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Domestic Violence

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FACULTY OF HEALTH AND SOCIAL SCIENCES
MSC PUBLIC HEATH
STUDENT ID:
UNIT CODE: DISSERTATION (PUB010-6)
THE INTERVENTIONS FOR WOMEN WHO HAVE
EXPERIENCE DOMESTIC VIOLENCE IN GHANA: A
SYSTEMATIC REVIEW
SUBMITTED IN PART FULFILMENT FOR THE AWARD OF
MSc PUBLIC HEALTH
AUTHOR :
SUPERVISOR : NASREEN
DATE : MAY, 2018
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Acknowledgement
I am most grateful to God, my heavenly father for his bounty, protection; good health and
sufficient grace that saw me complete this dissertation successfully. As a mature student,
studying and working at the same time despite child care problems has been one of the
greatest challenges I have ever come across. However, just like the quotation in the Bible
(Mathew 19.26) that says “With men this is impossible; but with God all things are possible”,
It really inspired me to have faith and trust in the Lord that he will surely take me through the
end.
I wish to appreciate my parents, siblings and friends who kept on encouraging and giving me
supporting different ways while I was writing this dissertation. In a very special way, I wish
to appreciate my Supervisor, Ms. Nazreen Ali for the guidance and unfailing support that saw
me successfully pursue the goals of my dissertation. I appreciate the loving concern and
moral support accorded to me by my friends in the writing of this dissertation and the entire
academic life. I am greatly indebted to you, and my prayer is that God reward you all for your
generosity.
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Declaration Page
This study was completely undertaken and written by ………………. I used my own words
or images and ideas. After conducting the study, I have formed the results from my work
except where stated otherwise by the reference and/or acknowledgement. The work is free
from any plagiarism as it was not copied from the scripts of other authors or candidates, and
no unauthorised materials were used.
Name:
Date:
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CONTENTS
CHAPTER 1: ............................................................................................................................ 9
1.0 Introduction ........................................................................................................................ 9
1.1 Rationale......................................................................................................................... 12
1.2 Research Question .......................................................................................................... 14
1.3 Aims and Objectives ...................................................................................................... 14
1.3.1 Specific Objectives .................................................................................................. 14
1.4 Study and hypotheses ..................................................................................................... 15
CHAPTER 2: .......................................................................................................................... 16
2.0 Literature Review ............................................................................................................ 16
2.1 Conceptual Framework for Domestic Violence ............................................................. 16
2.1.0 Psychological Perspective ....................................................................................... 17
2.1.1 Social Perspective .................................................................................................... 18
2.1.2 Feminist Perspective ................................................................................................ 19
2.2 Types and Perpetration of Domestic Violence ............................................................... 20
2.3 Attitudes towards domestic violence.............................................................................. 21
2.4 Determinants of domestic violence ................................................................................ 22
2.4.1 Age and intergenerational effects ............................................................................ 22
2.4.2 Marital status ........................................................................................................... 23
2.4.3 Patriarchal norms ..................................................................................................... 23
2.5 Consequences of domestic violence ............................................................................... 24
2.5.1 Physical and Mental Health ..................................................................................... 24
2.5.2 Work and daily activities ......................................................................................... 25
2.5.3 Child Development and Behaviour ......................................................................... 25
CHAPTER 3: .......................................................................................................................... 27
Methodology ........................................................................................................................... 27
3.0 Research Design ............................................................................................................. 27
3.1 Rationale for the Systematic Review ............................................................................. 28
3.2 Framing Research Question ........................................................................................... 28
3.3 Inclusion and Exclusion Criteria .................................................................................... 29
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3.4 Searching Strategy.......................................................................................................... 30
.............................................................................................................................................. 32
3.5 Selection of the Relevant Studies ................................................................................... 32
3.6 Data Extraction ............................................................................................................... 32
3.7 Data synthesis ................................................................................................................. 33
3.8 Quality appraisal ............................................................................................................ 34
3.9 Ethical Issues .................................................................................................................. 35
CHAPTER 4 ........................................................................................................................... 36
Results ..................................................................................................................................... 36
CHAPTER 5 ........................................................................................................................... 38
Discussion................................................................................................................................ 39
Implications .......................................................................................................................... 40
Limitations ........................................................................................................................... 40
CHAPTER 6 ........................................................................................................................... 42
6.0 Conclusion ........................................................................................................................ 42
References ................................................................................................................................ 43
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Abstract (250-350 words)
Background:
Methods:
Results:
Conclusions
Implications:
Keywords
Ghana, Accra, Developing Countries, Domestic Violence, Partner Violence, Domestic
Abuse, Intimate Partner Violence, Mental, Trauma, Depression, Post-Traumatic Stress
Depression (PTSD), Anxiety, married women, adult women, female adults, children, Justice,
Human Rights and Social Protection.
The goal of this study is elaborate and research on the understanding of the impact the
domestic violence has on women in Ghana. Domestic violence is a complex, elusive and a
real issue. Practitioners and researchers relate this phenomenon to gender-based power. For
example, in the case study for this research paper, Ghana, Domestic Violence is perceived to
take place in the domestic setting, that is, it is always hidden from the public eye. Currently,
women go through all forms of domestic violence from their partners causing severe mental
health issues. Research shows that post-traumatic stress disorder (PTSD); intimate partner
violence (IPV), depression, suicidal thoughts are major mental health issues that women
encounter in relationships. Medical practitioners do not evaluate the relationship of women’s
mental health status with domestic violence.
The following study will utilise systematic review in investigating the impact of domestic
violence on women’s mental health in the Ghanaian communities. Also, the study has used
multi sited ethnography at the transnational, national and the local level to bring out the
understanding of the influences and effects of such characters together with the remedies.
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Finally, the dissertation highlights the role of the anthropologist in ensuring a proper
disciplinary approach to the complex issue that end up interfering with the women mental
health. An example of domestic violence can be seen in Ghana’s advocacy and development
on domestic violence still rife in Ghana image (Public Agenda, 2017) with a poem “I love
you, that’s why I beat you” on domestic violence in Africa that justifies the bruises on the
body of his partner’s bode and the mind. As this happens to majority of the victims, the
abused woman always puts the blame of the daily battery on herself, and encourages herself
that, is not all about love like she thought it was “laughter and happiness” but “fear and
hate”, as the husband had eventually taught her (Carta et al., 2018).
Poem - “I love you, that is why I beat you”
“The hand that beats me caresses me. I cannot move away. Cannot say what is my heart, no
one must know my shame. I lay there beaten inside, dead inside, hating inside, dying inside.
Holding on to you and not in love but in fear while dreading the morning because I will get
another fist in my face. And you will whisper between the kisses, I beat you because I love
you (Carta et al., 2018).”
(Public Agenda, 2017)
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The above poem and picture stem from the ruthless of domestic violence in Ghana. A plague
that have emotional impact on millions of women everyday globally, frequently trapped in a
toxic situation without escaping. Intimate partner violence causes majority of women’s
experiences of abuse, during women’s years of reproductive in developed and developing
countries. In most cases, violence against women could lead to death; and also two thirds of
intimate partner victims or family linked homicides are women (The World’s Women, 2015).
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CHAPTER 1:
1.0 Introduction
The introductory chapter of this dissertation has the background to the specific study that was
conducted; the statement problem, the main objectives for the research and the research
questions. Further, the chapter has also illustrated the justifications for conducting the study,
definition of concepts, related limitations of the study together with the general layout of the
report which has also been included in the chapter.
Domestic violence is defined as an abuse by one person against another in any intimate
relationship that includes either marriage, cohabitation, or any form of relations in a family.
Research shows that as at now, Domestic violence is the most commonly committed form of
gender based violence in the world. The following research proposal, therefore, provides a
systematic review on the effect of domestic violence on the women’s mental health within the
Ghanaian communities. As you are aware, women generally consciously and unconsciously
face old and shifted norms in the society that has kept on promoting male privilege and
power, which hence, lead to domestic violence even within their intimate partner
relationships.
