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Health-Sector Responses to Intimate Partner Violence: fitting the Response Into the Biomedical Health System or Adapting the System to Meet the Response?
Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS). Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
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2018 (Engelska)Ingår i: Journal of Interpersonal Violence, ISSN 0886-2605, E-ISSN 1552-6518, Vol. 33, nr 10, s. 1653-1678Artikel i tidskrift (Refereegranskat) 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.

Ort, förlag, år, upplaga, sidor
Sage Publications, 2018. Vol. 33, nr 10, s. 1653-1678
Nyckelord [en]
intimate partner violence, health system, Spain, grounded theory
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi Genusstudier
Identifikatorer
URN: urn:nbn:se:umu:diva-114394DOI: 10.1177/0886260515619170ISI: 000430238500005PubMedID: 26691205Scopus ID: 2-s2.0-84982278063OAI: oai:DiVA.org:umu-114394DiVA, id: diva2:895086
Tillgänglig från: 2016-01-18 Skapad: 2016-01-18 Senast uppdaterad: 2018-10-16Bibliografiskt granskad
Ingår i avhandling
1. An insight into institutional responses to intimate partner violence against women in Spain
Öppna denna publikation i ny flik eller fönster >>An insight into institutional responses to intimate partner violence against women in Spain
2018 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
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.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå University, 2018. s. 63
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1992
Nyckelord
Intimate partner violence, nursing, health system, gender
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Forskningsämne
folkhälsa
Identifikatorer
urn:nbn:se:umu:diva-152636 (URN)978-91-7601-965-8 (ISBN)
Disputation
2018-11-09, Hörsal D Unod T9, Norrlands universitetssjukhus, Umeå, 09:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2018-10-19 Skapad: 2018-10-16 Senast uppdaterad: 2018-11-02Bibliografiskt granskad

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Öhman, AnnHurtig, Anna-KarinGoicolea, Isabel

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Journal of Interpersonal Violence
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologiGenusstudier

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