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Abstract
Introduction Women with disabilities in low- and middle-income countries (LMICs) face heightened risks of experiencing gender-based violence (GBV). The rapid growth of digital technologies has introduced new forms of violence, such as technology-facilitated gender-based violence (TFGBV), which disproportionately affects marginalised groups. Despite growing awareness, the intersection of disability, gender and TFGBV is under-researched. This scoping review aims to map and synthesise the evidence on TFGBV against women with disabilities in LMICs, exploring the manifestations of violence, its key vulnerabilities and protective factors within these settings.
Methods and analysis This scoping review will be conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews guidelines. A systematic search of peer-reviewed and grey literature will be performed in six databases, including CINAHL, Scopus, Web of Science, Social Sciences Citation Index, PubMed and PsycINFO. Studies published from 2010 onwards, focusing on women with disabilities in LMICs and involving any form of TFGBV, will be included. The search strategy includes broad query terms to capture diverse experiences of TFGBV. The identified literature will be screened and double-checked for relevance by independent reviewers. Data extraction will focus on key themes such as study design, forms of TFGBV and the risks and protective factors reported. We will conduct basic content analysis, and results will be presented in tables and narratives, providing a descriptive map of the evidence.
Ethics and dissemination This review will synthesise previously published studies and publicly available grey literature; therefore, ethical approval is not required. The findings will be disseminated through a peer-reviewed publication, presentations at relevant conferences and knowledge-sharing sessions with stakeholders working in the field of disability and GBV prevention. The review will inform future research and interventions aimed at addressing TFGBV in LMICs.
Trial registration details Open Science Framework (https://doi.org/10.17605/OSF.IO/GZ2UR).
- Disabled Persons
- Sexual and Gender Minorities
- Cell Phone
- Cyberbullying
- Gender-Based Violence
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STRENGTHS AND LIMITATIONS OF THIS STUDY
The study follows a systematic and rigorous methodological approach using Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews guidelines, ensuring transparency and reproducibility.
Inclusion of both peer-reviewed and grey literature broadens the scope and comprehensiveness of the review.
The use of independent reviewers for screening and data extraction enhances reliability and minimises bias.
The restriction to English-language sources may lead to the exclusion of relevant studies published in other languages. The reliance on publicly available literature may result in the omission of unpublished data or studies with restricted access.
Introduction
It has been well established that people with disabilities are at risk of greater exposure to violence1–3 and that these crimes are more likely to go unreported.4 There is also a gendered aspect to this phenomenon, with disabled women generally being more likely to experience violence,5 particularly sexual6–11 and intimate partner violence.2 12 Analyses of associations between intimate partner violence (IPV) and disability from seven violence-prevention programmes in low- and middle-income countries (LMICs), for example, documented consistent associations between exposure to IPV and disability, with associations getting stronger with increasing severity of self-reported disability.13
There is a dearth of evidence on the vulnerability of women with disabilities to interpersonal violence including sexual5 6 and intimate partner violence.2 The growing use of digital technology has increased interest in its role in gender-based violence, as it creates more opportunities for abuse.14 Technology-facilitated gender-based violence (TFGBV) was recently defined as ‘any act that is committed, assisted, aggravated or amplified by the use of Information and Communication Technologies (ICTs) or other digital tools, that results in or is likely to result in physical, sexual, psychological, social, political or economic harm, or other infringements of rights and freedoms’.15 TFGBV includes a spectrum of behaviours perpetrated online (and then often taken offline) through a range of everyday technological advances, such as mobile devices, social media platforms, interactive computer games, text messaging, email or any other related technologies. Common behaviours and tactics include cyberbullying, defamation, sexual harassment, image-based abuse, cyberstalking, cyber-grooming, doxing, impersonation, hate speech and gender trolling.16–21 Individuals can experience various forms of TFGBV, which may combine multiple forms of violence or be a continuation of offline violence.22
Emerging international evidence also indicates that similar to other forms of gender-based violence (GBV), TFGBV is a by-product of deeply rooted gender norms and systemic inequalities that may intersect with racism, homophobia, transphobia, ableism and other discriminatory structural dynamics.17 18 21 23 Consequently, women, young people, people with disabilities, sexual, gender, religious and ethnic minorities, First Nations peoples and those with intersecting marginalised identities are more vulnerable to online violence.16–18 21 24 25 Although emerging evidence suggests that people with intersecting marginalised identities are particularly vulnerable to online violence,1–3 6 7 the intersection of gender, disability and technology-facilitated violence is less understood.
