de o in an gi ls); and ma e nal dea h om unsa e abo ion. Sexual and ep oduc i e heal h: Violence agains women is associa ed wi h sexually ansmi ed in ec ions such as HIV unin ended p egnancies, gynecological p oblems, induced abo ions, and ad e se p egnancy ou comes, including misca iage, low bi h weigh and e al dea h. Risky beha io s: Sexual abuse as a child is associa ed wi h highe a es o sexual isk- aking (such as i s sex a an ea ly age, mul iple pa ne s and unp o ec ed sex), subs ance use, and addi ional ic imiza ion. Each o hese beha io s inc eases isks o heal h p oblems. Men al heal h: Violence and abuse inc ease isk o dep ession, pos - auma ic s ess diso de , sleep di icul ies, ea ing diso de s and emo ional dis ess. Physical heal h: Abuse can esul in many heal h p oblems, including headaches, back pain, abdominal pain, ib omyalgia, gas oin es inal diso de s, limi ed mobili y, and poo o e all heal h. The social and economic cos s o iolence agains women a e eno mous and ha e ipple e ec s h oughou socie y. Women may su e isola ion, inabili y o wo k, loss o wages, lack o pa icipa ion in egula ac i i ies, and limi ed abili y o ca e o hemsel es and hei child en (2). 4 1.2. RATIONALE The esea che had wo ked in p ima y heal h ca e cen e in Jeddah o many yea s and comple ed hospi al o a ions in he p og am o amily medicine. Du ing his obse ed he wide sp ead impac o all o all ypes o in ima e pa ne abuse on he physical, psychological and economic wellbeing o emale heal h wo ke s (FHW) om nu ses o consul an s who had highly esponsible posi ions. I obse ed a s ong endency o silence and shame in admi ing he p oblem. The e o e I decided o b ing ligh o p oblem by s udying abuse in his g oup o women. In addi ion he e is no p e ious esea ch on he p e alence o domes ic iolence among emale heal h wo ke s. 1.3. AIM To e alua e domes ic iolence among emale heal h wo ke s in Jeddah's gene al MO H hospi als 1.4. OBJECTIVES 1. To es ima e he p e alence o domes ic iolence among emale heal h wo ke in Jeddah's gene al MOH hospi als du ing May 2018. 2. To iden i y isk ac o s associa ed wi h domes ic iolence among emale heal h wo ke in Jeddah's gene al MOH hospi als. 5 CHAPTER 2 LITERATURE REVIEW 2.1. INTRODUCTION The amily is o en equa ed wi h sanc ua y a place whe e indi iduals seek lo e, sa e y secu i y, and shel e . Bu e idence shows ha i is also a place ha can impe il li es, and b eed some o he mos d as ic o ms o iolence pe pe a ed agains women and gi ls. Violence in he domes ic sphe e is usually pe pe a ed by males who a e, o who ha e been, in posi ions o us in imacy and powe – husbands, a he s, a he s-in-law, s ep a he s, b o he s, uncles, sons and o he ela i es. Domes ic iolence is in mos cases iolence pe pe a ed by men agains women. The Sec e a y- Gene al no ed ha domes ic iolence alone is on he inc ease (3). 2.2. Ope a ion De ini ion The e is no uni e sally accep ed de ini ion o iolence agains women. Some human igh s ac i is s p e e a b oad-based de ini ion ha includes "s uc u al iolence" such as po e y, and unequal access o heal h and educa ion. O he s ha e a gued o a mo e limi ed de ini ion in o de no o lose he ac ual desc ip i e powe o he e m. In any case, he need o de elop speci ic ope a ional de ini ions has been acknowledged so ha esea ch and moni o ing can become mo e speci ic and ha e g ea e c oss- cul u al applicabili y. Domes ic iolence includes iolence pe pe a ed by in ima e pa ne , amily membe s, and mani es ed h ough: “Physical abuse”; such as slapping, bea ing, a m wis ing, s abbing, s angling, bu ning, choking, kicking, h ea s wi h an objec o weapon, and mu de . 6 “Sexual abuse”;such as coe ced sex h ough h ea s, in imida ion o physical o ce, o cing unwan ed sexual ac s o o cing sex wi h o he s. “Psychological abuse”; which includes beha io ha is in ended o in imida e and pe secu e, and akes he o m o h ea s o abandonmen o abuse, con inemen o he home, su eillance, h ea s o ake away cus ody o he child en, des uc ion o objec s, isola ion, e bal agg ession and cons an humilia ion. “Economic abuse”; includes ac s such as he denial o unds, e usal o con ibu e inancially, denial o ood and basic needs, and con olling access o heal h ca e, employmen (3). 2.3. P e alence o iolence agains women: Abuse agains women is a social phenomenon wi h signi ican consequences o he ic ims and one ha aises b oade psychological, medical, legal, economic and sociological issues. I is women who a e mos ly he ic ims o public and domes ic iolence in all coun ies o he wo ld and acco ding o in e na ional li e a u e he phenomenon o iolence agains women is inc easing (8). 2.3.1 In e na ional View App oxima ely 1 ou o 5 women wo ldwide ha e been ic ims o bea ing by hei in ima e pa ne s and 1 ou o 3 will be ic ims o some o m o iolence in hei li e ime. Violence does no know any bounds, bu we should know ha i is he weak who su e (8). 2.3.1.1. G ea e Bos on USA 2006 This c oss-sec ional su ey ca ied ou in July 2006 wi h a communi y-based sample o women in ela ionships wi h males (n = 208) assessed demog aphics, (IPV) his o y, and heal h. Twen y-one pe cen o he quan i a i e sample epo ed (IPV) in he cu en ela ionship. 7 Quali a i e subjec s desc ibed how ic imiza ion esul ed in inju y and ch onic heal h conce ns and how (IPV) induced dep ession anxie y a ec ed hei sleep, appe i e, ene gy, and wellbeing. Expe iences o IPV a e ela ed o inc eased poo heal h among Sou h Asian women (9). In his s udy he sample size was small did no speci y he age ange o he da a collec ion ool used by he in e iewe . 