Adaptive work in the primary health care response to domestic violence in occupied Palestinian territory: a qualitative evaluation using Extended Normalisation Process Theory.
Adaptive work in the primary health care response to domestic violence in occupied Palestinian territory: a qualitative evaluation using Extended Normalisation Process Theory.
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在被占领巴勒斯坦领土的家庭暴力的初级卫生保健反应的适应性工作：使用扩展规范化过程理论的定性评价。
DOI：
10.1186/s12875-020-01338-z
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发表时间：
2021-01-02
影响因子：
2.9
通讯作者：
Colombini M
中科院分区：
文献类型：
--
作者：
Bacchus LJ;Alkaiyat A;Shaheen A;Alkhayyat AS;Owda H;Halaseh R;Jeries I;Feder G;Sandouka R;Colombini M
卫生系统应对侵害妇女的家庭暴力是一个全球优先事项。然而，人们对这些卫生系统干预措施如何在结构性障碍更大的中低收入国家发挥作用知之甚少。研究未能探讨背景干预的相互作用如何影响实施过程。“应对暴力和虐待的医疗保健”旨在加强对巴勒斯坦被占领土家庭暴力的初级医疗保健应对措施。我们探讨了适应性的工作，参与者从事谈判的上下文限制。定性研究涉及两个初级保健诊所的18名参与者，其中包括5名女病人、7名初级保健提供者、2名诊所个案管理员、2名卫生部性别暴力问题协调人和2名家庭暴力问题培训员。半结构化访谈被用来了解参与者参与HERA的经验，遇到的挑战以及如何谈判。数据进行了分析，利用专题分析，扩展规范化过程理论。我们收集了关于家庭暴力案件的识别和转介以及培训出勤率的诊所数据。HERA与巴勒斯坦的政治、社会文化和经济方面进行了互动。政治占领限制了妇女的行动和获得支助服务的机会，而随之而来的缺乏警察保护使提供者和妇女感到容易受到家庭报复。这与文化价值观交织在一起，影响了参与者在谈判强化暴力侵害妇女行为的规范结构时的选择。与会者参与了适应性工作，以应对这些挑战，并确保实施工作安全可行。叙述强调使用托词、隐藏的代理形式、管理行为、对知识的控制和酌情行动。护理途径并没有如预期的那样发挥作用，因为大多数妇女选择不寻求外部支持。干预的一个紧急特征是诊所病例管理者能够即兴发挥他们的作用。ENPT的灵活使用有助于使医疗服务提供者和女性患者参与的实践浮出水面，使HERA可行。调查结果对卫生系统在不同情况下应对暴力侵害妇女行为的循证干预措施的可转移性以及如何长期维持“健康和环境评估”具有影响。
A health system response to domestic violence against women is a global priority. However, little is known about how these health system interventions work in low-and-middle-income countries where there are greater structural barriers. Studies have failed to explore how context-intervention interactions affect implementation processes. Healthcare Responding to Violence and Abuse aimed to strengthen the primary healthcare response to domestic violence in occupied Palestinian territory. We explored the adaptive work that participants engaged in to negotiate contextual constraints. The qualitative study involved 18 participants at two primary health care clinics and included five women patients, seven primary health care providers, two clinic case managers, two Ministry of Health based gender-based violence focal points and two domestic violence trainers. Semi-structured interviews were used to elicit participants’ experiences of engaging with HERA, challenges encountered and how these were negotiated. Data were analysed using thematic analysis drawing on Extended Normalisation Process Theory. We collected clinic data on identification and referral of domestic violence cases and training attendance. HERA interacted with political, sociocultural and economic aspects of the context in Palestine. The political occupation restricted women’s movement and access to support services, whilst the concomitant lack of police protection left providers and women feeling exposed to acts of family retaliation. This was interwoven with cultural values that influenced participants’ choices as they negotiated normative structures that reinforce violence against women. Participants engaged in adaptive work to negotiate these challenges and ensure that implementation was safe and workable. Narratives highlight the use of subterfuge, hidden forms of agency, governing behaviours, controls over knowledge and discretionary actions. The care pathway did not work as anticipated, as most women chose not to access external support. An emergent feature of the intervention was the ability of the clinic case managers to improvise their role. Flexible use of ENPT helped to surface practices the providers and women patients engaged in to make HERA workable. The findings have implications for the transferability of evidenced based interventions on health system response to violence against women in diverse contexts, and how HERA can be sustained in the long-term.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
3.1
作者：
Hawe, Penelope;Shiell, Alan;Riley, Therese
通讯作者：
Riley, Therese
高度边缘化妇女代理权的概念化： 极端环境下的亲密伴侣暴力
影响因子：
3.3
作者：
Campbell, Catherine;Mannell, Jenevieve
通讯作者：
Mannell, Jenevieve
影响因子：
1.6
作者：
Al-Krenawi, A;Graham, J;Izzeldin, A
通讯作者：
Izzeldin, A
影响因子：
3.3
作者：
Al-Krenawi, Alean;Graham, John R.;Sehwail, Mahmud A.
通讯作者：
Sehwail, Mahmud A.