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An insight into institutional responses to intimate partner violence against women in Spain
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. University of the Basque Country UPV/EHU.
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

Intimate Partner Violence (IPV) has been widely acknowledged as a major public health issue and a human rights concern. The international burden of this type of violence have lead countries to develop institutional responses to address the consequences for women as well as to reduce its prevalence. With this aim, the Spanish government enacted in 2004 one of the most comprehensive laws in the world. Among all sectors, the role of health care professionals in the identification, management and prevention of IPV becomes essential. Thus, this thesis analyses institutional responses to intimate partner violence against women in Spain, focusing on the public health-care sector.

Methods

This thesis is based on three qualitative papers and one mixed methods paper. Data collection was conducted through in-depth interviews in the two first papers, documentary review and in-depth interviews in the third paper and focus groups in the fourth paper. In the first paper I used thematic analysis to explore the perceptions of professionals working in different sectors regarding institutional responses to IPV with special attention to prevention campaigns aimed at young people. In the second paper we used grounded theory to develop a conceptual model representing the diverse responses generated when attempting to integrate a response to IPV into a biomedical health system. The third paper mapped and explored the training in IPV that nursing students receive at the undergraduate level in Spain through the revision of public documents and individual in-depth interviews. The fourth paper explored nursing students’ perceptions of, and attitudes towards, IPV after having received specific training in the topic.

Main findings

One of the main findings in Paper I was that the sustainability of programmes to address IPV was always jeopardized by politicians and colleagues that did not considered that IPV should be prioritized. Concerning prevention campaigns, participants in that study perceived that they sent messages that did not fit young people’s needs and thus were ineffective. Besides, they stressed that institutional responses failed to focus on on men to discourage violence. The main finding of Paper II was the coexistence of a range of responses in the health sector that included avoidance, voluntariness, medicalization and comprehensiveness. Attitudes and beliefs of health-care professionals about IPV were strongly related with the development of this variety of responses. In relation with training (Paper III), the majority of nursing training programmes in the country have incorporated IPV training in their curricula. However, there was a great variability between universities in the topics included in the training. Which topics were included in the training programme was influenced by lecturers’ perceptions of IPV. Nursing students who have received training on IPV (Paper IV) showed an increased acknowledgement of IPV as a health issue and consequently considered that early identification of IPV and referral were part of their nursing role. However, readiness to act was limited by persistence of myths around IPV as believing false accusations of IPV being widespread.

Conclusions

Policies enacted with the aim of reducing IPV and its consequences in Spain have been essential for initiating institutional responses to IPV, specifically in the health sector. However, responses have been weakly institutionalized so far, favouring front line workers or ‘street level bureaucrats’ exercise of discretion. This leads to inequalities between and within regions in the country in the implementation of the policies. The most relevant element influencing the use of discretion in the case of IPV responses was the understanding of the relationships between gender inequities and IPV. The predominant gender regime of the institutions responsible for policy implementation influenced political and economic support for the development of responses to IPV.

Place, publisher, year, edition, pages
Umeå: Umeå University , 2018. , p. 63
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1992
Keywords [en]
Intimate partner violence, nursing, health system, gender
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
URN: urn:nbn:se:umu:diva-152636ISBN: 978-91-7601-965-8 (print)OAI: oai:DiVA.org:umu-152636DiVA, id: diva2:1256423
Public defence
2018-11-09, Hörsal D Unod T9, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2018-10-19 Created: 2018-10-16 Last updated: 2018-11-02Bibliographically approved
List of papers
1. Professionals' perception of intimate partner violence in young people: a qualitative study in northern Spain
Open this publication in new window or tab >>Professionals' perception of intimate partner violence in young people: a qualitative study in northern Spain
2017 (English)In: Reproductive Health, ISSN 1742-4755, E-ISSN 1742-4755, Vol. 14, article id 86Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Intimate partner violence (IPV) is a public health problem with devastating effects on young women's health. These negative effects increase when the exposure to IPV lasts for a long time and exposure at an early age increases the risk of adult IPV. Despite efforts made in the last few decades, data show little progress has been made towards its reduction. Thus, the aim of the study reported here is to explore professionals' perceptions regarding intimate partner violence (IPV) among young people, focusing on the characteristics of the phenomenon and their perceptions about existing programmes and campaigns aimed at addressing it.