From the international studies, they estimate that close to 35 per cent of the females across
the world have been victims of either physical or sexual violence at some point in their lives.
Furthermore, other recent systematic reviews also indicate that at least one out of the seven
female homicides are committed by male partners. Other than being types of domestic
violence, physical or sexual violence are also emotionally abusive acts and controlling
behaviours. Therefore, cases of domestic violence are related to gender inequality as well as
adverse health effects which may end up causing economic problems.
Until recently, about three decades to be accurate, domestic violence was not taken to be a
crime and remained to be a none-issue. This scandalous consequence of domestic violence
against women has taken an intensive effort by the United Nations to curb this ordeal
globally. This worldwide trend initiated when violence against abused women was framed as
a strong human rights violation in Vienna during the 1993 World Conference on Human
Rights. The Bill was initially drafted by Lawyers for Women’s Rights (LAWORI) in 1990
and handed over to the public in 2000 however; most communities did not provide support
for such efforts of bringing awareness on issues concerning domestic violence due to that, the
NGOs, public institutions and trade union in Ghana grouped together to advocate for the Bill.
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In 2004 election, the Domestic Violence Bill was the greatest controversial topic ever debated
in Ghana which involved struggles and intense campaigns between the NGOs and the
government due to cultural sovereignty deployed against female’s rights on patriarchal
dominance (Chavez and Griffin, 2009).
The policy also invoked commitments in Ghana for the rights of women under the
international law of the Declaration on Elimination of violence Against Women (DEVAW);
the 1992 Constitution of Ghana, the Criminal Code of 1960 (Act 29), the Domestic Violence
Act 2007 (Act 732). These also included the Domestic Violence Bill as a fulfilment of
Ghana’s international obligations and the Victim Support Unit (DOVSU). A newly formed
Women and Juvenile Unit (WAJU) was also set up by the Ghana Police Service to fight for
justice, equal rights and freedom to reduce the obstacles reported by women (Owusu and
Agbemafle, 2016). Various research studies and investigations shows that; domestic violence
does have a major impact on mental health among women. Ghana is among one of the
countries that have criminalised domestic and sexual abuse (Hodzi, 2009). One of the
predominant types of domestic violence in Ghana is intimate partner violence (IPV) causing
women’s poor health (WHO, 2008). Intimate partner violence (IPV) can be defined as
violence against women and comprises of sexual, emotional, physical abuse and controlling
behaviours by intimate partners (WHO, 2012).
According to Owusu and Agbemafle (2016) in Ghana, statistics shows that 33-52% of
women have experienced domestic violence in intimate partner violence in their lives as this
depressing issues remain a highly hidden sensitive problem that few women are brave to
confess openly. Most people tend to consider domestic violence as physical nature, yet here
are other abuses that affect women such as intimidation, threats, isolation, verbal and
emotional abuse. Furthermore, women experiencing violence at the hands of partners have a
higher percentage of acquiring mental health challenges as compared to women not going
through the same abuse (Stocklet al., 2013). Mental health disorders can be as a result of
physical, social, economic and environments operating at various stages of life mainly
associated by social inequalities in adult women (Allen et al., 2014).
Traumas are experienced by women going through violence and can be categorised as post-
traumatic stress disorder (PSTD) including anxiety disorder. Additionally, from the research
done, post-traumatic stress disorder (PTSD), depression, including suicidal thoughts make up
the most common mental health issues that women suffer from domestic violence due to
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traditional and cultural practices, religious beliefs and financial dependency on men were
mostly the main reasons why women are in silence instead of dealing with the abuse. Whiles
these causes influenced women to tolerate the abuse and to be silent in pain is also a powerful
that triggers further abuse (Asiedu, 2016).
Women in Ghana also live in an extremely patriarchal society whereby the men take all
major decisions being the head of the household. Many Ghanaian women feel reluctant to
make a report to the police but rather consult local church leader as is seen as more of a
private family matter than a legal matter (Ellsberg et al., 2008). Indeed, as illustrated by
Manuh (2009), married Ghanaian women are believed to prefer to stay in cruel relationship
because of being deprived of access to shelter and other basic needs in life (Oduro, Deere and
Catanzarite, 2015). Moreover, symptoms like feeling powerless and helpless, minimal self-
esteem, dysfunction in their sex life, self-medication by the use of alcohol, cocaine and other
drugs. Other mental disorders comprise of depression such as emotional, functional and
cognitive-somatic symptoms (Nat et al., 2014).
It remains clear that domestic violence is a global challenge considering the impact it has on
the mental health of women and it needs reinforcement. Violence against women’s mental
health is a vital risk factor and should be given greater attention. Experiences among
Ghanaian women living with violence has shown that, changes in legislation, public health
approaches to domestic violence can create a difference through provision of health services
for easy access in women’s lives at a particular time to avoid stigma and fear making them
reluctant to disclose their pain and as such needed a proactive role in domestic violence
prevention. Despite establishing policies and organisations with the responsibility for
ensuring social justice, human rights and social protection, domestic violence is widely
present and continue to have severe impact on women’s mental health and for that reason,
domestic violence especially against women should be curtailed once and for all (Rosche,
2014).
In attempts to tackle the menace, that has set head on in Ghana, an act, 2007 (Act 732) on the
domestic violence was enacted. The Domestic Violence Victims Support Unit (DOVVSU) of
Ghana police service was one of the major institutions that was then mandated to oversee the
full implementation and enforcement of the law. The unit, (DOVVSU) was established in
1998 as a Women Juvenile Unit (WAJU), which was also a specialized a unit within the
Ghana police service which came about to respond to the increasing number of reported
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claims on abuse and violence against women and children from some of their family
members.
In order to facilitate the unit in enhancing its duties, the unit was replicated in the year 2002
in all the regional capitals of Ghana. WAJU was then now mandated to investigate all the
cases related to women and children offences, as well as handling cases those cases related to
domestic violence. In addition, it is through the unit that the perpetrators were prosecuted in
accordance to their cases. Before the act on domestic violence was passed, WAJU was
relying on the already existing laws that touch domestic or violence against women. The laws
that they depended on includes the criminal code, 1960 (Act 29) and its amendments,
Intestate Succession Law, 1985 and the children’s act.
Despite making great strides to reduce cases of domestic violence and even providing a
platform for the victims to seek justice, most Ghanaians believed that WAJU was only an
institution where women and children could report cases and seek redress. Due to this reason,
men who have been victimised have always been reluctant to seek justice through WAJU.
For this reason, the name of WAJU was then changed to DOVVSU in the year 2005 so that it
can be neutral to accommodate cases of domestic violence without gender discrimination. In
order to strengthen the new unit, it was backed by a host of international and even Ghanaian
local legal frameworks and policies aimed at creating an environment that gives a timely and
equitable response to all the victims of abuse.
Now that DOVVSU had already been formed, it was now expected perfume various
functions which includes free services to members of the public, protection of the rights of
those vulnerable from any forms of abuse, establishment of an effective database from crime
protection as well as prevention and prosecution (Devries et al. 2013).
1.1 Rationale
The population in Ghana in the year 2017 was estimated to be 28,409,576 million, with
50.9% male and 49.1% female. In spite of the role played by women of Ghana in socio-
economic sector, the contribution to social life and the economy have largely been ignored.
Based on DV and its impact upon Ghanaian women’s mental health as the main topic, it is
relevant to uncover the factors on the prevalence of Domestic violence. Under the Ghanaian
constitution, both men and women have the same status under the law regardless of these
legal guarantees however; women are still subservient to men under the customary system
(GSHRDC, 2017). Identification of these factors will also give meaning to the causes (DV).
