title: Training Sri Lankan public health midwives on intimate partner violence: a pre- and post-intervention study.
abstract: BACKGROUND
  In many developing countries, intimate partner violence (IPV) training is not available for health providers. As a pioneer among developing countries, in 2009, the Sri Lankan Ministry of Health trained a group of community health providers known as public health midwives (PHMs) on IPV. We evaluated that training program's efficacy in improving PHMs' identification and management of IPV sufferers in Kandy, Sri Lanka.
  
  
  METHODS
  We conducted this study from August 2009 to September 2010. We used a self-administered structured questionnaire to examine the following variables among 408 PHMs: self-reported IPV practices, IPV knowledge, perceived barriers, perceived responsibility, and self-confidence in identifying and assisting IPV sufferers. We used McNemar's test to compare PHMs' pre- and post-intervention IPV practices. Using the Wilcoxon signed-rank test, we compared PHMs' pre-and post-intervention IPV knowledge, as well as their perceived barriers, responsibility, and self-confidence scores.
  
  
  RESULTS
  The IPV training program improved PHMs' IPV practices significantly. Six months after the intervention, 98.5% (n = 402) of the 408 PHMs identified at least one IPV sufferer in the previous three months, compared to 73.3% (n = 299) in the pre-intervention (p < 0.001). At post-intervention, 96.5% (n = 387) of the PHMs discussed IPV with identified sufferers and suggested solutions; only 67.3% (n = 201) did so at the pre-intervention (p < 0.001). In addition, after the intervention, there were significant increases (p < 0.001) in the median total scores of PHMs' IPV knowledge (0.62 vs. 0.88), perceived responsibility (3.20 vs. 4.60), and self-confidence (1.81 vs. 2.75). PHMs' perceived barriers decreased from 2.43 to 1.14 (p < 0.001).
  
  
  CONCLUSIONS
  An IPV training program for PHMs improved identification and assistance of IPV sufferers in Kandy, Sri Lanka. This training program has the potential to improve PHMs' skills in preventing IPV and supporting sufferers in other regions of Sri Lanka. Other developing countries might learn lessons from Sri Lanka's IPV training.
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. achi_cj@yahoo.com.
authors.forename: Achini Chinthika
authors.initials: AC
authors.lastname: Jayatilleke
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. kayokoyoshikawa@gmail.com.
authors.forename: Kayoko
authors.initials: K
authors.lastname: Yoshikawa
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. jyasuoka@m.u-tokyo.ac.jp.
authors.forename: Junko
authors.initials: J
authors.lastname: Yasuoka
authors.affiliation: Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA. kcpoudel@hotmail.com.
authors.forename: Krishna C
authors.initials: KC
authors.lastname: Poudel
authors.affiliation: Regional Director of Health Services Office, Ministry of Health, Kandy, Sri Lanka. nilani1954@yahoo.co.nz.
authors.forename: Nilani
authors.initials: N
authors.lastname: Fernando
authors.affiliation: Postgraduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka. achalauj@gmail.com.
authors.forename: Achala Upendra
authors.initials: AU
authors.lastname: Jayatilleke
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. mjimba@m.u-tokyo.ac.jp.
authors.forename: Masamine
authors.initials: M
authors.lastname: Jimba
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004496:Education, Continuing; D005260:Female; D006801:Humans; D008880:Midwifery / Q000193:education*; D011247:Pregnancy; D011637:Public Health Nursing; D013179:Spouse Abuse / Q000175:diagnosis / Q000517:prevention & control / Q000706:statistics & numerical data; D013188:Sri Lanka; D011795:Surveys and Questionnaires