The role of primary healthcare physicians in violence against Women intervention program in Indonesia

The role of family doctors in developing primary care systems in Asia: a systematic review of qualitative research conducted in middle-income countries 2010-2020

BACKGROUND

The Asia Pacific Region's middle-income countries (MICs) face unique challenges in the ongoing development of primary care (PC) systems. This development is complicated by systemic factors, including rapid policy changes and the introduction of private healthcare services, as well as the mounting challenges associated with ageing populations and increasing rates of chronic diseases. Despite the widespread acknowledgement of the importance of family doctors in the development of PC services, relatively little is known about how these roles have developed in Asian MICs. To address this gap, this systematic review presents a synthesis of recent research focused on the role of family doctors within the PC systems of MICs in the Asia Pacific Region.

METHODS

We searched six electronic databases (CINAHL Complete, Embase, PsycINFO, PubMed, Web of Science, and Index Medicus for the South-East Asia Region and Western Pacific) for peer-reviewed qualitative literature published between January 2010 and December 2020. The quality of the studies was evaluated using the Critical Appraisal Skills Programme tool. Eighteen articles were included in the analysis. Findings from these articles were extracted and synthesised using qualitative thematic synthesis. We used the Rainbow Framework to analyse the interconnections within health systems at the macro, meso and micro levels.

RESULTS

Our analysis of the included articles showed that family doctors play a crucial role in bridging the gap between hospitals and communities. They are essential in adopting holistic approaches to health and wellbeing and are in a unique position to try and address social, psychological, and biological aspects of health. Our findings also highlight the influence of policy changes at the macro level on the role and responsibilities of family doctors at the meso (organisational) and micro (interpersonal) levels.

CONCLUSIONS

Limited research has explored the role of family doctors in the ongoing development of primary care systems in MICs in the Asia Pacific Region. The findings of this review have significant implications for policymakers and healthcare administrators involved in ongoing improvements to and strengthening of PC systems. Areas of particular concern relate to policy linked with training and workforce development, insurance systems and public awareness of what primary care services are.

"Don't Turn a Blind Eye": An Instruction for Supporting Meaningful Conversations About Gender-Based Violence During Perinatal Care

BACKGROUND AND PURPOSE

Evidence suggests that Gender-based violence (GBV) is prevalent throughout the perinatal period. Women during this time have frequent contact with healthcare providers (HCPs), and there are many opportunities that HCPs can identify GBV and support women by early intervention during routine prenatal care. However, evidence shows that HCPs are still hesitant to address this issue. This study was conducted to explore the experiences of Survivors and HCPs on how to manage a meaningful conversation about GBV with survivors during perinatal care.

METHODS

A thematic approach has been used in this qualitative study.

RESULTS

Twenty-eight semi-structured interviews were conducted with survivors and HCPs. Three main themes emerged from the data analysis, including: "Knock gently on the door to enter the client's private world", "Show interest in clients' stories that are beyond their physical problems" and "Gradually and cautiously cross the hidden borders."

CONCLUSION

HCPs play a pivotal role in identifying GBV and providing support for survivors, particularly during their perinatal period. However, initiating a conversation around this sensitive topic needs time, skill, and enough knowledge. Validating survivors' experiences, providing a private and safe atmosphere without judgment, and creating empathy could lead to more disclosure of GBV. To have a meaningful conversation, HCPs need to have a holistic approach toward care, show interest in clients' stories beyond their physical problems, and support clients who have shared sensitive information.

How to Facilitate Disclosure of Violence while Delivering Perinatal Care: The Experience of Survivors and Healthcare Providers

Gender-based Violence (GBV) during the perinatal period is a serious concern as it is associated with many adverse outcomes for both the mother and the baby. It is well known that violence is under-reported. Thus, official statistics (both police reports and survey data) underestimate the prevalence of violence in general and during the perinatal period specifically. In this study conducted in Canada, we sought to explore the barriers to and facilitators of women disclosing their experiences of GBV within healthcare services to safely facilitate more disclosure in the future and reduce the harms that arise from GBV. We used thematic analysis to analyze in-depth interviews with 16 healthcare providers (nurses, midwives and physicians) and 12 survivors of GBV. The data reflect three main themes: "raising awareness of gender-based violence", "creating a shift in the healthcare system's approach toward gender-based violence" and "providing support for survivors and care providers." Our findings suggest that the healthcare system should increase its investments in raising awareness regarding GBV, training healthcare providers to respond appropriately, and building trust between survivors and healthcare providers. Healthcare providers need to be aware of their role and responsibility regarding identifying GBV as well as how to support survivors who talk about violence. Expanding a relationship-based approach in the care system and providing support for both survivors and health care providers would likely lead to more disclosures.