2.3.1.2.Samelelius L, Wijma B, Wing en G ,Wijma K in Sweden 2010 (10). A c oss-sec ional and popula ion-based su ey using he Abuse Sc eening In en o y (ASI) measu ing expe iences o physical, sexual and psychological abuse and including ques ions on heal h and social si ua ion, was sen by pos al o mail o 6000 women, andomly selec ed om he popula ion egis e . The ques ionnai e was comple ed and e u ned by 4150 (70%) o 5,896 eligible women. Resul s: 27.5% o he women epo ed abuse o any kind. O hose, 69.5% epo ed cu en su e ing om abuse. Abused su e ing women epo ed mo e anxie y, dep ession and sleep dis u bances, and a less ad an ageous social si ua ion han bo h non-abused and abused non-su e ing women (10). The sample size was la ge The age g oup was no speci ied he da a collec ion ool was he abuse sc eening in en o y (ASI) his was sen by email and andomly selec ed om popula ion. 2.3.1.3. Bos on Uni e si y School o Public Heal h, USA 2002 (11). A communi y-based, a c oss-sec ional s udy among Sou h Asian women (n=160) in ela ionships wi h male pa ne s. Pa icipan s we e ec ui ed ia communi y ou each (e.g. lie s, snowball sampling, e e als) and we e in e iewed in pe son by ained Sou h Asian women. Pa icipan s we e 18 o 62 yea s old (mean age 31.6) and p edominan ly 8 immig an (87.5%); 74.4% we e ma ied, 51.6% had child en, and 71.9% had amily incomes o mo e han $2100 pe mon h. Fo y pe cen o he sample epo ed physical IPV, sexual IPV, o inju y and need o medical se ices due o IPV om cu en male pa ne s. Twice as many pa icipan s epo ed needing o see a doc o o abuse- ela ed inju ies, bu no seeing one (6.3%), as ac ually seeing a doc o (3.1%). Only 11.3% o women epo ing IPV indica ed ha ing ecei ed any counseling ela ed o he abuse. O he a iables assessed we e no ela ed o abuse in cu en ela ionships (11). In his s udy he age g oup was wide, he sample size was small and hey su eyed only women cu en ly in ol ed wi h male pa ne s. The s udy conduc o women need seeing by counseling ha lead o dec eased numbe women epo ing iolence. 2.3.1.4. Jeyaseelan L, Kuma S, Neelakan an N, Peedicayil A, Pillai R, Du u y N s udy in India 2007 (12). Ano he s udy in India in 2007, using a c oss-sec ional household su ey was ca ied ou in u al, u ban and u ban-slum a eas ac oss se en si es in India, among women aged 15-49 yea s, li ing wi h a child less han 18 yea s o age. The sample was selec ed using he p obabili y p opo iona e o size me hod. T ained ield wo ke s adminis e ed a s uc u ed ques ionnai e o elici in o ma ion on spousal physical iolence. O 9938 women su eyed, 26% epo ed expe iencing spousal physical iolence du ing he li e ime o hei ma iage (12). The sample size o his s udy was la ge, he age g oup was wide, he da a collec ion ool was in e iewe ques ionnai e iled by ained iled wo ke s. This may ha e led he women unde epo ing physical abuse, pe haps because o pe sonal sensi i i y o he subjec o in ima e pa ne abuse by a ace o ace in e iewe . 9 2.3.1.5.Babu BV, Ka SK In india, BMC Public Heal h. 2009 (13). This popula ion-based s udy co e ing bo h ma ied women (n = 1718) and men (n = 1715) om h ee o he ou s a es o Eas e n India selec ed h ough a sys ema ic mul is age sampling s a egy. The p e alence o physical, psychological, sexual and any o m o iolence among women o Eas e n India we e 16%, 52%, 25% and 56% espec i ely. The a es epo ed by men we e 22%, 59%, 17% and 59.5% espec i ely. Men epo ed highe p e alence o all o ms o iolence apa om sexual iolence. Husbands we e mos ly esponsible o iolence in majo i y o cases and some women epo ed he in ol emen o husbands' pa en s (13). In his s udy he size was e y la ge, age g oup was no men ioned. The da a collec ion ool was in e iewe ques ione ; In e iews we e conduc ed using sepa a e p e-pilo ed s uc u ed ques ionnai es o women ( ic imiza ion) and men (pe pe a ion). 2.3.1.6.Malcoe LH, Du an BM, Mon gome y JM in New Mexico USA 2004 (14). This s udy was conduc ed a c oss-sec ional s udy o Na i e Ame ican women o de e mine p e alence o li e ime and pas -yea In ima e pa ne iolence (IPV) and pa ne inju y. Mo e han hal (58.7%) o pa icipan s epo ed li e ime physical o sexual (IPV); 39.1% expe ienced se e e physical (IPV); 12.2% epo ed pa ne - o ced sexual ac i i y; and 40.1% epo ed li e ime pa ne -pe pe a ed inju ies. A o al o 273 women had a spouse o boy iend du ing he p e ious 12 mon hs, all pa icipan s we e Na i e. Ame ican and 59.0% o pa ne s we e non-Na i e Ame ican. Among women wi h non- Na i e pa ne s pas -yea p e alence was 30.1% o physical o sexual IPV ; 15.8% o se e e physical IPV; 10 3.3% o o ced pa ne -pe pe a ed sexual ac i i y; and 16.4% o in ima e pa ne inju y (14|). The sample size o his s udy was la ge, he age g oup was no speci ied . The shady used he modi ied 18-i em Con lic Tac ics Scales any women who epo ed ha ing physical and sexual iolence. 2.3.2. Regional s udies Da a on he occu ence o iolence agains women a e sca ce in he A ab wo ld. The ew s udies ha ha e been conduc ed show ha wi e abuse is a signi ican heal h and social p oblem in his egion. Islam dic a es lo e and me cy be ween he spouses and p o ec ion o women om any physical, psychological o sexual iolence a home o ou side (15). 2.3.2.1. Ahmed AM, Elma di AE in Sudan (16). This s udy in es iga ed domes ic iolence in he Sudanese amily, au ho s s udied 394 li e a e, ma ied women a ending he A da Medical Cen e, Omdu man, om Oc obe 2001 o Feb ua y 2002. Th ough sel - adminis e ed ques ionnai es, he women p o ided da a on sociodemog aphic cha ac e is ics and abuse by he husband. Abuse was epo ed by 164 women (41.6%), who su e ed 525 iolen episodes in he p e ious yea , classi ied in o con olling beha io (194), h ea ening beha io (169) and physical iolence (162). F equency o iolen episodes a ied om 1 (25%) o 6 (20.7%). Violence du ing p egnancy was epo ed by 27 women (16.5%). E en s p eceding he abuse included suspicion o illici ela ions, ic ims “ alking back” and allega ion o inadequa e home ca e. Common eac ions epo ed by he women included s aying quie , c ying and esis ance (16). 