As technology develops, then, it broadens the scope for potential opportunities for violence and abuse, both by exacerbating conventional forms of GBV and by perpetrating qualitatively new forms of violence that were previously impossible, or which take a fundamentally different form online.14 17 20 23 During an era of intensified digital penetration in the sub-Saharan region, digital inclusion not only enables people with disabilities to shape their narrative and make their voices heard via digital technologies, but also opens up the risk of reproducing and entrenching old forms of discrimination, attitudes and covert microaggressions towards people with disabilities, and as the emerging data suggests, even more so for women and girls with disabilities.21
This study will be a scoping review; this type of review is ideal for mapping and synthesising available evidence and when research objectives include identifying and discussing concepts and trends across a breadth of sources.26 These are similar to systematic reviews in that they are systematic searches but distinct in that they do not seek to provide a definitive recommendation for practice.27 28 As such, this scoping review seeks to map and synthesise the available evidence on TFGBV with a specific focus on women with disabilities in low- and middle-income countries. This review sits within a wider mixed-methods study exploring how technologies (such as smartphones, tablets and everyday consumer digital products) variously promote, increase and enable violence against women with disabilities in LMICs and aims to identify strategies that this group may use to keep themselves safe when online.
The primary research question for this scoping review is as follows:
What is the scope of the evidence on technology-facilitated violence against women with disabilities in LMICs (ie, what type of literature exists, what methodology was used, where is this work published and what are its key findings including what are the core vulnerabilities for this group)?
The secondary research questions are as follows:
What are the manifestations of TFGBV and its intersections with gendered disability in the context of LMICs?
What are the trends, common behaviours and characteristics of perpetrators and survivors, risks and protective factors highlighted in the literature?
Methods and analysis
This scoping review will be conducted and reported in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR).29 The PRISMA-ScR checklist has been added as online supplemental appendix 1. The protocol has been registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/GZ2UR). This scoping review will be conducted in the following stages:
Supplemental material
Confirmation of inclusion criteria
Search
Protocol registration
Screening
Deduplication
Protocol registration update
Extraction
Synthesis
Reporting
Search strategy
Searches for peer-reviewed articles will be conducted on CINAHL, Scopus, Web of Science, Social Sciences Citation Index, PubMed and PsycINFO. We will also conduct a thorough search of grey literature sources including Google and the websites of large agencies and organisations. While the primary database searches cover a broad range of peer-reviewed literature, some relevant studies may not be fully indexed in these databases due to variations in indexing policies and delays in updates. To ensure comprehensive coverage, we will check if known and relevant publications are included in the search results and add them to the list of publications to be screened.
We will conduct searches on the following websites of large agencies and organisations:
UN Women
UNFPA
UNESCO
World Bank
WHO
Plan International
SightSavers
CBM
International Disability Alliance
UNHCR
Humanity and Inclusion
Inclusion International
World Vision International
Action Aid International
Global Rights for Women
Inclusion and exclusion criteria
Population
The population focus of this scoping review is women with disabilities who have access to ICT or digital tools and have experienced TFGBV. This scoping review is part of a broader study that focuses on women with disabilities aged 18–40 years. However, the scoping review itself will not impose an age restriction to ensure a comprehensive inclusion of relevant literature. This is also to capture studies focusing on younger women who are under 18 years but are often rampant users of technology. All types of disabilities and impairments will be included. Cisgender and transgender women will be included, and accordingly, said studies will be clearly identified. Women without disabilities and individuals who do not identify as women will be excluded. In order to retain the focus on women, we will exclude studies with mixed-gender samples.