Cross-sectional survey of underreported violence experienced by adolescents: a study from Indonesia

BACKGROUND

Global studies on adolescent victims of violence require serious attention due to the possibility that underreported cases may be higher than official records indicate. Since Indonesia expects to witness a demographic bonus, extensive research is needed to strengthen early detection, case handling, and prevention. Here, we report the outcomes of a survey on physical, verbal, and sexual violence experienced by adolescents in West Java, an Indonesian province inhabited by 18% of the country's total population.

METHODS

We conducted a cross-sectional survey in 2017 using the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool for Children (ICAST-C) questionnaire for detecting child abuse; an expert panel translated, simplified, and validated it based on a theoretical framework that combines paediatrics, public health, and medicolegal perspectives. We aimed to cover a large sample size and explore three types of violence (physical, verbal, and sexual) that have high evidentiary value in the forensic context. The respondents were adolescents in the first and second grades of middle school (12 to 14 years old) and high school (15 to 17 years old) in seven cities/municipalities in the province, selected through several stages of simple random sampling (N = 3452). We analysed the samples through univariate (percentage), odds ratio (OR), comparison, correlation, and correspondence analyses.

RESULTS

The results showed that 78.7% of the adolescents experienced violence in 2017, comprising those who encountered at least one incidence of physical violence (43.1%), verbal violence (12.2%), and sexual violence (4.5%). Data overlap includes 14.3% who experienced one type of violence in 2017, 7.4% who experienced two forms of violence, and 1.4% who underwent all three kinds of violence. The offenders were mainly adolescents across all types of violence, except for being forced to engage in sexual intercourse. Several victims of sexual violence did not state who the offenders were. Further, several characteristics showed a higher chance of experiencing violence than other characteristics, especially for adolescents who were still in middle school and those who lived only with their mothers. Correspondence analysis suggested subtle differences between characteristics.

CONCLUSION

We expect this study to help identify risk and protective factors that are essential to strengthening early detection efforts, decisive medicolegal examinations, case handling, and policy-making.

Relationship of knowledge about and attitudes towards violence with recognition of violence against women among health staff in pre-hospital emergency medical services

BACKGROUND

Domestic violence, specifically, violence against women, is prevalent in all segments of society regardless of social class, ethnicity, culture or country. In other words, domestic violence is a global concern.

AIM

The study aims to investigate the relationship between the attitude and knowledge of the health staff in pre-hospital emergency medical services about violence against women and their recognition of such form of violence.

METHODS

This descriptive study was conducted on 1023 paramedics and emergency medicine technicians who work in the pre-hospital emergency health setting and are members of the Paramedic and Pre-hospital Emergency Medicine Association. The Attitudes towards Violence against Women Scale (ATVAWS) and Health Staff's Recognition of Signs of Violence against Women Scale (HPRSVAWS) were used for data collection.

RESULTS

The mean scores for the ATVAWS and HPRSVAWS were 46.68 ± 6.92 and 20.31 ± 3.23, respectively. Of the participants, 48.5% had been subjected to violence, 43.93% had been subjected to violence perpetrated by their mothers, 41.53% had been exposed to physical violence and 4.2% remain exposed to domestic violence. Participants who had been exposed and those who remain exposed to domestic violence produced high scores in ATVAWS, which indicates an improvement in the traditional approach (less opposing view) to violence. High scores in the ATVAWS for (a) those who were exposed to violence in their workplaces, (b) who had never attended to actual or suspected cases of violence against women in their professional life, (c) who had attended to seven or more cases of violence against women, (d) who were less competent in physically examining actual or suspected cases of violence and (e) who had not been trained on violence against women, which indicates an increase in the traditional approach to violence.

CONCLUSION

The study found that health staff in emergency health stations better recognised the signs of violence against women as their attitudes towards violence were less similar to the traditional approach. That is, they mostly held non-violent views. The characteristics, attitudes, perceptions and values of health professionals were considered important factors in addressing violence.