Strengths and limitations of this study
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The study was conducted among undergraduate public health students thus study results may not be generalised to the undergraduate students of Kathmandu metropolitan city.
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The study prioritised ethical guidelines and standards in all aspects.
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Only the victim’s perspective was used to measure the prevalence of dating violence therefore the perpetrator’s viewpoint could not be covered by this study.
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The data obtained in this study were self-reported which may be subjected to recall and response bias.
Introduction
Globally, more than a quarter of women aged 15–49 who have been in a relationship have encountered instances of physical and/or sexual violence from their intimate partner at least once in their lives.1 The phase of adolescence and youth hold pivotal importance in the cultivation of healthy intimate relationships.2 Dating serves as a crucial medium for imparting values of cooperation, accountability, social adeptness and proper conduct.3 Nonetheless, it also presents a platform for sexual exploration and, regrettably, exploitation.3
Dating violence (DV) encompassing physical, psychological and sexual aggression within romantic relationships, stands as a pervasive public health concern with far-reaching implications for the well-being of the individuals involved.4 5 Its impact resonates not only with victims but also extends to perpetrators, families and communities at large.6 Among the demographic segment of undergraduate students, who are in a formative stage of their lives, the prevalence and dynamics of DV deserve specific attention due to their potential long-term effects on personal development and overall well-being.6
Worldwide almost one in four (24%) adolescent girls aged 15–19 have experienced physical and/or sexual violence from an intimate partner or husband.7 15 million adolescent girls, aged 15–19 years, have experienced forced sex. In the vast majority of countries, adolescent girls are most at risk of forced sex (forced sexual intercourse or other sexual acts) by a current or former husband, partner or boyfriend. Based on data from 30 countries, only 1% have ever sought professional help.7 A survey conducted in the USA shows that over 71% of women and over 55% of men first experienced intimate partner violence (sexual or physical violence, and/or stalking) under the age of 25.8
Nepal, an ancient and diverse nation in South Asia, has witnessed significant sociocultural transformations in recent decades, particularly in urban centres like Kathmandu metropolitan city. The topic of DV is delicate and many of the adolescent victims do not report the offence or seek help. DV is not an openly discussed topic in school, within the family and friends circle in Nepal.9 A study found that among 588 study participants 47% of them experienced any form of DV from their dating partner.10 Men were accused as perpetrators in around 90% of 5515 cases of violence against women reported from November 2017 to September 2021. Among the accused, 66% were intimate partners: boyfriends or husbands.11
The university environment serves as a crucible for personal growth and the establishment of lasting social connections. However, it is also a setting where power dynamics, communication challenges and individual vulnerabilities may converge, potentially leading to the emergence of DV.12 Experiencing DV in college can lead to a range of detrimental effects, both immediate and lasting. This encompasses physical injuries like sprains, bruises and black eyes, as well as enduring health issues such as chronic pain, frequent headaches and heightened susceptibility to sexually transmitted infections.13 14 Additionally, victims face significant psychological repercussions, including an elevated risk of developing depression, anxiety and post-traumatic stress disorder.15 Hence, the creation of a prevention package is imperative. To effectively develop such a package, it is crucial to have a comprehensive understanding of the prevalence and dynamics of DV within our specific context. This knowledge will serve as the foundation for crafting targeted and impactful prevention strategies.
Despite the growing recognition of DV as a critical issue worldwide, there is a notable gap in research pertaining to its prevalence and associated factors among undergraduate students in Nepal. Existing studies in Nepal have largely focused on broader gender-based violence or intimate partner violence, often neglecting the nuances specific to dating relationships among young adults pursuing higher education. Within this context, this study aimed to assess the prevalence of DV and associated factors among undergraduate public health students of Kathmandu metropolitan city of Nepal. This study seeks to address this gap by conducting a rigorous examination of DV prevalence and its associated factors within the specific demographic of undergraduate public health students in Kathmandu metropolitan city.
Methods and materials
Study design and population
We conducted an institution-based cross-sectional study among undergraduate public health students in Kathmandu metropolitan city of Kathmandu district, Nepal. The prevalence of DV was assessed on the basis of different forms of DV such as physical, emotional and sexual violence. The study was conducted within a 11-month period from May 2022 to March 2023.
Sample size
The required sample size was 352. Based on the formula for finite population, 
, where Z is the standard value of 95% CI (1.96), p is the previous proportion of DV (47%).3 N=total number of public health students among 14 colleges of Kathmandu metropolitan city=1246 and e is marginal error (5%). The non-response rate was set at 20% as a precautionary measure to mitigate the potential impact of non-response bias, particularly due to the sensitive nature of the research topic containing confidential data. This determination was reached after consultation with experts, resulting in a final sample size of 352. After determining the desired sample size, pre-testing was conducted among randomly selected 35 public health students of a public health college from a different municipality, constituting 10% of the total sample size in order to identify the errors and misleading questions. All these errors were removed after the pre-testing.