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It is therefore, vital to note the causes associated to these factors. Most violence is also caused
by traditional practices in the Ghanaian communities affecting women’s mental health. It is
well known that, when men give dowry for a woman’s hand in marriage, the men think they
have the power to control their women and as such whatever is being said by men should be
accepted without disagreement or she will be beaten (GSHRDC, 2017).
Furthermore, health research amongst women Africa, focus predominantly on reproductive
and maternal and health issues neglecting the importance of women’s mental health. It will
be useful to explore the role of satisfaction within the social networks in decreasing the risk
of mental health outcomes amongst abused Ghanaian women regarding to sexual, physical
assault, emotional abuse and psychological battering that links to IPV in Ghanaian women
with mental health outcomes (Devries et al. 2013). According to (Coker et al., 2008),
potential support could moderate any association between IPV and l series of mental health
consequences including alcohol abuse, depressive symptoms and other forms of abuse
(Lagdon, Armour and Stringer, 2014).
On note, an analysis will be done through systematic review concerning the most appropriate
evidence so as to have a clear comprehension concerning the effect of domestic violence
upon women’s mental health within the Ghanaian communities which can be provided to
policy makers and the government so as to establish suitable strategies to combat it (Mitchell
and Nyadzi, 2011). Although, we recognise what the causes and impact of domestic violence
on the lives of women but, we do not know enough information about what interventions
have been put in place to support women in Ghana or how successful it has been. Though
studies have been done by various scholars, the existing cultural, social and legal practices in
the country have not demonstrated the urge and will to effectively handle the problem
(Lagdon, Armour and Stringer, 2014). The proposed recommendations by various studies for
a long period have not been implemented to their fullest (Mitchell and Nyadzi, 2011).
The country still lacks implementation techniques to ensure that different forms of violent
acts against women are stopped. Studies show that, practical recommendations should have
their way in the cultural and legal setup in Ghana. By doing so, it would to enhance
progressive and promising elimination of the violence against women (Lagdon, Armour and
Stringer, 2014). Therefore, this study finds its way to bridge the gap left by offering
techniques and means through which the discovered solutions can be implemented efficiently
to end violence against women in Ghana.
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1.2 Research Question
“What interventions have been introduced to support women who have experienced domestic
violence in Ghana?
1.3 Aims and Objectives
The core goal concerning this systematic review is to investigate in details the effect of
domestic violence on the women’s mental health living in Ghana.
1.3.1 Specific Objectives
i. Systematically reviewing evidence meeting criteria for exclusion and inclusion of this
systematic review.
ii. Conducting procedure for quality appraisal in summarizing and critically evaluating
evidence selected.
iii. Assessing the effect of domestic violence on women’s mental health within the
communities in Ghana.
iv. Determine and evaluate the available violent action forms against women, girls and
children.
v. Identify situations that enhance prevalence of different types of violence against
women and girls.
vi. Perform a study about the impacts of various form of violence against women and
girls as well as the community.
vii. Identify the capacity by which the affected women and girls express willingness for
help.
viii. Provide factors that cause and influence violence against women and girls
ix. Provide recommendations about the intervention techniques to eliminate various
forms of violence against women.
x. Promote and improve levels of awareness among a population about the different
forms of violence against women.
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1.4 Study and hypotheses
The following hypotheses were tested for the study:
i. There is a statistically significant relationship between the domestic violence and the
impact imposed on the victim
ii. There is no statistically relationship between the domestic violence and the impact
imposed on the victim.
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CHAPTER 2:
2.0 Literature Review
The chapter gives an insight of the literature that is on the effects of domestic violence on the
health of women. The first illustrations provide the conceptual framework that is presented
together with the previously conducted studies in Ghana. The other risk factors that are
related to the Domestic violence will also be availed to clearly illustrate how women are the
most prevalent to the act. Further, the literature will also give a guide to the future action in
the bid to solve the problem arising due to domestic violence.
The theory formulated here has indicated the missing links and ideas for the additional data
that is required for the complete analysis of the problem. It takes into account the materials
on the practice methodologies that inform the interventions that aim at addressing domestic
violence issues from the perspective of some writers or researchers. The chapter also describe
the existing gap on the courses and impact the problem has on women, any interventions that
have been put in place to support women as well as level of success for the interventions.
2.1 Conceptual Framework for Domestic Violence
There are five main set factors that have always been used historically to illustrate the
determinants of domestic violence (Morris, 2014). This section though describes three main
frameworks that are related to the following disciples, the individual psychological factors,
male aggression factors, sociological factors and poverty and prevalence of cultures of
violence. According to the international studies that were conducted in the United States, the
role of individual psychology, male aggression and interpersonal relationships in the families
have been identified as the key factors that have led to the high prevalence of domestic
violence (Carson & Esbensen, 2017).
Despite their attempts to provide an approach towards in provision of solutions for the
domestic violence, they have been criticised, though, due to their lack of focus on critical
factors such as poverty and culture (Institute of Development Studies, 2018). Poverty and
culture appears to be more relevant for the developing countries hence needs an attention
(Wiseman, 2016). These individual and family centric approaches used also seem to give
priorities to response mechanism which includes psycho and family therapy, crime
techniques as well as retroactive responses to cater for the survivors’ needs, something which
is not useful in a scenario where medical and legal options may be prohibitively expensive
and difficult to access (Kenney, 2012). Moreover, these approaches that rely on costly
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therapies for their facilitation of the transformation do not necessarily contribute in the deeper
inequalities that have been seen to have an impact on the domestic violence. The frameworks
highlighted above therefore helps to give an insight for the domestic violence at the same
time giving explanations that helps counter the prevailing myths that in connection (Pool et
al., 2014).
2.1.0 Psychological Perspective
According to the (Mitchell & Anglin, 2009), the early psychological frameworks of domestic
violence seem to focus more on strictly psychological factors and psychiatric factor Further
analysis shows that in any intimate relationships during those days, one or both partners
exhibited gives abnormal characteristics that made them prone to domestic violence. For
example, women were considered to be masochistic while men have their own individual
problems that make them loss control and have excessive drive for aggressive behaviours. All
these behaviours of men and women are perceived to be from a genetic makeup and maybe
adverse socialization experiences that they undergo (Contreras and Cano, 2014).
Until lately, the connections concerning intimate partner violence (IPV) including poverty
had been ignored. Therefore, external and internal psychological difficulties are mostly
missed out when women competing with poverty and IPV are both observed through just one
lens or through the other. It proposes that powerlessness, stress, and social isolation of both
phenomena syndicate to produce depression, post-traumatic stress disorder, as well as other
emotional difficulties. Furthermore, to describe women’s methods of survival is focused on
coping with IPV in the framework of poverty that highlights the role of domestic violence
advocates, researchers, mental health providers can all play a major role in addressing these
firmly entwined phenomena (Goodman et al., 2009).
Other than psychological and psychiatric factors, other related frameworks in line with the
psychological perspective are psychopathology, psychodynamic, social learning theory and
interpersonal interactive. All these perspectives pay attention to the behaviours of individual
abusers. For example, psychopathology perspective argues that those men who are violent
towards their women counterparts had certain personality disorder or mental illness that
pushes them to be violent. The interpersonal perspective though does not only focus on the
behaviours of the perpetrators but also that of the victims (Herman, 2015)
In a social learning perspective theory, domestic violence in homes are perceived to be a
result of learning behaviours that are seen from the aggressive role models or even exposure
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to violence. Even though this argument has several evidences that supports it, it does not
contribute to the larger number of violence cases from our homes especially from abusers
who do not have any childhood abuse history nor come from violent origin homes (Lindsey,
2015).
Therefore, psychological explanations for domestic violence are considered limited as it does
not clearly address the issue of power and gender. Furthermore, the perspective does not
provide answers as to why men with mental illness tend to abuse their women whom they are
within relationship and not the case with their employees (Wallace, Roberson, 2016).
