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Montesanti S, Sehgal A, Zaeem L, McManus C, Squires S, Silverstone P. Assessing primary health care provider and organization readiness to address family violence in Alberta, Canada: development of a Delphi consensus readiness tool. BMC PRIMARY CARE 2024; 25:146. [PMID: 38684969 PMCID: PMC11059610 DOI: 10.1186/s12875-024-02396-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 04/18/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Family violence, which includes intimate partner abuse, child abuse, and elder abuse, is a serious public health concern. Primary healthcare (PHC) offers a vital opportunity to identify and address family violence, yet barriers prevent the effective implementation of family violence interventions in PHC settings. The purpose of this study is to improve family violence identification and response in Alberta's PHC settings by exploring readiness factors. METHODS An integrated knowledge translation approach, combining implementation science and participatory action research, was employed to develop a readiness assessment tool for addressing family violence within PHC settings in Alberta. The research involved three phases: phase 1 involved a rapid evidence assessment, phase 2 engaged a panel of healthcare and family violence experts to explore readiness components in the Alberta context, and phase 3 utilized a 3-round Delphi consensus-building process to refine readiness indicators. RESULTS Phase 1 findings from a rapid evidence assessment highlighted five main models/tools for assessing readiness to implement family violence interventions in PHC settings. In phase 2, additional concepts were identified through exploration with healthcare and family violence expert panel members, resulting in a total of 16 concepts for assessing family violence readiness within the Alberta PHC context. The 3-round Delphi consensus-building process in Phase 3 involved nine panelists, who collectively agreed on the inclusion of all concepts and indicators, yielding a total of 60 items for the proposed readiness assessment tool for addressing family violence in PHC within Alberta. CONCLUSION The current study lays the groundwork for future family violence intervention programs, offering insights into key components that promote readiness for implementing comprehensive programs and supporting PHC organizations in effectively addressing family violence.
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Affiliation(s)
- Stephanie Montesanti
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
- Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, AB, Canada.
| | - Anika Sehgal
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lubna Zaeem
- Islamic Family and Social Services Association, Edmonton, AB, Canada
| | - Carrie McManus
- Sagesse Domestic Violence Prevention Society, Calgary, AB, Canada
| | - Suzanne Squires
- Westgrove Clinic, Westview Primary Care Network, Spruce Grove, AB, Canada
| | - Peter Silverstone
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Colombini M, Mayhew SH, García-Moreno C, d'Oliveira AF, Feder G, Bacchus LJ. Improving health system readiness to address violence against women and girls: a conceptual framework. BMC Health Serv Res 2022; 22:1429. [PMID: 36443825 PMCID: PMC9703415 DOI: 10.1186/s12913-022-08826-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/10/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There is an increasing focus on readiness of health systems to respond to survivors of violence against women (VAW), a global human rights violation damaging women's health. Health system readiness focuses on how prepared healthcare systems and institutions, including providers and potential users, are to adopt changes brought about by the integration of VAW care into services. In VAW research, such assessment is often limited to individual provider readiness or facility-level factors that need to be strengthened, with less attention to health system dimensions. The paper presents a framework for health system readiness assessment to improve quality of care for intimate partner violence (IPV), which was tested in Brazil and Palestinian territories (oPT). METHODS Data synthesis of primary data from 43 qualitative interviews with healthcare providers and health managers in Brazil and oPT to explore readiness in health systems. RESULTS The application of the framework showed that it had significant added value in capturing system capabilities - beyond the availability of material and technical capacity - to encompass stakeholder values, confidence, motivation and connection with clients and communities. Our analysis highlighted two missing elements within the initial framework: client and community engagement and gender equality issues. Subsequently, the framework was finalised and organised around three levels of analysis: macro, meso and micro. The micro level highlighted the need to also consider how the system can sustainably involve and interact with clients (women) and communities to ensure and promote readiness for integrating (and participating in) change. Addressing cultural and gender norms around IPV and enhancing support and commitment from health managers was also shown to be necessary for a health system environment that enables the integration of IPV care. CONCLUSION The proposed framework helps identify a) system capabilities and pre-conditions for system readiness; b) system changes required for delivering quality care for IPV; and c) connections between and across system levels and capabilities.
