Background
Migrants from sub-Saharan Africa are among the fastest growing immigrant groups in developed countries.1-3 Australian Bureau of Statistics1 records show that in 2006, a total of 248,699 people born in Africa were living in Australia, constituting a 50% increase when compared with 147,876 people in 1996. According to the International Organization for Migration (IOM),4 a migrant refers to any person who is moving or has moved across an international border or within a state away from his/her habitual place of residence, irrespective of the person's legal status, reason for movement or length of stay. In accordance with this definition, migrants include refugees, skilled migrants and asylum seekers. Since 2006, more than 50,000 migrants from Africa have arrived in Australia. In Sweden, African women constitute one of the largest populations of birth-giving immigrant women.2 This movement to developed countries is mainly due to political, civil, social and economic unrest.2,5
Domestic violence (DV) is a significant public health issue.6,7 It is the physical and/or psychological abuse of a current or previous intimate partner.8 Generally, one in three women experience intimate partner violence in their lifetime.7 It is associated with a number of health issues such as depression,9,10 physical injury,11 an erosion of self-esteem12 and even unintended pregnancy and abortion.13 Also known as intimate partner violence, global estimates show that more than one-third of murders of women are committed by an intimate partner.14 The term "domestic violence" will be used in writing this review. Traditionally, DV is a lifelong issue for many African women: they are often abused and there is an expectation that they occupy a subordinate position in the family.15 On the other hand, men are expected to play a traditional role of breadwinner and are referred to as the head of the family.16-18
There are numerous challenges and stressors that come with settling in a new country which may include acquiring new job skills19 and beginning a new family and social life,5,16 and African men may not be employed or are employed at a lower level of work and income compared to their employment or status in Africa. As a result of this, the perceived loss of status from being the breadwinner and head of the family to a lesser role can create a loss of identity for some African migrant men,17 and this is the most stressful post-migration challenge for many African families.19 In an attempt to re-establish their control as the head of the family, they may inflict threats, yelling and physical abuse on their wives.16 Thus, while DV may be experienced by women in Africa because of their partner's experiences of civil conflict and post-conflict in their countries of birth, it can be exacerbated by additional stressors settling in a new country.14
African migrant women living in developed countries are under-represented in reporting of DV despite their ongoing experience of violence from their intimate partner.16,17,19,20 They generally only seek assistance when the violence is more severe than usual.20 The women lack an understanding of what constitutes DV, perhaps as a result of their socio-cultural perception of intimate partner violence as normal,16 adherence to traditional gender roles,19-21 poor language skills,20 low level of integration into Western culture,16 lack of understanding and trust in the formal criminal justice system in mediating at a time of matrimonial crisis,16,21 and concern for the safety and wellbeing of children.21 Cultural norms that reinforce keeping domestic issues within the private domain also constitute barriers to help-seeking by African migrant women experiencing DV in a developed country.16,21 African migrants often feel isolated,5,16 and there is a growing concern that African migrant women suffer DV in silence, not reporting it to law enforcement agents.16,20
An important element for the development of relevant intervention strategies to support African migrant women is a comprehensive understanding of their experiences of DV. Healthcare providers such as mental health workers, community nurses and women's health nurses need this understanding. Furthermore, this information is required in equipping health services for optimal care delivery for these women.
A search of sources, including the JBI Database of Systematic Reviews and Implementation Reports, the Cochrane Library, CINAHL and MEDLINE, identified no systematic reviews pertaining to the topic of the experiences of African women who have migrated to a developed country and encountered DV. This qualitative systematic review will therefore synthesize data from relevant studies to describe and explore the experiences of African women who have migrated to a developed country and experienced DV.
Inclusion criteria
Types of participants
The current review will consider studies that include women of African descent aged 16 years and above who have migrated from any of the 54 countries in the African continent to a developed country. These women may be single, married, widowed or in a de-facto relationship.
Phenomena of interest
The current review will consider studies that investigate the experiences of African women who have migrated to a developed country and have encountered DV. The experiences include African women's perceptions, perspectives, views, challenges, feelings, meanings, beliefs and thoughts of their migrating to a developed country and encountering DV. The experiences may include, but are not limited to, types of support, facilitators and barriers to help-seeking and health-seeking behaviors in relation to their DV experiences.
Context
The current review will consider studies in which the context involves women aged 16 years and above migrating to developed countries. According to Babecky et al.,22 developed countries include countries in the European Union (EU) and the Organisation for Economic Cooperation and Development (OECD). For the purpose of this review, developed countries will be the EU and OECD countries (e.g. Australia, New Zealand, Canada, United States of America, United Kingdom and countries in Europe and Scandinavia).
Types of studies
The current review will consider studies that focus on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography and qualitative components of studies using mixed-method designs.
Search strategy
The search strategy aims to find published and unpublished studies. Studies published in English language will be considered for inclusion in this review. Studies published from 1998 to present will be considered for inclusion in this review. The time period is selected to enable us to capture a wide range of contemporary data. A three-stage search strategy will be utilized for this systematic review. Only studies published in the English language will be considered.
Stage 1: An initial search of Google Scholar and ProQuest Central will be undertaken using a limited set of keywords. Initial keywords to be used will be experiences, African migrant women, DV and intimate partner violence. The titles of studies in the initial search will be reviewed to expand the keywords, and the index terms used to describe the studies will be identified.
Stage 2: Individual search strategies will be developed for each database using identified keywords and index terms. A second search will involve the use of individual search strategies developed for each database. The databases that will be searched for published literature include:
CINAHL
ProQuest Central
Science Direct
PsycInfo
PubMed
Scopus
Google Scholar
Web of Knowledge.
The database that will be searched for unpublished literature or gray literature will be ProQuest Dissertations & Theses and unpublished research reports from other websites of organizations that deal with migrants' health and wellbeing such as the IOM website and Foundation for Research and Women's Health website.
Stage 3: The reference lists of all identified studies will be searched for additional studies.
Assessment of methodological quality
Papers selected for retrieval will be assessed by two independent reviewers for methodological quality prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion or with a third reviewer.
Data extraction
Data will be extracted from papers included in the review using the standardized data extraction tool from JBI-QARI (Appendix II). The data extracted will include specific details such as the phenomena of interest, participants and method.
Data synthesis
Qualitative research findings will, where possible, be pooled using JBI-QARI. This will involve the aggregation or synthesis of findings to generate a set of statements that represent that aggregation, through assembling the findings rated according to their quality, and categorizing these findings on the basis of similarity of meaning. These categories will then be subjected to meta-synthesis to produce a single comprehensive set of synthesized findings that can be used as a basis for evidence-based practice. Where textual pooling is not possible, the findings will be presented in narrative form.
Appendix I: Appraisal instruments
Appendix II: Data extraction instruments
References