2.1.1 Social Perspective
The whole idea about the sociological perspective is the fact that several assumptions have
been made on the social structure that is assumed to have an effect on people and their
behaviours (Burr, 2015). A number of sociologists have conducted related research to
investigate on the risk factors as well as predictors of domestic violence (Lindsey, 2015). The
social factors in question include social stress, race, ethnicity, socio economic variables, age
and sex. In fact, researchers in their analysis concluded that factors such as work pressure,
poverty and poor housing results into unwanted frustrations which end up causing stress to
individuals thereby leading to other similar consequences in the family (Kite, Whitley, 2016).
However, other authors have differed with this assumption as they argue that violence is not
confined to families in the lower socio economic groups but spread across the class spectrum.
From the analysis, sociologists now view the family structures as institutions and platforms
for creating high risks for domestic violence (Belknap, 2014).
According to other (Wallace, & Roberson, 2016), domestic violence as a resource theory that
suggests that it is just but a resource that is used to derive power so that an individual who
lacks power may utilize violence resources within their relationship. As much as sociological
perspectives use family factors, psychological variables as well as the wider context into
understanding of domestic violence as a social issue, statistics argue that it is from
sociological work was majorly gender neutral as did not really focus on these patriarchal
natures of these social forces in the theories (Cools & Kotsadam, 2017). Therefore, in
conclusion, it is the social forces that have led to gender inequality in several families which
has given men more power to control the families as they abuse their partners.
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2.1.2 Feminist Perspective
The basis of this perspective is on the occurrence of domestic violence originates from a
social movement (Du, 2015). Researchers use this view to highlight the nature of the
domestic violence against women as a means for social control that emerges directly from the
patriarchal structure and the ideology of the family. In other terms, violence against women
has been explained as a forceful control, which is only focused on power and control that
men subject women or their junior position for women in the society. Control and power
occurs at both the social levels and in the context of families and those in intimate
relationships (Rakovec-Felser, 2014).
At the societal level, males are seen to occupy most positions for power in the government,
religious organizations and all other bodies in the society in general. It is argued that the same
trend that they use to overtake women at the societal level through power and control is the
same case when they get back to their families at home. Arguing from this perspective, main
reasons for domestic violence between husband and wives includes the alleged male
domination of the social structure and other socialisation practices that are aimed to enlighten
men and women on their specific roles (Walby, Towers and Francis, 2014).
The view of the domestic violence from the same feminist perspective also focuses on the
existence of relationship that is exhibited between cultural ideology of male dominance and
the existing structural forces that tend to limit women from accessing resources (Walby,
Towers and Francis, 2014). Hence, men use violence against women as criteria to maintain
their social control and power over women, evidence why women usually occupy the
subordinate positions in any social structure which comprises both men and women. The
traditional societies were therefore using the subordination as a cultural legacy for their
families. In a nutshell, the idea of violence against women has been a fundamental idea for
the system for male dominance that originated in the past across all cultures (Outlaw, 2009).
Even though the idea by the feminist has widely been accepted, it has also received dismissal
from some researchers about the view of the perspective on domestic violence (Bryson,
2016). They argued that the perspective is narrow and has not been able to account for
violence perpetuated by women. While the theory is marred with a lot of contradictions and
criticism from these researchers, their feminist counterparts on the other hand supported it as
one of the models that has provided a broad analysis of the gender and power in a society
(Thompson, 2016).
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Feminist perspectives have taken the lead in as an explanatory model for enlightening about
domestic Violence against women, which is as a result of its major strength in praxis or
advocacy approach. Feminist approach has put its focus on the women’s victimisation
terming it a social problem therefore calling for the need to patterned, continuing and harmful
use of any psychological or physical force to dictate and dominate women (Grose & Grabe,
2014).
Thompson (2012) mentioned that, the personal sphere is controlled by issues of power and as
such, power is simply not a matter of macro structures regarding to large-scale o social
issues; that revolves around relationships, identity as well as other microstructural facets of
social life. Moreover, gender is mainly socially constructed and it pivots on the social
significance connected to the differences amongst men and women. Therefore, gender has
broader social and political connotations. The oppressions that women encounter as well as
the problems being experienced from domestic violence are not merely ‘private troubles’ but
also ‘public problems’. Furthermore, this problem is not simply dispersed widely
geographically; nevertheless its incidence can also be extensive, making it an acceptable
behaviour and has severe impacts on women’s well-being and health (Thompson, 2012).
In Ghana, domestic violence and victim support unit popularly known as (DOVVSU) acts as
measures to combat violence amongst women. However, notwithstanding the surfeit of
national and international efforts, domestic violence issues still remains a major social
pandemic in the country, perhaps due to the nature of patriarchal of the country.
Notwithstanding this, (Dery and Diedong, 2014) argued, it is vital to know that violence
against women institutes violation of the human rights of women, and it hinders
achievements of gender equity as well as equality in patriarchal dominant society (ICRW,
2009). Even though, the importance of macro system level forces cannot be underestimated,
such as; religious practices, cultural mores and social norms of gender based violence against
women. It is also seen as a complex phenomenon that poses serious threat to women’s
mental health (Kaur and Garg, 2008; Htun and Weldon, 2012).
2.2 Types and Perpetration of Domestic Violence
The previous most international studies on the domestic violence are of quantitative in nature,
since they are based on the national demographic data and other health surveys. Such studies
measure the physical, psychological and sexual abuse by through the use of set of questions
on certain acts of violence and enquire from respondents in case they had once experience
Dissertation Page 21
any of them. The studies are meant to identify the attitudes towards sexual and physical
abuses on both men and women (Rash, 2010).
Even though they were more exploratory in nature, the studies that were conducted before
2008 in Ghana had very useful information and provided specific details that clearly
underlined the insight of domestic violence. For example, the first study on the nature and
level of domestic violence in Ghana majorly focused on how women understood domestic
violence and their response towards it. The study has also revealed that only five out of fifty
women confirmed that according to their ethnic groups, men are allowed to beat their wives
in the names of disciplining. Successive study by the gender centre though, was now
designed to clearly define the prevalence, types, context, responses and barriers to responses
together with the recommendations about domestic violence at the national level. Another
similar study that asked women to give their understanding of violence ("Prevalence and risk
factors of domestic violence against women; a cross-sectional study in Iranian women,"
2016). According to the findings of that research, most women understands that violence is
not only limited to physical abuse but also but also about the psychological mistreatments
that they undergo such as humiliations, threats, sexual harassment or prevention from seeing
any of family relatives. From a multidimensional perspective through women’s perspectives
on their rights, responsibilities, duties and their sufferings, domestic violence emerged as a
physical and psychological abuse.
According to this understanding, this study has therefore has looked into detailed information
available at the resources centre that are touching on all categories of physical, sexual,
economic and psychological abuse and their effects on the health’s of the affected women.
Other prior studies that were conducted in Ghana, and are used in this review has also
provided crucial scoping interviews with the key stakeholders as well as acts of controlling
behaviour; social violence. In reference to the international definitions, for domestic violence
and other prior research conducted in Ghana refers to any violence committed against an
individual by their intimate partners. The act states that this is so whether the act happens
within the confines of home or beyond (WHO, 2007; UNESCO, 2008).
2.3 Attitudes towards domestic violence
Just like other social behaviours that impacts on people’s attitudes, any attitudes towards
Domestic violence by an individual or victim solely depend on a range of factors. Such
factors include individuals’ belief on gender norms and norms that regulate the perpetration
Dissertation Page 22
of violence, the manner in which such beliefs are internalised, the social norms that control
the distribution of power and resources within the household as well as the social norms that
are used to shape the gender roles and behaviours in a society (Agustín, 2007).
Studies across different countries have shown that the attitude women have on violence
varies across all settings. It shows that those women who live in countries where domestic
violence is rampant find it more acceptable than those who live in areas where it has lower
prevalence. The research also shows that the need to accept beatings form men on their wives
tends to be rampant among those women who have experienced abuse than those who have
not (Agustín, 2007).
