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Published in: BMC Public Health 1/2013

Open Access 01-12-2013 | Research article

Mapping and exploring health systems’ response to intimate partner violence in Spain

Authors: Isabel Goicolea, Erica Briones-Vozmediano, Ann Öhman, Kerstin Edin, Fauhn Minvielle, Carmen Vives-Cases

Published in: BMC Public Health | Issue 1/2013

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Abstract

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.
Appendix
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Literature
1.
2.
3.
4.
5.
Ellsberg M, Jansen HA, Heise L, Watts CH, Garcia-Moreno C: Intimate partner violence and women’s physical and mental health in the WHO multi-country study on women’s health and domestic violence: an observational study. Lancet. 2008, 371: 1165-1172. 10.1016/S0140-6736(08)60522-X.CrossRefPubMed
6.
7.
Ansara DL, Hindin MJ: Formal and informal help-seeking associated with women’s and men’s experiences of intimate partner violence in Canada. Soc Sci Med. 2010, 70: 1011-1018. 10.1016/j.socscimed.2009.12.009.CrossRefPubMed
8.
Colombini M, Mayhew S, Watts C: Health-sector responses to intimate partner violence in low-and middle-income settings: a review of current models, challenges and opportunities. Bull World Health Organ. 2008, 86: 635-642. 10.2471/BLT.07.045906.CrossRefPubMedPubMedCentral
9.
Feder G, Davies RA, Baird K, Dunne D, Eldridge S, Griffiths C, Gregory A, Howell A, Johnson M, Ramsay J, et al: Identification and Referral to Improve Safety (IRIS) of women experiencing domestic violence with a primary care training and support programme: a cluster randomised controlled trial. Lancet. 2011, 378: 1788-1795. 10.1016/S0140-6736(11)61179-3.CrossRefPubMed
10.
Ramsay J, Carter Y, Davidson L, Dunne D, Eldridge S, Feder G, Hegarty K, Rivas C, Taft A, Warburton A: Advocacy interventions to reduce or eliminate violence and promote the physical and psychosocial well-being of women who experience intimate partner abuse. Cochrane Database Syst Rev. 2009, CD005043-
11.
Hegarty K, O’Doherty L, Taft A, Chondros P, Brown S, Valpied J, Astbury J, Taket A, Gold L, Feder G, Gunn J: Screening and counselling in the primary care setting for women who have experienced intimate partner violence (WEAVE): a cluster randomised controlled trial. Lancet. 2013, 382: 249-258. 10.1016/S0140-6736(13)60052-5.CrossRefPubMed
12.
Gottlieb AS: Intimate partner violence: a clinical review of screening and intervention. Womens Health (Lond Engl). 2008, 4: 529-539. 10.2217/17455057.4.5.529.CrossRef
13.
Colombini M, Mayhew SH, Ali SH, Shuib R, Watts C: An integrated health sector response to violence against women in Malaysia: lessons for supporting scale up. BMC Public Health. 2012, 12: 548-10.1186/1471-2458-12-548.CrossRefPubMedPubMedCentral
14.
Tower M: Intimate partner violence and the health care response: a postmodern critique. Health Care Women Int. 2007, 28: 438-452. 10.1080/07399330701226404.CrossRefPubMed
15.
Beynon CE, Gutmanis IA, Tutty LM, Wathen CN, MacMillan HL: Why physicians and nurses ask (or don’t) about partner violence: a qualitative analysis. BMC Public Health. 2012, 12: 473-10.1186/1471-2458-12-473.CrossRefPubMedPubMedCentral
16.
Btoush R, Campbell JC, Gebbie KM: Visits coded as intimate partner violence in emergency departments: characteristics of the individuals and the system as reported in a national survey of emergency departments. J Emerg Nurs. 2008, 34: 419-427. 10.1016/j.jen.2007.10.015.CrossRefPubMed
17.
18.
Gregory A, Ramsay J, Agnew-Davies R, Baird K, Devine A, Dunne D, Eldridge S, Howell A, Johnson M, Rutterford C, et al: Primary care identification and referral to improve safety of women experiencing domestic violence (IRIS): protocol for a pragmatic cluster randomised controlled trial. BMC Public Health. 2010, 10: 54-10.1186/1471-2458-10-54.CrossRefPubMedPubMedCentral
19.
Gutmanis I, Beynon C, Tutty L, Wathen CN, MacMillan HL: Factors influencing identification of and response to intimate partner violence: a survey of physicians and nurses. BMC Public Health. 2007, 7: 12-10.1186/1471-2458-7-12.CrossRefPubMedPubMedCentral
20.
Liebschutz J, Battaglia T, Finley E, Averbuch T: Disclosing intimate partner violence to health care clinicians–what a difference the setting makes: a qualitative study. BMC Public Health. 2008, 8: 229-10.1186/1471-2458-8-229.CrossRefPubMedPubMedCentral
