Sample size calculation:
The sample size in the first phase of the study (quantitative phase) to investigate the prevalence of intimate partner violence in the community was estimated based on the information of Khoshdel et al.'s [15] study, which estimated the prevalence at 80%, with an error of 5% and accuracy of 5%, and with adjustments for a limited population of 189 people. In this way, the sample size was considered to be 226 people, including 20% attrition.
In the second phase of this study (qualitative phase), targeted sampling will be done from among the people who participated in the first phase of the study (the highest score of the violence questionnaire and with the maximum variety) until the saturation limit is reached. The sample size in the intervention phase will be calculated according to the information obtained from the first phase.
Participants assessment and measurements:
Demographic data such as the age of the woman and her husband, the level of education of the woman and her husband, family composition, years of marriage, the status of the worker and her husband, current intimate relationship information, immigration status, alcohol consumption and substance abuse of the woman and her husband in writing and Self-reporting will be reported. The state of quality of life is measured by S-F12 questionnaire. In addition to using the DASS 21 questionnaire, which measures stress, anxiety, and depression, the health status is assessed by asking questions about the effects and physical injuries of violence, such as abortion, fracture, bone fracture, tooth fracture, bruise, scratch, tear, puncture, burn, tooth extraction. More serious injuries such as injuries to the head, eyes, ears, chest and abdomen, as well as blood sugar, blood pressure and lipid measurements will be measured. The IPV situation will also be measured with Haj Yahya et al.'s standard questionnaire (32 items and 4 factors to measure mental, physical, sexual and economic violence).
Procedure:
The implementation steps of the study are shown in Fig. 3:
A) The first phase (quantitative): In this phase, the first and second steps of the PRECEDE-PROCEED model will be done as follows:
a. The first stage (social assessment):
The first step begins with the final result, which is the quality of life of women living in Torbat Jam refugee camp. Different objective and subjective methods are available to check the quality of life, at this stage SF-12 standard quality of life questionnaire will be used to measure the quality of life. The SF-12 questionnaire is a general tool for measuring the health status of people aged 14 and over, which includes 12 questions and two mental and physical scales and 8 subscales (physical performance, limitations in playing physical roles, physical pains, general health, energy and Vitality is social functioning, playing an emotional role, and mental-psychological health.
b. The second stage (epidemiological, behavioral and environmental assessment):
At this stage, important health problems and the health status of the participants are examined. At this stage, the health status of Afghan women living in Torbat Jam refugee camp is analyzed using three indicators of anxiety, stress and depression (DASS21)[1], some physiological indicators (including blood sugar, blood fat, blood pressure) as well as some injuries caused by violence in women, such as a history of abortion due to violence, broken bones, broken teeth, etc. will be investigated. Also, to determine the status of IPV in Afghan women living in Torbat Jam refugee camp, Haj Yahya's standard questionnaire for measuring violence against women will be used. This questionnaire has 32 items and 4 factors to measure mental, physical, sexual and economic violence, and its validity and reliability have been confirmed in various studies in Iran.
B) The second phase (qualitative), after collecting the necessary information in the first phase and analyzing them, the second phase of the current study (qualitative phase) will begin. In this phase, the study of the third phase of the PRECEDE-PROCEED model (educational and ecological survey) will be conducted.
In the qualitative phase of this study, the semi-structured interview method will be used to collect information with an emphasis on predisposing, enabling and strengthening factors. At this stage, the researcher will participate in focus groups or conduct individual interviews with the participants while taking notes of the conversations, and with their permission, the conversations will be recorded and implemented on the same day. An interview guide will be used to guide the interview. The duration of each interview is expected to be 30–60 minutes, and data analysis will begin at the same time as data collection. The experiences and opinions of women and men about the dimensions, reasons and factors of violence against women will be collected with emphasis on predisposing, enabling and strengthening factors. In this phase of the study, which can be considered a qualitative study of phenomenology, behavioral and environmental factors that are closely related to IPV behavior are examined. Predisposing factors such as knowledge, attitude, beliefs, values, capacities and beliefs, enabling factors such as access to resources, rules and regulations, skills, etc., and reinforcing factors such as family, social groups, community leaders, decision makers and, … are identified, explained and categorized in this phase.
C) The third phase (intervention phase), in this phase of the study, based on the results obtained from the qualitative phase, with the localization of the existing conditions, the necessary interventions will be designed and implemented based on the fourth to eighth stages of the PRECEDE-PROCEED model.
a. The fourth and fifth stages of the PRECEDE-PROCEED model (administrative & policy assessment and intervention alignment and implementation):
Based on the qualitative phase, and the analysis of predisposing, strengthening and enabling factors, programs for intervention will be predicted. These interventions can include a range of life skills training, including increasing self-awareness, problem solving, effective communication, emotion management, empathy, interpersonal relationships, and introduction and coordination with available counseling and support centers, providing face-to-face and online counseling facilities, support Asking volunteer organizations and institutions to help (welfare, women's affairs of the governorship, etc.) and make special policies for this population.
b. Sixth to eighth steps of the PRECEDE-PROCEED model (evaluation of process, impact and outcome):
At this stage, evaluation will be done by using the questionnaires of the first phase of the study and also by checking the implementation process of the programs. The evaluation of the process will include the review and monitoring of the number of training sessions, the number of participants, access to training resources and the satisfaction of the participants. The Impact evaluation will examine the immediate impact of the programs on the IPV situation, and the Outcome evaluation will examine the health status and quality of life of Afghan women living in Torbat Jam refugee camp, after the interventions.
Data analysis:
SPSS software will be used for data analysis in quantitative phase. The data will be analyzed by implementing statistical tests of the descriptive statistics, compare means, Pearson’s correlations and linear regression analysis.
Qualitative data analysis will be conducted using the conventional thematic analysis methodology, following the six-step framework(Familiarizing Yourself with the Data, Generating Initial Codes, Searching for Themes, Reviewing Themes, Defining and Naming Themes, Producing the Report/Manuscript) proposed by Braun and Clarke[21].