{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T14:01:24Z","timestamp":1790776884547,"version":"4.1.0"},"reference-count":51,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["nihr134629"],"award-info":[{"award-number":["nihr134629"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,9,3]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Migrants living in precarious conditions often face gendered violence (GV) and poor mental health (MH). However, most of the existing GV and MH measures assume residentially stable populations, missing migration-related precarity or structural conditions shaping migrants\u2019 experiences. As a result, the intersection of GV, poor MH and precarity across migrant populations remains unstudied, especially in low- and middle-income country (LMIC) settings, that the National Institute for Health and Care Research (NIHR)-funded research programme Gendered Violence and Poor Mental Health among Migrants in Precarious Situations (GEMMS) aims to explore.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>This paper describes the development of the GEMMS survey tool and presents preliminary pilot validation evidence for selected adapted and newly developed components designed to measure GV, MH and precarity associated with migration across multiple LMIC settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>GEMMS survey tool development followed a participatory process with multicountry research teams, international experts, local advisory groups and community members with lived experiences. Guided by GEMMS\u2019 conceptual frameworks, items were drawn from validated instruments where possible and newly developed as informed by GEMMS\u2019 ethnography and country profiling. After several rounds of expert reviews, community consultations and item-level content validation, the tool was pilot-tested in Cambodia, India and South Africa (total n=198), to improve wording, sequencing, skip logics and order. Exploratory factor analysis was done to assess internal coherence of the newly adapted items.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Final survey tool comprises 216 items. Exploratory factor analysis of selected adapted and de novo migration-related and psychosocial item sets in pilot analyses identified two coherent migration-related and three MH-related factors: structural harm, socio-cultural marginalisation; social exclusion, belonging\/social integration and migration stress. All five factors were robust, with interpretable and meaningful loadings that aligned with the guiding theory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The GEMMS survey tool provides an integrated, context-responsive, structurally informed survey tool for measuring GV, MH and multidimensional precarity in migrant populations. This paper demonstrates its development process, pilot feasibility and preliminary validation evidence for selected components, while establishing a foundation for future intersectional and syndemic-informed analysis across diverse migrant populations in LMICs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-120912","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:36:38Z","timestamp":1790775398000},"page":"e120912","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Developing a survey tool to assess gendered violence and mental health burden in migrants living in precarity"],"prefix":"10.1136","volume":"16","author":[{"given":"Neha","family":"Adsul","sequence":"first","affiliation":[{"name":"Tata Institute of Social Sciences, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2073-4565","authenticated-orcid":false,"given":"Roomi","family":"Aziz","sequence":"additional","affiliation":[{"name":"Centre for Global Health and Intersectional Equity Research, University of Essex, Colchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muthusamy","family":"Sivakami","sequence":"additional","affiliation":[{"name":"Tata Institute of Social Sciences, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9205-2144","authenticated-orcid":false,"given":"Kamaldeep","family":"Bhui","sequence":"additional","affiliation":[{"name":"University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6719-9216","authenticated-orcid":false,"given":"Anuj","family":"Kapilashrami","sequence":"additional","affiliation":[{"name":"Centre for Global Health and Intersectional Equity Research, University of Essex, Colchester, UK"},{"name":"University of Essex, Colchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"2026093006351496000_16.9.e120912.1","doi-asserted-by":"crossref","DOI":"10.1016\/j.jmh.2023.100180","article-title":"Pandemic, precarity and health of migrants in South Asia: Mapping multiple dimensions of precarity and pathways to states of health and well-being","volume":"7","author":"Kapilashrami","year":"2023","journal-title":"J Migr Health"},{"key":"2026093006351496000_16.9.e120912.2","doi-asserted-by":"crossref","first-page":"2077","DOI":"10.1007\/s40615-021-01146-w","article-title":"2020 Syndemic: Convergence of COVID-19, Gender-Based Violence, and Racism Pandemics","volume":"9","author":"Khanlou","year":"2022","journal-title":"J Racial and Ethnic Health Disparities"},{"key":"2026093006351496000_16.9.e120912.3","doi-asserted-by":"crossref","DOI":"10.1136\/bmjph-2025-002561","article-title":"Sexual health of Syrian women in protracted forced displacement: the syndemic interplay of violence, war trauma, poor mental health and food insecurity","volume":"3","author":"Fahme","year":"2025","journal-title":"BMJ Public Health"},{"key":"2026093006351496000_16.9.e120912.4","doi-asserted-by":"publisher","DOI":"10.1177\/0971521514556947"},{"key":"2026093006351496000_16.9.e120912.5","doi-asserted-by":"publisher","DOI":"10.1093\/jrs\/fem002"},{"key":"2026093006351496000_16.9.e120912.6","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1080\/17441690701535998","article-title":"Forced Migration and Mental Health: Rethinking the Care of Refugees and Displaced Persons","volume":"3","author":"Miller","year":"2008","journal-title":"Glob Public Health"},{"key":"2026093006351496000_16.9.e120912.7","doi-asserted-by":"crossref","DOI":"10.1080\/16549716.2020.1783957","article-title":"Measuring mental health burden in humanitarian settings: a critical review of assessment tools","volume":"13","author":"Moore","year":"2020","journal-title":"Glob Health Action"},{"key":"2026093006351496000_16.9.e120912.8","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/j.encep.2020.03.009","article-title":"Migrations, trauma and mental health: A literature update on psychological assessment","volume":"46","author":"Brunnet","year":"2020","journal-title":"Encephale"},{"key":"2026093006351496000_16.9.e120912.9","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0317872","article-title":"You can\u2019t see what you don\u2019t measure! 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