Educational practices in the training of university students regarding violence against women

Abstract

This study aims to analyze the educational practices in the professional training of university students regarding violence against women.This descriptive, exploratory study utilized a qualitative approach, addressing eight university students from a public institution. The study used a semi-structured interview, and the statements were recorded and transcribed in full. Data analysis was conducted through content analysis. It was observed that most students said they had not studied violence in undergraduate programs.By enabling the development of skills to deal with abused women, the educational practices of the extension project are significant to the learning process, contributing to academic and professional development, despite the difficulties encountered during these activities. Therefore, it is concluded that academics and professionals should be trained in a multidisciplinary way to work within the community in the care of victims of violence.

Women’s health; Violence against women; Education, higher; Health education; Health promotion

Resumo

Objetivou-se analisar as práticas educativas sobre violência contra a mulher na formação profissional de estudantes universitários. Trata-se de estudo descritivo, exploratório, com abordagem qualitativa, que incluiu oito estudantes universitários de uma instituição pública. Utilizou-se entrevista semiestruturada, e os depoimentos foram gravados e transcritos na íntegra. O tratamento dos dados se deu por meio da análise de conteúdo. A maioria dos acadêmicos afirmou não ter estudado violência nos cursos de graduação. Por permitirem o desenvolvimento de habilidades para lidar com mulheres violentadas, as práticas educativas do projeto de extensão são significativas para seu aprendizado, contribuindo para a formação acadêmica e profissional, apesar das dificuldades vivenciadas no decorrer dessas atividades. Depreende-se, então, que se deve capacitar acadêmicos e profissionais de forma multidisciplinar para atuar no atendimento a vítimas de violência na comunidade.

Saúde da mulher; Violência contra a mulher; Educação superior; Educação em saúde; Promoção da saúde

Resumen

El objetivo fue analizar las prácticas educativas sobre violencia contra la mujer en la formación profesional de universitarios. Se trata de un estudio descriptivo, exploratorio, con abordaje cualitativo, que incluyó ocho estudiantes universitarios de una institución pública. Se utilizó una entrevista semi-estructurada, siendo los testimonios grabados y transcritos de manera completa. Los datos fueron analizados por medio del Análisis de Contenido. La mayoría de los académicos manifestó no haber estudiado violencia durante la carrera. Puesto que permitieron el desarrollo de habilidades para tratar con mujeres violentadas, las prácticas educativas del proyecto de extensión fueron significativas para su aprendizaje, contribuyendo a la formación académica y profesional, a pesar de las dificultades vivenciadas durante el transcurso de estas actividades. Por lo tanto, se debe capacitar a académicos y profesionales de una forma multidisciplinaria para trabajar en la atención a víctimas de violencia en la comunidad.

Salud de la mujer; Violencia contra la mujer; Educación superior; Educación en salud; Promoción de la salud

Today, due to the growing harmful and destructive potential, the issue of violence is receiving increasing attention in academic circles. Different disciplines from a number of universities have developed research projects and interventions focusing on violence ¹, which is considered a complex, multi-causal and historical social phenomenon that affects individuals, families, communities and society as a whole. The solution to the problem requires the involvement of different social sectors, involving multiple perspectives and different types of intervention ².

In the contemporary world, violence against women is a public health issue, which impacts on the biological, social and psychological fields. Due to its cyclical nature and the fact that it is widespread throughout society, combating violence against women requires access to a complex range of care and health services, thus requiring treatment approaches that go beyond resources traditionally used in health ³.

Therefore, the involvement of public and academic institutions and organizations from civil society in the implementation of public policies and preventative programs, projects and actions is essential, notably through university extension projects, which seek to address the causes and tackle the factors that stimulate and encourage the occurrence of violence ⁴. University extension projects involve interdisciplinary, educational, cultural, scientific and political processes, through which an interaction is promoted that transforms not only the university, but also the social groups which interact with it. It also involves academic practice, inherent to teaching and research, as stated in the Constitution of 1988 ⁵, in order to promote and guarantee values of democracy, fairness and the development of society in its human, ethical, economic, cultural and social dimensions ⁶.

