Reflections on a Study’s Journey: Overcoming Challenges in Gender-Based Violence Research among Adolescents

Dear Editor, We are writing this letter to detail the challenges encountered while seeking approvals for our research on gender-based violence (GBV) among adolescents. As a team, we designed a study aimed at conducting a knowledge, attitude, practice, and experiences survey among adolescents in the district. The experience was characterized by numerous ethical and logistical difficulties as shown in Figure 1, which ultimately led us to make significant adjustments to our research plan.Figure 1: Key challenges and strategic adjustments in GBV research on adolescentsThe first and most significant challenge will be obtaining approval from the Institutional Ethics Committee, particularly regarding the consent and assent forms. Some adolescents are expected to hesitate in providing their assent, while some parents are likely to object to their children being asked such sensitive questions. To address this concern, we decided to substitute medical students as the study subjects. Another challenge we encountered was a component of the survey designed to explore individual experiences with GBV among adolescent participants. Collecting such sensitive information without causing psychological distress can be a daunting task. Adolescents may face immense psychological barriers in disclosing sensitive experiences, and the process of seeking assent will need to be handled delicately to ensure their comfort and willingness to participate. Despite our design including psychiatric/psychological and legal support if needed to address any potential mental trauma, creating an instrument that effectively captured these experiences while ensuring participant safety proved to be a complex task. Ensuring these resources are available and properly integrated into the study which was crucial for maintaining ethical integrity, but it would extend the timeline and increase administrative demands such as additional approvals from child welfare agencies, education boards, and legal authorities. When the study subjects were changed from adolescents to medical students, an unexpected challenge arose with medical colleges. They expressed concerns that students might experience post-traumatic stress disorder (PTSD) or recall distress if they had been exposed to or witnessed violence, despite the study protocol, including psychiatric support for affected participants. The term “gender-based violence” itself was seen as stigmatizing, raising fears that disclosures could harm the institution’s reputation. Furthermore, many within the medical community lacked a clear understanding of GBV, its forms, and gender roles. Some healthcare professionals, despite their public health backgrounds, viewed traditional male–female gender roles as normal and focused on the perceived stigma rather than recognizing the study as an opportunity to design targeted interventions and address these critical issues. Considering all the challenges, we decided to shift the study to an interventional design, a change supported by the ethics committee. This made the study more ethically feasible, as obtaining consent from adolescents was complex, and medical students were better equipped to handle sensitive topics like GBV. The intervention included an orientation session on GBV, allowing for structured engagement and measurement of knowledge and attitudes along with experiences without causing distress. Mental health support was already integrated to reduce psychological harm. Targeting medical students aimed to impact future healthcare providers’ responses to GBV. However, this shift meant losing an important demographic—adolescents—who face unique risks and dynamics related to GBV. This gap limited the study’s applicability to younger populations and reduced the understanding of GBV in environments like schools and homes. Moreover, the focus on medical students may not have captured the full spectrum of GBV experiences, and some institutions hesitated to participate due to concerns over stigma. While the shift made the study more manageable, it also limited its potential to address GBV in adolescents. We wanted to share our experience to highlight the challenges GBV researchers face, hoping future studies can benefit from these insights. Despite the challenges, researchers must address these sensitive topics to develop effective policies and interventions. Conducting an interventional study proved rewarding for both participants and researchers. In conclusion, while the complexity and need for collaboration presented challenges, they should not stop critical research. Persistent research is essential for understanding, creating solutions, and improving safety for those affected by GBV. It is time we can no longer bury our heads in the sand but rather confront these critical issues head-on. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.