In contrary that perception, wife beating in Ghana, where it was highly accepted is now
becoming less accepted. Moreover, the Ghana DHS statistics of 2003 and 2008 indicates that
respondents of the people condoning wife beating has really decreased, translating to 35.7
percent for men and 45.9 per cent amongst women where the largest changes are taking place
in the upper east and upper west regions of Ghana. Both the upper east and west regions of
Ghana were traditionally prevalence to domestic violence and so a good number of awareness
campaigns that has always been held there have brought in sensitization efforts. Therefore,
this study will also review the trends of the awareness and understand on what social norms
have brought about the changes (Issahaku, 2012).
2.4 Determinants of domestic violence
Previous research done on domestic violence in Ghana has shown evidence in the existence
of relationship between the cases of domestic violence and range of individual socio
economic factors that exists on those areas. Considering the conceptual framework that has
been highlighted above, there are more evidence that shows that these individual
determinants of domestic violence do interact with the factors out at the level of the families
(Ghana, Institute of Development Studies (Brighton, England),, & University of Ghana,
2016). The determinants and how the review captured them are highlighted below;
2.4.1 Age and intergenerational effects
Studies shows close relationship between the cases of domestic violence and the age of
victims together with the perpetrators. According these sources, the incidences are lower
among the older women as compared to their life times when they were still young. Thorough
scrutiny of the references on their literature on the analysis of Ghana DHS 2008 clearly
supports this finding (Olorunsaiye, ProQuest (Firm), & University of North Carolina at
Dissertation Page 23
Charlotte, 2015). However, the available results did not indicate any particular patterns
among the victims of domestic violence. Also, the data showed that cases of domestic
violence in Ghana was common in women and men whose families were had higher cases of
violence; that is, there fathers used to beat their mothers. Other findings indicated that those
who had high exposure to domestic violence while were in the childhood stages had higher
chances of being victims of the same as an adult. The above about the relationship of
domestic and violence are consistent with the theories of intergenerational transmission of
domestic violence. Therefore, as this research focuses on the effect of domestic violence, it
shall also look at the effect distribution across age and generations.
2.4.2 Marital status
According to the existing studies on marriage relationships, in many parts of the world
married couples are assumed to have unconditional sex access to their partners, especially
women. In relation to Ghana, it is reported that attitudes, beliefs and practices have however
violent actions against women being dismissed due to the beliefs that women should give up
their rights to husbands at the point of marriage especially after the bride prices are paid
(Adodo-Samani, 2015). Also divorced women due to violence tend to report complaint of
higher cases of domestic violence then those who are still in their marriage as the violence
continues even after separation. A close analysis of the 2008 DHS statistical data available
shows that the domestic cases in Ghana was not common in currently married couples as
compared to those who were once married and separated or divorced. Thus, the role of
marital status on domestic violence needed a review in order to determine effectively the
effects of domestic violence on the lives of women (Archampong, 2010).
2.4.3 Patriarchal norms
A lot of theories have been advanced to explain patriarchy as an explanation to domestic
violence, and that it is through violence that men excise control over women. In fact, a
number of researches that has been conducted has reinforced the notion that Ghana as a
patriarchal country. For example, in their proverbs, oral traditions and folklore, women are
celebrated due to their life giving capacity. Husbands on had a duty to secure the obedience
and fidelity of their wives. The existence of cultural traditions such as dowry payments and
wife inheritance in Ghana has reinforced men’s superiority and has hence encouraged
violence on women (Eswaran and Malthotra, 2011).
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Other factors that have been found to accelerate this behaviour include forced marriage,
widowhood rites and FGM. The facts stated above are true since women have been made
dependent on men due to low education level and training. Women have also been restricted
to receive cash credit or any form of employments, only to be servants of their husbands
where they were expected not to complain but take instructions. Hence, the study must
review the role of patriarchal norms as another determinant of domestic violence (Eswaran
and Malthotra, 2011).
2.5 Consequences of domestic violence
The main focus for this review is to study the impact of domestic violence on the health of
women (Wiseman, 2016). Therefore, this highlight on the consequences of domestic violence
gives a brief prior knowledge on the state of domestic violence and some of the effects it has
had on the health of the victims, especially those from Ghana (Sapkota, 2012,). As evident
from the previous analysis, persistence of domestic violence does not only go against the
human right but is also a hindrance to gender equality across a variety of social, economic
and political outcomes (Oduro, Deere and Catanzarite, 2015). Despite being limited, the few
studies that had been conducted on the consequences show that DV is typically associated
with a long list of adverse consequences on the physical and mental health. The study has
also reported existence of direct and indirect effects of domestic violence within the family
on children’s physical and emotional wellbeing even in their future life prospects (Sapkota,
2012)
2.5.1 Physical and Mental Health
One of the majorly reported consequences of domestic violence are poor physical and mental
health. Victims also face adverse effects such as physical injuries, pregnancy complications,
risks of contracting HIV and other sexually transmitted diseases as well depression.
Statistical research shows that women shows that those women who had experienced any
physical or sexual abuse by their intimate partners have 16 per cent more likely to give birth
to low weight babies than their fellows who did not face any kind of violence. The same
victims were also twice likely to have depression and up to 1.5 times more likely to be
infected with the HIV virus (Bonomi & Glass, 2008)
García-Moreno et al. (2008) in their analysis narrates that domestic violence has specifically
adverse consequences on the mental health as evident on those women who once had sexual
violence from their partners who are reported to have high level of emotional stress. Such
Dissertation Page 25
women were more likely to think about suicide and even attempt to commit it. As for Ghana,
several cases of adverse psychological and emotional effects that has resulted from domestic
violence is evident in the literatures available. According to the analysis on these reports,
women were always on constant fear whenever their husbands got home. Once their
husbands got home their freedom got limited and would even suffer from stress due to
tension and low self-esteem (Wiseman, 2016).
The three recent studies from Ghana has indicated the harmful effects of domestic violence
on taking pregnancy to full term and the health of the babies born (Pool et al., 2014), between
domestic violence and victims health status (Addai and Adjei, 2014) and between domestic
violence and mental health (Sipsma et al., 2013). Other reports on the effect of the victim’s
health by Adu-Gyamfi (2014) reported similar non-physical side effects of domestic violence.
These effects according to his findings were erosion of a person’s sense of dignity,
confidence, self-esteem and respect. The worse part of it is that these victims fears even
going out with these injuries with the fear of being found (Moosa, 2012).
2.5.2 Work and daily activities
Findings from the previous research studies link experiences of domestic violence to their
capability to access better livelihood options, and the fact that they have fewer skills as well
as lower productivity (Moosa, 2012). In their study on the consequences of domestic violence
in Ghana, Britwum and Cusack (2009) found that victims of domestic violence were always
off the work due to direct effect of violence. Even though the major concerns were women,
the study by Duvvury, Minh and Carney (2012) indicated that men were also victims of
domestic violence where the study showed that they can lose up to 6 days of working in any
single violence incident (Moosa, 2012).
2.5.3 Child Development and Behaviour
Even though women are the major victims of the violence in any household, children are
also either directly or indirectly affected by domestic violence. Some of the immediate effects
includes lower birth weight, increased emotional and behavioural problems and lower IQ
scores (Aizer, 2011). Such children who suffer from social and emotional problems that are
related to domestic violence have been found to have lower academic achievement in their
career (Carrell and Hoekstra, 2010).