11 2.3.2.2.Mohannad Al-Nsou n Ma wan k and Ghadah Al-Kayyali in In ima e pa ne iolence - Domes ic iolence - A i udes - Women’s heal h - Jo dan 2009 (17). A c oss-sec ional s udy among e e -ma ied women aged 18–49 who isi ed he public heal h clinics in he go e no a e o Balka, Jo dan, was ca ied ou in Augus 2006, a o al o 356 women we e success ully in e iewed. Desc ip i e s a is ics and adjus ed odds a ios om logis ic eg ession we e used o assess associa ions be ween a i udes owa ds IPV and selec ed backg ound a iables. The as majo i y (87%) o women epo ed di e en ypes o IPV agains hem in he las 12 mon hs. The mos common ypes o epo ed iolence we e emo ional abuse (47.5%), ollowed by wi e bea ing (19.6%). Almos one- hi d o women jus i ied wi e bea ing by husbands. Olde age, younge age a ma iage, u al esidence, and non-wo king s a us we e signi ican ly associa ed wi h suppo i e a i udes owa ds wi e bea ing. The s udy shows a high p e alence o IPV agains women du ing he pas yea , and a high a e o jus i ica ions o wi e bea ing. Inc easing women’s empowe men , pa icula ly economic secu i y h ough wo k ou side he home, may p o ec women om iolen beha io in his con ex (17). The ange o age g oup was wide, he sample size was la ge. The da a collec ion ool was in e iewe. 2.3.2.3.Sala i Z, Nakhaee N in Ke man hospi als, I an Republic. Asia 2008 (18). This was a c oss-sec ional s udy done om Ma ch h ough July 2005 in he ou main hospi als o Ke man, I an, which has ma e ni y uni s. In o al, 416 ou o 460 women who we e asked o pa icipa e ag eed o be 18 speci ic issues and compiling less de ailed in o ma ion on a ange o issues. The ques ionnai e was hen ansla ed and p e es ed in six coun ies (Bangladesh, B azil, Namibia, Samoa, Thailand, and he Uni ed Republic o Tanzania). The expe iences om hese p e es s we e e iewed a he hi d mee ing o he esea ch eams, and used o make u he e isions o he ques ionnai e. Following a inal p e es , he ques ionnai e selec ed o his S udy was he comple ed e sion 9.9 (Annex 4), and was used in Bangladesh, B azil, E hiopia, Japan, Namibia, Pe u, Samoa, Thailand, and he Uni ed Republic o Tanzania. An upda ed e sion o he ques ionnai e ( e sion 10), which inco po a es he expe ience in he i s eigh coun ies, was used in Se bia and Mon eneg o. The ques ionnai e was ansla ed and independen ly back- ansla ed and discussed o es ablish accu acy, cogni i e unde s anding, and cul u al accep abili y. The ques ionnai e included ques ions ele an o measu ing physical, sexual and emo ional iolence by an in ima e pa ne and socio- demog aphic cha ac e is ics. Labeling o a ious o ms o in ima e pa ne iolence, including physical, sexual and emo ional iolence, in he 12 mon hs p io o he in e iew. The ques ionnai e included he ollowings: 19 Pe sonal da a age, educa ion le el, na ionali y, ma i al s a us, du a ion o ma iage, numbe o child en, occupa ion, du a ion o wo k, mon hly income Pa ne da a: age, educa ion le el, na ionali y, occupa ion, mon hly income, smoking and d ug abuse his o y. Validi y and eliabili y o domes ic iolence ques ionnai e, design by WHO and e iew by expe esea ch eams. 3.3.2. Da a en y and analysis: All da a en e ed in a PC using SPSS p og am e sion 16 a e coding all a iables. AP- alue o <0.05 was used o signi icance, and app op ia e s a is ical es ca ied ou . 3.4. Pilo s udy: A pilo s udy using he ques ionnai e on a sample o emale heal h wo ke in ma e ni y and child hospi al is no included in his epo . The me hodology and he ques ionnai e we e es ed is necessa y changes we e made: -Allow 2 hou s o a ques ionnai e. -Remo e ques ion on smoking and subs ance misuse o FHW. -The esea che s o add ess con iden iali y by no w i ing he names o FHW on he ques ionnai e and each ques ionnai e was inse ed in o an en elope and sealed. 20 3.5. E hical conside a ions: The ollowing s ep was done o ul ill he e hical equi emen . Fi s A pe mission le e om he E hics Resea ch Commi ee o NMS | FCM (CEFCM) o conduc he s udy. A e ha pe mission om hospi als o conduc he s udy he e. Then e bal consen was ob ained om each subjec pa icipa ing in he s udy and no w i en consen because he e was conce n ha he signa u e could be used o iden i y pa icipan s and su icien consen was indica ed by comple ing he ques ionnai e. Finally, Con iden iali y o he in o ma ion abou he pa icipan s was gua an eed and ha he in o ma ion used o esea ch pu poses. 21 Chap e 4 RESULTS AND DISCUSSION In his chap e , esul s will be p esen ed along wi h he discussion and in he same o de as he objec i es. 4.1. RESPONSE RATE The in es iga o ecei ed 300 esponses o 300 ques ionnai es, gi ing a esponse a e o 100%. The high esponse a e was mainly due o he app oach used by he in es iga o whe e she handed he ques ionnai e o each emale heal h wo ke he sel and ook i by he end o he day. Ano he ac o behind his was he s udy popula ion being cap i e. The ques ionnai e used in his s udy was sel -adminis e ed. 22 4.1.1. Cha ac e is ics o he s udy g oup:- Table1:- Demog aphic cha ac e is ics o he s udy g oup (n=300). Demog aphic cha ac e is ics No. % Age <30 yea s 140 46.7 30-<40 yea s 118 39.3 40+ 42 14.0 Range 20-56 yea s mean  SD 31.25 ± 7.38 yea s Na ionali y Saudi 220 73.3 Non Saudi 80 26.7 Ma i al s a us Single 125 41.7 Ma ied 157 52.3 Di o ced 16 5.3 Widowed 2 0.7 Occupa ion Physician 70 23.3 Nu se 141 47.0 Technician 47 15.7 O he s 42 14.0 Educa ion le el Diploma 123 41.0 Bachelo 157 52.3 Mas e deg ee 8 2.7 O he s 12 4.0 Wo king du a ion <5 yea s 150 50.0 5-<10 yea s 82 27.3 10+ yea s 68 22.7 Mean  SD 6.1+ 5.4 yea s The able shows ha sligh ly less han one hal o he esponden s (46.7%) a e in he age g oup <30 yea s, and he majo i y a e Saudis 23 (73.3%) and o e hal o hem (52.3%) a e ma ied. The physicians cons i u ed almos one qua e (23.3%) and he nu ses o med 47% o he pa icipan s. The mean wo king du a ion was o 6.1+5.4 yea s. Table2:- Financial s a us o he esponden s. Financial si ua ion No. % Mon hly income <5000 SR 91 30.3 5000-10000 SR 105 35.0 >10000 SR 104 34.7 Financial suppo o he amily Yes 229 78.4 No 63 21.6 Sha ing pa ne in home expendi u e Yes 146 86.4 No 23 13.6 Sha ing pa ne in