Experience of Dating Violence’s Victims in Indonesia: A Photovoice Study

Dating violence is one of the major violence issues that is continuously threatening female youth in Indonesia. Dating violence can cause significant negative consequences to its victims, which are often underestimated in areas with strong patriarchal cultures. This study aims to identify the experience faced by dating violence victims, which could help expand the literature and provide insights for better violence prevention programs. Photovoice design was used and data were gathered through interviews and a focus group. Participants involved in this study are nine female youth victims of dating violence in Kupang, Indonesia. Analysis of interviews and focus group identified five main themes: 1) types of dating violence, 2) risk factors, 3) protective factors, 4) impacts of dating violence, and 5) withstanding and withdrawing from the relationship. Dating violence risk factors were patriarchal attitude, social and economic condition, lack of knowledge about dating violence, and exposure to violence. Factors that protect female youth from dating violence were positive selfconcept, knowledge about dating violence, the role of parents, educational institutions, and health institutions. Reasons for victims to withstand their dating relationships were varied. Types and impacts of dating violence were also varied based on unique experiences. This study provides a deeper understanding of the experience of dating violence victims through photovoice methodology. These experiences were affected by religious and cultural beliefs distinctive to the Indonesian context, highlighting the need for more culture-fit interventions.

women have a higher risk of being the victim of dating violence compared to men. Around 30% of women worldwide had previously been physically and or sexually assaulted by their partners (WHO, 2019). To make the problems worse, the majority of the victims (55-95%) didn't reach out for any type of help (Vagi et al., 2015). In Indonesia, according to the Indonesia National Commission on the Elimination of Violence against Women, there were 406,178 cases of violence against women that are being reported in 2018. This number is 14% higher than the number of cases from the previous year. They also reported that there were 2,073 cases of dating violence, which makes it the number 2 highest case of violence for domestic violence against women (Komisi Nasional Perempuan, 2019). In Kupang, a province capital in Eastern Indonesia, Women's Home Center said that around 30 cases of dating violence were detected in 2017, which number could be drastically underestimated due to the tendency of victims not reporting the cases (Rumah Perempuan Kupang, 2018).
WHO stated that the risk factors for intimate partner violence and sexual violence are low education, exposure to violence in childhood, unequal power in intimate relationships, and attitude and norms accepting violence and gender inequality (WHO, 2019). These risk factors were commonly found in Kupang, an underdeveloped area in Indonesia with a high poverty rate and low human development index value (Kiling et al., 2019).
A previous descriptive study on dating violence among adult women aged 18-22 in Jakarta, Indonesia showed that generally, respondents tend to disagree with dating violence, but some others were are also seem to be acceptable towards dating violence. However, all respondents in this study were still keeping the relationship with their partner despite agreeing or disagreeing with the violence (Ayun & Puspitawati, 2018). Another quantitative study on dating violence showed that the higher the masculine ideology, the higher the risk of a man conducting an act of psychological, physical, and sexual violence towards his partner (Adidingsih, 2020). Other qualitative studies on dating violence focused on perceptions of adolescents on dating violence (Taylor et al., 2017), girls' motives to stop perpetrating adolescent's dating violence (Blackburn et al., 2020).
A photovoice study on family-based interpersonal violence managed to provide psychosocial support to participants (Haymore et al., 2012). A qualitative systematic review on 17 photovoice studies that addressed gender-based violence found that violence was strongly affecting female victims and the approach helped victims to care for themselves and in harnessing community resources (Christensen, 2019). To date, we found no other photovoice study that targeted female youth who experienced dating violence. The objective of this study is to explore and tell stories about the experience of dating violence victims using photos taken by themselves. Female youth victims are targeted in this study, as they are one of the most vulnerable populations to experience dating violence.

Method Study Design and Ethics Approval
This is a qualitative-Participatory Action Research (PAR). PAR is a research method that combines theory and practice. The action element of this study is in empowering the marginalized community (female youth as victims of dating violence) to speak up for themselves. Ethics approval was granted by Health Research Ethics in the author's associated university.

