Title: NIHR Global Health Research Group on health system responses to violence against women at University of Bristol
Funder: Department of Health and Social Care

Abstract: a) Key objectives of UoB's 2017 strategy include responsible globilisation, diversity, inclusivity, internationalisation and building global relations, including the development of research partnerships with institutions in LMICs and collaborative research programmes. Our global research strategy is overseen by a Global Challenges Steering group, and draws its membership from our University Research Committee, members of our research institutes, and academics experienced in working with LMIC partners. The University has invested significantly (£1m p.a.) in four interdisciplinary University Research Institutes, which are catalysts for interdisciplinary research, providing expertise and a hub for networking, dissemination, and public engagement and partnership working. Two of these institutes (those focussed on environment and health) are particularly pertinent to global health research. The University also promotes and nurtures ODA activity through interdisciplinary forums such as the International Development Group and provides funding to enable development of new partnerships as well as investing in sustaining those international research groupings which have already been established. b) UoB is the UK leader in domestic violence and health research. The domestic violence and health research group currently has 12 researchers, funded by NIHR and MRC grants and fellowships. The Population Health Sciences Institute, where this research group is based, has expertise in epidemiological, qualitative, trial and evidence synthesis methods that will underpin the work of our proposed Group, building capacity in these methods in partner countries. Our strong track record of collaboration with researchers in LMICs through PhD studentships, post-doctoral fellowships and hosting sabbaticals will ensure we grow capacity in this area. As outlined in our Letter of Endorsement, the University will contribute matched funding for 1.5 PhD studentships, access to Short Courses for academics from our LMIC partners, and a visiting Professorship scheme for academics to spend up to 3 months at UoB. The proposed NIHR Global Research Group on improving the health system response to VAW is perfectly aligned with the University aims of building world-class global health research and will benefit from this commitment, experience, and underpinning infrastructure. c) The Group builds on partnerships with the LSHTM Gender Violence and Health Centre through an NIHR HTA grant, an NIHR Programme Grant for Applied Research, and an MRC GCRF foundation award. There is a formal relationship between An Najah National University (ANNU) and the University of Bristol, exemplified by HESPAL (British Council) scholarships for PhD studentships and honorary appointments for ANNU faculty members. The goal of our proposed NIHR Global Health Research Group is to build the research capacity of our LMIC partners and in the UK departments for collaborative research. The MRC GCRF grant has already linked UoB, LSHTM, University of Sao Paulo, ANNU and the WHO’s Reproductive Health and Research Department. This proposal will strengthen those links through a group structure and develop new links with the University of Peradeniya and Kathmandu University. Our partner universities in the Group will also act as hubs for VAW researchers in other HEIs in Brazil, the Occupied Palestinian Territories (OPT), Sri Lanka and Nepal, helping amplify our impact on national VAW health research capacity. Our choice of new partners is informed by a previous VAW collaboration between our LSHTM researchers and researchers in those universities, providing familiarity with the local context and partners. Our proposed Group will help develop the epidemiological, social science and health service research capacity in partner countries to improve the health systems response to VAW, particularly in sexual and reproductive healthcare settings. Sustainability of capacity and capability of our Group will be ensured by implementation of training and support within partner institutions, continuing exchange of junior and mid-career academics and collaboration with partners on research grant applications, building on the strong track record of the UoB and LSHTM research teams. A crucial partnership that will also underpin the Group is the relationship between the WHO and UoB and LSHTM researchers in this proposal. The WHO Department of Reproductive Health and Research has spearheaded global initiatives on the health care response to VAW, through supporting research and developing global policy and guidance on health systems’ response to VAW. Our Group will support the International Network of VAW Researchers that has been created by the WHO to focus on development and evaluation of health system-based interventions. This network is a mechanism for translating the work of our Group into global health research practice. d) The named co-investigators and partners have already been involved in developing the topics and themes articulated in this proposal. During the first month, a meeting will be convened in London with the Group to refine the research questions and programme trajectory, as well as review resource allocation. The PI in each country will attend monthly video conference steering group meetings, chaired by one of the co-Directors, to monitor progress of the research, capacity building activities, and impact across the group, as well as sharing learning between partners. In each country, a stakeholder advisory group including policy makers, service users and providers (both municipal and NGO-based) will be convened to advise the country programme. The proposed group will work through informal consensus on prioritising research topics and themes. These stakeholder groups, which will consist of strategic partners, will be put into place in the inception phase of the programme. They will also support the intervention implementation, impact activities and translation of evidence into policy and practice. An explicit objective will be facilitating the integration of VAW into existing and new studies of sexual and reproductive health (SRH) researchers in our LMIC partner countries, through enhancing their understanding of the issue, the specific ethical and safety considerations needed for this research and sharing tools and methodological approaches. Our LMIC partners will connect with other SRH researchers to enable them to incorporate VAW measures and interventions into their studies of family planning, antenatal, postnatal care and HIV/STI research. This will involve other universities than those in which PIs are based. We are already developing these stakeholder groups in Sao Paulo and OPT to inform our MRC GCRF VAW programme and have extensive experience of integrating the views of service users, providers and health care commissioners in our NIHR-funded research programmes in the UK, pioneering methods of engagement with survivors of domestic violence. This work with stakeholders is a form of research co-production which we want to develop further with our partner countries. Within our UK domestic violence research we have also prioritised knowledge translation in the form of policy development (e.g. NICE guidelines on DVA https://www.nice.org.uk/guidance/ph50) and implementation of services (e.g. the IRIS primary care DVA programme commissioned in 33 areas http://www.irisdomesticviolence.org.uk/iris/about-iris/about/). We will work with our partners to articulate research translation and implementation strategies tailored to their country and health system contexts and needs.