METHODS: Twelve professionals from education, health and municipal social services were interviewed. All but one of the interviews were recorded and transcribed verbatim. Data were analysed according to the methodology of inductive thematic analysis, with the support of Atlas.ti software. The transcripts were read several times and coded line by line. Afterwards, codes were grouped into themes. The developed themes were refined into two phases with the participation of all the authors.

RESULTS: From the analysis, the following three themes were identified: "A false sense of gender equity", "IPV among young people: subtle, daily and normalized", and "Mass media campaigns do not fit young people's needs". According to the participants, psychological abuse in the form of controlling behaviour by their partners is the most common type of IPV young women are exposed to, although exposure to other types of IPV was also acknowledged. This violence was described as something subtle, daily and normalized and, consequently, not something that is easy to recognize for the girls that are exposed to it, nor for adults working with young people.

CONCLUSIONS: The study participants showed good knowledge of the characteristics IPV has among young people. This knowledge was reflected in locally implemented IPV prevention projects, which they considered successful in addressing young people's needs. However, these interventions lacked formal evaluation, political support and continuation. The study participants did not believe that nationwide mass media campaigns realistically reflected the specific characteristics of IPV among young people. Thus, participants perceived these campaigns to be ineffective.

Keywords
Intimate partner violence, Professional role, Qualitative research, Young people
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-138468 (URN)10.1186/s12978-017-0348-8 (DOI)000406709600002 ()28728584 (PubMedID)
Available from: 2017-08-23 Created: 2017-08-23 Last updated: 2018-10-16Bibliographically approved
2. Health-Sector Responses to Intimate Partner Violence: fitting the Response Into the Biomedical Health System or Adapting the System to Meet the Response?
Open this publication in new window or tab >>Health-Sector Responses to Intimate Partner Violence: fitting the Response Into the Biomedical Health System or Adapting the System to Meet the Response?
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2018 (English)In: Journal of Interpersonal Violence, ISSN 0886-2605, E-ISSN 1552-6518, Vol. 33, no 10, p. 1653-1678Article in journal (Refereed) Published
Abstract [en]

This study aims to analyze how middle-level health systems' managers understand the integration of a health care response to intimate partner violence (IPV) within the Spanish health system. Data were obtained through 26 individual interviews with professionals in charge of coordinating the health care response to IPV within the 17 regional health systems in Spain. The transcripts were analyzed following grounded theory in accordance with the constructivist approach described by Charmaz. Three categories emerged, showing the efforts and challenges to integrate a health care response to IPV within the Spanish health system: "IPV is a complex issue that generates activism and/or resistance," "The mandate to integrate a health sector response to IPV: a priority not always prioritized," and "The Spanish health system: respectful with professionals' autonomy and firmly biomedical." The core category, "Developing diverse responses to IPV integration," crosscut the three categories and encompassed the range of different responses that emerge when a strong mandate to integrate a health care response to IPV is enacted. Such responses ranged from refraining to deal with the issue to offering a women-centered response. Attempting to integrate a response to nonbiomedical health problems as IPV into health systems that remain strongly biomedicalized is challenging and strongly dependent both on the motivation of professionals and on organizational factors. Implementing and sustaining changes in the structure and culture of the health care system are needed if a health care response to IPV that fulfills the World Health Organization guidelines is to be ensured.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
intimate partner violence, health system, Spain, grounded theory
National Category
Public Health, Global Health, Social Medicine and Epidemiology Gender Studies
Identifiers
urn:nbn:se:umu:diva-114394 (URN)10.1177/0886260515619170 (DOI)000430238500005 ()26691205 (PubMedID)2-s2.0-84982278063 (Scopus ID)
Available from: 2016-01-18 Created: 2016-01-18 Last updated: 2018-10-16Bibliographically approved
3. Mapping and exploring training in gender-based violence for undergraduate nursing students in Spain: A mixed-methods study
Open this publication in new window or tab >>Mapping and exploring training in gender-based violence for undergraduate nursing students in Spain: A mixed-methods study
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Health-care professionals, and nurses especially among them, play an essential role in the health sector’s response to gender-based violence. To be able to successfully address this major public health issue they need specific training in the topic.