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Affiliation(s)
| | | | - Claudia García-Moreno
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Gene Feder
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
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Sawyer S, Melvin G, Williams A, Williams B. A New Scale of Readiness for Health Care Students to Encounter Partner Abuse. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP14877-NP14897. [PMID: 33356777 DOI: 10.1177/0886260520981131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Partner abuse (PA) is associated with significant morbidity and mortality worldwide. Health care practitioners regularly encounter patients experiencing PA and require comprehensive education on how to respond. This study describes the creation and validation of a new measure of readiness to encounter patients experiencing PA for health care practitioners and students.Initial item development and content validation were informed by expert feedback. Psychometric properties were assessed using data collected from Australian health care students, using Principal Components Analysis (PCA) and Confirmatory Factor Analysis (CFA). Internal consistency, inter-scale correlations, and test-retest analysis were performed.An initial pool of 67 items was reduced to 48 following content validation by 5 experts as a measure of construct validity. A total of n = 926 responses were collected, which were randomly split into two groups to perform a PCA and CFA. The PCA resulted in a 31-item version, which was further reduced to a 27-item version following the CFA, containing four factors. Internal consistency and test-retest analyses demonstrated good reliability.The produced scale is a 27-item measure of readiness to encounter patients experiencing PA, which has demonstrated good psychometric properties with a sample of Australian health care students. Results indicate that self-efficacy and Emotional-readiness are a large component of readiness. The scale may be used to measure the readiness of a cohort, or as a pre and post-intervention measure, and results may provide insight into the educational needs of a cohort.
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Affiliation(s)
- Simon Sawyer
- Monash University, Frankston, Victoria, Australia
| | - Glenn Melvin
- Australian Catholic University, Fitzroy, Victoria, Australia
| | - Angela Williams
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Brett Williams
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
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d’Oliveira AFPL, Pereira S, Bacchus LJ, Feder G, Schraiber LB, de Aguiar JM, Bonin RG, Vieira Graglia CG, Colombini M. Are We Asking Too Much of the Health Sector? Exploring the Readiness of Brazilian Primary Healthcare to Respond to Domestic Violence Against Women. Int J Health Policy Manag 2022; 11:961-972. [PMID: 33327691 PMCID: PMC9808197 DOI: 10.34172/ijhpm.2020.237] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 11/15/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND There is growing recognition of the health sector's potential role in addressing domestic violence (DV) against women. Although Brazil has a comprehensive policy framework on violence against women (VAW), implementation has been slow and incomplete in primary healthcare (PHC), and little is known about the implementation challenges. This paper aims to assess the readiness of two PHC clinics in urban Brazil to integrate an intervention to strengthen their DV response. METHODS We conducted 20 semi-structured interviews with health managers and health providers; a document analysis of VAW and DV policies from São Paulo and Brazil; and 2 structured facility observations. Data were analysed using thematic analysis. RESULTS Findings from our readiness assessment revealed gaps in both current policy and practice needing to be addressed, particularly with regards to governance and leadership, health service organisation and health workforce. DV received less political recognition, being perceived as a lower priority compared to other health issues. Lack of clear guidance from the central and municipal levels emerged as a crucial factor that weakened DV policy implementation both by providers and managers. Furthermore, responses to DV lost visibility, as they were diluted within generic violence responses. The organizational structure of the PHC system in São Paulo, which prioritised the number of consultations and household visits as the main performance indicators, was an additional difficulty in legitimising healthcare providers' time to address DV. Individual-level challenges reported by providers included lack of time and knowledge of how to respond, as well as fears of dealing with DV. CONCLUSION Assessing readiness is critical because it helps to evaluate what services and infrastructure are already in place, also identifying obstacles that may hinder adaptation and integration of an intervention to strengthen the response to DV before implementation.
