Open-access Approach to violent situations in population surveys: scoping review

ABSTRACT

This paper aimed to map population surveys that identify data on domestic, intra-family, intimate partner and sexual violence, including approaches to sexual behavior and sexual and gender diversity. This is a scoping review that follows the guidelines of the Joanna Briggs Institute and the PRISMA checklist. The search was carried out from December 2021 to April 2022 in the LILACS and Medline databases, Brazilian Digital Library of Theses and Dissertations for gray literature, and extended to 18 sources among websites and institutions relevant to the theme. Out of the 1,191 publications retrieved, 57 were included. Most of the surveys were conducted in Brazil, Portugal and the United States, with a recent increase in the last two decades. The studies focused mainly on domestic or sexual violence and obtained data by means of face-to-face interviews. It is clear that variables such as risk and protective factors, predictors and social determinants of violence are still underexplored in surveys, limiting the understanding of the matter. This review can support the planning of new research and subsequent prevention actions, evaluation of health services and interventions, as well as the fulfillment of public policies to manage the social and individual burden imposed on victims of violence.

KEYWORDS Epidemiological surveys; Questionnaires; Violence; Exposure to violence

RESUMO

O artigo teve como objetivo mapear inquéritos populacionais que identificam dados sobre violências domésticas, intrafamiliares, por parceiro íntimo e sexual, incluindo abordagens sobre comportamento sexual e diversidade sexual e de gênero. Realizou-se uma revisão de escopo conforme as diretrizes do JBI e do checklist PRISMA-ScR. A busca foi conduzida de dezembro de 2021 a abril de 2022 nas bases de dados Lilacs e Medline, Biblioteca Digital Brasileira de Teses e Dissertações para a literatura cinzenta, e extensiva a 18 fontes, dentre sites e instituições pertinentes ao tema. Das 1.191 publicações recuperadas, 57 fizeram parte da amostra final. A maior parte dos inquéritos foi conduzida no Brasil, Portugal e Estados Unidos. Os estudos focaram, principalmente, na violência doméstica ou sexual, sendo seus dados obtidos por entrevista presencial. Percebe-se que variáveis como fatores de risco e proteção, preditores e determinantes sociais de violência ainda são pouco exploradas nos inquéritos, limitando a compreensão do fenômeno. A revisão aqui relatada pode subsidiar o planejamento de novas pesquisas e subsequentes ações de prevenção, avaliação de serviços e de intervenções em saúde, bem como a implantação de políticas públicas de manejo da carga social e individual impostas às vítimas de violência.

PALAVRAS-CHAVES Inquéritos epidemiológicos; Questionários; Violência; Exposição à violência

Introduction

Violence is a matter that permeates various contexts, histories, cultures, genders, and can be experienced by people at different stages of development. The world report on violence, proposed and carried out by the World Health Organization (WHO) in 2002, was the first to globally address the issue, showing that more than 1.6 million people lost their lives annually as a result of collective, interpersonal or self-inflicted violence. WHO identified that the impact of those losses may indirectly harm an immeasurable number of people and showed that where situations of violence persist, health is strongly compromised collectively1.

When gender is specifically addressed, it is possible to identify that violence against women is present in all countries and cultures, harming millions of victims and their families. The WHO report estimated the prevalence of violence against women and informed that about 641 million women suffered violence in 2018 worldwide, and only 6% of them reported having been sexually assaulted by someone other than their husband or intimate partner. Due to underreporting, it can be said that the real number is probably significantly higher, and aggravated by the covid-19 pandemic2, 3.

An estimated 37% of women living in the poorest countries have experienced physical or sexual violence from their partner throughout their lives. Some of those countries reach rates up to one in two women. Younger women are at greater risk of recent violence. Among those who have been in an intimate relationship, the highest rates (up to 16%) of intimate partner violence in the last twelve months involved people between 15 and 24 years of age2.

Intimate partner violence is the most common form of violence against women. According to the Pan American Health Organization (PAHO), violence against women is a widespread public health and human right problem. In Americas, one in three women suffers physical or sexual violence during her lifetime, and risk factors are found at the individual, family, community, and social spheres3.

The United Nations (UN) 2030 Agenda for Sustainable Development, in its sixteenth goal, provides for peace, justice and effective institutions. The goal for significantly reducing all forms of violence and mortality rates emphasizes the importance of research on this matter4.