A university extension project, especially in a public institution, can be seen as a way in which the privilege of higher education, which is only available to a small part of the population, can give back to wider society. In this sense, the university extension enables the integration of the knowledge of students, professors and society, enabling the production of new emancipatory knowledge, grounded in scientific and popular knowledge ⁷, and the training of professionals to work in health promotion ⁸. Given these issues, the question arose: what is the significance of educational practices on violence against women in the professional training of university students? This question led to the objective of analyzing the significance of these educational practices in higher education.

Method

A descriptive, exploratory study with a qualitative approach was conducted at the Universidade Estadual de Montes Claros (the State University of Montes Claros) (Unimontes). This study was initially composed of 14 participants, who were scholarship students on the research project “Diagnosis and analysis of violence against women in the city of Montes Claros, Minas Gerais: research and action” and students from the undergraduate programs in nursing, medicine, dentistry and social service of Unimontes.

The project had two phases: the first (exploratory stage) comprised documentary research of crimes recorded against women with official organs, with identification of the incidence, prevalence and major risk areas in the years 2010-2011; while the second phase consisted of the implementation of the project, with women’s workshops for the promotion of health and citizenship being developed, as well as the preparation of educational materials - brochures, booklets and posters - addressing ways to promote and protect health and life, establishing a culture of peace. Finally, the results were disseminated in scientific circles.

The political-pedagogical project of the undergraduate nursing degree of Unimontes is governed by the principles of ethics, citizenship, the health-disease process and care of the Unified Health System (SUS), and is based on the Lei de Diretrizes e Bases da Educação Nacional Law (National Education Guidelines and Foundations) (LDB) ⁹ and CNE/CES Resolution 3/2001 ¹⁰, establishing national curriculum guidelines for the undergraduate course in nursing.

The course takes place over eight periods and the curricular structure states that the Complete Care for Women course in the fourth period includes discussions of violence and discrimination against women. The project calls for the training of general nurses with the expertise to carry out care activities in a range of areas, being able to identify and intervene in situations of health and disease, promoting the health of the individual in a holistic manner, or in other words, including all stages of the life cycle ¹¹.

The medical course is characterized by humanistic training, focused on the development of ethical commitment and technical, scientific and personal competence, seeking to train professionals who can create solutions to the health problems prevalent in Brazil. The method used is problem-based learning (PBL). The course comprises six years of full time teaching, with 28 places being offered semiannually ¹².

The objective of the degree in dentistry is to train professionals who are able to observe, collect and interpret data, formulating the diagnosis of maxillofacial diseases, in order to enhance the national profile and promotion of health. The course consists of ten periods, with full-time classes and a semester based enrollment system, offering 24 places. The curriculum does not include disciplines that address violence against women ¹².

The degree course in social work aims to train professionals who are able to work with different forms of social issues, proposing a critical posture when dealing with the reality to be addressed. The course curriculum features no specific units on violence against women, but it can be inferred that the issue is addressed ¹².

The gathering of information on all courses took into consideration data saturation. Thus, of the scholarship students, only eight participated in this study. The researcher was not included as a participant, to ensure the impersonality of the results.

The study used two instruments for data collection. To analyze the profile of the subjects, a questionnaire that allowed access to the following data was used: identification, age, gender, skin color/ethnic background, course and graduation period. The second was a semi-structured instrument with the following guiding questions: 1) “What is the significance of educational practices on violence against women for your professional training?”; 2) “What is your perception of the strategies and techniques used for the development of the educational workshops?”; 3) “What are the biggest difficulties you faced in the realization of the educational workshops?”; and 4) “What is the contribution of the educational workshops to your training?”.

Data was collected through individual interviews recorded on smartphones at convenient dates, times and locations agreed in advance with the subjects. The depositions lasted an average of 30 minutes and were collected between September and November 2013. After collection, the interviews were transcribed verbatim, recording the verbal and non-verbal communication for further analysis.