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Affiliation(s)
| | - Stephanie Pereira
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Gene Feder
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lilia Blima Schraiber
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Janaina Marques de Aguiar
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Renata Granusso Bonin
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Sawyer S, Schneider M, Western D, Bourke-Taylor H, Farnworth L, Lawerence K, Lentin P, McLelland G, Melvin G, Recoche K, Schweitzer R, Simmonds J, Storr M, Thomacos N, Williams A, Williams B. The Readiness of Australian Health Care Students to Encounter Patients Experiencing Partner Abuse. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP9575-NP9590. [PMID: 33371765 DOI: 10.1177/0886260520981136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Partner abuse is a significant contributor to mortality and morbidity worldwide, and has been identified as a priority health care issue. Most health care students rarely receive education on partner abuse and report not feeling ready to encounter patients experiencing partner abuse. Analysis of the current readiness of health care students and can inform educational needs to address this gap. The READIness to encounter partner abuse patients Scale was delivered to a convenience sample of Australian prequalification health care students. Participant demographics and estimated hours of education were also reported. Mean readiness scores were calculated by discipline. The relationship between hours of education and readiness scores was calculated using linear regression. A total of 926 participants were included in the analysis. Approximately half of the participants (47.5%) reported less than two hours of education. Mean readiness of students was 4.99 out of 7 (SD 0.73, range 4.39-5.95). Linear regression revealed a significant association between hours of education and readiness, r(925) = .497, p < .000. Australian health care students receive little education about partner abuse, and do not report feeling ready to encounter patients experiencing partner abuse. An individual's confidence and belief in their abilities appear to be the key factor influencing overall readiness. Participants indicated a strong belief that responding to partner abuse was part of their professional role, which is a positive change from previous research. Higher hours of education is associated with higher readiness, though which educational methodologies are most impactful remains unclear.
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Affiliation(s)
- Simon Sawyer
- Australian Catholic University, Fitzroy, Victoria, Australia
| | | | | | | | | | | | | | - Gayle McLelland
- Southern Cross University, East Lismore, New South Wales, Australia
| | | | | | | | | | | | | | - Angela Williams
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
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Colombini M, Alkaiyat A, Shaheen A, Garcia Moreno C, Feder G, Bacchus L. Exploring health system readiness for adopting interventions to address intimate partner violence: a case study from the occupied Palestinian Territory. Health Policy Plan 2020; 35:245-256. [PMID: 31828339 PMCID: PMC7152725 DOI: 10.1093/heapol/czz151] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2019] [Indexed: 11/14/2022] Open
Abstract
Domestic violence (DV) against women is a widespread violation of human rights. Adoption of effective interventions to address DV by health systems may fail if there is no readiness among organizations, institutions, providers and communities. There is, however, a research gap in our understanding of health systems' readiness to respond to DV. This article describes the use of a health system's readiness assessment to identify system obstacles to enable successful implementation of a primary health-care (PHC) intervention to address DV in the occupied Palestinian Territory (oPT). This article describes a case study where qualitative methods were used, namely 23 interviews with PHC providers and key informants, one stakeholder meeting with 19 stakeholders, two health facility observations and a document review of legal and policy materials on DV in oPT. We present data on seven dimensions of health systems. Our findings highlight the partial readiness of health systems and services to adopt a new DV intervention. Gaps were identified in: governance (no DV legislation), financial resources (no public funding and limited staff and infrastructure) and information systems (no uniform system), co-ordination (disjointed referral network) and to some extent around the values system (tension between patriarchal views on DV and more gender equal norms). Additional service-level barriers included unclear leadership structure at district level, uncertain roles for front-line staff, limited staff protection and the lack of a private space for identification and counselling. Findings also pointed to concrete actions in each system dimension that were important for effective delivery. This is the first study to use an adapted framework to assess health system readiness (HSR) for implementing an intervention to address DV in low- and middle-income countries. More research is needed on HSR to inform effective implementation and scale up of health-care-based DV interventions.
