DATA COLLECTION TOOLS

3.5.1. Questionnaire

I developed the questionnaire drawing on standardized tools and questions that have been previously tested in research conducted by the Gender & Health Research Unit, including a

TRAINING

MULTIPLE CHOICE QUESTION PAPER (COMPULSORY)

SELF ADMINISTERED

QUESTIONNAIRE (VOLUNTARY) _{QUESTIONNAIRE (VOLUNTARY)} SELF ADMINISTERED

MULTIPLE CHOICE QUESTION PAPER (COMPULSORY)

89 questionnaire used in a situation analysis of sexual assault services (49), another on the completion of SAECKs by health care providers (51) and a questionnaire used in a Survey of Men’s Health and Relationships (119) (Annexure A).

Information was collected on which training the provider attended, and socio-demographic characteristics of providers, which included age in years and sex. Information was also collected on their rank (doctor or nurse), the level of the facility where they currently worked in (e.g. clinic/community health centre or district, regional or tertiary hospital), whether the facility had a crisis centre and if it ran 24 hours a day for seven days a week, the province they currently worked in, their length of service in total number of years and at their current facility, and their work at the facility. They were then asked specifically about the number of rape survivors that they consulted as a percentage of all survivors that come to their facility, whether they had examined a rape survivor and completed a J88 form in last three months, and the number of adult and paediatric rape cases that they consulted in last three months.

Questions on previous training included the country where they received their basic health education, hours of training they previously received on counselling, whether their first training on counselling was during their undergraduate or in-service years and when did they last receive training on counselling. They were questioned about previous training on rape: the hours of training during undergraduate training and in-service years, when was the last training they received, and what was the content that they had covered during in-service training.

Providers were asked about the main reason for working in rape services and to rate what influence the following factors had on them for working in the field: experience of sexually assault of someone close to them, an opportunity to advance at work, intellectual interest in the area, extra pay for being on call, feeling passionate about rape issues, or only part of their work. Providers were also asked about what they felt was the importance of certain aspects of care. This included being non-judgemental towards patients, planning follow-up care for all patients, explaining to patients about their care, thinking about patient’s psychological needs, listening to patient’s problems, keeping good records, providing evidence-based care, and making sure that national management guidelines are followed.

90 Data were collected on rape myths, gender attitudes and empathy levels. Health care providers were asked whether they strongly agreed, agreed, disagreed or strongly disagreed with 21 statements on rape myths using a Likert scale with scores of one to four. This included statements such as “some women lie about rape to punish men”, “if a woman doesn’t physically fight back, you can’t really say it was rape”, “only certain types of women are raped”, and “a woman who is raped brings shame on her family”. Gender attitudes were assessed in a similar fashion using another 21 statements that had to be scored with the same Likert response options. Examples of statements included the following: “a man needs other women, even if things with his wife are fine”, “it is a woman’s responsibility to avoid getting pregnant”, “if a woman cheats on a man, it is okay for him to hit her”, and “it is important that a father is present in the lives of his children, even if he is no longer with the mother”. For the assessment of empathy levels, health care providers scored four statements using a five-level Likert scale. This ranged from a score of one if the statement did not describe them well to a score of five if it did. Two examples of statements related to empathy were “I am often touched by things that I see happen” and “when I see someone being taken advantage of, I feel protective toward them”. The gender and rape-attitude scores were based on work done by Burt in the 1980s (385), and Pulerwitz and Barker with men in Brazil in 2008 (386), while the empathy score was based on work done by Abbey et al. (387).

A version of the WHO’s instrument for violence against women was used to enquire about the experience of rape or IPV for female health care provider and perpetration thereof for male providers (388). This included acts of such as slapping, pushing, shoving, hitting, threatening a partner or using a weapon against them, or tricking, threatening or forcing them to have sex or having sex with them when they were too drunk to say no.

3.5.2. Multiple choice question paper for the examination

I developed 75 multiple choice questions for the examination with the assistance of two senior researchers (Annexure B). These were based on the content and teaching material provided. All three of the researchers had extensive experience in both undergraduate and postgraduate

91 education and in setting multiple-choice questions for examinations in the health field. Attempts were made to match the number of questions per topic proportionately to the amount of teaching provided on the said topic. Each question had four options with a single best answer, which are commonly used in medical assessments and are found to discriminate better between high and low performers (389).

In total there were six questions on the context of sexual assault in South Africa, six on sexual rights, eight on the law and judicial processes, three on communication, four on the general provision of medical care, nine on mental health, six on preventing and managing pregnancy after rape, four on preventing and managing infectious disease excluding HIV and then four on the HIV, nine on examination and evidence collection with an additional eight that had a specific focus on children, three on documentation, one on follow-up care and four on vicarious trauma.

Providers were made to complete the multiple choice question papers in the venue used for the training on the first day prior to commencing the training and on the last day during a closing session. At least two of the researchers remained in the venue at all times to ensure that providers completed the papers unaided and this was done without any breaks.