Preventing violence requires addressing structural economic and social inequalities to ensure access to education, housing and safe work, and transforming gender-discriminatory norms and institutions2. Successful interventions also include strategies ensuring that essential services be available and accessible to survivors, support women’s organizations, challenge unjust social norms, reform discriminatory laws, and strengthen legal and care responses2. To this end, it is necessary for governmental, educational and research institutions to develop investigations based on the design of population surveys to map and monitor data that contribute to the definition of priorities, investments and that are able to subsidize public policies and intersectoral practices to fight against violence5.

Jointly analyzing survey data and routine secondary data from the Unified Health System (SUS) adds to and widens the understanding of health about a country’s population. In addition, surveys allow for the indicators assessed to be intersected for population subgroups, evidencing and monitoring social inequalities in health5.

Surveys carried out in different countries6, 7, 8 question issues related to violence. They make possible to compare protection speeches with the reality of each place, in addition to ensuring data for the design of policies aimed at confronting that issue. The existing surveys in Brazil, even the Atlas of Violence9, are not sufficient to cover the various contexts and scenarios of violence existing in the Country. Many need to be reviewed and improved10, bringing relevance to this review.

Scoping reviews allow for mapping, synthesizing, and analyzing broad and varied evidence on a given topic, in addition to subsidizing the construction of new investigations11. Therefore, for the construction of surveys and studies on violence, it is useful to map the available evidence on how research and surveys on violence are carried out, what are the means used to approach the respondents, which variables to be applied, what hinds and eases the research, what is the methodological orientation, among others.

The purpose of the scoping review is not to inform the results on the outcomes of studies on violence, such as, for example, a traditional systematic review on the subject, but to guide, based on evidence in the literature, the best practices on how to carry out surveys and studies on violence with the population and to subsidize censuses, population studies, surveys, inquiries, and epidemiological studies that are, in turn, tools for the planning of public policies for managing violence and its consequences.

Thus, this study aimed to develop a scoping review to map population surveys with the purpose to identify data on domestic, intrafamily, intimate partner and sexual violences, including approaches to sexual behavior and sexual and gender diversity. The findings are expected to support the design of strategies for collecting and analyzing data on violence for further use in population surveys.

Material and methods

This is a scoping review classified as a descriptive, exploratory and bibliographic study. It followed the JBI methodology for scoping reviews12, 13 and the PRISMA-ScR14 checklist. The protocol here adopted was registered on the Open Science Framework (OSF) platform under DOI: 10.17605/OSF.IO/AJ6GC. Scoping reviews contain a search question and criteria broader than traditional systematic reviews, although they also adopt systematic and transparent methods during their preparation. It is a study design useful to broadly map the available evidence on a given theme14.

The PCC acronym strategy was chosen for the research question definition, as follows: P for problem – population-based surveys; C for concept – domestic, intrafamily, intimate partner and sexual violences, including approaches also to sexual behavior and sexual and gender diversity as to those related to equity policies; and C for context – global. The review aimed at knowing surveys and population-based that addressed data on violence.

The selected documents contained data on respondents who suffered some kind of violence, such as the intentional use of force or power, real or threatened, against oneself, against another person, against a group or a community, which resulted or had the possibility of resulting in injury, death, psychological damage, developmental disability or deprivation15.

The eligible documents were those which addressed inquiries on data collection containing domestic, intrafamily, intimate partner and sexual violences, including approaches on sexual behavior and sexual and gender diversity, regardless the accountable institutions, and cultural or geographical aspects. Inquiry is understood as research methodologies adopting systematic data collection strategies based on interviews applied to a significant sample of the population under analysis with the aim to support the design and assessment of public policies16.

Search design

Preliminary searches were performed through databases that publish protocols, such as OSF, Cochrane, Figshare, JBI and PROSPERO, where no scope or systematic reviews on the subject were identified. Database searches were carried out from December 2021 to April 2022 and prioritized the retrieval of population-based surveys published in report format. Upon the absence of that material, studies published in the format of scientific papers were adopted.

An initial search limited to national and international databases – such as the Institute of Applied Economic Research (IPEA) and the National Institute of Justice (USA) – was carried out to identify documents on the theme. Both relevant words from the text, titles and abstracts, and index terms used to describe the retrieved documents were used to develop a complete search design.