Concepts
This scoping review focuses on technology-facilitated violence against women with disabilities. This includes the ways in which common consumer technologies (such as smartphones, tablets and everyday consumer digital products) variously promote, increase and enable violence against women with disabilities. Evidence relating to disability gender-based violence that does not involve any use of technology will be excluded.
Context
Only evidence from LMICs will be included. We will draw on the World Bank Country and Lending Groups Database (as of 1 August 2024) for the LMIC definition/inclusion. High-income country evidence will be excluded.
Types, period and language of resources
We will include primary and review research articles, scoping and systematic reviews, editorials and reports. PhD theses will also be included provided that the PhD examination/viva was undertaken by at least one examiner external to the higher education institution on the record. Grey literature will be included if it relates to research or reviews of research. Studies published from 2010 onwards focusing on women with disabilities in LMICs and involving any form of TFGBV will be included. Only material in English will be included. Policy-focused grey literature, dissertations, PhD theses with only internal examiners, opinion pieces, news articles, press releases and blogs will be excluded.
Query strings
We will use query strings of search terms to cover the critical aspects of our research questions. For the more generalised topics included (eg, ‘disability’ and ‘low- and middle-income countries’), we will use query strings that have been used and validated in recent scoping and systematic review work by the review authors.30 We will also use the AND and OR operators to ensure that we include studies that used different terminology and covered all elements of interest. We have provided the full electronic search strategy for one of the databases in online supplemental appendix 2. Search terms will be tested by the first author (SH) and a library expert from Stellenbosch University.
Supplemental material
Other search strategies
We will manually check the search results to ensure we do not miss relevant articles already known to us. In addition, we will review the reference lists of the articles and reports we include to find any additional studies that our search might have missed.
Search expiration and repetition
The search will be completed by 30 September 2024, and we do not currently intend to update or repeat this review beyond this date.
Search strategy justification
Databases and interfaces: We chose these databases because they are comprehensive sources of peer-reviewed research in the relevant fields of interest. We have selected a long list of databases in order to search as widely as possible. This is because scoping reviews are intended to capture as much literature as possible to map out the boundaries of a topic, rather than to drill down into more specific questions, as a systematic review would involve.
Grey literature: We will use both Google and specific websites to obtain a wider range of unpublished work or work that is published in a thesis, rapid evidence review, working paper, etc.
Queries: The proposed search terms have been selected to cover the critical aspects of our research questions. For the more generalised topics included (eg, ‘disability’ and ‘low- and middle-income countries’), we have used query strings that have been used and validated in recent scoping and systematic review work by the review authors.30 We also used the OR and AND operators to ensure that we include studies that used different terminology and covered all elements of interest.
Screening
For both the peer-reviewed and grey literature, once searching has concluded, RIS files (from grey literature search and from each database) that include potentially relevant titles and abstracts will be produced. These records will then be imported into CADIMA (https://www.cadima.info/index.php), a free-to-use, web-based tool that facilitates scoping reviews, systematic reviews and evidence gap maps for deduplication. The remaining titles and abstracts will be screened, and each one will be considered for inclusion or exclusion by two independent reviewers (authors on this review).
Once this initial process has concluded, screeners will begin screening full-text records. The CADIMA tool will then highlight inconsistencies for the team to consider records with differing reviewer assessments. Inconsistencies will be discussed in weekly meetings between the screeners and resolved with reference to a discussion of the inclusion criteria. When studies are excluded, a reason for exclusion will be provided to facilitate reporting in the final scoping review. Once agreement has been reached, a final set of studies will be included and reviewed. These results will be reported on in full in the final scoping review report and will be visualised using PRISMA-ScR (http://www.prisma-statement.org/Extensions/ScopingReviews?AspxAutoDetectCookieSupport=1) diagram, allowing for a clear graphic representation of the process of inclusion and exclusion.
