Predictors of help-seeking behaviour among women exposed to violence in Nigeria: a multilevel analysis to evaluate the impact of contextual and individual factors

Objectives To simultaneously examine contextual and individual-level predictors of help-seeking behaviour among women exposed to physical and sexual violence in Nigeria. Design A multi-level cross-sectional study. We fit three 3-level random intercepts models to examine contextual and individual-level characteristics associated with help seeking, simultaneously. Setting Nigerian Demographic and Health Survey for 2008. Participants 5553 women (15-49years) who reported physical or sexual violence, drawn from 23715 women in the Nigerian Demographic and Health Survey that responded to questions on violence exposure. Main outcome measures Help seeking to prevent future victimisation was based on self-report. Results In our sample of women exposed to physical and sexual violence, 39.7% reported that they sought help to stop the perpetrator from hurting them again. Rates of help seeking were geographically patterned by state (range: 12% to 65%). State-level development, measured by the Human Development Index (z-score), was positively associated with help seeking (OR=1.30, 95% CI 1.05 to 1.61), after adjusting for individual-level characteristics. State-level prevalence of violence against women (z-score) was negatively associated with help-seeking (OR=0.68, 95% CI 0.55 to 0.84), suggesting that service providers who may target their programmes to areas with high prevalence of violence, may need to simultaneously address barriers to help seeking. Few individual-level characteristics were associated with help seeking, including wealth, marital status, employment status, ethnicity, history of witnessing domestic violence and relationship to perpetrator. Conclusions Efforts to support female survivors of violence should consider broader social and contextual determinants that are associated with help-seeking behaviours.