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• W3084075712 abstract "Intimate partner violence (IPV) is a serious public health issue, and nurses have the potential to screen, navigate to interventions, and provide support, but responses to IPV differ greatly in mainland China, Hong Kong, Macao, and Taiwan. We conducted a scoping review to examine the nursing literature on IPV in the above four regions in China. We conducted a comprehensive search of 11 Chinese and English databases from database inception to January 31, 2020, for eligible papers including empirical studies, reviews, reports, and expert opinion articles. We hand searched references lists and other studies published by the first and corresponding authors of included articles. Two reviewers independently screened articles and extracted data, and three reviewers cross-checked the extracted results. We also conducted quality appraisal for applicable empirical studies. A total of 58 Chinese-language and 63 English-language articles were included, 58 from Taiwan, 44 from Hong Kong, 13 from mainland China, and six from institutions outside China, but none from Macao. The quantitative and qualitative studies described the prevalence and complex nature of IPV, comparable to non-nursing and international studies. Nurse-led advocacy and Qigong (traditional Chinese mind-body health practice) interventions showed promise for improving mental health in women in Hong Kong. There was a low level of knowledge and preparedness to respond to IPV among Chinese nurses, especially in mainland China. Mixed methods studies in Hong Kong and Taiwan as complex designs were generally well-conducted. Nursing case reports from Taiwan uniquely supplemented the evidence base. In Hong Kong and Taiwan, varying designs were used to study various facets of IPV, targeting victims, nurses and other key stakeholders. In mainland China and Macao, IPV research was limited in quantity, quality, and diversity. As more research in the area of IPV is needed, factors influencing nursing research on IPV also merit investigation, while taking into consideration socio-economic-political-cultural factors. Intimate partner violence (IPV) is a serious public health issue, and nurses have the potential to screen, navigate to interventions, and provide support, but responses to IPV differ greatly in mainland China, Hong Kong, Macao, and Taiwan. We conducted a scoping review to examine the nursing literature on IPV in the above four regions in China. We conducted a comprehensive search of 11 Chinese and English databases from database inception to January 31, 2020, for eligible papers including empirical studies, reviews, reports, and expert opinion articles. We hand searched references lists and other studies published by the first and corresponding authors of included articles. Two reviewers independently screened articles and extracted data, and three reviewers cross-checked the extracted results. We also conducted quality appraisal for applicable empirical studies. A total of 58 Chinese-language and 63 English-language articles were included, 58 from Taiwan, 44 from Hong Kong, 13 from mainland China, and six from institutions outside China, but none from Macao. The quantitative and qualitative studies described the prevalence and complex nature of IPV, comparable to non-nursing and international studies. Nurse-led advocacy and Qigong (traditional Chinese mind-body health practice) interventions showed promise for improving mental health in women in Hong Kong. There was a low level of knowledge and preparedness to respond to IPV among Chinese nurses, especially in mainland China. Mixed methods studies in Hong Kong and Taiwan as complex designs were generally well-conducted. Nursing case reports from Taiwan uniquely supplemented the evidence base. In Hong Kong and Taiwan, varying designs were used to study various facets of IPV, targeting victims, nurses and other key stakeholders. In mainland China and Macao, IPV research was limited in quantity, quality, and diversity. As more research in the area of IPV is needed, factors influencing nursing research on IPV also merit investigation, while taking into consideration socio-economic-political-cultural factors. Intimate partner violence (IPV) can be defined as behaviour within an intimate relationship that causes physical, sexual, or psychological harm [[1]WHOResponding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines. World Health Organization, Geneva2013https://apps.who.int/iris/bitstream/handle/10665/85240/9789241548595_eng.pdf?sequence=1Google Scholar], which is a serious public health issue but often overlooked and underreported [[2]WHOGlobal and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence. World Health Organization, Geneva2013https://www.who.int/reproductivehealth/publications/violence/9789241564625/en/Google Scholar]. Compared to men, women are more vulnerable in terms of prevalence and severity of IPV victimisation [[3]Heise LL Kotsadam A. Cross-national and multilevel correlates of partner violence: an analysis of data from population-based surveys.Lancet Glob Health. 2015; 3: e332-e340Summary Full Text Full Text PDF PubMed Scopus (248) Google Scholar,[4]Stockl H Devries K Rotstein A et al.The global prevalence of intimate partner homicide: a systematic review.Lancet. 2013; 382: 859-865Summary Full Text Full Text PDF PubMed Scopus (414) Google Scholar. Globally, one in three women with intimate relationship has been a victim of IPV [[5]WHOGlobal status report on violence prevention 2014. World Health Organization, Geneva2014https://www.who.int/violence_injury_prevention/violence/status_report/2014/en/Google Scholar]. Substantial evidence has linked the victimisation of women experiencing IPV with negative physical and mental health consequences [[6]Campbell JC. Health consequences of intimate partner violence.Lancet. 2002; 359: 1331-1336Summary Full Text Full Text PDF PubMed Scopus (2415) Google Scholar,[7]Ellsberg M Jansen HA Heise L Watts CH Garcia-Moreno C. Intimate partner violence and women's physical and mental health in the WHO multi-country study on women's health and domestic violence: an observational study.Lancet. 2008; 371: 1165-1172Summary Full Text Full Text PDF PubMed Scopus (1134) Google Scholar. Growing concerns about the high prevalence and adverse health impacts of IPV lead to calls for collaborations within and outside the health sector [[8]Michau L Horn J Bank A Dutt M Zimmerman C. Prevention of violence against women and girls: lessons from practice.Lancet. 2015; 385: 1672-1684Summary Full Text Full Text PDF PubMed Scopus (129) Google Scholar]. Among health care professionals, nurses are uniquely positioned to respond to IPV [[9]Hewitt LN. Intimate partner violence: the role of nurses in protection of patients.Crit Care Nurs Clin North Am. 2015; 27: 271-275Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar]. As the largest single professionals in the health sector [[10]WHOState of the world's nursing 2020: investing in education, jobs and leadership. World Health Organization, Geneva2020https://www.who.int/publications/i/item/nursing-report-2020Google Scholar], nurses serve at the front line of health care delivery and are often the first point of contact for IPV victims [[11]Ali P McGarry J. Supporting people who experience intimate partner violence.Nurs Stand. 2018; 32: 54-62Crossref PubMed Google Scholar], who most often perform in-person identification interventions among all health care professionals [[12]Sprague S Slobogean GP Spurr H et al.A scoping review of intimate partner violence screening programs for health care professionals.PLoS One. 2016; 11e0168502Crossref PubMed Scopus (13) Google Scholar]. However, significant disparities exist in nursing practice, education, research, and policy at national, regional, and global levels, greatly impairing the potential of nursing to achieve sufficient health care and the Sustainable Development Goals (SDGs), in the context of IPV, SDG Goal 5 is gender equality [[10]WHOState of the world's nursing 2020: investing in education, jobs and leadership. World Health Organization, Geneva2020https://www.who.int/publications/i/item/nursing-report-2020Google Scholar,[13]The Lancet2020: unleashing the full potential of nursing.Lancet. 