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2.6 Domestic violence and HIV positive pregnant women
Studies from Africa countries reveal the existence of a relationship HIV infections and
women’s experience of their partner’s violence. The relationship has been identified to have
resulted from the gender inequality in those countries. Besides gender inequality, poverty and
denial to education access is also another factor that makes women vulnerable to HIV
infection. Further studies also reveal that cases of intimate violence found within the HIV
infected women is as a result of HIV disclosure (Mohammed, et al, 2017)
On pregnant women, exposure to intimate violence has been found to be even worse for
maternal and infant health effects. A combination of the two, intimate violence and HIV
infection have been witnessed to result into adverse effects where in this scenario,
psychological violence is considered to be common than physical violence (Aizer, 2007).
The existence of intimate partner violence on HIV positive pregnant women has been see to
result to them giving birth to HIV positive children where the research says that perpetrators
of such have no post-secondary education and are HIV negative. Therefore, there are degree
that are associated with this act, for example premature birth and the risk is high on HIV
infected women (Taft et al, 2013).
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CHAPTER 3:
3. Methodology
3.0 Research Design
Being the vital part of the research in the social sciences, research design has made it possible
for the utilisation of the available evidence in the resources used to in a manner that it may
answer the research question with less possible ambiguity. Therefore, a choice of required
study design is vital for a more for quality research as it dictates the research outcome and
existence of the research result. The study is considered a systematic review since a
systematic literature review study design has been employed for the study followed by
summing up of the findings in relatively descriptive way.
For a successful literature review, all the crucial studies that are related to certain topics were
identified, evaluated, combined and summarised to in a systematic way. In reference to
(Pettice & Roberts, 2006), systematic literature review is defined as a type of review which
involves a comprehensive identification, appraisal and synthesis of all the necessary studies
on specific topics. In order to achieve the required data, the design is made to
methodologically collect all the literature that are deemed to be relevant to the proposed
question, the design then critically evaluate the strengths and weaknesses through enabled
transparent criteria that utilizes collective evidence in providing an answer to the research
question (Cronin, et al. 2008).
The use of literature review was quite significant in this research as it always indicated gaps
due to lack of knowledge as well as providing recommendations in specific areas that require
improvements for future health care. Systematic review further makes the summary of
findings from relevant evidence easier to be accessed by decision makers and investigators
(Hemingway and Brereton, 2009). Additionally, it is transparent, reproducible, effective,
intervention feasibility and could be centred on issues which are particular together with
instructions which are significant to the researcher (Anderson, et al, 2014).
Systematic Review is the best due to limited time and resources associated with investigating
materials and population needed to conduct an actual research. Quality of the data and
investigations is minimal in primary studies as it requires a lot of resources and time on the
number of people that have to be included in the research (Bowling, 2014). Also, there are
numerous pertinent literatures previously published on unseen nature of domestic violence
Dissertation Page 28
resulting in severe psychiatric health issues on Ghanaian women (Knight and Hester, 2016)
however, there is risk of drawing conclusion focused on these studies which could be
defective (CRD, 2009) that could not talk about the reality of the issue at present (Sofaer and
Strech, 2012). For that reason, a systematic review is a suitable study design to recap the
results of the evidence to be accessible for both researches and decision makers (Petticrew,
2009). To provide reliability, validity and biases, a research question is framed to explain the
criteria of inclusion and exclusion. A broader search is done to explore all relevant existing
reviews in the area that is of interest to the topic. Studies which are only appropriate and
clear are chosen to extract their data. Finally, the studies are critically appraised, data
synthesised and presented in a transparent format (CRD, 2009).
3.1 Rationale for the Systematic Review
The study was aimed at identifying any effects domestic violence has had on the health of
women in Ghana. In order to successfully arrive at this, a systematic review was considered
key design to identify and present the necessary research for the analysis and decision making
(Semahegn & Mengistie, 2015). Also, systematic review was considered appropriate since
from it, the researchers can determine the consistency of the findings and whether they can be
generalised to different populations thereby limiting any forms of biasness that may occur
and at the same time, increasing the reliability and precision for any estimates made.
Therefore, health care professionals and policy makers could make decisions based on the
generalised and consistent data that are not biased as opposed to single primary research. The
other idea for not opting for primary research is that such a research involves very large
volumes of samples to be used that represents large volumes of populations from a wider area
that may involve a lot of cost and time in the case of data collection (Leibovici and Reeves,
2008)
3.2 Framing Research Question
In accordance to (CRD, 2009), research question framing is the most important and initial
level in the design since its success base on the ability of an investigator to be exact and
precise when making a determination for the focus in the study. Unambiguous, structured and
clear-cut questions need to be stated in addressing the challenges before the start of the
review. The research question for this systematic review is ‘What are the effects of domestic
violence on women’s mental health in the Ghana’
Dissertation Page 29
3.3 Inclusion and Exclusion Criteria
In order to clearly define exact sources and samples to be used in the research, an inclusion
and exclusion criteria was used. The inclusion criteria were used to identify the study
population that is consistent, uniform, reliable and is in objective manner, while exclusion
criteria were used to realise those characteristics that can make the identified population or
research Materials unrealistic (Simpson, Sweetman, & Doig, 2010).
In the case of our study, for this specific dissertation, the executive summaries for various
crucial literatures that had been identified were scrutinized through the models of inclusion
and exclusion. Keen notice was taken to ensure that the criteria used ensure provision of clear
cut in the identification with no ambiguity. While identifying the resources, care was also
taken that the criterion used should not lead to materials that are too broad or too narrow to
ensure that no information is lost or generalisation especially in the research findings. For a
successful analysis, the following inclusion and exclusion criteria was used.
Inclusion Criterion
Exclusion Criterion
1. Research concerned with primary
sources
Research primaries that are not primary
2. Research concerned with mental
issues as a result of domestic violence
Research and investigation not concerned
with mental issues as a result of domestic
violence
3. Study focusing on countries which are
developing and Ghana
Studies not involved with countries which
are developing
4. Studies concerned with impact of
domestic violence
Research not focusing on domestic violence
5. Literature published after 2007
Research published before the year 2007
6. Research published using the English
language
Studies from research not published in
English
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3.4 Searching Strategy
Parallel literature research studies for six electronic databases were conducted; MEDLINE,
EMBASE, CINAHL, University of Bedfordshire discover platform, ASSIA and international
bibliography of social sciences that were undertaken for the period of 2007 – 2018. The
systematic review enabled the framing of the research question hence utilizing the inclusion
and exclusion criteria, data extraction, qualities appraisal that includes narrative analysis
results and data interpretation. Further, the reference list from retrieved studies and
specialized interdisciplinary journals in violence were hand searched to retrieve information
that might not have been accessed through the database searches.
The study included that of the prevalence of the domestic violence that was conducted
between the years 2007 to 2018 that was published for the ages from18 to 65 years. However,
women with special disabilities or suffering from certain diseases like AIDs were included in
the study. The other category which was excluded; were those women with more than 65
years together with the violent cases against pregnant women whose cases were found to be
of separate review.
From the online and electronic databases, text words terms were used in combinations to
AND “OR” Boolean Operator to arrive at a given maximum number of searches. The
keywords were also utilized in searching EBSCOhost (Discover), Boolean operators "OR"
together with "AND" to come up with search strings such as: (Abuse * OR Partner violence
*OR IPV, *OR Domestic violence * OR gender violence *) PTSD AND (mental illness *OR
mental problems *OR mental challenges *OR mental diseases *) AND (effect * OR impact
*) AND (developing countries * OR Ghana * OR Accra). The database utilized for searching
the primary studies will include PubMed, SCIENCE DIRECT, CINAHL, PsycINFO,
SCOPUS, and Medline since the database of this kind has journals which are peer reviewed
articles of relative advantages to both research and health including list of references.
Journals that had full denied access, the authors were emailed to find out if journals could be
provided however, no reply was received. To determine whether the research studies found
were relevant, the abstract then goes through screening for both inclusion and exclusion
criteria.
Also, there were few limitations on accessing full text document related to the study within
ProQuest however, to have full text document the institution has to give access to view
Dissertation Page 31
documents to connect to ProQuest. The Librarians were contacted via phone calls, face to
face and email for other research articles related to the topic on domestic violence in Ghana.