21.
Ramsay J, Rutterford C, Gregory A, Dunne D, Eldridge S, Sharp D, Feder G: Domestic violence: knowledge, attitudes, and clinical practice of selected UK primary healthcare clinicians. Br J Gen Pract. 2012, 62: e647-e655.CrossRefPubMedPubMedCentral
22.
Robinson L, Spilsbury K: Systematic review of the perceptions and experiences of accessing health services by adult victims of domestic violence. Health Soc Care Community. 2008, 16: 16-30.CrossRefPubMed
23.
Vung ND, Ostergren PO, Krantz G: Intimate partner violence against women, health effects and health care seeking in rural Vietnam. Eur J Public Health. 2009, 19: 178-182. 10.1093/eurpub/ckn136.CrossRefPubMed
24.
Atun R, De Jongh T, Secci F, Ohiri K, Adeyi O: Integration of targeted health interventions into health systems: a conceptual framework for analysis. Health Policy Plan. 2010, 25: 104-111. 10.1093/heapol/czp055.CrossRefPubMed
25.
Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O: Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004, 82: 581-629. 10.1111/j.0887-378X.2004.00325.x.CrossRefPubMedPubMedCentral
26.
Allen NE, Javdani S, Lehrner AL, Walden AL: “Changing the text”: modeling council capacity to produce institutionalized change. Am J Community Psychol. 2012, 49: 317-331. 10.1007/s10464-011-9460-z.CrossRefPubMed
27.
D’Avolio DA: System issues: challenges to intimate partner violence screening and intervention. Clin Nurs Res. 2011, 20: 64-80. 10.1177/1054773810387923.CrossRefPubMed
28.
Ortiz-Barreda G, Vives-Cases C: Violence against women: the role of the health sector in international legislation. Gac Sanit. 2012, 26: 483-489. 10.1016/j.gaceta.2011.09.027.CrossRefPubMed
29.
Ortiz-Barreda G, Vives-Cases C: Legislation on violence against women: overview of key components. Rev Panam Salud Publica. 2013, 33: 61-72. 10.1590/S1020-49892013000100009.CrossRefPubMed
30.
Vives-Cases C, Ortiz-Barreda G, Gil-Gonzalez D: Mapping violence against women laws in the world: an overview of state commitments. J Epidemiol Community Health. 2010, 64: 474-475. 10.1136/jech.2009.090365.CrossRefPubMed
31.
32.
Boletín Oficial del Estado: Ley Orgánica 1/2004, de 28 de diciembre, de medidas de protección integral contra la violencia de género. 2004, Madrid (Spain): Organic Law 1/2004, of protective measures against gender based violence
33.
Ruiz-Perez I, Plazaola-Castano J, Blanco-Prieto P, Gonzalez-Barranco JM, Ayuso-Martin P, Montero-Pinar MI: Intimate partner violence: a survey conducted in the primary care setting. Gac Sanit. 2006, 20: 202-208. 10.1157/13088851.CrossRefPubMed
34.
Ministry of Health and Social Policy and Equality: Informe de Violencia de Género 2006 [Gender based violence report 2006]. 2006, Madrid (Spain): Ministry of Health and Social Policy and Equality
35.
Ministry of Health and Social Policy and Equality: Informe de Violencia de Género 2007 [Gender Based Violence Report 2007]. 2007, Madrid (Spain): Ministry of Health and Social Policy and Equality
36.
Ministry of Health and Social Policy and Equality: Informe de Violencia de Género 2008 [Gender Based Violence Report 2008]. 2008, Madrid (Spain): Ministry of Health and Social Policy and Equality
37.
Ministry of Health and Social Policy and Equality: Informe de Violencia de Género 2009 [Gender Based Violence Report 2009]. 2009, Madrid (Spain): Ministry of Health and Social Policy and Equality
38.
Ministry of Health and Social Policy and Equality: Informe de Violencia de Género 2010 [Gender Based Violence Report 2010]. 2010, Madrid (Spain): Ministry of Health and Social Policy and Equality
39.
Goicolea I, Vives-Cases C, Minvielle F, Briones-Vozmediano E, Öhman A: Applying the WHO Recommendations on the health-sector response to violence against women to the Spanish health system. Gaceta Sanitaria. 2013, in press
40.
Graneheim UH, Lundman B: Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004, 24: 105-112. 10.1016/j.nedt.2003.10.001.CrossRefPubMed
41.
Walker L, Gilson L: ‘We are bitter but we are satisfied’: nurses as street-level bureaucrats in South Africa. Sco Sci Med. 2004, 59: 1251-1261. 10.1016/j.socscimed.2003.12.020.CrossRef
42.
Lipsky M: Street-level bureaucracy: dilemmas of the individual in public services. 1980, New York: Russel Sage Foundation
43.
Buse K, Mays N, Walt G: Making health policy. 2005, Berkshire, UK: Open University Press
44.