2019; 394: 1879Summary Full Text Full Text PDF PubMed Scopus (32) Google Scholar. Thus, it is important to identify and summarise the state of nursing research in this arena. China is the most populous country in the world with more than 1·4 billion people, including mainland China [[14]National Bureau of Statistics of the People's Republic of ChinaChina Statistical Yearbook 2019. China Statistics Press, Beijing2019Google Scholar], two Special Administrative Regions of Hong Kong and Macao [[15]Ministry of Foreign Affairs of the People's Republic of China. The Hong Kong Special Administrative Region.https://www.fmprc.gov.cn/mfa_eng/ljzg_665465/zgjk_665467/3572_665469/t17814.shtml(accessed Jan 31, 2020).Google Scholar,[16]Ministry of Foreign Affairs of the People's Republic of China. Macao Special Administrative Region.https://www.fmprc.gov.cn/mfa_eng/ljzg_665465/zgjk_665467/3572_665469/t17811.shtml(accessed Jan 31, 2020).Google Scholar, and Taiwan [[17]Ministry of Foreign Affairs of the People's Republic of China. Taiwan Province.https://www.fmprc.gov.cn/mfa_eng/ljzg_665465/zgjk_665467/3572_665469/t17813.shtml(accessed Jan 31, 2020).Google Scholar]. Despite differences in dialects (e.g., Mandarin, Cantonese, Hokkien), characters (simplified Chinese, traditional Chinese), political systems (socialist, capitalist), legal and regulatory systems, and even sovereignty disputes [[17]Ministry of Foreign Affairs of the People's Republic of China. Taiwan Province.https://www.fmprc.gov.cn/mfa_eng/ljzg_665465/zgjk_665467/3572_665469/t17813.shtml(accessed Jan 31, 2020).Google Scholar], Chinese populations share similar cultural backgrounds, and all face the challenging issue of IPV. For example, the life-time prevalence of IPV was estimated to range from 17·4% to 24·5% for psychological violence, from 2·5% to 5·5% for physical violence, and from 0·3% to 1·7% for sexual violence in general population in mainland China [[18]Yang T Poon AWC Breckenridge J. Estimating the prevalence of intimate partner violence in mainland China – insights and challenges.J Fam Violence. 2019; 34: 93-105Crossref Scopus (16) Google Scholar]. The life-time and past-year prevalence of IPV against women was reportedly 9·4% and 1·5% in Hong Kong in 2006 [[19]Broadhurst R, Bouhours B, Bacon-Shone J. The International Violence Against Women Survey: Final Report of the 2006 Hong Kong IVAWS.http://www.ssrc.hku.hk/files/reports/crime/SSRN-id2076994.pdf(accessed Jan 31, 2020).Google Scholar]. The life-time and past-year prevalence of IPV against women was reported as 24·5% and 9·8% in Taiwan in 2016 [[20]Ministry of Health and WelfareStatistical survey of intimate partner violence against women in Taiwan in 2016. Ministry of Health and Welfare, Taipei2017https://dep.mohw.gov.tw/DOPS/cp-1147-36858-105.htmlGoogle Scholar]. Totally 24 female and 2 male victims of IPV were documented in Macao in 2019 [[21]Social Welfare BureauBrief report of cases in central registration system of domestic violence in 2019. Social Welfare Bureau, Macao2020http://www.ias.gov.mo/ch/preventing_combatingGoogle Scholar]. Influenced by Confucian philosophy, violence towards women is not concordant with Chinese cultural values that emphasise harmony, but wife battering has been justified by its patriarchal ideology [[22]Tang CS Cheung FM Chen R Sun X. Definition of violence against women: a comparative study in Chinese societies of Hong Kong, Taiwan, and the People's Republic of China.J Interpers Violence. 2002; 17: 671-688Crossref Scopus (32) Google Scholar]. Furthermore, domestic violence is considered as a private, often shameful, family affair that should not be disclosed to outsiders [[23]Tang CSK Lai BPY. A review of empirical literature on the prevalence and risk markers of male-on-female intimate partner violence in contemporary China, 1987-2006.Aggress Violent Behav. 2008; 13: 10-28Crossref Scopus (97) Google Scholar]. However, in contexts of long-term influence of Western culture in Hong Kong and Macao, rapid social development in Taiwan since 1960s, and tremendous economic growth in mainland China within four decades, Chinese women's status have been improved and power dynamics in intimate relationships have been altered [[24]Tiwari A Chan KL Cheung DST Fong DYT Yan ECW Tang DHM. The differential effects of intimate terrorism and situational couple violence on mental health outcomes among abused Chinese women: a mixed-method study.BMC Public Health. 