The search design included the descriptors “violence”, “exposure to violence”, “demographic inquiry”, “demography” and their variations, following the Health Sciences Descriptors (DeCS) and the Medical Subject

Headings (MeSH), adapted to each source of information, as well as the combination of the Boolean operators AND and OR. Given the non-classical characteristics of databases researched, the search in each of them had to be adapted to the resources available in their electronic addresses. We used strategies such as manual searches on website icons, simple search with terms like “violence” and “survey”, “violence and survey”, “violence”, among others, in search boxes of electronic addresses. Table 1 summarizes strategies, dates, and results of the searches carried out in each source. There was no restriction as for language or publication period.

Table 1
Description of search dates, results and designs as per each data source

Data sources

Searches were performed in databases and websites of institutions most commonly involved with these themes. Databases initially searched were LILACS and MEDLINE, in addition to Ipea portals, Observatory of Violence Against Women in Santa Catarina, Observatory of Violence Against Women in Rio Grande do Sul, Judicial Observatory of Violence Against Women in Rio de Janeiro, National Observatory of Gender Violence in Lisbon, Brazilian Institute of Geography and Statistics (IBGE), Oswaldo Cruz Foundation, and Alcohol and Drugs Research Unit (UNIAD).

Further databases were identified and added during the selection process or in the reading phase of the publications in full: Laboratory for the Analysis of Violence, Brazilian Forum on Public Security, Marielle Franco Institute, Maria da Penha Institute, Patrícia Galvão Institute, Sou da Paz Institute, Brazilian Association for the Defense of Women, Children and Youth (ASBRAD), Association for Victim Support (APAV), Jorge Careli Latin American Center for the Study of Violence and Health (Information and Document Center (NID)/CLAVES), besides those already proposed in the review protocol. The search for unpublished studies and gray literature was carried out in the Brazilian Digital Library of Theses and Dissertations (BDTD).

Selection of documents

All identified quotes were collected and inserted into an Excel spreadsheet. Titles and abstracts were analyzed by pairs of independent reviewers as to the inclusion criteria for the review. A pilot test was conducted to adjust the level of agreement among reviewers. All potentially relevant documents were retrieved in full. Pairs of independent reviewers assessed the full text of the selected quoting in detail, being the reasons for their exclusion from the studies recorded and reported. Any disagreement between reviewers at each stage of the selection process was solved with the aid of a third reviewer. Research outcomes were depicted by means of the flowchart PRISMA14.

Data retrieval

In the first stage, pairs of reviewers extracted data independently, using an extraction form prepared and previously tested by the reviewers. The extracted data included bibliographic details and specific information for the review, following the topics: i) bibliographic details: study title, author(s), publication date, geographic location, and type of publication; ii) study details: objective(s), study design, study population – sex/gender, age, education, geographic region, income, race/color, marital status, occupation, religion, and whether they have children –, sample, screening instruments, and violence rates; iii) specific information for this scoping review: types of violence, variables adopted to describe conditions of domestic, intrafamily, intimate partner and sexual violences, including approaches to sexual behavior and sexual and gender diversity and related to equity policies and forms of investigation; and iv) main troubles.

There was no need to contact the authors whose documents were selected by de research for missing data or additional information.

Data summary

Based on the JBI scoping review guidelines12, 13 to illustrate and summarize key findings, data were depicted separately in tabular and graphical form for each approach.

A brief description accompanied the results. All findings were merged and classified as to main categories retrieved during the data retrieval process. Specific subcategories were related to the review questions so to identify and clarify how the literature addressed: i) population; ii) concept, i.e., description, methodology or methods; iv) context, v) tracking and sizing instruments, v) research design, vi) types of population surveys.

Results

The search resulted in 1,191 publications, of which 5717, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73 were accepted for the scoping review, as shown in the figure 1.

Figure 1
Flow diagram of the study selection process as per PRISMA, 2020

Table 2 informs that the accepted studies were mostly published from 2011 to 2020 and that only three publications discussed the theme before the year 2000. It should be noted that, in 2021 and 2022 alone, four studies have already been published on the matter. Brazil led in the number of publications in that sample, making South America the continent with the highest number of publications on the theme (n = 30), followed by the United States (n = 8), Portugal (n = 3), Bangladesh (n = 2), and Spain (n = 2). Africa (n = 6) and Asia (n = 4) were also representative in the sample. Regarding the sample of this review, most of the selected material was published in scientific papers.

Table 2
Systematization of the studies included in the review sample as per author, year, type of publication, country of origin, and territorial coverage. Sorted as per selection in the sample.