Colombini M, Mayhew S, Ali SH, Shuib R, Watts C: “I feel it is not enough…” Health providers’ perspectives on services for victims of intimate partner violence in Malaysia. BMC Health Serv Res. 2013, 13: 65-10.1186/1472-6963-13-65.CrossRefPubMedPubMedCentral
45.
Tower M, Rowe J, Wallis M: Normalizing policies of inaction–the case of health care in Australia for women affected by domestic violence. Health Care Women Int. 2011, 32: 855-868. 10.1080/07399332.2011.580406.CrossRefPubMed
46.
O’Campo P, Kirst M, Tsamis C, Chambers C, Ahmad F: Implementing successful intimate partner violence screening programs in health care settings: evidence generated from a realist-informed systematic review. Soc Sci Med. 2011, 72: 855-866. 10.1016/j.socscimed.2010.12.019.CrossRefPubMed
47.
Hegarty K, Taft A, Feder G: Violence between intimate partners: working with the whole family. BMJ. 2008, 337: a839-10.1136/bmj.a839.CrossRefPubMed
48.
Ministry of Health and Social Policy and Equality: Common protocol for a healthcare response to gender violence. 2012, Madrid (Spain): Ministry of Health and Social Policy and Equality
49.
Devries KM, Kishor S, Johnson H, Stockl H, Bacchus LJ, Garcia-Moreno C, Watts C: Intimate partner violence during pregnancy: analysis of prevalence data from 19 countries. Reprod Health Matters. 2010, 18: 158-170. 10.1016/S0968-8080(10)36533-5.CrossRefPubMed
50.
O’Reilly R, Beale B, Gillies D: Screening and intervention for domestic violence during pregnancy care: a systematic review. Trauma Violence Abuse. 2010, 11: 190-201. 10.1177/1524838010378298.CrossRefPubMed
51.
Shah PS, Shah J: Maternal exposure to domestic violence and pregnancy and birth outcomes: a systematic review and meta-analyses. J Womens Health (Larchmt). 2010, 19: 2017-2031. 10.1089/jwh.2010.2051.CrossRef
52.
Muslera-Canclini E, Natal C, Garcia V, Fernandez-Munoz P: Description of registration of episodes of gender violence in medical records in the Principality of Asturias, Spain. Gac Sanit. 2009, 23: 558-561. 10.1016/j.gaceta.2009.02.015.CrossRefPubMed
53.
Ruiz-Perez I, Plazaola-Castano J, Vives-Cases C, Montero-Pinar MI, Escriba-Aguir V, Jimenez-Gutierrez E, Martin-Baena D: Geographical variability in violence against women in Spain. Gac Sanit. 2010, 24: 128-135. 10.1016/j.gaceta.2009.10.014.CrossRefPubMed
54.
Edin KE, Dahlgren L, Lalos A, Hogberg U: “Keeping up a front”: narratives about intimate partner violence, pregnancy, and antenatal care. Violence Against Women. 2010, 16: 189-206. 10.1177/1077801209355703.CrossRefPubMed
55.
Kulkarni SJ, Bell H, Rhodes DM: Back to basics: essential qualities of services for survivors of intimate partner violence. Violence Against Women. 2012, 18: 85-101. 10.1177/1077801212437137.CrossRefPubMed
56.
Watt MH, Bobrow EA, Moracco KE: Providing support to IPV victims in the emergency department: vignette-based interviews with IPV survivors and emergency department nurses. Violence Against Women. 2008, 14: 715-726. 10.1177/1077801208317290.CrossRefPubMed
57.
Abramsky T, Watts CH, Garcia-Moreno C, Devries K, Kiss L, Ellsberg M, Jansen HA, Heise L: What factors are associated with recent intimate partner violence? findings from the WHO multi-country study on women’s health and domestic violence. BMC Public Health. 2011, 11: 109-10.1186/1471-2458-11-109.CrossRefPubMedPubMedCentral
58.
Martin SL, Coyne-Beasley T, Hoehn M, Mathew M, Runyan CW, Orton S, Royster LA: Primary prevention of violence against women: training needs of violence practitioners. Violence Against Women. 2009, 15: 44-56. 10.1177/1077801208327483.CrossRefPubMed
59.
Garcia MM: La atencion primaria, antes y despues de la Ley general de Sanidad [Primary health care before and after the Health Law]. Treinta años del Sistema Sanitario español (1981–2011) Treinta años de la federación de asociaciones para la defensa de la sanidad publica [Thirty years of the Spanish Health System (1981-2011) Thirty years of the federation of associations for the defense of public health care]. Edited by: Palomo L. 2011, Madrid: FADSP
Metadata
Title
Mapping and exploring health systems’ response to intimate partner violence in Spain
Authors
Isabel Goicolea
Erica Briones-Vozmediano
Ann Öhman
Kerstin Edin
Fauhn Minvielle
Carmen Vives-Cases
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2013
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-13-1162

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