 

Objective: To map and explore training on gender-based violence that nursing students receive at universities in Spain.

Design: Mixed-methods approach

 

Setting: Spain

 

Methods: Systematic review of public documents followed by in-depth interviews with university lecturers

 

Results: Eighty per cent (92/115) of nursing training programmes included content regarding gender-based violence. There was great variability in the topics included in the training. Health consequences due to gender-based violence exposure and the role of the health sector in addressing these health consequences were the most frequently included topics. Ethical issues and legislation were the least frequent ones, as these were only dealt with in one and 18 training programmes, respectively.

In the qualitative analysis of the interviews, two categories were identified: ‘Supportive legislation and supportive lecturers are essential for integrating gender-based violence training’ and ‘Approach to gender-based violence shapes the contents and the subject in which it is incorporated’. The first category refers to the main drivers for training integration, while the second category refers to how lecturers’ perceptions influenced the way in which training was implemented.

 

Conclusions: As many as 80% of the nursing education programmes included specific training in gender-based violence, although with great variability in the contents among the universities. For this study’s participants, enacted legislation, and lecturers interested in the topic and in decision-making positions were key drivers for this extensive implementation. The variability observed across universities might be explained by lecturers’ different approaches to gender-based violence and the nursing profession.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-152634 (URN)
Available from: 2018-10-16 Created: 2018-10-16 Last updated: 2018-10-16
4. Nursing students' discourses on gender-based violence and their training for a comprehensive healthcare response: A qualitative study.
Open this publication in new window or tab >>Nursing students' discourses on gender-based violence and their training for a comprehensive healthcare response: A qualitative study.
Show others...
2018 (English)In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 68, p. 208-212Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Gender-based violence is a worldwide major public health issue with detrimental effects on the health of women. Nurses can play an essential role in its identification, management and prevention. Specific training is essential to be able to successfully address gender-based violence and accordingly, has been incorporated into many university's training programmes for nurses and other health care professionals. Research aimed at exploring attitudes and perceptions of gender-based violence in undergraduate student nurses following these new training programmes is scarce.

OBJECTIVE: The aim of this qualitative study was to explore third- and fourth-year nursing students' perceptions and attitudes toward gender-based violence.

DESIGN: A focus groups based qualitative study.

SETTING: A public University in Spain.

PARTICIPANTS: Purposive sample of 42 nursing students who joined 7 focus groups.

METHODS: Focus groups discussions following a semi-structured interview guide. Discussions were transcribed and analysed following critical discourse analysis to identify interpretative repertoires.

RESULTS: From the analysis, three interpretative repertoires emerged. The first, 'Gender-based violence is something serious', reflected participants' acknowledgment of the social relevance of this type of violence. The second interpretative repertoire, 'Men are defenceless!', related to the perception that national legislation on gender-based violence was discriminatory to men and the perception of a lack of social sensitisation toward intimate partner violence against men. The last one, 'Trained to address gender-based violence but still unprepared' encompassed participants' confidence in their ability to identify gender-based violence but uncertainty as to how to respond to gender-based violence exposed women in terms of professional practice.

CONCLUSIONS: Participants perceived that training has increased their knowledge and self-confidence in identifying cases. However, training should strongly challenge widespread myths about gender-based violence that could negatively affect their performance as nurses.

Place, publisher, year, edition, pages
Churchill Livingstone, 2018
Keywords
Discourse analysis, Gender-based violence, Nursing students, Qualitative research
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-150569 (URN)10.1016/j.nedt.2018.06.011 (DOI)000442056100037 ()29966882 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2006-1512
Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2018-10-16Bibliographically approved

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