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Affiliation(s)
- Manuela Colombini
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Abdulsalam Alkaiyat
- Public Health Department, Faculty of Medicine and Health Sciences, An-Najah National University, Rafidia Street, PO Box 7, Nablus, Palestine
| | - Amira Shaheen
- Public Health Department, Faculty of Medicine and Health Sciences, An-Najah National University, Rafidia Street, PO Box 7, Nablus, Palestine
| | - Claudia Garcia Moreno
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Gene Feder
- Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Loraine Bacchus
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Fisher CA, Rudkin N, Withiel TD, May A, Barson E, Allen B, O'Brien E, Willis K. Assisting patients experiencing family violence: A survey of training levels, perceived knowledge, and confidence of clinical staff in a large metropolitan hospital. ACTA ACUST UNITED AC 2020; 16:1745506520926051. [PMID: 32716732 PMCID: PMC7385847 DOI: 10.1177/1745506520926051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Family violence is a public health issue. It occurs in many forms, is most commonly directed at woman and children, and contributes significantly to death, disability, and illness. This study was conducted in the clinical staff in a large metropolitan hospital and aimed to determine levels of family violence training, self-perceived knowledge and confidence, specific clinical skills, and barriers to working effectively in the area. Methods: A short, targeted online survey was designed to capture the required information. Descriptive statistics were calculated, and free-text responses were analyzed using qualitative content analysis. Results: Survey responses were received from 534 staff (242 nurses, 225 allied health, 67 medical). Sixty-five percent had received some form of family violence training, mostly of short duration (1–3 h); 72% reported having little or no confidence working in the area, while 76% indicated that they had little or no knowledge in the area. Longer duration training was associated with an increase in knowledge and confidence ratings. Family violence screening rates and knowledge of several specific family violence clinical skills (how to appropriately ask clients about family violence and family violence risk factors) were also low. Thirty-four percent indicated that they did not know what to do, when a patient disclosed experiencing family violence. The most commonly indicated barriers to working effectively in this area were suspected perpetrators being present, perceived reluctance of patients/clients to disclose when asked, and time limitations. Conclusion: This research provides a useful snapshot of clinical staff perceptions of their family violence skill levels in a large metropolitan Australian tertiary hospital. It highlights the need for further in-depth training in clinical health professionals in family violence. The research will allow for family violence training to be tailored to the needs of the professional discipline and clinical area.
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Affiliation(s)
- Caroline A Fisher
- Allied Health, The Royal Melbourne Hospital (RMH), Melbourne, VIC, Australia.,The Melbourne Clinic, Melbourne, VIC, Australia
| | - Nadine Rudkin
- Allied Health, The Royal Melbourne Hospital (RMH), Melbourne, VIC, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Toni D Withiel
- Allied Health, The Royal Melbourne Hospital (RMH), Melbourne, VIC, Australia.,School of Allied Health, La Trobe University, Melbourne, VIC, Australia
| | - Amanda May
- Allied Health, The Royal Melbourne Hospital (RMH), Melbourne, VIC, Australia
| | - Elizabeth Barson
- Allied Health, The Royal Melbourne Hospital (RMH), Melbourne, VIC, Australia
| | - Beverley Allen
- Tweddle Child & Family Health Service, Footscray, VIC, Australia
| | - Emma O'Brien
- Allied Health, The Royal Melbourne Hospital (RMH), Melbourne, VIC, Australia
| | - Karen Willis
- Allied Health, The Royal Melbourne Hospital (RMH), Melbourne, VIC, Australia.,School of Allied Health, La Trobe University, Melbourne, VIC, Australia
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Po-Yan Leung T, Phillips L, Bryant C, Hegarty K. How family doctors perceived their 'readiness' and 'preparedness' to identify and respond to intimate partner abuse: a qualitative study. Fam Pract 2018; 35:517-523. [PMID: 29300886 DOI: 10.1093/fampra/cmx109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There are few existing studies which have investigated the meanings of 'readiness' and 'preparedness' among family doctors working with female patients who experience intimate partner abuse (IPA). OBJECTIVES We aimed to explore how doctors perceived the concepts of readiness and preparedness to identify and respond to IPA against female patients. METHODS We adopted purposive sampling and conducted individual semi-structured interviews with 19 doctors (11 females and 8 males) practising in primary care. Thematic analysis identified dominant and associated themes, and the coding framework was transformed into a thematic map. We further applied cross-coding and code-confirming procedures in analysing the transcripts. RESULTS Participants described differences in the meanings of readiness and preparedness when responding to IPA, though they considered that these two concepts were inter-related. The findings revealed four themes of doctors' perceived 'readiness' to identify and respond to IPA: self-efficacy, emotional readiness, motivational readiness and attitudinal readiness, whereas doctors' perceived 'preparedness' comprise two themes: IPA knowledge and communication skills. CONCLUSION Whether doctors are ready to identify and respond to IPA might be influenced by their emotional concerns as well as individual motivational beliefs and values, in addition to their attitudes and perceived self-efficacy, revealing a multidimensional concept. Besides enhancing doctors' preparedness by means of IPA knowledge and communication skills, training and IPA research could address further their emotional readiness and legitimize doctors' role to intervene in IPA cases.
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Affiliation(s)
- Traci Po-Yan Leung
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Lisa Phillips
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Christina Bryant
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Kelsey Hegarty
- Department of General Practice, University of Melbourne, Victoria, Australia
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