The content analysis method ¹³ was used to analyze the data. This is a set of communication analysis techniques that use systematic procedures to describe the content of messages in three stages: pre-analysis; exploration of material; treatment of results, inference and interpretation. The corpus consists of eight interviews, with sentences being defined as register units and paragraphs as context units.

The participation of the students was subject to the signing of a free and informed consent form. Before data collection began, the participants were informed about the rationale and objectives of the research as well as their right not to participate or to withdraw at any time, without prejudice to the respondent. The privacy and anonymity of the information collected was guaranteed and the names of those interviewed were replaced by the letter “E” followed by the initial of the student’s course and the order of the interviews (EE2, EE5, EE6, EE8, EM1, EM4, EO3 and ES7).

All the respondents in the study were female, given that only women were included in the selection process for the research grant and the prevalence of the female gender in the undergraduate courses taken by participants. The following inclusion criteria were applied for participation in the study: a scholarship from the “Diagnosis and analysis of violence against women in the city of Montes Claros, Minas Gerais: action and research” research project and that the individual attended an interview at a previously scheduled date and time.

The ethical principles of Resolution 466/2012 ¹⁴ of the Conselho Nacional de Saúde (the National Health Council) (CNS), which governs research involving human beings, were followed.

Results and discussion

The problem of violence against women is currently considered to be a major public health issue, given that it affects not only the person suffering the violence, but also society itself. The phenomenon is independent of socioeconomic, cultural and educational levels, as everyone is susceptible to violence ¹⁵. Determinants, such as the invisibility of violence, an absence of sensitivity, a lack of training of health professionals, the trend toward the medicalization of cases and little coordination between the different sectors of society, make the problem even more complex and intervention difficult ¹⁶.

Profile of those interviewed

All eight respondents were female. Three (37.5%) were 25, four (50.0%) described themselves as brown skinned, and three (37.5%) were in the eighth period of the nursing course, as described in Table 1.

Table 1
Epidemiological profile of those interviewed. Montes Claros/MG, 2013

Variable	n = 8	%
Age
20 years old	1	12.5
21 years old	1	12.5
23 years old	2	25.0
25 years old	3	37.5
27 years old	1	12.5
Skin color/ethnic background
White	3	37.5
Brown	4	50.0
Black	1	12.5
Course/Period
Nursing/6th	1	12.5
Nursing/8th	3	37.5
Medicine/9th	1	12.5
Medicine/10th	1	12.5
Dentistry/7th	1	12.5
Social Services /7th	1	12.5
Gender
Male	–	–
Female	8	100

Perception of educational practices against violence against women

How to better understand and apply the concept of the promotion of health is constantly under discussion. Thus, the 1^st International Conference on Health Promotion, held in Ottawa, Canada, in 1986, defined health promotion as the process of empowering the community to work on improving its quality of life and health, including greater participation in control of this process ¹⁷. The concept of health promotion combined with educational practices is associated with tackling historical social inequality in order to promote health in the context of popular and political efforts, which enable social rights to be achieved ¹⁸. The following statements were observed in the speeches delivered by the students interviewed in this study regarding educational practices about violence against women:

“It’s really good” (EE2);

“It was further knowledge” (EO3);

“It’s good for both sides” (EM4);

“It was very important” (EE5, EE6 and EE8);

“It meant a lot” (ES7).

Health education is a social practice that covers processes which can increase the reflection and the critical awareness of those involved. This educational practice should be based on a communication process based on dialogue aimed at working with, rather than at, people. This dialogue infers that everyone has the potential to be the protagonists of their own history, and are motivated to organize themselves and to change their perspective ¹⁹. Extension activities make a decisive contribution to the formation of university student, as they extend the universe of references in which the student is inserted and allow contact with major contemporary issues. They expand the reality experienced by students, which enriches their experience in methodological and theoretical terms; and at the same time reaffirms the ethical commitment and solidarity of public universities with society ⁶.