Most studies wanted to know the opinion of more than one interviewee. The most common opinion came from women, even when gender violence was not directly addressed. Elderly people and adolescents were also quite assessed in the surveys. The low number of studies questioning the opinion or experience of children and vulnerable populations is noteworthy. Regarding the retrieval method, 49 studies adopted interviews17, 18, 22, 23, 24, 25, 28,29, 30, 31, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 68, 69, 70, 71, 72, 73 and eight applied questionnaires19, 20, 21, 26, 28, 32, 67, 68. Face-to-face interviews were the main retrieval method adopted in 43 studies17, 18, 22, 23, 24, 25, 28, 29, 33, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 72, 73, while face-to-face questionnaires were applied in four studies20, 21, 26, 32. Online questionnaires were the mean in three studies19, 27, 68, while online interviews were the retrieval method of just one study71. The purposes of the studies accepted in the sample of this review are summarized in table 3.

Table 3
Description of the studies included in the review sample as for author, purpose, sample, and method of collection.

Only two studies17, 64 did not deal with sociodemographic data on the population surveyed. Maternity or paternity status was the least investigated among the information retrieved by the data extraction instrument. The most investigated variable was the age of the person interviewed. Curiosity about the interviewee’s race/color was shown in less than half of the studies. Table 4 depicts the sociodemographic variables assessed in the sample studies.

Table 4
Sociodemographic variables adopted in each study of the sample

Of the 57 studies, 26 investigated domestic violence17, 18, 19, 20, 21, 24, 25, 26, 28, 31, 33, 35, 36, 40, 41, 43, 44, 50, 52, 54, 55, 56, 57, 58,63,71. Most of these, 18 studies17, 20, 24, 26, 28, 33, 35, 36, 40, 41, 43, 44, 50, 52, 56, 57, 58, 63 researched the forms of violence; three studies investigated the place where violence occurred18, 20, 41; and three others explored the relationship between the victim and the aggressor54, 55, 56. Only two investigated violence against pregnant women25, 50; one explored the experience of violence19; one investigated the reasons for domestic violence31; and another wanted to know the parents’ attitude about domestic violence71.

Research on situations of intrafamily violence appeared in ten studies17, 20, 34, 39, 54, 55, 57, 67, 68, 70, eight of which questioned the experience of that violence17, 20, 34, 39, 54, 67, 68, 71 and only two investigated the relationship between the victim and the aggressor55, 57. Sixteen studies contained variables on situations of intimate partner or sexual violence16, 17, 18, 19, 20, 26, 27, 29, 32, 33, 57, 62, 65, 66, 68, 69, 71, of which twelve exhibited data on forms of violence17, 19, 20, 26, 27, 29, 32, 33, 62, 65, 66. Just one explored the relationship between victim and aggressor57, and another one discussed violence in the first sexual experience68. Twenty studies exhibited variables on sexual behavior17, 18, 20, 29, 32, 34, 54, 56, 58, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, of which twelve investigated sexual violence17, 55, 58, 62, 63, 66, 67, 68, 69, 70, 72, 73, and thirteen explored sexual harassment18, 20, 29, 32, 34, 54, 57, 63, 65, 66, 69, 71, 73.

Only six studies adopted variables on sexual diversity and gender identity20, 32, 57, 68, 71, 73, of which three investigated violence related to gender stereotypes32, 71, 73, such as the stereotype that women would not be able to fill leadership positions, and the other three explored sexual and gender discrimination20, 57, 68, questioning whether homosexual couples should have the same rights as hetero affective couples.

More specifically regarding sexual violence, inquiries retrieved variables to measure the magnitude of the problem related to sexual violence, identification of risk and protection factors, identification of possible consequences of sexual violence, guidance on care, strategies and public policies for managing the consequences of violence and the monitoring and evaluation of services, interventions or treatments received by victims of violence.

Discussion

Data discussion considers that the aim of this scoping review is to map population surveys identifying data on domestic, intrafamily, intimate partner and sexual violences. It includes approaches to sexual behavior and sexual and gender diversity and guides the design of data collection and analysis on violence to be carried out in population surveys.

The first step in planning a survey on violence is to determine the central purpose of the study. The surveys included here had the aim to estimate the prevalence of violence in the population, whether sexual, domestic, urban, interpersonal, among others, providing an epidemiological understanding and regional peculiarities and particularities74.

Most studies in this sample focused on domestic or sexual violence when compared to other types of violence. As to the literature, the justification lies in the increasing number of studies on domestic violence in recent years75, which can be attributed to the growth of public concern on domestic violence driven by awareness campaigns, social movements and cultural changes76.