Sampling technique
At first, a list of all public health colleges within Kathmandu metropolitan city (affiliated with Tribhuvan University, Kathmandu University, Purbanchal University and Pokhara University) was obtained from the respective university’s website. These colleges were selected to draw the sample and the total number of students with each year/semester was collected from the Public Health department of each college. 11 colleges were selected using simple random sampling out of 14 colleges and probability proportionate sampling was done to select the population (students) from selected colleges and from each academic year/semester. Then, individual participants in each academic year/semester were selected by using simple random sampling. We also reached out to the students who were not present during the data collection period. Those students who were not willing to give verbal as well as written consent were excluded from the study (online supplemental file 1).
Supplemental material
Data collection tools and technique
The data collection was done using a structured questionnaire. The socio-demographic variables included age, gender, ethnicity, parental marital status, currently living with, family type, parent’s education, parent’s occupation, working status, income and permanent residence. Likewise, behavioural factors included alcohol or tobacco consumption, previous violence experience from parents, exposure to watching pornography. DV was measured by various questions on the basis of following themes from previous literature; physical violence (slapping, kicking, beating, hair pulling and throwing things or using any type of physical force to hurt or injure), emotional violence (verbal abuse, set priorities and boundaries, tried to keep away from family and friends, insulted, threatened and embarrassed, offensive name calling, stalking, checking phone and delete contact information) and sexual violence (unwanted physical touch, kissing, intimacy, rape, posted and shared private pictures, sex texting).3 16 17 The developed tools were back and forth translated into Nepali and English language to maintain the face validity of the tool by experts. Self-administered questionnaires were provided to the participants explaining the aim of the research, its meaning and the procedure for responding to each question. The completeness and consistency of the questionnaire were ensured by revisiting the form after data collection. In the current study, the scale had acceptable internal consistency (Cronbach’s α=0.828) (online supplemental file 2).
Supplemental material
Data management and analysis
The questionnaire was checked and reviewed at the time of data collection for completeness and consistency. Data entry was done by using Microsoft Excel 2019 and exported to IBM SPSS V.24 for analysis. Missing values were not inferred. For all dependent and independent variables frequency and percentage were calculated for each category. Using logistic regression, we performed bivariate and multivariable analysis to observe the association of independent variables with DV. Statistical testing was done for a 95% significance level, where a p value of <0.05 was considered to be significant.
Ethical consideration
The participants were informed about the aims, methods and benefits of the study. It was assured that confidentiality and privacy will be maintained and the collected information will be used only for study purposes.
Results
Socio-demographic characteristics of study participants
Table 1 shows the distribution of 352 study participants according to demographic characteristics. The majority of the respondents (54.3%) belong to the 22–25 years age group and more than one-third (39.2%) belong to the 18–21 years age group. Among the participants, about three-fourth (72.7 %) of the respondents were female respondents. Majority (65.9%) of the students were Brahmin/Chhetri, followed by Janajati and others (Dalit, Madhesi, Muslim and Dasnami) with 22.4% and 11.6%, respectively. Most of the students (81%) were from a nuclear family (a family that included two married parents and their children) and the rest of the others were from joint families (families comprised more than two generations—grandparents, parents and children).
Socio-demographic characteristics of study participants
Behavioural characteristics of participants
Table 2 shows the experiences of some behavioural factors among 352 public health students of Kathmandu metropolitan city. Regarding alcohol consumption habits of respondents, the majority (73.6%) had never consumed while one-fourth (26.4%) had consumed alcohol. On the other hand, 67.6% of the dating partners consumed alcohol. Similarly, among 352 respondents, only 20.5% of them were exposed to the watching of pornography. Out of the respondents, 10.8% had ever been exposed to violence done by parents or family members.
Behavioural characteristics of the participants
Dating violence prevalence among respondents
Table 3 reveals the current and past dating relationship status of the 352 respondents. Among 352 respondents, 182 respondents had engaged in a dating relationship during the time of study or at any time in the past. Among those having current or past relationships, a majority of the respondents (74.2%) had experienced any type of emotional violence, about one-fifth (22.5%) had experienced sexual violence and a few of them (9.3%) were facing some kind of physical violence.
Prevalence of dating violence
Consequences of dating violence
The table 4 below shows the consequences of DV. Among the 182 respondents having a current or past dating relationship, more than one-fifth (22%) of respondents had never faced violence from a partner, a majority (42.3%) had trust issues, 15.9% had faced depression/anxiety, 13.7% had sleeping or eating disorders, few (12.1%) of them said that they considered never dating anyone else again after facing violence from a previous dating partner and nearly one-fourth (23.6%) said that DV had no consequences for them.