child en expendi u e Yes 141 86.0 No 23 14.0 Mon hly income o he husband <3000 SR 34 20.2 3000-5000 SR 52 31.0 5001-10000 SR 37 22.0 5001-10000 SR 45 26.8 The able shows ha he majo i y o he esponden s (78.4%) a e p o iding inancial suppo o hei amilies, and he o e whelming majo i y o he ma ied esponden s a e sha ing wi h hei pa ne in he home expendi u e (86.4%) and he child en expendi u e. 24 Table3:- Cha ac e is ics o he cu en o p e ious pa ne s. Demog aphic cha ac e is ics No. % Age <30 yea s 15 9.0 30-<40 yea s 91 54.8 40+ 60 36.2 Range 25-57 yea s mean  SD 37.7 ± 6.6 yea s Na ionali y Saudi 96 56.8 Non Saudi 73 43.2 Educa ion le el Illi e a e 5 3.0 P ima y 10 6.0 In e media e 33 19.6 Seconda y 44 26.2 Uni e si y 63 37.5 Pos g adua e 13 7.7 Smoking s a us Cu en smoke 67 39.0 Ne e smoked 89 51.7 Ex-smoke 16 9.3 D ug abuse Cu en abuse 5 2.9 Ne e abused 164 95.3 Ex-abuse 3 1.7 The able desc ibes he ele an cha ac e is ics o he cu en o p e ious pa ne s o he pa icipan s. I shows ha he g ea majo i y o hem a e in hei 4 h decade o olde (91%) wi h a mean age o 37.7+6.6 yea s, and sligh ly mo e han one hal o hem a e Saudis (56.8%). Sligh ly mo e han one hi d (37.5%) ha e uni e si y quali ica ions, in addi ion o 25 7.7% who ha e pos g adua e deg ees. Also, i was no iced ha 39% a e cu en smoke s and small numbe a e (2.9%) a e d ug abuse s. 4.2.PREVALENCE OF EXPOSURE TO DOMESTIC VIOLENCE ABUSE 4.2.1.PREVALENCE OF ABUSIVE VIOLENCE FEMALE HEALTH WORKERS: O 300 emale heal h wo ke s answe ed he ques ionnai e, epo ed ha hey we e exposed o one o mo e o he si ua ions e lec ing di e en ypes o abusi e iolence. I was almos hal o hem (45.3%) we e exposed o one o mo e o hese iolen si ua ions. The mos equen abusi e iolence was emo ional iolence (39.3%) ollowed by mode a e physical iolence (35.7%), and he leas equen was sexual abuse (7.3%). 26 4.2.2. Exposu e o domes ic iolence abuse Table 4: Sel epo ed exposu e o he pa icipan s o domes ic iolence. Domes ic iolence No. % Physical iolence by an in ima e pa ne ( amily membe ) Mode a e iolence Was slapped o had some hing h own a he ha could hu he . 96 32.1 Was pushed o sho ed 91 30.3 Se e e iolence Was hi wi h is o some hing else ha could hu 36 12.0 Was kicked, d agged, o bea en up 23 7.7 Was choked o bu n on pu pose 4 1.3 Pe pe a o h ea ened o use o ac ually used a gun, kni e, o o he weapon agains he . -- 0.0 Sexual iolence Was physically o ced o ha e sexual in e cou se when she did no wan o. 19 6.3 Had sexual in e cou se when she did no wan o because she was a aid o wha pa ne migh do. 13 4.3 Was o ced o do some hing sexual ha she ound deg ading o humilia ing. 10 3.3 Emo ional abuse by an in ima e pa ne Was humilia ed in on o o he people 114 38.0 Pe pe a o had done hings o sca e o in imida e he on pu pose. 79 26.3 Pe pe a o had h ea ened o hu someone she ca ed abou 25 8.3 27 Almos one hi d o he pa icipan s a e exposed o some so o mode a e domes ic iolence by in ima e pa ne and o amily membe , he iolence was ep esen ed by being slapped o had a ha m ul objec h own a hem pushed (32.1%) o had been pushed o sho ed (30.3%). In he same line, bu o a lesse ex en , 12% epo ing being hi by is , and 7.7% exp essed ha hey had been kicked, d agged o bea en up. Mo eo e , ou pa icipan s epo ed ha hey had been choked o bu n on pu pose. Meanwhile, i was obse ed ha 6.3% o ou pa icipan s epo ed ha hey we e o ced o ha e sexual in e cou se agains hei will, mo eo e , 4.3% indica ed ha hey did so because hey we e a aid o he consequences o e usal and 3.3% o hem we e exposed o deg ading o humilia ed sexual ac s. Rega ding he emo ional abuse by in ima e pa ne , i was ound ha mo e han one hi d o he emales (38%) we e humilia ed in on o o he people, and 26.3% we e exposed pu posi ely o sca e o in imida ion. 34 Table 8 Exposu e o he pa icipan s o se e e physical iolence acco ding o hei demog aphic cha ac e is ics. Demog aphic cha ac e is ics o he pa icipan s Exposu e o se e e physical iolence Yes No X2 P F eq. % F eq. % Na ionali y Saudi 42 19.1% 178 80.9% 8.973 0.003 Non Saudi 4 5.0% 76 95.0% Age ca ego ies <30 yea s 19 13.6% 121 86.4% 2.737 0.254 30-<40 yea s 17 14.4% 101 85.6% 40+ yea s 10 23.8% 32 76.2% Ma i al s a us Single 19 15.2% 106 84.8% 10.707 0.005 Ma ied 20 12.7% 137 87.3% Di o ced 7 43.8% 9 56.3% Occupa ion Physician 8 11.4% 62 88.6% 2.691 0.442 Nu se 20 14.2% 121 85.8% Technician 10 21.3% 37 78.7% O he s 8 19.0% 34 81.0% Educa ion le el Diploma 18 14.6% 105 85.4% NA NA Bachelo 26 16.6% 131 83.4% Mas e deg ee 0 .0% 8 100.0% O he s 2 16.7% 10 83.3% * NA No applicable The able shows ha he pe cen age o esponden s who epo ed ha hey had been exposed o se e e o ms o iolence was signi ican ly 35 highe among Saudis (19.1%) and di o ced (43.8%) emales i compa ed o hei coun e pa s p<0.05. Table 9 Exposu e o he pa icipan s o se e e physical iolence acco ding o hei inancial s a us. Financial s a us o he pa icipan s Exposu e o se e e physical iolence Yes No X2 P F eq. % F eq. % Mon hly income <5000 SR 4 4.4% 87 95.6% 13.277 0.001 5000-10000 SR 24 22.9% 81 77.1% >10000 SR 18 17.3% 86 82.7% Financial suppo o he amily Yes 38 16.6% 191 83.4% 1.193 0.286 No 7 11.1% 56 88.9% Sha ing pa ne in house expendi u e Yes 23 15.8% 123 84.2% Fishe 0.512 No 3 13.0% 20 87.0% Sha ing pa ne in child en expendi u e Yes 23 16.3% 118 83.7% Fishe 0.111 No 1 4.3% 22 95.7% Mon hly income o he pa ne <3000 SR 2 5.9% 32 94.1% 4.601 0.203 3000-5000 SR 8 15.4% 44 84.6% 5001-10000 SR 9 24.3% 28 75.7% >10000 SR 8 17.8% 37 82.2% Rega ding sel - epo ed exposu e o ou pa icipan s o se e e physical iolence acco ding o hei inancial s a us, i was ound ha 36 ha ing highe mon hly income is he only cha ac e is ic which inc ease signi ican ly he likelihood o exposu e o se e e iolence p<0.05. Table 10 Exposu e o he pa icipan s o se e e physical iolence acco ding o cha ac e is ics o he pa ne s: Cha ac e is ics o he pa ne s Yes No X2 P F eq. % F eq. % Na ionali y Saudi 21 21.9% 75 78.1% 7.192 0.007 Non Saudi 5 6.8% 68 93.2% Age <30 yea s 1 6.7% 14 93.3% 1.248 0.536 30-<40 yea s 14 15.4% 77 84.6% 40+ yea s 11 18.3% 49 81.7% P esence o o he wi e Yes 9 45.0% 11 55.0% Fishe 0.001 No 17 11.3% 134 88.7% Smoking s a us Cu en smoke 20 29.9% 47 70.1% 16.615 <0.001 Ne e smoked 6 6.7% 83 93.3% Ex-smoke 1 6.3% 15 93.8% D ug abuse Cu en abuse 0 .0% 5 100.0% NA NA Ne e abuse 25 15.2% 139 84.8% Ex-abuse 2 66.7% 1 33.3% * NA No applicable Wi h espec o he cha ac e is ics o he pa ne s, he able demons a es ha being Saudi (21.9%), husband ha ing ano he wi e 37 (45%) and cu en smoke (29.9%) a e manlie anima ed wi h pe pe a ion o e e . iolence agains hei wi es p<0.05. 