Participants and Research Team
Participants in this study were nine young females. Participants were recruited using purposive sampling method with several inclusion criteria: 1) female youth between the age of 15-24 years old, 2) victims of dating violence, 3) live in Kupang, Indonesia. As previously said, young women are at higher risk of being the victims of dating violence, therefore the authors chose the female youth as the participants of the study, within the age range for youth defined by United Nations. To collect the participants, the first author sent out messages on a chatting application to advertise the research project. The participants then contacted the first author and met for the first time with the first author to make sure the participant is qualified and willing to participate.
The first author visited the participants several times and frequently chatting with them through messenger applications to establish the relationship. At the end of this research, participants were compensated for their contribution with a small souvenir (e.g., a keychain and a tote bag). The data saturation was considered achieved and interviews were stopped at the ninth participant after all authors agreed that there was no more new information obtained from the interview session of the ninth participant. Information from the ninth participant was determined by the authors to be similar to the other information that has been previously collected. This is aligned with the definition that sees saturation as a method of identifying redundancy in the data, in which data saturation has been reached when the new data repeat what has been expressed in previous data (Saunders et al., 2018). The demographics data of the participants can be seen in Table 1 below.

Photovoice and Research Stages
Data from this study were gathered using the photovoice approach. Photovoice is a method developed by Wang and Burris to enable people to identify, represent, and enhance their community through photos. Photographs taken by community members were discussed so people can record and reflect on their strengths and concerns (Wang & Burris, 1997). The overall process of this study was done from March 2019 to June 2020. A diary and an audit trail were kept throughout the study duration. The photovoice method in this study was implemented through several steps. Firstly, the first author met all participants to explain the process of the study and to get their consent. Then, participants were instructed to take as many photos as they want to describe their experience of dating violence. The photos were taken using a mobile phone owned by participants. After taking photos, the participant then interviewed using a semi-structured interview approach by the first author to get stories behind photos taken. The main question that works as a guideline for the interview is "What's the meaning behind this photo?" The interviews were held using Bahasa Indonesia with Asikin, Aipipidely, & Kiling Kupang dialect and then translated to English when the authors wrote the publication. Six participants were interviewed face-to-face in places of their choosing, but due to the COVID-19 pandemic in Indonesia, the other three participants were interviewed through phone call. On average, participants took two photos each, and interview durations ranged from 11 to 32 minutes.
After concluding that data saturation was reached, participants were invited to an online focus group. Out of nine participants, only seven participated in the discussion. One of the participants reasoned that she did not have the time, while the other one did not respond when contacted. The focus group was conducted and recorded through the Zoom Application and lasted for 62 minutes. It was facilitated by the first author and observed by the other authors and one other female observer. The main questions being discussed during the focus group were based on SHOWED method that consisted of five main questions: 1) What do you See here?
2) What's really Happening here? 3) How does this relate to Our lives? 4) Why does this problem exist, how could this image Educate the community? 5) What can we Do to improve the situation? (Wang & Burris, 1997).
These five questions work as the main structure of the focus group, however, the authors also asked several follow-up questions throughout the discussion. For these five questions, the authors asked each participant to choose one picture out of all the pictures they have taken, which they think is the most significant to their experience, then answered the questions based on that picture.

Analysis
Data from interviews and focus group was analyzed manually using thematic analysis developed by Braun and Clarke (2006) without any software, in which the process went through six stages: 1) familiarization with the data, 2) generating initial codes, 3) searching for themes, 4) reviewing themes, 5) define and renaming themes, and 6) create the report. Data were coded by all three authors, and themes derived from data were discussed by all three authors. Participants provided feedback in the data through messenger application and also through the study launch event. This study also used Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist to make sure keys information is being reported in the study (Tong et al., 2007).

Results
Thematic analysis of the data resulted in five main themes and 21 sub-themes. Table 2 below presents the main theme and sub-theme from this research.

Theme 2: Risk Factors
The present study identified four risk factors for dating violence in female youth. Ana described that her partner thinks that as a man he has to be more dominant than her and that he should not be weak in front of her. This attitude can be described as a patriarchal attitude. Patriarchy itself is defined by Walby (1990) as a set of structured and institutionalized social relations that allow men to dominate, oppress and exploit women. This patriarchal attitude has made the male partner believe that he has the right to hurt Ana to show his dominance. This belief also makes Ana's partner take her for granted and does not care if she leaves him.
Next, the socio-economy status of the couple can also be the risk factor of dating violence. Ana explained that her partner is financially more stable than her and has a higher social status in the community because of his father's position. This made him think that he deserves to be more dominant and acts as he pleases towards Ana.
His father also is at his peak, therefore he is someone respected so no one can disrespect him, he doesn't like that (being disrespected), because he is someone respected, someone, from higher (social) status so he doesn't want anyone to disparage him.
This study also identified the lack of knowledge on dating violence as one of the risk factors. Bunga explained that because of her lack of knowledge, she thought that the controlling behavior coming from her partner is proof that he loves her enough to care about her. In the focus group, Bunga also stated that most people are still lacking information about dating violence, so they don't even realize that they are a victim of dating violence.
Another risk factor face found in this study is exposure to violence. Fani explained that her partner used to be a victim of bullying, which she believed is one of the reasons why he is abusive to her. Desi also added that in