Violence against women is a violation of human rights, requiring the commitment of the entire society to eradicate its causes and eliminate the consequences of this violation. In this respect, the role of universities to develop research and extension projects that give public visibility to these issues is of great importance. These projects are part of the university performing its function of interacting with civil society in order to transform it ²⁰.

Extension projects achieve better results if they are linked to the processes of training people (education) and the generation of knowledge (research). In relation to education and extension, the guideline of inseparability makes students the protagonist of their own training, giving them primacy in the process of obtaining the skills necessary for their professional activities, as well as the prerequisites for training as citizens, which allow them to recognize themselves as agents of rights and duties, capable of acting for social change, towards equality and the full recognition of human dignity ⁶. In this study, these beliefs can be seen in the following lines:

“These practices can also help prevent violence against women” (EE5);

“We gain experience to deal with these situations if they are part of our daily life” (EM1).

At another extension program – Univali Mulher (Univali Woman), developed at the Universidade do Vale do Itajaí (the University of the Vale do Itajaí) in Santa Catarina, which also aimed to stimulate the prevention of violence against women – students argued that the coexistence of teachers and undergraduate and post-graduate students showed that each participant must contribute to the process and that the whole group is strengthened by the relationships formed, as they emphasize respect for the knowledge of each other in building multidisciplinary knowledge ²¹. Regarding the development of educational practices, respondents in the present study also considered dialogue between different areas important when approaching a common problem:

“It prepares us to take a multi-professional approach, which is more directly aimed at the problem” (EM1);

“It was very interesting (…) spending time with people from other areas” (ES7).

Academic training and violence against women

Given what has hitherto been discussed, it is essential that violence is studied through many scientific interfaces and is the subject of permanent discussion on the part of society to define appropriate and effective programs and policies to tackle the problem, as well as creating proposals and focused teaching strategies to address the various concrete expressions of violence in their different contexts ²². A study conducted in a philanthropic maternity unit in Ribeirão Preto found that health professionals said that they had not been properly instructed on how to deal with situation of violence against women during their university courses ²³. They stated that when the issue was discussed, the approach was sporadic and fragmented and observed that the curricula of undergraduate courses do not provide information on the period in which the subject will be studied, nor the way in which learning will be conducted.

Similar results were observed in the present study, as can be seen in the reports of the subjects:

“It’s considered a public health problem” (EM1);

“Violence against women isn’t really studied at college” (EM1);

“We didn’t study the subject on my course” (EO3);

“We didn’t study violence against women at all at university” (EE5);

“It isn’t something that’s included on our course curriculum” (EE6).

The study “Domestic violence in the conception of teachers of health professionals”, carried out in Brazil in 2009 ²⁴, argued out that it is necessary to fill this gap in professional training and that teachers must use innovative methods to allow and encourage their students to develop critical awareness of issues affecting the life and health of the population, and encourage them to recognize their important role as members of a society that opposes violence.

Another study on the subject, conducted in a hospital, addresses the practices of the health team and indicates that, according to the professionals asked, cases of violence are not very common in their work. According to the author, it is possible that this claim arises from a lack of professional training in identifying and dealing with cases of violence ²⁵. Questions like “have you been beaten at home by a family member?” Or “have you felt or do you feel afraid of anyone?” can allow women to talk about situations of violence suffered. This approach must be handled carefully in order to facilitate professional-victim interaction and subsequent care ²⁶.

Rosa et al ²²conducted a study of students in the final year of undergraduate courses in nursing, medicine and dentistry at the Universidade Federal de Santa Catarina (Federal University of Santa Catarina), and found that health professionals have great difficulty identifying cases of violence, and that this is due to a lack of sensitivity and attention paid during care. The results also suggested that normally after graduation, professionals continue to behave in a manner that they criticized as students, even knowing that such behaviors are not appropriate for those who deal with health. This shows that students are not being properly sensitized and trained to address the problem.

