Title: Women with disabilities’ experiences of intimate partner violence: A qualitative study
from Sweden
Version: 1 Date: 03 Apr 2023
Reviewer's report:
This manuscript addresses the important and understudied topic of violence against women
with disabilities. Overall, it is a well written manuscript and I believe the study methodology
was relevant and the results are interesting. I have some questions and comments about the
manuscript that I hope will help improve it even further.
1. Page 4, line 94-96: Consider rephrasing this sentence or clarify why women with
physical disabilities may have difficulties in distinguishing appropriate forms of contact from
inappropriate ones. I realise that, due to their dependence, the women might be vulnerable to
these kinds of abusive behaviours, but I don’t understand why they would not understand that
it is abusive if their only disability is physical. Also, though I understand it is not intended that
way, at least to me, the wording of the sentence sounds a bit victim blaming, as if the problem
would be that the women do not understand it is abuse, rather than the perpetrator exploiting the
womens’ vulnerability. Related, in the last sentence of the same paragraph (page 5, line 102-103)
you state that women with intellectual disabilities may not recognize that they are experiencing
sexual abuse. Do you think that this is limited to sexual abuse?
2. Page 5, line 106-109. You state that the lifetime prevalence of IPV in Sweden is 14%. In
the reference given, it is stated that 14% of women report physical IPV since the age of 18.
Considering that you put emphasis on the importance of emotional abuse in the rest of your
manuscript I would suggest being specific in this context. If I remember correct, your reference
(the NCK study) state that 20% of women report emotional abuse by an intimate partner since
the age of 18 but they do not give an overall estimate for all forms of intimate partner violence
over the lifecourse. Other Swedish studies report higher lifecourse prevalence rate, e.g., the
study you refer to further on by Lövestad report 41% for emotional abuse and 27% for physical/
sexual while Nybergh (https://doi.org/10.1186/1471-2458-13-845 ) report 37% for emotional
abuse and 25% for sexual/physical. Overall lifecourse IPV was reported at 16% in yet another
study (https://doi.org/10.1371/journal.pone.0216451). Similar, as you have stated, Ahnlund
report past year prevalence among older adults at 6% while Wiklund (https://doi.org/10.1186/
s12877-022-03638-8) report elder abuse since the age of 65 to be 18%. The point I am trying to
make is that the prevalence varies greatly depending on methodology and hence, please try to
be specific and consider stating that the prevalence has been reported between X and Y, instead
of a very specific prevalence rate.
3. Also, consider revising reference 24. It is not an original source, rather it references the
national public health report which also is not an original source. The statement that older adults
are more often subjected to IPV was surprising to me and hence I tried to look up the reference
but was not able to fully grasp were the information originated. Most studies I have read, state the
opposite, i.e., that the prevalence is higher among younger respondents. This is true for example
for the study by Lövestad that you reference, but that do not include respondents over the age of
65. Though elder abuse is extremely common among older adults with cognitive impairment, it is
difficult to compare those numbers with IPV in general, because of methodological differences.
Hence, I would be very interested to read the original source for the statement that you have
credited to reference number 24.
4. Page 5, line 124-126. Consider rephrasing this sentence. It sounds like qualitative studies
about IPV are unique to Sweden and the Nordic countries. Of course I understand that you are
aware of the extensive international literature on the subject, but consider rephrasing for clarity.
5. Page 7, line 165-168. Considering that the aim of the study was specifically to study violence
against women with disabilities it is surprising to me that you did not ask participants about
their disabilities. Is this not essential if one is to understand how the abuse specifically relates
to the disability or how the disability affected the women’s experiences? Please expand on your
reasons for not including this in the data collected.
6. Related to my last comment, I lack an interview guide. Which questions did you ask the
informants?
7. Page 8. From the data analysis paragraph it is not clear to me if more than one of the authors
were involved in the data coding? Later on it sound like the first author did the coding and
discussed with the other authors but in this paragraph it is stated that “we” performed the different
parts of the data collection. Could you please clarify.
8. Page 9 and forward: Methodological considerations and reflexivity. This part is well written,
and I really appreciate that you have put so much emphasis on this.
9. Page 11, line 271. “but he was/is very harsh” Considering that this is a quote it seems strange
to use “was/is”. Was past or present tense used in the quote?
10. Page 12, line 292. You categorise neglect and refusal to help as a form of psychological
abuse. In literature about elder abuse neglect is a form of abuse in its own right. Is this not
the case for women with disabilities? Some of these forms of abuse also seem to be directly
disability related, which goes back to my comment number 5-6, why did you not ask about
the women’s disability and experiences of abuse in relation to their disabilities? And also, in
addition to naming neglect as a specific form of abuse, should not disability related violence
be its own category.
11. I assume that the term “godman” refers to the Swedish “god man”. I have never heard this
word in English, but rather trustee for “god man” and “administrator” for “förvaltare”. But I am
on thin ice here, perhaps godman is the right term.
12. Page 15, line 374-375. Though I agree with the authors that it is not ok that the women
perceived they needed to be beaten, I would suggest removing this sentence considering that
this is the result section of the manuscript and the question reads like a very strong opinion from
the authors.
13. Page 16, line 390-393. I agree with the authors that it seems logical that the one that earns
the most, pays the most for the children. However, as is mentioned later on line 403-405 it is
not stipulated like that in the law. I would guess that similar disputes are rather common during
separation or divorce and I am not totally convinced that it should be classified as abusive.
Perhaps you could expand a bit about your reasoning about this. Also, perhaps you have other
examples of financial abuse or abuse occurring after the separation that would strengthen this
theme?
14. Page 20, line 489. You mention different forms of abuse, but physical violence is not
included.  Were there examples of physical violence in the findings?
15. Page 20-21 line 504-524. I think that the finding that women with disabilities are vulnerable
in many different relationships is important. Actually, I kept thinking while reading your
manuscript that the Swedish term “violence in close relationships” would probably be better
suited and I kept wondering about why you use intimate partner violence in your title and aim.
I appreciate that you added a paragraph about this in the discussion, but I do not understand
why the term “intimate partner violence” would be more gendered than “violence in close
relationships”. Yes, the kind of perpetrator is mentioned, but an intimate partner may be of both
sexes.
16. Page 24, line 593-594. The last sentence reads like it is related to your own findings, but
you have a reference. Please clarify what is your own results and in what way it relates to the
finding in reference number 54.
17. Most of the conclusion is about the societal response to women with disabilities subjected
to IPV. This is however only very briefly mentioned in the previous parts of the manuscript.
Rather, the second half of the conclusion reads like an implications-paragraph. Consider adding
an implication section and write a conclusion that is in line with the aim and results of the study.
18. There is no limitation section. Though you have a nice paragraph about methodological
concerns and reflexivity there is probably other limitations to your study that would be worth
discussing. For example, there is no discussion about how the sampling method affected the
results and about transferability of results.
19. Min final comment is about the abbreviation “WWD” which I fail to see why you need to
use. To increase readability, I would suggest avoiding abbreviations when not necessary or when
it is not an abbreviation generally used in society or in research. From my perspective, “WWD”
does not fall into any of those categories (even if WWS is an accepted abbreviation in disability
studies). Though this is of course also about individual preference, I suggest considering not
using the abbreviation.