Emails were sent to experts from the Standpoint for literature on domestic violence in Ghana
especially on women’s oriented talk show popularly known as ;the Oprah of Ghana’ some of
the information received were topics on taboos, domestic violence, rape, child abuse and
many more sensitive topics that gives women a platform for their voice to be heard in Ghana.
Also, few literatures were retrieved on domestic violence the Ghana websites on ‘Speak
Online Magazine’ for the most recent information on news, magazines that publish and
discuss rights pieces of media that produces societal dialogue regarding to human rights
issues in everyday stories.
Finally, the flow chart was created to show how the process of screening. The searches
realized up to 2345 primary studies which through analysis were then reduces to 464 after a
thorough screening of the titles and abstracts which was aimed to determine whether their
contents were in line with the required information in the scope of review. The other
requirements in the data assessing was the scrutiny of the sources, that was done to check on
the existence of any duplicates within the database, accounting for only 170, that is, 13 per
cent of the total studies. Other sources excluded were on the basis of stories on the domestic
violence as a problem and the studies on its risk factors while they did not give a satisfaction
on the prevalence of domestic violence. Having fully gone through the contents of the
sources that were identified, a total of 120 study sources were identified for the systematic
review.
Dissertation Page 32
Figure 1: Flow Chart Screening Process
3.5 Selection of the Relevant Studies
In order to identify the relevant sources, a framework provided by the centre for information
dissemination of Bedfordshire University, which provided for two consecutive phases for the
review. During the first phases, relevant information was identified and titles and abstracts
scrutinised that was done through the provided inclusion and exclusion criteria.
In the second phase, the identified relevant primary studies were further retrieved and
judgement made for their suitability, again using the inclusion and exclusion. Upon the
identification of all the necessary materials, now a full list of reference was retrieved to
determine should there be any other relevant materials necessary for the systematic review.
3.6 Data Extraction
After all the selected studies were identified through an eligibility study, the details of the
content for each source were extracted using data extraction form. An outline for the
Articles provided by
electronic databases
Articles found for screening
the full text
Number of articles meeting
criteria for eligibility from
databases
Number of articles qualifying
to be utilized in the study
Exclude journals which are
irrelevant after screening title
and abstract
Articles found from other
sources
Dissertation Page 33
University for Data Extraction was used after it was modified in relation to the question being
researched on and in accordance to the data synthesis strategy that was to used. In order to
limit biasness and maximise reliability, a standard extraction form was deemed useful. The
data information that was also important for the analysis were study title, name pf the author,
year of publication, name of the journal where published, study setting, time frame, sample
size and target information (Greenhalgh, n.d).
All the details extracted were then recorded in the Microsoft Excel in a manner that it
answered the question. a table, as shown below was used to record evidence collected from
studies selected. The extracted data was divided into three types which are study
characteristics, results, and general information.
Headings to be utilised are shown in the samples below:
3.7 Data synthesis
Once the research question was developed and relevant literature review resources availed,
the next step was data synthesis also known as evidence synthesis. The synthesis involved
gathering, combining and summarizing of the findings from theses relevant literatures with
an objective to answer the review question. The process was strictly utilizing the data that
was screened from the available sources. Options available for the data synthesis were
through the use of the quantitative manner by use of meta-analysis or by use of the narrative
approach which was necessarily in the case it was inappropriate to combine the results of
meta-analysis (Schwarzer, Carpenter, & Rücker, 2015). For this case review, the different
individual studies used in the research defined both the exposures and outcome variables in a
different manner as compared to the dissimilar aspects within the study. Due to this reason,
Dissertation Page 34
narrative approach was deemed fit for the synthesis for the it was inappropriate to combine
and execute a meta-analysis (Greenhalgh, n.d).
3.8 Quality appraisal
In order to critically assess the quality of the primary studies for meeting the inclusion and
exclusion criteria, Quality Appraisal was necessary (Kang, Sibille, Kaminski, & Tseng,
2011). The action aided an investigation of the disparities in finding individual studies and
determining strengths of particular methods of sampling, study designs, and, tools for
collecting data (Kitchenham, 2004). The core issues were; if the results can be proved to be
valid, if the results are of any advantage. Each study selected was assessed in every subgroup
where it was rated either 0 (not satisfied) or 1 (satisfied). The chart below in figure 3, shows
an outline for the quality appraisal checklist, while figure 4 is an illustration of the appraisal
framework that was used for the final grading criteria (Greenhalgh, n.d).
Figure 3: Quality Appraisal Individual Checklist Studies
Dissertation Page 35
Figure 4: Quality Appraisal Framework: Final Criteria Grading
Reference
number of
study
High (Score is greater
than seven)
Medium (Score between
three and six)
Low
(Score less
than three)
1
2
3
4
3.9 Ethical Issues
For every research review and any other studies, ethical considerations are very crucial. They
are the norms and standards for conduct in a research that help in distinguishing bad or good.
It was therefore important to have ethical considerations to prevent against fabrication or
falsifying of data hence promoting the pursuit of knowledge and truth which was a primary
goal of this dissertation review (Spencer, n.d). The considerations should be done to ensure
that all the research that involves human subjects and research are done in a manner that the
participants are treated with care and their interests protected.
Findings from secondary analysis can misinform deliberately and for that reason, during the
researcher it was ensured that the results are valid and reliable together with obtaining ethical
approval from the appropriate authorities. Suppose the ethics are not followed properly, like
in this scenario, it could have resulted into loss of validity, reliability and generalisability of
the research outcomes. Therefore, the IHR – Library Based Ethics Approval Form version
was done and submitted to Institute of Health Research at the University of Bedfordshire
before study begins with an assigned dissertation supervisor. They reviewed the proposal and
approved it in the due period as this research did not involve any human participation hence
there was no great concern on issue to do with rights protection. The approval was important
to allow the committee to verify whether the research meets the commonly accepted ethical
and legal principles (Yoo, 2016).
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CHAPTER 4
Results
Introduction
Considering the publication years, there was a systematic increase in publications on the topic
of study between the years 2007 to 2018. The initial search on using the pre-selected terms
from these publications identified 1500 titles and abstracts that were then subjected to
screening. From the total number of the titles and abstracts identified, 805 articles were
excluded after a thorough analysis that was based on the predetermined inclusion and
exclusion criteria and another 15 articles were excluded since they had limited information
for the assessment. This implies that the remaining 680 articles were selected and their full
text submitted for further retrieval; 20 more articles were added after the expert team on the
ground were contacted making it a total of 700 articles available text for screening in the full
text articles.
Upon the receipt and compilation of all the full text articles, they were then subjected to a
thorough scrutiny to determine their eligibility for the review. Of all the 700 articles, only 31
met the study selection criteria while the remaining were excluded from the review study due
to lack of comparison group and unavailability of correlation value between the comparison
group and existence of duplicate information in the database, ending up with 15 studies, that
were now selected for the study.
During the scrutiny and exclusion, some sources excluded were on the basis of stories on the
domestic violence as a problem and the studies on its risk factors while they did not give a
satisfaction on the prevalence of domestic violence. Therefore, the 15 articles identified were
the once used for the review.