2015; 15: 314Crossref PubMed Scopus (12) Google Scholar]. In addition, gender equality and women's empowerment has been actively advocated by organisations like UN Women China since the late 1990s [[25]UN Women. UN Women China.https://asiapacific.unwomen.org/en/countries/china(accessed Jul 1, 2020).Google Scholar]. IPV against women has gained increased attention as a research topic after the UN Fourth World Conference on Women held in Beijing in 1995 [[26]UNReport of the Fourth World Conference on Women.1995https://www.un.org/womenwatch/daw/beijing/pdf/Beijing%20full%20report%20E.pdfGoogle Scholar]. An increasing number of studies showed some evidence about prevalence, determinants, correlates, and consequences of IPV in Chinese populations over the last three decades [[27]Zhang H Zhao R Macy RJ Wretman CJ Jiang Y. A scoping review of 37 years of intimate partner violence research in China.Trauma Violence Abus. 2019; (published online Oct 20.)https://doi.org/10.1177/1524838019881738Crossref PubMed Scopus (4) Google Scholar]. Nurse researchers from Hong Kong and Taiwan contributed to the growing body of evidence, and IPV is integrated into nursing education and practice in responding to almost the earliest laws against domestic violence in Asia [28Tiwari A Wong J Fong DYT et al.Intimate partner violence in obstetric/gynecology patients: A Chinese perspective.Expert Rev Obstet Gynecol. 2008; 3: 317-330Crossref Scopus (3) Google Scholar, 29Chan CH Tiwari A Fong DYT Ho PC. Post-traumatic stress disorder among Chinese women survivors of intimate partner violence: a review of the literature.Int J Nurs Stud. 2010; 47: 918-925Crossref PubMed Scopus (11) Google Scholar, 30Chen YH Huang JJ. Nursing discourse on domestic violence in Taiwan.J Nurs. 2009; 56 (in Chinese): 36-45Google Scholar, 31Lai FC. An exploration of domestic violence and sexual abuse prevention and intervention in nursing curriculum.New Taipei J Nurs. 2009; 11 (in Chinese): 1-6Google Scholar, 32Hsieh HF Wang HH Chang SC. The development of forensic nursing from the perspective of domestic violence and sexual assault preventive policies.J Nurs. 2013; 60 (in Chinese): 96-102Google Scholar]. Ample literature illustrates the unique role of nurses in IPV prevention and intervention in Chinese settings, but mainly in Hong Kong and Taiwan where approximately 59,000 and 175,000 nurses are practicing [[33]Nursing Council of Hong Kong. Statistics and Lists of Nurses 2019. https://www.nchk.org.hk/en/statistics_and_lists_of_nurses/statistics/index.html(accessed Jul 1, 2020).Google Scholar,[34]Taiwan Union of Nurses Association. Taiwan nursing workforce statistics in year 2019. http://www.nurse.org.tw/publicUI/Eng/Y108.aspx(accessed Jul 1, 2020).Google Scholar. Laws on domestic violence in mainland China and Macao were both launched in 2016, and require reporting of IPV from medical institutions [[35]Social Law Office of Legislative Affairs Commission of NPC Standing CommitteeExplanations on anti-domestic violence law of the People's Republic of China. China Legal Publishing House, Beijing2016Google Scholar,[36]Macao SAR. Law on Preventing and Combating Domestic Violence.https://bo.io.gov.mo/bo/i/2016/23/lei02_cn.asp(accessed Jan 31, 2020).Google Scholar. More than 4·5 million nurses in mainland China are the largest group of its health care workforce [[37]The State Council of the People's Republic of China. The number of registered nurses in China reached 4.45 million. http://www.gov.cn/xinwen/2020-05/12/content_5511066.htm(in Chinese, accessed Jul 1, 2020).Google Scholar]. However, IPV is not considered within the scope of nursing practice in spite of reporting laws, and only limited nursing research on IPV exists from mainland China and Macao, the city with about 2,500 nurses [[38]Statistics and Census Service of Macao SAR. Health Statistics: Nurses 2019. https://www.dsec.gov.mo/en-US/Statistic?id=202(accessed Jul 1, 2020).Google Scholar]. Nursing's responses to IPV have progressed at different paces in the four regions, leading to large variations in nursing research on IPV. The purpose of this scoping review was to examine the nursing literature on IPV in China, including mainland China, Hong Kong, Macao, and Taiwan, in order to inform culturally congruent and acceptable strategies to address this complex issue. The advantage of using a scoping review over a systematic review is that a scoping review has a broader scope than traditional systematic review as the inclusion criteria are more expansive and less restrictive [[39]Munn Z Peters MDJ Stern C Tufanaru C McArthur A Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach.BMC Med Res Methodol. 