Used exclusion criteria
Any non-English publications, as we do not have the resources or language skills on our team to mass translate existing literature.
Any studies that include the concept at hand but do not specifically engage with the population.
Studies that do not otherwise meet our inclusion criteria.
Studies published before 2010.
Screener instructions
Screeners involved in this review will all be co-authors/part of the project team. Each author is already aware of the review’s objectives and scope, as we have decided on them together. The use of CADIMA will allow us to quickly identify issues with specific reviewers being repeatedly incorrect about exclusion/inclusion criteria. However, in brief, the instructions for screening will be as follows:
Examine the title and abstract of each search record allotted to you. If you feel that the record should be excluded, exclude the study and make sure that you provide a clear reason for doing so, so that this can be detailed and documented in our final reporting.
For included studies, proceed to a full-text review. For full-text reviews, try to be as consistent, objective (ie, based on the inclusion criteria rather than your own personal judgement) and precise as possible in your assessments.
Should you have any doubts about the process or inclusion criteria, discuss these with the wider team during contact points to ensure that uncertainties are resolved before moving too far ahead in the process.
Screening reliability
As described above, three independent screeners will screen the title and abstract (if peer-reviewed literature) or title (if grey literature) of all search results in order to exclude obviously unrelated research and literature. Weekly meetings will be held to resolve disagreements. The same reviewers will then review the full texts of literature that is considered potentially relevant on title and/or abstract. After reviewing full texts, only the literature considered most relevant to our research questions will be included.
Screening reconciliation procedure
The first author (SH) will act as the gold standard screener in this review. If any disagreement occurs, they will conduct independent screening of the literature on which there are disagreements, and the three screeners will then discuss these outcomes together and make a final decision on inclusion.
Screening procedure justification
This procedure is well-established and widely followed in evidence synthesis, and many components draw on the guidelines from the JBI Scoping Review Methodology Group (https://jbi.global/scoping-review-network/resources).
Data management and sharing
CADIMA will assist the team in managing all screening and inclusion decisions and ensuring that these decisions are transparent and can be described in detail in final reporting.
Data extraction
Using Microsoft Excel, we will extract the following data for each included study:
Details including title, author(s), year and country of publication (where available) and journal name.
Publication type.
Study design (qualitative or quantitative, and descriptive or evaluative).
Setting and duration.
Sample size, inclusion criteria and demographic characteristics of the sample.
Study strengths and limitations.
Type and role of technology (eg, social media platforms, to enable/protect).
Type of manifestation of TFGBV (eg, online/offline, physical violence, sexual violence, emotional abuse).
Characteristics of the perpetrator and survivors.
Risk and protective factors, if identified.
The extraction sheet will be refined prior to extraction and then piloted on a sample of five studies prior to finalisation and wider use.
Extraction stages
After the publications to be included have been identified, extraction will proceed in three stages:
A small selection (n=5) of publications will be selected for testing. Two team members will independently extract data from these publications using an extraction spreadsheet designed by the team.
Next, the authors will discuss and resolve inconsistencies, refining the team’s approach, if need be, before moving ahead with extraction.
Finally, two team members will divide the remaining publications among themselves for data extraction. A random sample of publications (about 10% of the total number of included items) will be double extracted by the Gold Standard reviewer (SH) for quality assurance. Any difficulties that arise during the extraction process will be discussed among the team to reach consensus.
Extractor masking
It is not deemed necessary to employ masking for this review, which is not designed to identify the risk of bias or the efficacy of specific interventions. For the purposes of a review of this kind, for which knowledge of the intention and context of the review is critical, it is not especially valuable to use a masked or blinded process for extraction.
Extraction reliability
No formal reliability statistics will be reported for the extraction. However, piloting of the extraction sheet, thorough training, regular team meetings and the use of Gold Standard double coding of a subset of items will improve reliability.
