Mechanisms that Trigger a Good Health-Care Response to Intimate Partner Violence in Spain. Combining Realist Evaluation and Qualitative Comparative Analysis Approaches.
BACKGROUND
Health care professionals, especially those working in primary health-care services, can play a key role in preventing and responding to intimate partner violence. However, there are huge variations in the way health care professionals and primary health care teams respond to intimate partner violence. In this study we tested a previously developed programme theory on 15 primary health care center teams located in four different Spanish regions: Murcia, C Valenciana, Castilla-León and Cantabria. The aim was to identify the key combinations of contextual factors and mechanisms that trigger a good primary health care center team response to intimate partner violence.


METHODS
A multiple case-study design was used. Qualitative and quantitative information was collected from each of the 15 centers (cases). In order to handle the large amount of information without losing familiarity with each case, qualitative comparative analysis was undertaken. Conditions (context and mechanisms) and outcomes, were identified and assessed for each of the 15 cases, and solution formulae were calculated using qualitative comparative analysis software.


RESULTS
The emerging programme theory highlighted the importance of the combination of each team's self-efficacy, perceived preparation and women-centredness in generating a good team response to intimate partner violence. The use of the protocol and accumulated experience in primary health care were the most relevant contextual/intervention conditions to trigger a good response. However in order to achieve this, they must be combined with other conditions, such as an enabling team climate, having a champion social worker and having staff with training in intimate partner violence.


CONCLUSIONS
Interventions to improve primary health care teams' response to intimate partner violence should focus on strengthening team's self-efficacy, perceived preparation and the implementation of a woman-centred approach. The use of the protocol combined with a large working experience in primary health care, and other factors such as training, a good team climate, and having a champion social worker on the team, also played a key role. Measures to sustain such interventions and promote these contextual factors should be encouraged.
Unit of Epidemiology and Global Health, Department of Clinical Medicine and Public Health, Umeå University, Umeå, Sweden; Grupo de Investigación de Salud Pública, Universidad de Alicante, Alicante, Spain.
Isabel
I
Goicolea
Grupo de Investigación de Salud Pública, Universidad de Alicante, Alicante, Spain; Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia. Universidad de Alicante, Alicante, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
Carmen
C
Vives-Cases
Unit of Epidemiology and Global Health, Department of Clinical Medicine and Public Health, Umeå University, Umeå, Sweden.
Anna-Karin
AK
Hurtig
Institute of Tropical Medicine, Antwerp, Belgium.
Bruno
B
Marchal
Unit of Epidemiology and Global Health, Department of Clinical Medicine and Public Health, Umeå University, Umeå, Sweden; Grupo de Investigación de Salud Pública, Universidad de Alicante, Alicante, Spain.
Erica
E
Briones-Vozmediano
Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
Laura
L
Otero-García
Grupo de Investigación de Salud Pública, Universidad de Alicante, Alicante, Spain; Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia. Universidad de Alicante, Alicante, Spain.
Marta
M
García-Quinto
Unit of Epidemiology and Global Health, Department of Clinical Medicine and Public Health, Umeå University, Umeå, Sweden.
Miguel
M
San Sebastian
D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards*; D005260:Female; D006801:Humans; D000066511:Intimate Partner Violence; D008297:Male; D010348:Patient Care Team / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D012984:Software; D013030:Spain