In relation to this aspect of academic training, respondents in the present study showed the same difficulty, reporting that they do not feel able to identify victims of violence or the type of violence suffered:

“I’d say that today I know more about the subject from taking part in this, and that could make it easier for me” (EE2);

“I wouldn’t, if I hadn’t been part of this group” (EO3);

“I wouldn’t. Except once I came across this at work and I had to use the Maria da Penha Law” (EM4).

Difficulties in carrying out the workshops

A study conducted with forty undergraduate students in nursing from a private institution in Rio Grande do Sul, which developed practical activities in a public hospital in the region, found that the educational practices allowed the students to develop, autonomously, their transforming know-how and ability to cooperate in the promotion of health education, in spite of the difficulties encountered in staging these practices ²⁷. Similarly, it was noted in this study that the educational practices or workshops were challenging for respondents, who encountered some difficulties:

“I think the greatest difficulty is the question of adherence” (EE2);

“The greatest difficulty I found was the adherence of the women” (EO3);

“Sometimes the lack of adherence of some of the women was a difficult factor” (EE5);

“We had a lot of problems in relation to the adherence of the women” (ES7);

“The main difficulty for me was time, trying to coordinate university with the times of the group” (EE8);

“Another difficulty was the time pressures of my university course” (EE5).

This study promoted educational workshops in more than one community, and there was some difficulty in performing activities, given the imbalance between the local structure and the number of women who wished to participate. This can be seen in the interviews, which indicated great difficulties such as the “number of participants, sometimes there were a lot at Castelo Branco” (EM4) and “infrastructure, because often the place that the PSF offered wasn’t the most welcoming environment” (EM1). These findings were corroborated by a study that was based on the development of an extension project ²¹, whose authors stated that one of the main difficulties for the development of the workshops related to the physical environment where the meetings were held, which generated the need for changes during the project.

Contribution of educational workshops to graduation

The concept of violence as a complex, historically constructed, multifactorial and interdisciplinary phenomenon, indicates the challenge of allocating resources between different areas and the community. Multiple determinations of the phenomenon of violence require interventions in all spheres involved, to cover the complexity of the problem ²⁸. Taking into account the fact that violence suffered by women has not only physical, but also psychological and social consequences, it is necessary to provide victims with good quality care, which should be developed by a multidisciplinary team in order to cover all aspects of life ²⁹. Vieira et al ³⁰ described the need to understand violence beyond its biological aspect, considering that health professionals should not only intervene in physical complaints but also in the promotion of health and prevention.

Colomé ³¹ draws attention to the responsibility of universities and training centers in the training of health professionals from different areas committed to social issues such as the strengthening of the SUS, and the creation of educational projects in order to prepare students for facing the problems experienced by society. Regarding this aspect, university extension projects are critical to academic training and combined with teaching and research, allow dialogue between university and society.

Participation in university extension programs can take place through public events, lectures, courses, and the planning and execution of programs and projects that meet the identified needs. With respect to violence against women, the university plays an important role in identifying the causes of interpersonal violence, in the planning of public policies and programs aimed at prevention and care provided to victims, as well as bringing greater public visibility to the issue, encouraging victims to express themselves more on the subject ²⁰.

A study by Guedes, Silva and Fonseca ³²of victims of violence, reveals that women consider violence to be aggression against the physical and emotional order, which produces severe effects on mental health. Among the events that affect mental health, we can cite post-traumatic stress, eating, and multiple personality disorders, as well as fear, fatigue, depression, anxiety, sexual dysfunction and sleep disorders. According to the interviewees in this study, the educational practices on violence against women allowed the development of greater sensitivity when detecting signals that indicate violence:

“Often, a woman comes to the health service complaining of things like, a pain” (EE5);

“It can seem as though the woman is suffering from an illness” (EE6);

“Violence against women is also a cause of other somatic or psychosomatic illnesses” (EM1).

A group of 15 undergraduates from a public university in São Paulo held educational workshops on domestic violence ³³. During the project, students reported that they learned a lot from each other and gave more value to details, highlighting the importance of interaction between professionals, as a facilitator and disseminator of knowledge that favored adopting a more suitable position in care. The workshops revealed the skills and competences acquired by the students, who successfully developed their skills.