Extraction reconciliation procedure
Through regular meetings to discuss extractions, we will ensure that disagreements are discussed in the context of the aims of the scoping review. If agreement or consensus cannot be reached on specific points, a third team member will be asked to review the contentious study/studies. The senior author’s decision will be final, to ensure overall consistency.
Extraction procedure justification
The extraction procedures used in this scoping review represent the adaptation of standard procedures for systematic reviews with the more pragmatic approach of a scoping review.
Data management and sharing
We will share the extracted data in the form of an extraction table to be uploaded to a data repository, with a link included in the final manuscript. In alignment with the FAIR (Findable, Accessible, Interoperable, Reusable) principles, our data extraction table and processes will be well documented and easy to read, to support accessible, transparent and replicable methods.
Synthesis and analysis
As previously noted, this review will not adopt the statistical data transformations used in many systematic reviews or meta-analyses. However, we will use the following steps to aim for the clear and effective communication of this scoping review’s research question and its objectives.
First, the extracted data will be categorised in basic content analysis with predefined categories such as year of publication, setting, country of origin, methods used, findings, etc. These categories will then be used as the columns of a data extraction table, which will be populated by data extracted from the included studies. Next, we will work to produce a narrative that describes and summarises the data captured in this table. Specific attention will be given to the findings which help to answer the review’s research question and provide detail on variation across countries, different kinds of literature and different types of participants or settings. Gaps in the research will also be highlighted to guide or prompt future research to answer outstanding research questions or meet unresolved objectives.
Missing data
Missing data are an expected part of the process of conducting reviews, with which the authors are experienced. The authors will access full texts through institutional subscriptions, interlibrary loans and direct requests to authors where necessary. If full-text access remains unavailable, we will document this as a limitation and assess the study based on the available abstract and metadata while transparently reporting any potential impact on the findings.
Data validation
As it relates to scoping reviews, ensuring the validity of included data involves assessing its relevance and appropriateness for meeting the review’s objectives. As such, we will have regular discussions to ensure the whole team stays focused on the aim of this review, rather than beginning to explore additional research questions. We will also make sure to handle the data with care and transparency, which will be supported by the use of software to allow for tracking each data entry back to its first screening. The full text of each study will be reviewed by at least two team members. While the quality of studies is not our main aim, the tabulation and thematic analysis process described above will serve as a form of triangulation where findings recur across multiple studies. Should any of the included studies be retracted after our search date, this will be documented in our reporting but should not affect our overall findings, due to the nature of scoping reviews.
Synthesis plan
As detailed previously, the goal of this scoping review is to present the scope of the existing academic and grey literature on this topic and to inform the wider study within which this scoping review is set. The stages for synthesising extracted data will be as follows:
Preparation and organisation: using Microsoft Excel, the extracted data will be organised according to key variables from the extraction tables and coded according to areas of interest (eg, manifestations of TFGBV).
Presentation of data: as a team, we will decide on the best ways to represent the data from the abovementioned analysis. We may tabulate or graphically represent these data according to, for example, impairment type or form of violence. This will allow us to highlight overlapping and diverging patterns in these data, as well as to highlight gaps in the existing research.
Narrative: alongside the abovementioned tabulation/graphic representation of our findings, we will provide a narrative that links back with our research question, aims and objectives.
In summary, we will aim to comprehensively describe and map the existing literature, with a view to answering the primary and secondary research questions.
Criteria for conclusions/inference criteria
Effect size and significance are not the goal of a scoping review such as the one we propose here. We do not expect this to be the case, but should saturation be observed in aspects of our investigations, we will emphasise this and suggest new directions for future research.
Synthesis blinding
There is no substantial value to blinding data synthesis for a scoping review. We will aim for transparency and accountability within our research team, but everyone involved in synthesis will be aware of the research question and objectives of this review. We will also make sure that the inclusion/exclusion criteria are strictly adhered to, to minimise bias.
