Evaluating the Effect of a Gender-Based Violence Training for Health Providers in Ermera and Liquica Municipalities, Timor-Leste

Abstract

Introduction: Gender-based violence (GBV) is a pervasive human rights issue affecting the health and wellbeing of its victims. Timor-Leste has one of the highest rates of GBV in the world. Given victims’ care-seeking behaviors, health providers are often a first line of defense when it comes to intervening in GBV. This paper evaluates health providers’ ability toidentify clients experiencing GBV and deliver informed and empathetic care to GBV survivors following an intensive 5-day GBV training (post-intensive) and separately, after a 14-month learning lab training period (endline) implemented in Liquica and Ermera municipalities, Timor-Leste. Methods: This study examined the changes to health providers’ scores from post-intensive period to endline across five domains (GBV knowledge, attitudes, empathy, perceptions of system support, and confidence) following participation in the World Health Organization’s ‘Responding to GBV’ training curriculum as adapted for Timor-Leste. A paper-based questionnaire was administered to providers at baseline, following the intensive 5-day training, and again at 14-months following the monthly learning labs training period. The statistical significance of pairwise bivariate comparisons between provider’s baseline, post-intensive and endline scores across the five GBV domains was assessed using Wilcoxon rank sum tests. Multiple linear regression was used to assess change in domain-specific scores from the post-intensive period to the endline after adjustment for covariates. Results: Seventy-eight providers participated in all three study timepoints (baseline, 5-day and 14-month endline). Using multiple linear regression and adjusting for baseline score only, there was a significant positive relationship between post-intensive score and endline knowledge and empathy domains. After further adjustment for baseline score, sex, age group, profession, and attendance at monthly learning labs, there was improvement in endline score from the post-intensive score for the knowledge, empathy, and confidence domains, however these results were only marginally significant. Conclusion: The ‘Responding to GBV’ training showed sustained improvements across all domains of the training from baseline to endline, and promise of further improvements to in knowledge, empathy and confidence domains from post-intensive training to endline. Future research using a larger sample size and more robust participant linkages across time will help to confirm whether the 14-month training lab sessions are beneficial.