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Mapping and exploring health systems' response to intimate partner violence in Spain
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Public Health Research Group, Department of Community Nursing, Alicante, Spain.ORCID iD: 0000-0002-8114-4705
Preventive Medicine and Public Health and History of Science, Alicante University, Alicante, Spain.ORCID iD: 0000-0003-3083-106X
Umeå University, Faculty of Medicine, Department of Nursing.
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2013 (English)In: BMC Public Health, ISSN 1471-2458, Vol. 13, no 1, Article Number: 1162- p.Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: For a comprehensive health sector response to intimate partner violence (IPV), interventions should target individual and health facility levels, along with the broader health systems level which includes issues of governance, financing, planning, service delivery, monitoring and evaluation, and demand generation. This study aims to map and explore the integration of IPV response in the Spanish national health system.

METHODS: Information was collected on five key areas based on WHO recommendations: policy environment, protocols, training, monitoring and prevention. A systematic review of public documents was conducted to assess 39 indicators in each of Spain's 17 regional health systems. In addition, we performed qualitative content analysis of 26 individual interviews with key informants responsible for coordinating the health sector response to IPV in Spain.

RESULTS: In 88% of the 17 autonomous regions, the laws concerning IPV included the health sector response, but the integration of IPV in regional health plans was just 41%. Despite the existence of a supportive national structure, responding to IPV still relies strongly on the will of health professionals. All seventeen regions had published comprehensive protocols to guide the health sector response to IPV, but participants recognized that responding to IPV was more complex than merely following the steps of a protocol. Published training plans existed in 43% of the regional health systems, but none had institutionalized IPV training in medical and nursing schools. Only 12% of regional health systems collected information on the quality of the IPV response, and there are many limitations to collecting information on IPV within health services, for example underreporting, fears about confidentiality, and underuse of data for monitoring purposes. Finally, preventive activities that were considered essential were not institutionalized anywhere.

CONCLUSIONS: Within the Spanish health system, differences exist in terms of achievements both between regions and between the areas assessed. Progress towards integration of IPV has been notable at the level of policy, less outstanding regarding health service delivery, and very limited in terms of preventive actions.

Place, publisher, year, edition, pages
BioMed Central, 2013. Vol. 13, no 1, Article Number: 1162- p.
Keyword [en]
Health system, Health policy, Intimate partner violence, Spain, Mixed methods, Content analysis
National Category
Public Health, Global Health, Social Medicine and Epidemiology
URN: urn:nbn:se:umu:diva-84013DOI: 10.1186/1471-2458-13-1162PubMedID: 24325328OAI: diva2:678689
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2013-12-12 Created: 2013-12-12 Last updated: 2015-04-29Bibliographically approved

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Goicolea, IsabelÖhman, AnnEdin, KerstinMinvielle, Fauhn
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