38 Table11:- Exposu e o he pa icipan s o sexual iolence acco ding o hei demog aphic cha ac e is ics. Demog aphic cha ac e is ics o he pa icipan s Exposu e o sexual iolence Yes No X2 P F eq. % F eq. % Na ionali y Saudi 17 7.7% 203 92.3% 0.188 0.664 Non Saudi 5 6.3% 75 93.8% Age ca ego ies <30 yea s 7 5.0% 133 95.0% 2.521 0.284 30-<40 yea s 12 10.2% 106 89.8% 40+ yea s 3 7.1% 39 92.9% Ma i al s a us Single 1 .8% 124 99.2% 23.063 <0.001 Ma ied 16 10.2% 141 89.8% Di o ced 5 31.3% 11 68.8% Occupa ion Physician 6 8.6% 64 91.4% NA NA Nu se 8 5.7% 133 94.3% Technician 5 10.6% 42 89.4% O he s 3 7.1% 39 92.9% Educa ion le el Diploma 8 6.5% 115 93.5% NA NA Bachelo 11 7.0% 146 93.0% Mas e deg ee 2 25.0% 6 75.0% O he s 1 8.3% 11 91.7% *NA No applicable 39 The able shows ha he pe cen age hose who epo ed ha hey had been exposed o sexual iolence was signi ican ly highe among he di o ced pa icipan s (31.3%) p<0.05. O he wise, no signi ican di e ence was obse ed acco ding o o he demog aphic cha ac e is ics. 40 Table 12 Exposu e o he pa icipan s o sexual iolence acco ding o hei inancial s a us. Financial s a us o he pa icipan s Exposu e o sexual iolence Yes No X2 P F eq. % F eq. % Mon hly income <5000 SR 3 3.3% 88 96.7% 3.805 0.149 5000-10000 SR 8 7.6% 97 92.4% >10000 SR 11 10.6% 93 89.4% Financial suppo o he amily Yes 19 8.3% 210 91.7% Fishe 0.260 No 3 4.8% 60 95.2% Sha ing pa ne in house expendi u e Yes 20 13.7% 126 86.3% Fishe 0.181 No 1 4.3% 22 95.7% Sha ing pa ne in child en expendi u e Yes 18 12.8% 123 87.2% Fishe 0.580 No 2 8.7% 21 91.3% Mon hly income o he pa ne <3000 SR 3 8.8% 31 91.2% NA NA 3000-5000 SR 4 7.7% 48 92.3% 5001-10000 SR 5 13.5% 32 86.5% >10000 SR 8 17.8% 37 82.2% * NA No applicable The able shows ha he e a e no signi ican di e ences in he equency o epo ed exposu e o sexual iolence among he pa icipan s acco ding o hei inancial s a us p>0.05. 41 Table 13 Exposu e o he pa icipan s o sexual iolence acco ding o cha ac e is ics o he pa ne s. Cha ac e is ics o he pa ne s Exposu e o sexual iolence Yes No X2 P F eq. % F eq. % Na ionali y Saudi 14 14.6% 82 85.4% 1.610 0.205 Non Saudi 6 8.2% 67 91.8% Age <30 yea s 1 6.7% 14 93.3% 1.483 0.476 30-<40 yea s 14 15.4% 77 84.6% 40+ yea s 6 10.0% 54 90.0% P esence o o he wi e Yes 5 25.0% 15 75.0% Fishe 0.077 No 16 10.6% 135 89.4% Smoking s a us Cu en smoke 14 20.9% 53 79.1% 8.325 0.016 Ne e smoked 5 5.6% 84 94.4% Ex-smoke 2 12.5% 14 87.5% D ug abuse Cu en abuse 2 40.0% 3 60.0% NA NA Ne e abuse 18 11.0% 146 89.0% Ex-abuse 1 33.3% 2 66.7% * NA No applicable The able shows ha he pe cen age o epo ed sexual iolence was signi ican ly highe among pa icipan s whe e hei pa ne s a e cu en smoke s (20.9%) p<0.05. O he wise, he e a e no signi ican di e ences ela ed o o he displayed cha ac e is ics o he pa ne s. 42 Table14:- Exposu e o he pa icipan s o emo ional iolence acco ding o hei demog aphic cha ac e is ics. Demog aphic cha ac e is ics o he pa icipan s Exposu e o emo ional iolence Yes No X2 P F eq. % F eq. % Na ionali y Saudi 103 46.8% 117 53.2% 19.369 <0.001 Non Saudi 15 18.8% 65 81.3% Age ca ego ies <30 yea s 55 39.3% 85 60.7% 0.871 0.647 30-<40 yea s 49 41.5% 69 58.5% 40+ yea s 14 33.3% 28 66.7% Ma i al s a us Single 53 42.4% 72 57.6% 7.872 0.020 Ma ied 54 34.4% 103 65.6% Di o ced 11 68.8% 5 31.3% Occupa ion Physician 30 42.9% 40 57.1% 3.195 0.362 Nu se 48 34.0% 93 66.0% Technician 21 44.7% 26 55.3% O he s 19 45.2% 23 54.8% Educa ion le el Diploma 48 39.0% 75 61.0% NA NA Bachelo 62 39.5% 95 60.5% Mas e deg ee 5 62.5% 3 37.5% O he s 3 25.0% 9 75.0% * NA No applicable The able shows ha he pe cen ages o pa icipan s who epo ed exposu e o emo ional iolence we e signi ican ly highe among Saudis 43 (46.8%) and di o ced pa icipan s (68.8%) p<0.05. Howe e , no s a is ically signi ican di e ences we e de ec ed acco ding o o he cha ac e is ics. Table15:- Exposu e o he pa icipan s o emo ional iolence acco ding o hei inancial s a us. Financial s a us o he pa icipan s Exposu e o emo ional iolence Yes No X2 P F eq. % F eq. % Mon hly income <5000 SR 18 20.0% 72 80.0% 21.428 <0.001 5000-10000 SR 53 51.0% 51 49.0% >10000 SR 47 45.2% 57 54.8% Financial suppo o he amily Yes 99 43.6% 128 56.4% 4.635 0.031 No 18 28.6% 45 71.4% Sha ing pa ne in house expendi u e Yes 57 39.3% 88 60.7% 1.481 0.224 No 6 26.1% 17 73.9% Sha ing pa ne in child en expendi u e Yes 56 40.0% 84 60.0% 1.622 0.203 No 6 26.1% 17 73.9% Mon hly income o he pa ne <3000 SR 9 26.5% 25 73.5% 7.020 0.071 3000-5000 SR 16 31.4% 35 68.6% 5001-10000 SR 17 45.9% 20 54.1% >10000 SR 23 51.1% 22 48.9% The able shows ha exposu e o emo ional iolence was signi ican ly mo e equen among pa icipan s wi h highe mon hly 50 Table 11and ig 5 shows he able shows ha he pe cen age hose who epo ed ha hey had been exposed o sexual iolence was signi ican ly highe among he di o ced pa icipan s 31.3% (p<0.05). Fig [5] Rela ionship be ween sexual iolence and ma i al s a us 0.00% 25.00% 50.00% 75.00% 100.00% single ma ied di o ced sexual iolence no-sexual iolence 51 Al hough able 14 and ig 6 showed ha he pe cen ages o pa icipan who epo exposu e o emo ional iolence we e signi ican ly highe among di o ced 68.8% (p<0.05) in compa ison o ma ied 34.4% and single 42.4% . Fig [6] Rela ionship be ween