2018; 18: 143Crossref PubMed Scopus (1238) Google Scholar]. Therefore, it was possible to include a wider breadth of literature in order to fulfill the purpose of the review. A search for previous scoping and systematic reviews on IPV research in China identified several publications [[23]Tang CSK Lai BPY. A review of empirical literature on the prevalence and risk markers of male-on-female intimate partner violence in contemporary China, 1987-2006.Aggress Violent Behav. 2008; 13: 10-28Crossref Scopus (97) Google Scholar,[27]Zhang H Zhao R Macy RJ Wretman CJ Jiang Y. A scoping review of 37 years of intimate partner violence research in China.Trauma Violence Abus. 2019; (published online Oct 20.)https://doi.org/10.1177/1524838019881738Crossref PubMed Scopus (4) Google Scholar,[30]Chen YH Huang JJ. Nursing discourse on domestic violence in Taiwan.J Nurs. 2009; 56 (in Chinese): 36-45Google Scholar, but no review on this topic was found at our scale. In addition to IPV, other relevant terms such as domestic violence, marital violence, and dating violence were searched. We found that IPV against women was most often reported and the topic of nursing research, but we included any studies that included male victims of IPV as well. The protocol was not registered. We followed applicable items from the Joanna Briggs Institute reviewer's manual and the PRISMA extension for scoping reviews to ensure rigor [[40]Joanna Briggs Institute. JBI reviewer's Manual.https://wiki.joannabriggs.org/display/MANUAL(accessed Jan 31, 2020).Google Scholar,[41]Tricco AC Lillie E Zarin W et al.PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation.Ann Intern Med. 2018; 169: 467-473Crossref PubMed Scopus (3586) Google Scholar. We (QL, HL, KC, IV) conducted a search of the literature published from database inception through January 31, 2020, in six Chinese and five English electronic databases. Chinese databases included China National Knowledge Infrastructure (CNKI), Wanfang Data (Wanfang), VIP, China Biology Medicine disc (CBMdisc), Airiti Library, and National Digital Library of Theses and Dissertation in Taiwan (NDLTD). English databases were PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Cochrane Library. Search terms in simplified Chinese (used in mainland China) and traditional Chinese (used in Hong Kong, Macao, and Taiwan), as well as Medical Subject Headings (MeSH) and free text words, were used accordingly for each database, including “intimate partner violence”, “domestic violence”, “spouse abuse”, “gender-based violence”, “battered women”, “family violence”, “spousal violence”, “marital violence”, “wife abuse”, “dating violence”, “violence against women”, “cold violence”, “nursing”, “nurses”, “midwifery”, “health personnel”, “China”, “Chinese”, “Hong Kong”, “Macao”, “Taiwan”, and “Taiwanese”. The search strategy for all databases in all languages is provided in the appendix (pp 1–4). For included studies, we hand searched references lists and other articles published by the first and corresponding authors to further identify relevant papers not captured by search strategies. Papers obtained through manual search were limited to those published before 2020. Due to the nature of the scoping review, methodology and type of the studies were not limited [[42]Arksey H O'Malley L. Scoping studies: towards a methodological framework.Int J Soc Res Methodol. 2005; 8: 19-32Crossref Scopus (8387) Google Scholar]. Articles were deemed eligible if the following inclusion criteria were met: (1) focused on any facets of IPV (e.g., prevalence, risk factors, consequences, correlations, interventions, victims’ experience, nurses’ perceptions) in or relevant to China; (2) published in academic nursing journals, or non-nursing journals but the first and/or corresponding author with a nursing background, or thesis/dissertation from candidates with a nursing background; (3) language was either simplified Chinese, traditional Chinese, or English; (4) study designs were either empirical study (e.g., quantitative study, qualitative study, mixed methods study), review (e.g., literature review, scoping review, systematic review), report, or expert opinion (e.g., commentary, editorial). Articles were excluded if they were: (1) studies recruited participants outside China; (2) research on domestic violence directed at elder abuse or child abuse; (3) translation reports, conference abstracts, book chapters, guidelines. Based on classifications from Gray et al. [[43]Gray JR Grove SK Sutherland S. The practice of nursing research: appraisal, synthesis, and