Developing a survey tool to assess gendered violence and mental health burden in migrants living in precarity

Background: 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’ 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. Aim: 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. Methods: 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’ conceptual frameworks, items were drawn from validated instruments where possible and newly developed as informed by GEMMS’ 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. Results: 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. Conclusion: 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.