Lay abstract: Violence against women (VAW) is a violation of human rights and damages the health and well-being of women and their children. It is an obstacle to reaching the United Nations Sustainable Development Goals (SDGs), particularly SDG 5 related to gender equality and empowerment of women and SDG 3 relating to good health and well-being. Our NIHR Global Health Research Group aims to help health care systems in low and middle income countries (LMIC) respond effectively to women who experience violence. By building research capacity and conducting research on training and support programmes as well as working with existing services, we will ensure women and their children receive appropriate care by doctors and nurses, leading to better health outcomes. We are at an early stage of collaboration with researchers, primary health care providers and VAW agencies in Brazil and the Occupied Palestinian Territories (West Bank) to develop an intervention in primary health care. Our proposed Group will extend the scope of that collaboration to other health care settings, particularly sexual and reproductive health services (e.g. family planning, maternal and child health, HIV) and to the poorest, most vulnerable populations in those countries. The Group will also develop collaborations with academics, health care providers and VAW services in two new countries, (Nepal and Sri Lanka), extending multi-disciplinary research capacity building and pilot health care based VAW research in these countries. The Group will build on the research and policy expertise of VAW researchers at the University of Bristol who have significant experience of working with organisations who can put the findings to practical use. Much of this has been developed with NIHR funding, particularly two Programme Grants for Applied Research, led by Feder, one in collaboration with Bacchus. The Group will be a multi-disciplinary collaboration of researchers and service providers who are committed to implementing and evaluating VAW interventions in health care settings. We aim to build research capacity, exchange knowledge within the Group, share findings with VAW researchers in other LMICs who want to develop health care responses, and use the findings to inform policies and practice, supporting their implementation and service evaluation. Our main goal is to improve the VAW response of health care systems in LMICs, so that women experiencing violence (particularly domestic violenc) are asked in a sensitive and supportive way about abuse, are able to disclose their experience to health care professionals, receive appropriate care and support within the health care setting, and are linked with relevant VAW services, including legal and psychological support, where available. Through multi-disciplinary research we will achieve the following objectives: (i) evaluate the readiness of the Brazilian, Occupied Palestinian Territory/West Bank (OPT/WB), Nepalese and Sri Lankan sexual and reproductive health services to identify VAW, respond to the needs of women experiencing violence, and offer referral to VAW services. (ii) conduct research studies with patients and providers to inform the development of the intervention. (iii) develop a tailored training and support intervention for health care professionals with stakeholder involvement (iv) pilot the intervention in reproductive and sexual health settings (all collaborating countries) and primary care settings (Nepal and Sri Lanka)

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;8.5 RESOURCES AND INFRASTRUCTURE (HEALTH SERVICES)
Health categories: DISPUTED AETIOLOGY AND OTHER