In the present study, students reported developing a broader and more humanized vision, recognizing the need for preventive measures against domestic violence, a conclusion corroborated by another study ³³ and evidenced by the following statement of a respondent: “It was interesting (...) the issue of the groups being guided, because we had to pay attention to the perspectives of the women, from talking you can grasp the idea” (ES7).

Another extension project that used educational workshops, conducted by students on the nursing, social work and nutrition courses of the Universidade Federal de Juiz de Fora (Juiz de Fora Federal University), concluded that these activities contributed to increasing the creativity, the conception of ideas and the development of skills during group practices ³⁴. In the present study students also evaluated the contribution of educational workshops to their professional training as follows:

“It’s good (…) to develop this skill of group practice” (EM4);

“One contribution was learning how to work in large groups” (EM4);

“Working with videos, songs, theater and dynamic activities” (EM1).

Alves et al ³⁵ reported in their experience with educational groups on violence against women that the interaction between the participants of these groups was important, allowing the exchange of experiences and professional growth, preparing them to deal with the reality of violence and multiplying the culture of peace in the social environment, thus breaking the cycle of violence.

Final considerations

Among the findings of this study, it was found that while violence is a complex, worldwide phenomenon, professional training to deal with the problem is still lacking. Most academics involved in the study, at the end of their degrees, reported that the issue was not addressed during their courses and found that they had the opportunity to learn about violence when participating in the development and implementation of the extension project.

Respondents said that despite the difficulties, such as reconciling their college schedules and activities with the extension project and the low adherence of women in the community to the activities, the educational workshops were extremely positive, as they provided greater academic knowledge, influencing creativity and the ability to work with situations of violence. They said they also had the opportunity to learn to work in groups and to develop activities with the basic objective of humanizing relationships, which they believed would favor the identification and management of cases of violence.

In this context, we emphasize the need to train academics and professionals in a multidisciplinary manner to work in caring for victims of violence in the community. It is therefore necessary that universities review the curriculum structures of their courses, creating courses that pass on knowledge on gender issues and discuss the issue of violence against women and other minorities. Furthermore, it is suggested that the issue is also addressed in a transversal manner, using a number of curriculum subjects to reinforce the content and encourage the adoption of practices aimed at identifying and helping to eliminate violence against women.

The extension project proved to be important for academic training, as it expanded the horizons of students to ensure practical experience in dealing with such situations. It is hoped that the results of the present study will encourage undergraduate courses to review their curriculum frameworks and incorporate the theme of “violence”, which is described in literature as an important public health problem.

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• ²¹
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  » http://bit.ly/1sXwn5t
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  Nascimento EFGA, Ribeiro AP, Souza ER. Percepções e práticas dos profissionais de saúde de Angola sobre a violência contra a mulher na relação conjugal. Cad Saúde Pública. [Internet]. 2014 [acesso 20 nov 2014];30(6):1-10. Disponível: http://bit.ly/1WtZc5C
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  Brasil. Secretaria Especial de Políticas para as Mulheres. Programa de prevenção, assistência e combate à violência contra a mulher: plano nacional: diálogos sobre violência doméstica e de gênero: construindo políticas públicas. Brasília: SEPM; 2003 [acesso 16 nov 2013]. Disponível: http://bit.ly/22urCML
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  Silva PLN, Oliveira EMS, Abreu GGD, Souza AAM, Oliveira RS, Rocha RG. Atendimento do enfermeiro à mulher vítima de violência doméstica. Rev Enferm UFPE. [Internet]. 2014 [acesso 29 nov 2014];8(6):1604-11. Disponível: http://bit.ly/1sXxsdG
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Publication Dates

• Publication in this collection
  May-Aug 2016

History

• Received
  30 Sept 2015
• Reviewed
  9 May 2016
• Accepted
  18 May 2016