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The high centralization scores in La Virgen 0. The lower centralization scores in the other two cases indicate that the mere existence of a social worker in the team is not enough to promote consultations on IPV Table 2 and Figs.
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The qualitative analysis showed that among teams with a social worker who was motivated, interested and knowledgeable on IPV, it was easier to generate interest on IPV among the other professionals. This is in contrast with the other two cases, where the response focused more on filling legal reports and convincing women to denounce the perpetrator than on caring for the woman herself Table The women malaise approach has influenced how the professionals approach their women patients: This approach also inspired concrete actions beyond the clinical setting, like the organization of therapeutic women's groups: This study shows that the conditions of the team affect the way individual health care providers respond to women exposed to IPV.
Health care professionals respond better to women exposed to IPV when they work in teams: SNA studies have showed that denser networks favour the diffusion of changes, especially when the adoption of the new behaviour requires social reinforcement. However, we have acknowledge that none of the networks showed a very high density, which might reflect that IPV is yet to become a health issue in which health care professionals routinely consult and collaborate with others.
Team structure, processes and climate have an impact on interdisciplinary team working; the importance of ensuring regular team meetings and the availability of organizational support to foster interdisciplinary team work in primary care that emerged from this study has been reported elsewhere, although not in relation with IPV.
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More importantly, they allow for a more comprehensive response to IPV in which professionals from different sectors and with different expertise are involved. The importance of an interdisciplinary response to IPV has also been acknowledged in the WHO guidelines and in the literature. This study shows that social workers play a key role when it comes to IPV. We also showed, however, that having a social worker within the team is not enough to foster a team-based response to IPV. Teams that have a good climate and horizontal leadership that allows freedom to health care professionals to innovate stimulate individuals to adopt innovations.
Finally, this study underlines the relevance of a women-centred approach for facilitating health care responses to IPV, and the importance of developing concrete strategies for the implementation of such approach.
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The literature shows that the implementation of women-centred care for different health issues i. Despite inclusion of women-centred care as a key strategy for responding to women exposed to IPV within health services in the WHO guidelines, there is no explicit guidance in how such approach can be implemented. Our findings point out two concrete actions that can support health care professionals to implemented women-centred care in general and specifically for dealing with women exposed to IPV.
First, meetings to discuss cases can serve as spaces to learn, share and debrief, and help teams and individual health care professionals to improve how they implement a women-centred care in their consultations.
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Second, the women's therapeutic groups serve four goals. They constitute a complementary way to respond to women's needs, serve as well as a backup for professionals beyond their consultations, provide a way of identification, and remind professionals of how care should be delivered within the team. While the design of the study allows us to see that there are connections between team level conditions and processes on one hand, and individual readiness to respond to IPV, there are some limitations.
Due to the design, we cannot demonstrate a cause-effect relationship. In addition, we focus here in team level factors, while there could be contextual factors beyond the team that could have influenced the responses. We could only carry out an in-depth analysis of four cases. It would have been interesting to explore more contrasting cases i. Team level strategies and processes influence how health care professionals respond to women exposed to IPV. Better individual readiness to detect and respond to IPV and a more comprehensive response to women exposed to IPV are implemented in teams which: What is known about the topic?
Primary health care teams can play an important role in responding to women exposed to intimate partner violence, but there is huge heterogeneity in regard to how each team and each professional responds and little is known about how team factors influence such responses.. To respond better to intimate partner violence primary health care teams should: The corresponding author on behalf of the other authors guarantee the accuracy, transparency and honesty of the data and information contained in the study, that no relevant information has been omitted and that all discrepancies between authors have been adequately resolved and described..
Goicolea was the PI in this project, has bene involved in the entire project, proposed the idea for this manuscript, organized the structure and developed the first draft. Briones-Vozmediano has been involved in the entire project, participated in data collection and analysis and have critically revised successive manuscripts. All authors have approved the final version of the manuscript and all agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved..
The authors declare that there is no conflict of interest. We have to point out that one of the authors E. Briones-Vozmediano is associated editor in Gaceta Sanitaria. However, she has not been involved in any of the steps of the editorial process of this article.. The authors are grateful to the Observatory of Women's Health of the Spanish Ministry of Health, and to the professionals in charge of IPV programs within the regional health system for facilitating access to relevant information and contacts.
The authors are especially grateful to the primary health care teams and to the women patients who participated in this study, who shared their time, enthusiasm, experiences and expertise, and facilitated access to unpublished information.. Why do certain primary health care teams respond better to intimate partner violence than others? A multiple case study. Isabel Goicolea a , b ,.
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Under a Creative Commons license. Recibido 05 junio , Aceptado 03 octubre Methods We used a multiple embedded case study. In each case quantitative and qualitative data were collected using a social network questionnaire, interviews and observations. Conclusions Better individual responses to intimate partner violence were implemented in the teams which: En cada caso se recolectaron datos cuantitativos y cualitativos mediante un cuestionario de redes sociales, entrevistas y observaciones.
Conclusiones Los equipos que respondieron mejor a la violencia de pareja fueron aquellos que: Introduction Men's intimate partner violence IPV against women is a global public health problem that has devastating effects on the health and wellbeing of women and children.
Methods Setting and case selection We adopted a multiple, embedded case study design, since this design allows for an in-depth exploration of the interrelationship of context, processes and outcomes as they happen in their natural setting. Total scores for practice issues, as well as other characteristics of each case can be found in Appendix 2 online , while more details on the methods for data collection and sample can be found in Appendix 3 online.
Ninety-three professionals filled in the SNA questionnaire. Interaction between users and professionals and between the team members was observed and reported in written notes. Data analysis Responses to the SNA questionnaire were tabulated and entered in a matrix. Next, the preliminary codes were refined, expanded and finally aggregated to develop themes.
Ethical considerations Ethical approval for this study was granted by the Ethical Committee of the University of Alicante Spain. Confidentiality was assured, and pseudonyms were used for the cases. Number of relational ties, density and centralization of the networks in each of the PHC teams. Themes and selected quotations. She is my patient, but she is also known by her nurse, by the social worker… She will be a patient who receives a coordinated support from the team.
Family doctor 1, La Virgen Team meetings are opportunities that I always use to tell the other professionals: I can give some suggestions and we can share the burden, the anxiety Social worker, El Campo I have been working in this team six years and I can tell you that we have never talked about IPV in any of our weekly meetings. They underestimate the value of psychosocial approaches […] In addition, the relationships between the professionals are not that good.
The medical coordinator has failed to promote team work. We do not have team meetings [in Zarzas]. Social worker, El Campo. I mean, there are women who are almost imploring you to ask them… Family doctor 2, El Campo When the aim and care focuses on the woman, then […] establishing a trust relationship will be more important than any other issue, more important than filling a report, the protocol, the bruise… This approach will help me to make appropriate decisions.
Sometimes, we insist that they have to fill a denouncement form immediately Family doctor 3, Cristina Now that we have the women's group there are issues that we can handle here in the health care center.
Simón Hergueta
In the group, women work out issues that are different from the ones that can be dealt with in individual consultations. Family doctor 4, La Virgen.
Primary health care teams can play an important role in responding to women exposed to intimate partner violence, but there is huge heterogeneity in regard to how each team and each professional responds and little is known about how team factors influence such responses. What does this study add to the literature? The authors are especially grateful to the primary health care teams and to the women patients who participated in this study, who shared their time, enthusiasm, experiences and expertise, and facilitated access to unpublished information.
The health-systems response to violence against women. Global and regional estimates of violence against women: World Health Organization; Health-sector responses to intimate partner violence in low-and middle-income settings: Bull World Health Organ.