The selection procedure used is illustrated in the figure below (Figure to be labelled later)
Dissertation Page 37
Language
not English
n = 12
Figure 3: Flow diagram of study selection
Title and abstracts
searched
and
assessed
n = 1500
Excluded n = 805
Insufficient available
information
to accomplish
assessment n = 15
Full text retrieved and
evaluated for eligibility
n =
680
Excluded n = 669
Study design/comment/
editorial/letter n = 210
Background/discussion n =
38
Published before 2000 n = 228
Research Not Mental n = 93
Child age unclear n = 7
Studies carried outside Ghana
As a country n =
4
9
Research not focusing on
Domestic Violence n = 14
Duplicate publication n = 18
Articles
meeting
study
selection
criteria
Articles
included in
the review n = 15
Excluded n = 9
No clear
ly defined
comparison group n = 3
No correlation value
between
comparison group
s
n = 4
Studies identified
through contacting
expert
n = 13
Studies identified
through
screening
bibliography n = 7
n = 31
Dissertation Page 38
The study considered both quantitative and qualitative type analysis. However, the review
also found quantitative analysis to be productive. All these selected studies were school based
works where their authors used cross sectional descriptive study design. All the articles used
were primary as indicated in the inclusion and exclusion criteria and were written in English,
published between the years 2008 to 2018 in a peer reviewed journal. Only studies on
domestic violence and specifically on mental health in Ghana were included. No restrictions
were put on the ages, ethnicity, income levels, rural or urban residential or cultural or
religious beliefs of women.
Summary of the selected studies
Findings of the study
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CHAPTER 5
Discussion
Domestic violence, particularly in women continue to be a burning issue for policy makers,
activists, and researchers even though there have not been any global terms agreed for
domestic violence due to the complexity of measuring and defining abuse (Asiedu, 2016).
According to Doku & Asante, (2015), (IPV) which is an intimate partner violence can be
termed as threatened or actual sexual, emotional, psychological or physical abuse from a
former or current partner which at the moment is a concern for public health across the globe.
WHO, (2013) stated that, sexual and physical violence prevalence in African countries, 30%
of women have experienced any form of violence globally (Oduro, Deere & Catanzarite,
2015). Ghana being the main geographical area of this systematic review study is amongst
one of the developing countries facing challenges to combat domestic violence against
Ghanaian women’s mental health. The consistent predicting findings from this systematic
review will reveal the same impacts estimates in comparison to other developing countries in
Africa.
Domestic violence will be seen to be associated with long-term and short-term psychological
mental health issues such as; the tendency towards addiction, depression, ideation for suicide
and anxiety (Rahman, Nakamura, Seino, Kizuki, 2012). Within the Ghanaian communities,
domestic violence reporting is shown to be lower than 4% in women attributed to
consideration of such cases being less appropriate and not seeking help to the extent and they
depend on nature of violence employed by their husband (Doku, & Asante, 2015). However,
the rate of domestic violence and partner violence is very high at about 19%. The effects of
domestic and partner violence continue to be unacceptable where 10-69% of women globally
prove to have been assaulted by their partners at one point during their life. 14% -52% of
girls in schools are victims of abuse either sexually or by violence. The estimates could be far
less as compared to actual persists since violence against women is an issue which is
sensitive and only a few women take the courage to confess openly (Owusu, & Agbemafle,
2016). Given Ghana share same cultures with other African countries, there is a high
possibility of this systematic review sharing similar findings concerning domestic violence.
The finding may also show that women suffering from domestic violence may go through
mental health issues and other severe illness in comparison to women not going through
domestic violence. Among the effects likely to be shown by this research from women going
Dissertation Page 40
through mental health issues also include posttraumatic stress disorders, depression, anxiety,
and suicidal symptoms.
Implications
The result predicted could have consequences on government making public health policies
and practice very effective. The study could provide a deeper comprehension and insight
concerning the effect of domestic violence on women’s mental health living in Ghana which
could stimulate alteration and come up with well-planned policies to curb domestic violence
(Owusu & Agbemafle, 2016). Currently, there is not magical quick solution to tackle the
problem of domestic violence. Findings from this systematic review together with quality
appraisal may provide a framework of great help in designing studies that are unbiased and
efficient in looking for the effects of domestic violence on women’s mental health. Therefore,
the systematic review may serve as a valuable guide for investigators in reflecting findings.
Limitations
Since the design utilised depends on findings acquired from original studies, its reliability and
validity also rely on the used primary studies. Even though quality appraisal and screen
strategies are employed in assessing quality and suitability of primary research, there could
be errors and bias in previous primary research, selection, language, and publication
minimizing review strength (CRD, 2009). To perform a rigorous kind of this design
consumes a lot of time and it’s hard to combine result from all the relevant studies
(Kitchenham, 2004). Using narrative synthesis could act as a limitation due to bias both
unconscious and conscious; the writer may provide some sources with higher privilege in
comparison to others. There could be difficulties in how narrative analysis is performed and
its ways of communication which could cause finding a summary of deceptive and also weak
reviews. Even if all the strategies for searching will be employed, it is a must that relevant
articles may be missed, making the findings also misleading (Kitchenham, 2004). Measuring
the impact of domestic violence in Ghana is not easy due to lack of healthcare professionals
addressing the problem of domestic (Baron et al. 2016).
Dissemination
After completing the review, some techniques will be used in spreading the acquired
information so as to add the available knowledge concerning the impact of domestic violence
on women mental health living in Ghana. Findings from this study will be widely
disseminated to researchers, scholars undertaking postgraduate studies, and relevant
Dissertation Page 41
authorities developing policies while delivering services for health. The researcher will make
a compilation for all the findings as a requirement to fulfil for the award of Master’s Degree.
After this, a copy will be provided to the library in the university to aid postgraduate scholars
as they design their systematic reviews. A copy of the review will be sent to Ghana
publishers to be published to make sure it reaches a huge number of Ghana audience and at
the same time raise awareness in communities concerning the effects of domestic violence.
The researcher will also request for opportunities for presenting evidence from the review in
relevant seminars and conferences and the review can be made available online to be utilized
for referencing. The finding will also be communicated by using Research Gate so as to reach
other research groups and researchers with an interest in this specific area.
HTTPS://WWW.GLOBALGIVING.ORG/PROJECTS/ANTI-VIOLENCE-SHELTER-IN-
GHANA-NEEDS-SUPPORT/REPORTS/?SUBID=14952
Dissertation Page 42
CHAPTER 6
6.0 Conclusion
Despite the existence of efforts to combat domestic violence, it is very disappointing to
realize that little has been done in countries that are developing just like Ghana to be specific.
The systematic review proposed will study the effects of partner and domestic violence in
women’s mental among the communities in Ghana. The study would evaluate all the effects
of these vice and give reasons as to why nothing much have been done, how effective are
government policies in mitigating the vice and highlight the numerous strategies. Mental
health problems as a result of domestic violence are neither fully investigated nor reported.
Nature of this research is at their early stages and need more stimuli so as to move the same
forward.
The researcher chooses to use systematic review which will follow some protocols. The
initial one will be searching evidence from numerous electronic databases that will be
included by utilising specific criteria for both inclusion and exclusion criteria. Followed by
data from publications will be also be extracted with the use of pre-defined data extraction
form in spreadsheet analysing using narrative synthesis and meta-analysis. Findings from
this review could add to knowledge existing and can foster strategies which are new, policies
and interventions to tackle this challenge. It is good to keep in mind of the limitation
experienced by using a systematic review as they could negatively affect the results. The
findings may not be similar with other developing countries as a result of language and
publication bias. However stern actions will take place to reduce limitation and errors.
After completion, other studies can be established from the review proposed, and such could
include ways of mitigating mental disorders in women from Ghana as a result of domestic
violence to enable the whole population to stay healthy (Bezruchka, 2012, p.158). For that
reason, it is good to study the effects of domestic violence on mental health issues in women
as it will work as a step to stimulate change in policies to address the vice of domestic
violence. The review will also encourage further primary studies concerning the effects of
domestic violence on women’s health and their mental issues. Furthermore, this will provide
enough systematic review in enhancing public health and research designs in future.
Dissertation Page 43
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Dissertation Page 54
Appendices
These are intended to give you the opportunity to provide supplementary materials that
support the discussion and analysis in the main text. Do not include unrelated and
unnecessary appendices.
Examples of appendices include supporting information such as the data collection tools
used, ethical clearance documents, etc. The exact nature of the appendices will vary
with the type of study undertaken.

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