Synthesis reliability
The co-authors will be involved in synthesising the data for this review. The first author (SH) will lead the synthesis process. Sections of the data will be synthesised by her and then shared with the wider team for verification and review. Each section will be completed before a new section is started.
Synthesis reconciliation procedure
All feedback from the wider group will be discussed on a section-by-section basis during team meetings, and consensus will be reached on how to present the data.
Publication bias analyses
We will aim to minimise bias by conducting as broad a search as possible by using multiple databases and highly detailed search queries and by incorporating both grey literature and theses, along with published articles. We will also report in detail on the choices made during this review process to ensure that our search is as transparent and replicable as possible. An unavoidable bias in our search will be the inclusion of only English language sources, but this will be acknowledged in reporting. Should other specific limitations be encountered in the process (eg, due to unavailable resources or time constraints), these will be acknowledged and detailed in full.
Synthesis procedure justification
Our synthesis will be driven by the objective of mapping and consolidating the existing literature. The above stages of synthesis are standard methods for the organisation and presentation of these data. By tabulating/graphically representing the data extracted, we aim to allow readers insight into the original data as presented in the source material, as well as identifying patterns in and connections between these data. The narrative description we intend to provide will further assist the reader in understanding the connections and patterns in these data and how these data assist in answering the research questions.
Synthesis data management and sharing
We will provide notes and draft outputs from our synthesis on reasonable request, following publication of our findings. Since we plan to use already published studies for this review, issues around participant confidentiality are not applicable.
Patient and public involvement
Patients and the public were not involved in the development of this protocol, including its design, methodology, or plans for dissemination.
Ethics and dissemination
This scoping review will synthesise data from already published research and publicly available grey literature. As it does not involve any primary data collection or human subjects, ethical approval is not required. However, the authors will ensure that the review process is conducted with integrity and transparency. The review aims to map the available evidence on TFGBV against women with disabilities, respecting the confidentiality of participants from the included studies. Special attention will be given to the ethical use of data, ensuring that all sources are properly cited and acknowledged in the final output.
Furthermore, it is possible that the prior work of the scoping review authors may be included, based on our planned search terms. We will moderate this potential bias by ensuring that this co-author is not involved in extraction for her own studies. We do not believe that including these authors’ research in the review is automatically a conflict of interest. The intention of this scoping review is to map and consolidate the existing literature on technology-facilitated violence against women with disabilities in LMICs. As the authors are active researchers in this field, it is possible their work will emerge in included studies, and their exclusion would result in a less comprehensive/inaccurate overview of the research in this area.
The findings of this scoping review will be disseminated through multiple channels to ensure maximum impact and reach. A manuscript summarising the review’s outcomes will be submitted for publication in a peer-reviewed journal specialising in disability studies, gender-based violence or technology-related violence. The review will also be presented at academic conferences and seminars targeting professionals and researchers working in disability, gender and violence prevention. In addition, key findings will be shared with relevant stakeholders, including policymakers, non-governmental organisations and advocacy groups in LMICs, particularly those involved in supporting women with disabilities. This approach aims to inform future research, policies and interventions addressing TFGBV in vulnerable populations.
Ethics statements
Patient consent for publication
Acknowledgments
We acknowledge the assistance of Yusuf Ras from Stellenbosch University for his assistance with the search terms.
References
Footnotes
X @Lieketseng Ned
Contributors SH: substantial contributions to the conception and design of the protocol and revising it critically for important intellectual content. BT-P: drafting the protocol, revising it critically for important intellectual content and preparing the protocol for registration and publication. ET: drafting the protocol critically for important intellectual content. XH: substantial contributions to the design and revisions of the protocol. LN: substantial contributions to the conception and design of the protocol and final approval of the version to be published. LN is the guarantor of the work. KS: substantial contributions to the conception and design of the protocol and final approval of the version to be published.
Funding This study is funded by the Sexual Violence Research Initiative, with Stellenbosch University contract number: S009253. The funders had no role in the writing of the protocol or in the decision to submit the paper for publication.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.