emo ional iolence and ma i al s a us The di e ence was highly signi ican p<0.05 and he high p e alence among di o ced women we e expec ed and could be explained by he di o ced popula ion, do no ole a e abuse in hei ma iage. Ano he eason migh ha e been dishones y abou he eason behind he di o ce. The wi e migh ha e go en a di o ce due o di e en easons o he han abuse bu lied abou i o ha e mo e sympa hy om socie y and no be 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% single ma ied di o ced 52 judged. The wi es in he s a is ics migh ha e had an equally abusi e eac ion owa ds hei husbands bu he husbands did no accep he humilia ion and ga e hem a di o ce. Fu he mo e, some women ha e di e en de ini ions and pe cep ion o abuse. Fo example, a small push om a husband migh ha e been pe cei ed o he wi e as an unaccep able deg ada ion and had insis ed on a di o ce. As o he ma ied women, s a is ics migh ha e shown ha hey a e less abused han he di o ced ones o di e en easons. One eason could ha e been due o hei ea o socie y. Socie y nega i ely pe cei es di o ced women and es ic s hem cul u ally. Fo ha eason, ma ied women who a e in ac being in an abusi e ela ionship could be p essu ed o emain in hei ma iage. Also, some women hink i is na u al o be abused om hei spouses because o hei upb inging. Many o hese women ha e had male igu es in hei li es as single women ha ha e abused hem, and made hem accus omed o ha li e s yle. 53 4.4.2.Female heal h wo k’s educa ion No signi ican di e ence was obse ed be ween domes ic iolence FHW and non-abused FHW ega ding le el o FHW’s educa ion. Fig[ 7]. Rela ionship be ween physical abuse and FHW’s educa ion. 0.00% 22.50% 45.00% 67.50% 90.00% diploma bachelo mas e deg ee o he non-physical abused 54 4.4.3.Financial s a us Domes ic iolence was signi ican highe among FHW who ha e highe mon hly income ,who suppo ing hei amilies inancially, sha ing hei pa ne s in he child en expendi u e. 4.4.3.1.FHW income Table (6) showed ha he mos equen ly exposed o mode a e physical abuse a e hose who ha e highe mon hly income, and hese obse a ions a e s a is ically signi ican p<0.05. Table 9 Rega ding sel - epo ed exposu e o ou pa icipan s o se e e physical iolence acco ding o hei inancial s a us, i was ound ha ha ing highe mon hly income is he only cha ac e is ic which inc ease signi ican ly he likelihood o exposu e o se e e iolence p<0.05. Bu in he able 12 he e a e no signi ican di e ences in he equency o epo ed exposu e o sexual iolence among he pa icipan s acco ding o hei inancial s a us p>0.05. 55 Finally, able 15 and ig 8 showed ha exposu e o emo ional iolence was signi ican ly mo e equen among pa icipan s wi h highe mon hly income (p<0.05) (45.22). Fig( 8) Rela ion be ween emo ional abuse and FHW income The associa ion be ween iolen abuse wi h highe income may esul om jealous eeling o he wi e wi h high income . In addi ion eeling o husband ha his wi e is wo king woman ,s ayed ou side his home o long ime ,make mo e s ess on him leading o mo e abuse . This esul unexpec ed because by he end o he mon h he income was high co e ing he needs o li e bu on he o he hand he e is some wi es e uses o spend he home o he husband, and demands he man o shoulde he esponsibili ies in ull, as i she we e on main enance. The esul is inancial p essu e leading o he iolen eac ion o he husband. In li e a u e (13) some socio-economic cha ac e is ics o women ha e signi ican associa ion wi h he occu ence o domes ic iolence. In (14) 0.00% 20.00% 40.00% 60.00% 80.00% 100.00% <5000 5000-10000>10,000 >10,000 emo ional sbuse no-emo ional abuse 56 inc eased domes ic iolence in low socio-economic le el .Bu in (19) physically abused women less equen ly had highe income. 4.4.3.2. FHW and suppo ing hei amilies inancially: The able 6 and ig 9 showed ha exposu e o physical iolence was signi ican ly mo e equen wi h FHW who a e suppo ing hei amilies inancially 40.5% (p<0.05). Fig (9 ) Rela ionship be ween physical FHW abuse and suppo ing hei amily. 0. 20. 40. 60. 80. 100. suppo amily non-suppo amily physical abuse no-physical abuse 57 The able 15 and ig 10 showed ha exposu e o emo ional iolence was signi ican ly mo e equen wi h FHW who a e suppo ing hei amilies inancially 43.6% (p<0.05). Fig ( 10) Rela ion be ween emo ional abuse and FHW who a e suppo ing hei inancially This inding was expec ed and could be explained by he jealousy o he husband om he wi e’s amily and his belie ha he dese es he money mo e han hem, And ha she spends mos o he ime o wo k which is om amily ime. Al hough om he poin o some men ha ma iage is an independen company be ween couples need o suppo all aspec s o he psychological and inancial, pa icula ly in di icul 0. 10. 20. 30. 40. 50. 60. 70. 80. 90. 100. suppo amily non-suppo am emo ional abuse no-emo ional abuse 58 economic condi ions When o assis spending on he amily lead o de iciencies in he company's needs( hei won’s home, child en school…) 4.4.3.3.FHW and sha ing pa ne in house and child en expendi u e: Table 6 showed he p e alence o physical iolence among FHW who sha ing hei pa ne s in child en expendi u e (37.6%) his obse a ions a e s a is ically signi ican p<0.05. bu , he e is no s a is ically signi ican di e ences be ween hose who a e sha ing hei pa ne s in he house expendi u e and hose who a e no p>0.05. This esul was unexpec ed because usually he husband eel she had he income was high enough o co e ing he need o hei child en and he hough ha included he esponsibili y o he child en because she was no spend enough ime wi h he kids (e.g. maid, clo hing , oys and o he en e ainmen ).Habi o known ha he s ewa dship in he hands o men and is o spend on his amily and when he wi e pa icipa es in spending on child en leads o he possibili y o impac s eng h o men, which makes i e lec s he sense o iolence agains his wi e. By wo main easons, he i s , is ha he eels ha he is no doing his job as a man in p o iding o his amily and his could cause us a ion and a need o p o e ha he is s ong and masculine which migh esul in abuse. 