Consequences of dating violence
Analysis of binary logistic regression of associated variables
Table 5 describes the association of covariates with DV. From the bivariate analysis (crude OR), the variables such as age, sex of participants, father’s occupation, dating partner’s consumption of alcohol, exposure to watching pornography and ever being exposed to violence done by parents or family members had a statistically significant association with prevalence of DV. After adjusting the variables using multivariate logistic regression, participants’ sex, dating partner’s consumption of alcohol and ever being exposed to violence by parents or family members are associated with DV. The DV was more likely among male participants (adjusted OR (aOR) 3.95, 95% CI 1.14 to 13.58), and among participants whose partner consumed alcohol (aOR 4.58, 95% CI 1.70 to 12.34). Participants who had ever been exposed to violence done by parents or family members were more likely to have DV (aOR 5.97, 95% CI 1.39 to 25.49).
Factors associated with dating violence among participants
Discussion
The current study sought to estimate the prevalence of DV among undergraduate public health students of Kathmandu. It is one of the very few studies conducted in Nepal as well as Southeast Asia to address such topics using probabilistic sampling strategies and significantly contribute to our understanding of DV. Among those with dating experience, the study found a noteworthy 78% prevalence of DV. Factors such as male gender, partner’s alcohol consumption and exposure to parental violence exhibited significant associations with the experience of DV.
The study found that approximately one-third (32.4%) of the participants were presently engaged in a dating relationship, while a substantial majority (40.9%) had engaged in dating relationships in the past. Among the 182 students who had either current or prior dating experiences, a striking 78.0% disclosed that they had encountered some form of DV from their partners. A previous study conducted in Nepal encompassing 1276 college students highlighted that almost half (46%) of the participants reported having engaged in a dating relationship.3 Additionally, it was noteworthy that nearly half (47%) of the students in that study revealed that they had experienced victimisation from DV.3
In our study, male students reported a notably greater prevalence of DV experiences compared with females. This observation aligns with similar trends found in various international studies.17 However, it is important to approach comparisons between genders cautiously for a couple of reasons. First, societal norms around traditional male social roles can pose significant barriers for men in reporting DV experiences. Research has documented dismissive or hostile responses to male survivors by providers, potentially contributing to under-reporting.18 Furthermore, it is plausible that girls may have under-reported instances of DV in this study. The normalisation and acceptance of DV may be linked to the socialisation of hegemonic gender norms, where female passivity and submissiveness are associated with female sexuality, while male aggression and dominance are linked with male sexuality.19 Qualitative research could provide valuable insights into these attitudes and norms. Lastly, it is worth noting that contemporary forms of DV, such as cyber-based partner violence, were not included in this study, suggesting a potential avenue for future research in this area.
Individuals whose partners engaged in alcohol consumption were more likely to have encountered instances of DV. A similar study revealed that individuals whose partners engaged in alcohol consumption were more likely to have encountered instances of DV20 21 and found that alcohol problems predicted the perpetration of physical aggression.22 Exposure to parental violence is strongly linked to a higher prevalence of DV. This finding aligns with previous research indicating that exposure to parental violence, in conjunction with a patriarchal cultural context, serves as a notable risk factor, as observed by other researchers.16 23 24 Individuals who have experienced violence from parents or family members are at a higher risk of experiencing DV.
Limitations
First, the study was conducted among undergraduate public health students, which may limit the generalisability of the results to all undergraduate students in Kathmandu metropolitan city. Second, the data obtained in this study were self-reported, which may be subjected to recall and response bias. Third, the prevalence of DV was measured solely from the victim’s perspective, excluding the perpetrator’s viewpoint. Lastly, the questionnaire was developed using various literature sources, and despite pretesting, certain questions remained inadequately addressed. Notably, the question regarding alcohol and tobacco use combined both substances into a single query, asking participants if they consumed alcohol or tobacco. Similarly, sleep issues and eating disorders were combined into a single question, preventing accurate identification of whether respondents experienced sleep issues, eating disorders or both. These limitations highlight the need for more precise question structuring in future research.
Conclusion
In conclusion, this pioneering study sheds crucial light on the prevalence of DV among undergraduate public health students in Kathmandu, Nepal. The findings underscore the seriousness of the issue, revealing a noteworthy prevalence of DV among those with dating experience. Importantly, the study identifies key factors, including male gender, partner’s alcohol consumption and exposure to parental violence, that exhibit substantial associations with the experience of DV. These results provide invaluable insights that can inform targeted interventions like comprehensive educational programmes including awareness about healthy relationships, youth empowerment, self-defence training and policies like anti-violence and zero-tolerance for abuse and violence and support mechanisms to combat DV within this vulnerable demographic. Moving forward, it is imperative that concerted efforts are made to implement evidence-based strategies aimed at fostering healthy, respectful relationships among undergraduate students in Kathmandu and beyond.
Data availability statement
Data are available upon reasonable request.
Ethics statements
Patient consent for publication
Ethics approval
Ethical approval was obtained from the Institutional Review Committee (IRC) of Manmohan Memorial Institute of Health Sciences (MMIHS) (Ref no.= 79/148). A written consent was obtained from each administration of 11 colleges included in this study and written informed consent was also taken with each and every respondent during data collection.
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