Exploring the complex pathway of the primary health care response to intimate partner violence in New Zealand.
Exploring the complex pathway of the primary health care response to intimate partner violence in New Zealand.
复制标题
DOI：
10.1186/s12961-018-0373-2
复制
发表时间：
2018-10-19
影响因子：
4
通讯作者：
Koziol-Mclain J
中科院分区：
文献类型：
--
作者：
Gear C;Eppel E;Koziol-Mclain J
将针对亲密伴侣暴力的可持续应对措施纳入医疗保健领域是国际上一个持续存在且复杂的问题。新西兰发挥着主导作用，建立了国家卫生系统基础设施，以应对医院和选定社区环境中的亲密伴侣暴力行为。然而，初级卫生保健部门的资源和参与程度有限。本研究的重点是影响新西兰初级卫生保健机构内对亲密伴侣暴力的可持续反应的因素。利用复杂性理论，我们将针对亲密伴侣暴力的可持续初级卫生保健应对措施重新概念化为复杂的适应系统。为了探索主体之间的相互作用，我们分析了告知医疗保健中亲密伴侣暴力应对措施的关键政策、战略、指南和评估文件的功能。我们按时间顺序将这些文件按其功能串联在一起，以展示影响亲密伴侣暴力反应的话语如何从代理互动中产生。本文介绍了过去二十年新西兰卫生系统应对亲密伴侣暴力的复杂性实施叙述，重点关注初级卫生保健部门的参与。我们展示了随着时间的推移，竞争性话语如何导致系统差距和意想不到的后果。我们的研究结果考虑了对初级卫生保健中亲密伴侣暴力的可持续反应的影响，并呼吁人们关注对新西兰整个卫生系统方法提出挑战的系统相互作用。复杂性理论的使用有助于以创新的视角来看待持续存在的复杂问题。鉴于问题的复杂性和新西兰的领导作用，分享经验教训对于参与制定应对亲密伴侣暴力的医疗保健系统方法的国际社会至关重要。
Integrating sustainable responses to intimate partner violence in health care is a persistent and complex problem internationally. New Zealand holds a leading role, having established national health system infrastructure for responding to intimate partner violence within hospital and selected community settings. However, resources for, and engagement with, the primary health care sector has been limited. The present study focuses on what affects a sustainable response to intimate partner violence within New Zealand primary health care settings. Utilising complexity theory, we reconceptualised a sustainable primary health care response to intimate partner violence as a complex adaptive system. To explore interactions between agents, we analysed the function(s) of key policy, strategy, guideline and evaluation documents informing intimate partner violence responsiveness in health care. We chronologically threaded these documents together by their function(s) to show how discourse influencing intimate partner violence responsiveness emerges from agent interactions. This paper presents a complexity informed implementation narrative of the New Zealand health system response to intimate partner violence across the last two decades, focused on the participation of the primary health care sector. We demonstrate how competing discourses have contributed to system gaps and unintended consequences over time. Our findings consider implications for a sustainable response to intimate partner violence in primary health care and call attention to system interactions that challenge a whole health system approach in New Zealand. Use of complexity theory facilitates an innovative perspective of a persistent and complex problem. Given the complexity of the problem and New Zealand’s leadership, sharing the lessons learnt is critical for the international community involved in developing health care system approaches to intimate partner violence.
影响因子：
2.3
作者：
Ashton, Toni;Tenbensel, Tim
通讯作者：
Tenbensel, Tim
影响因子：
1.2
作者：
Bowen, Glenn A.
通讯作者：
Bowen, Glenn A.