Theme 3: Protective Factors
Protective factors can be defined as factors that protect female youth from being a victim of dating violence.
Protective factors found in this study are positive self-concept, knowledge about dating violence, parents, school, and healthcare institution. Self-concept is someone's ideas and beliefs about themselves. Participants of the study explained in the focus group that positive self-concept can lead someone to realize their worth and understand that they deserve to be treated with respect. Further, Bunga explained that it is important for female youth to educate themselves about dating violence. Bunga also added the victim of the violence itself should dare to speak up to get out from the toxic relationship that they are having.

In my opinion, we need to speak up, even through you (the author) or through other things, but with us speaking out, it means that we can get out of our toxic zone.
During the focus group, Desi also mentioned that with the proper knowledge about dating violence, someone would be able to notice signs of violence right away so it can help them to prevent perpetuation. Also in the focus group, Heni stated that parents have a role to protect their daughters from dating violence. Heni believes that the parents need to be positively protective and build a close relationship with their children, so they would feel comfortable discussing their relationship with the parents. Heni further explained that the local health care institutions need to provide counseling about reproductive health. She believed that this would help the prevention of sexual violence.

Theme 4: Impacts of Dating Violence
Impacts of dating violence on the participants of the study are including psychological impact, social impact, spiritual impact, and also impacted their self-development. Psychological impacts are the ones affecting the participants the most. Ana, Desi, Intan, and Grace reported that they lost the sense of trust in their partner and easily feeling suspicious. Grace explained that all the positive memories she had with her partner were ruined because of the hurtful things he said to her. Although her partner already apologizes, the pain that she feels because of the hurtful things he said still would not go away. She symbolizes this feeling through a photo that she took of a crumpled piece of paper (see Figure 3).

Asikin, Aipipidely, & Kiling
So after the hurtful things he did, and being rude to me, like saying hurtful words.

It (the paper) becomes crumpled, not like new anymore.
Another participant, Heni, also reported that the sexual violence she received from her boyfriend had turned her to hate her own body. She believed that the reason her body is fat now is that she is no longer a virgin. Since she is no longer a virgin, she believes there are changes in her hormone that affects her physical body. She expressed this in a self-portrait photo that she took (see Figure 4). Next, participants reported that they couldn't socialize with certain friends because their partner tries to control the people they interact with. Two of the participants, Caca and Bunga also stated that they feel that their partner tries to keep them away from God, which has affected their spirituality. Heni also mentioned that she felt like she was cheating on God, by pretending as if she is a "pure" person when she had sex with her partner, which she considered as a sin.
During her interview, Caca said that she could no longer pursue her hobbies and talent because her partner prohibited her from doing so. She symbolizes this through the picture that she took. In the picture there are a bunch of fire matches that implicates Caca's hobbies and talent, then on the opposite side, there are a couple of fire matches with one broken leg, which implies that all the steps that she took were chosen for her by someone else (see Figure 5).

Figure 4
A Self-Portrait Portraying Decline in Self-Esteem

Relationship
The majority of the participants had separated from their partners by the time they participate in this study. However, few participants are still in a relationship with the perpetrator. Fani explained that in her religion she was told to always forgive people who wrong her. Therefore, she keeps forgives her partner every time he apologizes for abusing her.
She expressed this on the photo of a cross that she took (see Figure 6).

Figure 6
A Cross, Illustration on How Christianity Inspires Forgiveness One of the participants, Ela mentioned that she had started a new relationship with her new boyfriend. She said that her new boyfriend had helped her to be able to build a romantic relationship in a more trusting way.
However, she claimed that sometimes she would still feel anxious about trusting her new boyfriend, but she is trying to change that.
There is still those kinds of feeling (un-trust), but he always tries to be positive. So I tried to erase those (un-trust).
Participants experienced negative and positive changes after ending their relationship, Ela explained that when she finally broke up with her partner, she cried constantly for a whole month. Caca also mentioned that when she first broke up with her partner, she turned to alcohol and cigarettes as her escape. Intan added that since she broke up, she hasn't been interested in starting a new relationship with anyone.
During her interview, Caca stated that after broke up with her partner, she went through a few positive changes.
Now she can pursue and explore her hobbies and talents.
All the positive things I always wanted to do are possible now. Basically, I really change from how I used to be.
Caca also went through some positive changes after she broke up with her partner. She said these days she is more confident, positive, and independent.

