Adaptive work in the health care response to domestic violence in Palestine
Adaptive work in the health care response to domestic violence in Palestine
复制标题
巴勒斯坦家庭暴力卫生保健应对措施的适应性工作
DOI：
10.1093/eurpub/ckaa166.533
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发表时间：
2020
影响因子：
4.4
通讯作者：
Bacchus L
中科院分区：
文献类型：
--
作者：
Bacchus L
卫生系统应对针对妇女的家庭暴力是一个全球优先事项。然而，人们对它们是否或如何在存在更大结构性障碍的中低收入国家发挥作用知之甚少。HERA（HEALCHEMICAL应对暴力和虐待）的目的是加强对家庭暴力在西岸的Palestina.MethodsThe样本的定性研究是18名参与者在两个初级卫生保健诊所，包括5名妇女，9个初级卫生保健提供者，两个基于性别的暴力协调中心和两个家庭暴力培训师。数据进行了分析，使用主题分析绘制扩展的规范化过程理论（ENPT）和女权主义奖学金。我们收集的数据识别和转介的家庭暴力cases.ResultsHERA与政治，社会文化和经济方面的背景下，创造了一定程度的不可预测性和不确定性的干预工作。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。与会者开展了适应性工作，以应对这些挑战，并确保在各种制约因素的背景下，执行工作是安全和可行的。参与者的叙述强调使用的托词，隐藏的形式的机构和管理行为（自我和他人），以确保所有参与在implementation.ConclusionsThe调查结果的安全HERA如何可以持续在长期的影响，特别是关于为妇女提供支持。需要在卫生系统内各级提供支持，以促成变革，加强对暴力侵害妇女行为的应对措施。临床病例管理者角色的转变是HERA的一个紧急特征。扩展的规范化过程理论有助于阐明干预背景相互作用的细微差别。
BackgroundA health system response to domestic violence against women is a global priority. However, little is known about whether or how they work in LMICs where there are greater structural barriers. HERA (HEalthcare Responding to violence and Abuse) aimed to strengthen the primary healthcare response to domestic violence in the West Bank of Palestine.MethodsThe sample for the qualitative study was 18 participants at two primary health care clinics and included five women, nine primary health care providers, two gender-based violence focal points and two domestic violence trainers. Data were analysed using thematic analysis drawing an Extended Normalisation Process Theory (ENPT) and feminist scholarship. We collected data on identification and referral of domestic violence cases.ResultsHERA interacted with political, sociocultural and economic aspects of the context, creating a degree of unpredictability and uncertainty in working of the intervention. 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 within a context of constraints. Participant narratives highlight the use of subterfuge, hidden forms of agency and governing behaviours (of self and others) to ensure the safety of all involved during implementation.ConclusionsThe findings have implications for how HERA can be sustained in the long-term, particularly with regards to the provision of support for women. Support at all levels within the health system is needed to enable change and strengthen the response to violence against women.Key messagesHealth care providers and women worked with and around contextual constraints. The transformation of the clinic case manager role is an emergent feature of HERA.Extended Normalisation Process Theory helped to articulate nuances about intervention-context interactions.