59 The second eason could be ha he man in he ma iage eels ha he emale is no doing he ole and is spending mo e ime a wo k han wi h he amily which in his pe cep ion is he main ole. On he o he hand, o he men do no link ea ning money wi h hei masculini y; hey ha e no issues in hei emale pa ne s o help p o iding o he amily because hey belie e ha ma iage is a pa ne ship. 66 5.1.2. Epidemiology o domes ic iolence : 5.1.2.1. The di o ced FHW had signi ican ly a highe p e alence o his o ical domes ic iolence in compa ison o single and ma ied. 5.1.2.2. NO s a ically signi ican di e ence among he esponden acco ding o he ype o occupa ion o FHW. 5.1.2.3. NO s a ically signi ican di e ence among he esponden acco ding o he educa ion le el o FHW. 5.1.2.4. The p e alence o Domes ic iolence was mo e common among FHW who ha e highe mon hly income. The p e alence o physical and emo ional iolence was mo e common among FHW who ha e highe mon hly income. 5.1.2.5. Domes ic iolence was mo e common among FHW who we e suppo ing hei amilies inancially. 5.1.2.6. Domes ic iolence was mo e common among FHW who w e sha ing hei pa ne in he child en expendi u e. 67 5.1.2.7 .No s a is ically signi ican di e ence be ween hose who a e sha ing hei pa ne s in he house expendi u e and hose who a en’ ega ding he p e alence o Domes ic iolence . 5.1.2.8. No s a is ically signi ican di e ences in equency o epo ed exposu e o sexual iolence among FHW acco ding o hei inancial s a us. 5.1.2.9. No signi ican di e ence impac on Domes ic iolence acco ding o mon hly income o he pa ne . 5.1.2.10. Domes ic iolence was mo e common among pa icipan whom pa ne s cu en smoke s. 5.1.2.11. The p e alence o Domes ic iolence was no s a is ically signi ican di e en acco ding o he pa ne who d ug misuse. 5.1.2.12. Domes ic iolence was mo e common among FHW whose pa ne s ha e o he wi es. 5.1.2.13.The p e alence o Domes ic iolence was no s a is ically signi ican di e ences acco ding educa ional le el o pa ne s. 68 5.1.2.14. No signi ican di e ence impac on Domes ic iolence acco ding occupa ion o he pa ne s. 5.1.2.15. Slapped o h owing an objec was he mos equen me hod o physical abuse, using choking o bu ning we e he leas . 5.1.2.16. Fo ced o ha e sexual in e cou se when she didn’ wan o was he mos equen o m o sexual iolence and being o ced o do some hing sexual ha she ound deg ading o humilia ing was he leas . 5.1.2.17. Humilia ing he FHW in on o o he people was he mos equen me hod o emo ional abuse. Th ea ening o hu someone she ca ed abou was he leas . 5.2 RECOMMENDATIONS Recommenda ion o his s udy all in o p ac ice and be e esea ch. 5.2.1. Female heal h wo ke s: Fo he emale who wo ks ha ha e been abused o ecognize ha abuse a ec he wo k and i s o all he li e and he amily. Wo k a ec ed because i a ec he pa ien also because he pa ien need ca e. Ca ing o he pa ien needs a lo o a en ion and a clea mind and soul : 69 - When a emale doc o is unde he p essu e o abusing she can' no make he igh decision o make he igh diagnosis and ea men - When a emale nu se is unde he p essu e o abusing she can no do he ca e ha he pa ien needs and making he igh ins uc ion o he pa ien - When a emale echnician is unde he p essu e o abusing she can no do he job well like doing he lab p ocedu es which lead o he w ong esul s o he pa ien . - When a emale adminis a ion is unde he p essu e o he abuse she can' no do deal wi h he pa ien which migh lead o misunde s anding which lead o mo e us a ion. In conclusion a emale heal h wo ke who ha e been abused need o i s o all ecognize ha she is abused hen a e ha need o seek help and be ea ed physically and mo e impo an psychosocial. Rega ding he amily especially i she ha e kids hey need mo e a en ion and e o om he o ise a heal h men ally kids o he socie y . A emale dese es o be physically, men ally and heal hy woman so he communi y can bene i om he and he wo k. 70 5.2.2. Physicians Abuse is a common and complex public heal h issue ha equi es he a en ion o amily physicians dedica ed o imp o e he heal h o his na ion's amilies. Physicians in p ima y heal h ca e cen e and hospi als in s a clinic can implemen he ollowing ecommenda ions: -All physician should be ained in issues o amily and in ima e pa ne iolence h ough unde g adua e and g adua e medical educa ion as well as con inuing p o essional de elopmen . -Physicians ha e a majo ole in lowe ing he p e alence, scope and se e i y o in ima e pa ne iolence. I is impo an o unde s and ha domes ic iolence is o en hidden om public awa eness. Physicians need aining o be ale o he signs and symp oms o po en ial abuse in women epo ing wi h inju y, ce ain obs e ic and gynecological p oblems, psychosoma ic diseases and psychia ic di icul ies such as anxie y and dep ession. -Women should also be assessed o iolen ela ionships each ime hey p esen o heal h cen e , p e-na al clinic o counseling se ice despi e he p esen ing se ice eques . -Sc eening and plans o ac ion agains domes ic iolence should be concen a ed owa d bo h Saudi and non-Saudi women and o do sc eening we should ha e s anda d scale o measu e domes ic iolence acco ding o ou cul u e and eligion. 