As a result, domestic violence has become more visible and important in society, leading to an increasing demand for research and studies on the theme. However, public interest in data on other types of violence, such as violence against children, for example, has decreased in recent years. The literature connects this result with stress, dissatisfaction and negative feelings related to the spreading of information about violence against children and adolescents76, 77.

Many studies have aimed to identify risk and protective factors related to violence. As for other studies, this type of study is useful to verify whether there is a correlation between the type of violence and age, gender, race, socioeconomic status or other factors able to support local actions and planning for prevention, care, and managing of violence74, 78, 79.

Besides, we observed that the study variables and questions – whether the victim received the help she needed, what types of resources she received from the services after the violence, where she sought for help, who gave her support, for example – help to identify the consequences of violence also for the victims, by means of consequences on emotional and physical health, and family and social impacts, as for society in general, since the planning of prevention and care actions is an investment in reducing costs and social burdens that result from sexual violence.

To understand the consequences of violence, studies assessed the presence of mental health problems, risk behaviors, impact on productivity, and costs associated with health, social, and victim rights care74, 78, 79.

Surveys here analyzed have the potential to guide public policies, since they provide important information for the planning of prevention and intervention strategies as for the violence theme79, 80, 81. An example is the great concern about the risk of sexual violence against women and the LGBTQIA+ population. Thus, women care services, by means of those studies, are encouraged to find signs of violence in the women there attended, rendering explicit help to address resources and efforts to where they are most needed and effective, in a cost-effective basis82.

Some surveys also aimed to monitor and evaluate interventions for the handling of violence consequences. When a study confirms the positive results of a practice or intervention, that data subsidizes the dissemination of good practices or evidence-based interventions83. When they raise weaknesses or challenges in the handling of violence situations, the survey results uncover issues that need improvement, better planning or local or cultural adaptations.

It is to note that online forms as research tools for surveys had scarce use in the violence surveys here analyzed.

Yet, online survey forms can be valuable tools for research on violence, as they allow for data to be collected confidentially and anonymously, without the need for displacement or face-to-face approach by an interviewer, which can encourage people to provide more sensitive information in detail about experiences of violence that can be difficult to report in person. Besides, online forms can be quickly disseminated through a broaden scope84, increasing the possibility of responses coming from people from most remote regions.

However, studies reveal that the use of online tools for studies on violence tends to increase the representation of younger people to the detriment of older ones, which may cause bias in the results85. One of the indications of the literature specialized in remote surveys is that they be carried out by means of short and simple questions, easy to be understood by the respondents, and with the aid of powerful tools capable of ensuring total data security86, 87.

Population-based surveys and studies are essential tools for understanding violence. When well performed, by means of comprehensive, sensitive, and careful variables, they help to identify the prevalence and patterns of violence, as well as the risk and protective factors connected to violence. Thus, they also subsidize the identification of predictors, social determinants, risk and protection factors, as allow for the evaluation of the existing interventions effectiveness and guide the design of new policies and strategies for prevention and care of victims5, 15.

Limitations of the review

The main limitation of this study was the lack of description as to the variables analyzed by some surveys, and the lack of availability of forms and instruments for data collection in open format. The lack of full data retrieval instruments made it impossible to list and analyze in depth the variables adopted by all the surveys included in this study.

Conclusions

Main variables and matters investigated by the surveys included in this scoping review aimed to identify the risk and protective factors related to violence and to evaluate existing programs, interventions and policies for the handling of their consequences and guidance in the design of new public policies, strategies and cost-effective interventions for good practices in the care of victims of those violences. It is to advise that surveys be carried out with vulnerable populations based on age range, socioeconomic condition or gender or race/color, allowing for a more in-depth and intersectional analysis of types of violence. It is also important to say that data on violence can be related to various variables and social determinants of health so that a profile can be drawn and public policies can be developed to fight against the types of violence occurring in various spheres of society.

  • Financial support: CNPq 401933/2021-0

Acknowledgments

We would like to thank the State University of Campinas – School of Nursing (FEnf UNICAMP), and the Institute of Advanced Studies of the University of São Paulo (IEA USP) for their institutional support for the fulfillment of this study. We would also like to thank the National Council for Scientific and Technological Development (CNPq) for financing this review.

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Edited by

  • Editor in charge: Ana Maria Costa

Publication Dates

  • Publication in this collection
    21 Oct 2024
  • Date of issue
    Jul-Sep 2024

History

  • Received
    15 Jan 2024
  • Accepted
    10 June 2024
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