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. 2025 May 29;25(1):770.
doi: 10.1186/s12913-025-12627-7.

Knowledge, attitudes, and preparedness of healthcare providers trained to respond to violence against women: evaluation of the adapted World Health Organization curriculum in two municipalities in Timor-Leste

Cory N Spencer  1   2 , Xylia Ingham  3 , Guilhermina de Araujo  4 , Laurensius Amir  3 , Kayli Wild  4   5
Affiliations

Knowledge, attitudes, and preparedness of healthcare providers trained to respond to violence against women: evaluation of the adapted World Health Organization curriculum in two municipalities in Timor-Leste

Cory N Spencer et al. BMC Health Serv Res. .

Abstract

Background: Addressing violence against women (VAW) has been identified as a global health priority, and healthcare providers (HCPs) have an important role in supporting survivors of violence. Despite global advocacy for change, VAW has historically received less attention than infectious or chronic diseases, particularly when health system resources are scarce. To help address these challenges, the World Health Organization (WHO) curriculum on responding to VAW in LMICs was adapted as in-service training in Timor-Leste in 2020–2021, with the goal of training HCPs in two municipalities. We evaluated the impact of the curriculum on HCP knowledge, attitudes, and preparedness using a pre- and post- study design.

Methods: HCPs were recruited from all health facilities in Liquica and Ermera and trained over five days. An adapted version of the WHO curriculum questionnaire was administered pre- and post-training. Using the Wilcoxon signed-rank test, we compared HCPs’ pre- and post-training scores in each domain (n = 193). Individual and training-level factors associated with improvement were investigated via regression modeling.

Results: Only 4.7% of HCPs had previously received training on responding to VAW. Median total scores for knowledge of the clinical signs of violence (6.67 vs. 8.89), attitudes towards the unacceptability of violence (6.43 vs. 8.57), individual preparedness (5.67 vs. 8.67), and perceived system support (8.33 vs. 10.0) significantly increased post-training. Attitudes were less likely to improve for older participants (Odds Ratio = 0.42, 95% UI = 0.18–0.95).

Conclusions: This evaluation supports existing evidence that in-service training for HCPs on responding to VAW is effective. The model of engaging all health staff – including medical doctors, nurses, midwives, and other positions – has the potential to shift the culture of care within municipal health systems. Ongoing phases of implementation, including regular follow-up support, present the opportunity to collectively address system barriers to providing survivor-centred care and should be further evaluated.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12913-025-12627-7.

Keywords: Health system improvement; Healthcare providers; Timor-Leste; Training; Violence against women.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Training staff explained project aims prior to data collection and informed consent was obtained from participants. The project was granted technical and ethical approval by the National Institute for Health (INS) Human Research Ethics Committee in Timor-Leste (ID: 417). The evaluation was reviewed and granted a non-research determination by the University of Washington (UW) Institutional Review Board (ID: STUDY00013460). All methods were carried out in accordance with the relevant guidelines and regulations put forth by the INS Human Research Ethics Committee in Timor-Leste and UW IRB. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

References

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    1. World Health Organization, Department of Reproductive Health and Research, London School of Hygiene and Tropical Medicine, South African Medical Research Council. Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence. Geneva: World Health Organization; 2013.
    1. General Directorate of Statistics Ministry of Planning and Finance and Ministry of Health. Timor-Leste Demographic and Health Survey 2016. Dili and Rockland: The DHS Program and ICF; 2018.
    1. The Asia Foundation. Understanding Violence against Women and Children in Timor-Leste: Findings from the Nabilan Baseline Study. Dili: The Asia Foundation; 2016.
    1. World Health Organization. Violence against women prevalence estimates, 2018: global, regional and national prevalence estimates for intimate partner violence against women and global and regional prevalence estimates for non-partner sexual violence against women. Geneva: World Health Organization; 2021.

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