Developing and validating the Nepalese Abuse Assessment Screen (N-AAS) for identifying domestic violence among pregnant women in Nepal
Manandhar, Pratibha; Chalise, Pratibha; Rishal, Poonam; Campbell, Jacquelyn C; Henriksen, Lena; Infanti, Jennifer Jean; Joshi, Sunil Kumar; Lukasse, Mirjam; Pun, Kunta Devi; Schei, Berit; Swahnberg, Katarina
Peer reviewed, Journal article
Accepted version
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https://hdl.handle.net/11250/3145220Utgivelsesdato
2024Metadata
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https://doi.org/10.1371/journal.pone.0292563Sammendrag
This study culturally adapted and validated a Nepalese version of the Abuse Assessment
Screen (AAS) tool for identifying domestic violence among pregnant women in Nepal, creat-
ing the Nepalese Abuse Assessment Screen (N-AAS). International and national topic
experts reviewed the initial N-AAS version using the Delphi method, and pregnant women
participated in cognitive interviews, providing feedback on the N-AAS as user experts. Sub-
sequent pre-testing of a comprehensive questionnaire, which included the translated ver-
sion of the N-AAS, occurred in two tertiary care hospitals using an electronic format known
as Color-Coded Audio Computer-Assisted Self-Interview (C-ACASI). The study assessed
the content validity index, compared the concurrent validity of the N-AAS with the gold stan-
dard interview, estimated the prevalence of domestic violence from two hospitals, and calcu-
lated the Kappa coefficient. The reliability of the entire questionnaire was also evaluated
through a test-retest analysis, with content validity rated as “good to excellent” by topic and
user experts and high test-retest reliability (91.2–98.9%), indicating consistency across
questionnaires completed at two different time points, with 12% of participants reporting any
form of violence. The N-AAS demonstrated �91.7% specificity for all forms of abuse, accu-
rately identifying non-abuse cases. In addition, moderate to excellent sensitivity was
observed for emotional abuse (52.5%) and physical abuse since marriage (50%), while sen-
sitivity for physical abuse in the past 12 months was 100%. Thus, the N-AAS demonstrated
reliable test-retest results with a good Kappa coefficient and specificity, as well as showing
excellent sensitivity for detecting recent physical abuse and moderate sensitivity for detecting emotional abuse and physical abuse since marriage. Because cultural context
often leads women to normalize and tolerate abuse from spouses and family members and
women are thus reluctant to report abuse, the results imply that the N-AAS can serve as a
valuable screening tool for domestic abuse in antenatal care settings in Nepal.