71 - Ba ie s o communica ion need o be educed. P i a e ooms a e needed in PHCCs and s a clinic in hospi al o discussion sessions should he e be any indica ion o abuse su e ed by a woman. Mo eo e , physicians need o eassu e hei clien s abou he con iden iali y o in o ma ion and discuss sa e y issues wi h hem. -The physicians mus ha e a ole in aining and sensi iza ion o p ima y heal h ca e wo ke s and s a clinic in hospi al (nu ses heal h educa o s and social wo ke s) on he issue o domes ic iolence . This may enable hem o de ec ea ly signs o domes ic iolence among he emale heal h wo ke s hey se e. 5.2.3. MINSTRY OF HEALTH The e a e impo an poin s o be add essed and s essed by hem ha may help o dec eased domes ic iolence among emale heal h wo ke s hese includes he ollowing: -They should gi e FHW mo ning shi in hospi al. -The mo he FHW has he igh o educe he wo king hou s and gi e he hou s o b eas - eeding and ca ing o he child en . -Reconside he scheduling o ma e ni y lea e depending on he needs o wo king mo he s and hei physical and psychological heal h. 72 -Conside a ion he wo king condi ions o women subjec ed o iolence in o de o ensu e hei p o ec ion du ing wo king hou s. -Se up a house specialized ba e e s in he speci ica ions o ensu e hei p o ec ion and ehabili a ion. 5.2.4. Heal h educa ion Abuse should be added o he lis o heal h educa ion opics o be add essed by physicians and heal h educa ion p o ide s a p ima y ca e cen e hospi al school and public mee ings. This can be inco po a ed wi hin he egula schedule o heal h educa ion and du ing heal h weeks. Heal h educa ion on egula basis h ough he mass media o he communi y. The mass media has a ole in add essing abuse as a opic o public conce n in ele ision, adio p og am, local magazines and newspape s o p omo e awa eness in he communi y ha abuse is c ime o encou age he whole communi y o accep esponsibili y and ake posi i e s eps o educe and p e en abuse. 73 5.2.5. Communi y ole Communi y leade ha e a majo ole in p e en ion and solu ion o p oblem o domes ic iolence : -The deploymen o communi y awa eness abou he p oblem o domes ic iolence. - Inse ed in o he s udies and scien i ic esea ch in uni e si ies and specialized ins i u es. - To accele a e he esea ch he causes o iolence and ways o con on i in e ms o scien i ic. - As he pa icipan s call o iews on he p o ec ion o amily o he sessions designed o ain employees on how o deal wi h communica ions And p o ec ion o ic ims. -Es ablishmen and ac i a ion o o ices o he Family Guidance and s eng hening he ole o social wo ke s and psychologis s in all sec o s o socie y o sol e social p oblems and psychological acing abuse s and hei amilies, -Issuing pe iodic bulle ins o aise awa eness o he phenomenon o domes ic iolence and p o ec ing ic ims, shall edi a numbe o specialis s in his a ea, - Hold mee ings and o ums dealing wi h he discussion o his Phenomenon, 74 - The aining o physicians in he ield o o ensic de ec ion heads on women in inciden s o sexual assaul , - To expedi e he p epa a ion o a p ocedu al manual o dealing wi h cases o domes ic iolence in all ac o s on he p e en ion and esponse o domes ic iolence. O he in communi y ha e mane ole like imam make p esen a ion o lec u es(khu ba) in mosques o : -Explaining wha Islamic amily li e should look like. -Ad ice husband o ea hei wi es wi h goodness especially in con lic si ua ion whe e he husband is innocen and he wi e is ebellious and a aul . -They should alk abou women's igh s in Islam and concen a e on hei lec u e abou woman's wo k and he sala y whe e he husbands ha e no igh o ake sala y o hei wi es. E o s should be exe ed by go e nmen al and p i a e agencies o imp o e heal h educa ion. Mo eo e la ge amilies, abused women by pa ne o any membe o amily wi hou cause should be add essed and discussed in mass media, heal h educa ion p og ams and public ac i i ies. Fu he s udies a e ecommended on belie s and p ac ices conce ning ma iage in Saudi A abian socie y. Such esea ch should add ess he issue o husband abuse and he dynamics o abusi e spouse ela ionships in he egion. 75 5.3. Limi a ions: The p e alence o women abuse de e mined only among heal h wo ke in hospi al and gene aliza ion o esul s should be made wi h cau ion. The accu acy o he esponses could ha e been educed by he limi ed ime o comple e ques ionnai e has i ook app oxima ely wo hou s o inish ques ionnai e which is e y di icul in busy place by p o isional wi h alo o esponsabili yis . Mo e o e domes ic iolence is conside ed a sensi i e issue and many emale heal h wo ke s may no ha e disclosed he p oblem because ongoing emo ional dis ess and a isk o c iminal a ack om pa ne i she speak abou a sensi i e si ua ion. 82 13-Numbe o child : male ( ) Female ( ) NA ( ) Sec ion 2:The ollowing in o ma ion eques ed is o you pa ne o p e ious pa ne 14-Age: ( ) 15-Na ionali y : Saudi ( ) non-Saudi ( ) 16-Educ ion le el: P ima y( ) In e media e ( ) Seconda y( ) Diploma ( ) Bachelo ( ) Mas e ( ) 17-Occupa ion: 18-Mon hly income: <3000 ( ) 3001-5000( ) 5001-10000( ) >10000 ( ) 19-Smoking: Cu en ( ) Ne e ( ) Qui ( ) 20-D ug abuse : Cu en ( ) Ne e ( ) Qui ( ) 21-did he c/o anxie y o dep ession: Yes( ) NO ( ) 22-did he c/o sleep dis u bance: Yes( ) NO ( ) 23-did he had amily hex o domes ic abuse: Yes( ) NO ( ) Sec ion 3: Domes ic Violence Ques ionnai e 83 A-Physical iolence by an in ima e pa ne ( amily membe ). Expe iencing only one o bo h o he i s wo i ems is labeled 'mode a e'; i any o he o he ou i ems we e expe ienced, his was labelled 'Se e e' physical iolence. NO YES MODERATE VIOLENCE 24-Was slapped o had some hing h own a he ha could hu he . 25-Was pushed o sho ed NO YES Se e e iolence 26-Was hi wi h is o some hing else ha could hu 27-Was kicked, d agged, o bea en up 28-Was choked o bu n on pu pose 29-Pe pe a o h ea ened o use o ac ually used a gun, kni e,o o he weapon agains he . 84 B-Sexual iolence by an in ima e pa ne : Expe iencing any o he h ee i ems is labelled as ' sexual iolence' sexual iolence YES NO ✓✐✍Was physically o ced o ha e sexual in e cou se when she did no wan o. 31-Had sexual in e cou se when she did no wan o because she was a aid o wha pa ne migh do. 32-Was o ced o do some hing sexual ha she ound deg ading o humilia ing. 85 C-Emo ional abuse by an in ima e pa ne : Expe iencing any o he h ee i ems is conside ed 'emo ional iolence' Expe iencing only one i em is labeled 'mode a e'; expe iencing wo o mo e is se e e; ' iolence emo ional' YES NO people o he o on in humilia ed Was-33 o sca e o hings done had Pe pe a o -34 .pu pose on he in imida e someone hu o h ea ened had Pe pe a o -35 abou ca ed she Thank you