generation of evidence.8th ed. Elsevier, St. Louis, Missouri2017Google Scholar], we further categorised quantitative research into four types: descriptive, correlational, quasi-experimental, and experimental. For the purpose of this study, we defined reports and grouped them into four categories: (1) nursing case report: an article that concretely documents nursing care for an individual case, including review of the literature, case profile and history, nursing process of assessment-diagnosis-planning-implementation-evaluation, and discussion; (2) nursing experience report: an article that generally summarises key points of nursing for a group of patients; (3) project report: an article that concretely documents a particular improvement project with assessment, goal(s), review of literature, planning, implementation, evaluation, and discussion; (4) case report: an article that concretely describes and interprets one or two cases. Based on the study design, QL and HL independently examined methodological quality of applicable empirical studies using appropriate appraisal tools selected from CONSORT (for randomised trial) [[44]Schulz KF Altman DG Moher D CONSORT GroupCONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials.Lancet. 2010; (webappendix: 1–6)Google Scholar], COREQ (for qualitative research) [[45]Tong A Sainsbury P Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.Int J Qual Health Care. 2007; 19: 349-357Crossref PubMed Scopus (9200) Google Scholar], GRAMMS (for mixed methods study) [[46]O'Cathain A Murphy E Nicholl J. The quality of mixed methods studies in health services research.J Health Serv Res Policy. 2008; 13: 92-98Crossref PubMed Scopus (357) Google Scholar], SPIRIT (for study protocol) [[47]Chan AW Tetzlaff JM Altman DG et al.SPIRIT 2013 statement: defining standard protocol items for clinical trials.Ann Intern Med. 2013; 158: 200-207Crossref PubMed Scopus (2328) Google Scholar], and STROBE (for observational study) [[48]von Elm E Altman DG Egger M Pocock SJ Gotzsche PC Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.Lancet. 2007; 370: 1453-1457Summary Full Text Full Text PDF PubMed Scopus (4932) Google Scholar], seen in the appendix (pp 5–10). In order to appraise the quality of the wide variety of studies, we created criteria for categorising the quality of studies into four groups (low, low-to-moderate, moderate-to-high, and high) mainly on the basis of comparison within and across different designs. Detailed criteria and rationale for each appraisal tool are provided in the appendix (p 11). No studies were excluded on the basis of appraisal results. Discrepancies between two reviewers were solved through discussion; if a consensus was not reached, a third reviewer (KC) made the final decision. Included studies were grouped into four categories of mainland China, Hong Kong, Taiwan, and outside China, based on the location of the first author's institution or the leading institution if more than one was reported. Data were extracted by QL and HL with a data extraction table designed by the research team and tested a priori. Data extracted included first and corresponding authors, year, institution and its location, funding, publication language, journal, page number, key words, design, aim, study site, participants and setting, key findings, and IPV-related terms. KC, CL, and IV cross-checked the extracted data to ensure accuracy. Additionally, the latest 2-year impact factor of applicable journal was recorded via Annual Report for Chinese Academic Journal Impact Factors (journals from mainland China) [[49]Xiao H. Annual report for chinese academic journal impact factors (Natural Science) 2019. China Academic Journals (CD ed) Electronic Publishing House, Beijing2019Google Scholar], Academic Citation Index (journals from Taiwan) [[50]Academic Citation Index. Academic Citation Index 2019.http://www.airitiaci.com(accessed Jan 31, 2020).Google Scholar], or Journal Citation Reports (journals in Science Citation Index) [[51]Clarivate Analytics. Journal Citation Reports 2019. https://clarivate.com/webofsciencegroup/solutions/journal-citation-reports/(accessed Jan 31, 2020).Google Scholar]." @default.
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• W3084075712 title "Nursing research on intimate partner violence in China: A scoping review" @default.
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