Strengthening health systems response to violence against women: protocol to test approaches to train health workers in India.

backgroundGlobally, including in low- and middle-income [LMIC] countries, there is increased attention to and investment in interventions to prevent and respond to violence against women; however, most of these approaches are delivered outside of formal or informal health systems. The World Health Organization published clinical and policy guidelines

methodsThe study will employ a mixed-methods study design. A quantitative assessment of health care providers' and managers' knowledge, attitudes, and practices will be conducted pre, post, and 6 months after the training. Qualitative methods will include a participatory stakeholders' meeting to inform the design of the training intervention design, in-depth interviews [IDIs] and focus-group discussions [FGDs] with health care providers and managers 3-6 months after training, and IDIs with women who have disclosed violence to a trained health care provider, approximately 6 months after training. The study will also validate two tools: a readiness assessment of health facilities and a health management information system form in a facility register format which will be used to document cases of violence. DISCUSSION: The multiple components of this study will generate data to improve our understanding of how implementation of the Guidelines works, what barriers and facilitators to implementation exist in this context, and how current implementation practices result in changes in terms of health services and providers' practices of responding to women affected by violence. The results will be useful for governmental and non-governmental and United Nations Agency efforts to improve health systems and services for women affected by violence, as well as for researchers working on health systems responses to violence against women in India and possibly other contexts.