Discussion
This study adds several interesting findings on the topic of interpersonal violence. The use of photovoice managed to capture and portrait the devastating impact of dating violence on female youth's psychological state. Two pictures of crumpled paper and body portraits and stories behind them illustrate psychological scars, wounds that are harder to perceive compared to physical scars from dating violence. These portraits describe how unique each experience the different types of dating violence, and also signify the need for personalized psychological intervention on these victims. A previous meta-analysis on school-based interventions aimed to prevent or reduce dating violence found that more specific programs are needed (Rue et al., 2017). Schoolbased prevention should be able to target multiple forms of dating violence (Vivolo-Kantor et al., 2016). A study even suggested a primary intervention at the elementary and middle school level along with trauma-focused intervention. Practitioners who work with youth and young adults also suggested being more aware of how to identify those who suffered from dating violence (Miller et al., 2018). In a community with high-risk factors such as Kupang, personalized psychological intervention for victims is urgent, and need to consider specific contexts influencing the victims.
One of the participants also mentioned how her boyfriend used to be exposed to bullying in school. The previous study has shown that people who experienced higher levels of bullying also significantly have higher rates of intimate partner perpetration and victimization (Adhia et al., 2019). Bullying victims among students also seem to be reporting significantly higher physical dating violence victimization and higher emotional abuse compare to students who are not victims (Espelage & Holt, 2007).
Another notable information found in this research is regarding the decision to maintain the relationship because of the religious factor. One of the participants believes her religion advises to always forgive people A contextual reason mentioned by a few participants of the study, when they decide to keep their relationship is because they had sexual intercourse previously. Sex before marriage is something that is not socially accepted by Indonesian society especially in the eastern side of Indonesia. Virginity in the culture of people in Eastern Indonesia is seen as something precious that is only to be given to the husband (Sabarni & Hidajat, 2018).
This social construct resulted in, the victims of dating violence being afraid that if they broke up with their partner, another man will not accept them since they are no longer virgins. The rejections to the idea of sex before marriage itself come mainly from people's religious and cultural beliefs, which is also practiced in other countries besides Indonesia (Kim, 2020;Mehrolhassani et al., 2020). Virginity is spiritually constructed as something precious that defines the value of women, therefore it needs to be protected (Mehrolhassani et al., 2020). This social construct then promotes tolerance for violence and encourages the victims of dating violence to stay with their partners, even though they were abused.
All these religious and cultural beliefs that developed in Indonesia are preventing the victims of dating violence to be able to escape from their abusive partner. It promotes tolerance to the violence itself, which encourages the perpetuation of dating violence among female youth. As mentioned before patriarchal attitude has been structured and institutionalized in the society, therefore it is the responsibility of all layers of the society to change this culture. Interventions that are engaging with the community and can improve social network seems to show positive results on reducing violence against young women and adolescent girls (Yount et al., 2017).
Parenting intervention at an early age can also reduce the association of high-risk females to be involved with aggressive peers and partners in adolescence (Ehrensaft et al., 2018). In addition, key stakeholders such as youth peers and women empowerment organizations can help to eliminate these harmful beliefs by educating society about dating violence and provide counseling assistance to dating violence victims.

Limitations
There are several limitations to this study. The first limitation is only seven out of nine participants can participate during the focus group, limiting the amount of possible data gathered. Another limitation of this study is the participants are only female. It is suggested for future researchers to explore the perspectives of male victims of dating violence.

Conclusion
This research explores the psychological experience of dating violence victims by providing information on types of dating violence, risk factors, protective factors, impacts of dating violence, and the victim's decisions to withhold or withdraw from the relationship. While some of this study's findings were already underlined by Asikin, Aipipidely, & Kiling WHO and under research findings, the use of photovoice helped to portrait the significance of the psychological impacts of dating violence. This study also indicates that interventions that consider religious and cultural beliefs are urgently needed to help the victims to escape dating violence and reintegrates them into their social life.

Funding
The authors have no funding to report.