Feder Gene S, Hutson Madeleine, Ramsay Jean, Taket Ann R
Centre for Health Sciences, Barts and the London, Queen Mary's School of Medicine and Dentistry, and Institute of Primary Care and Public Health, London South Bank University, London, England.
Arch Intern Med. 2006 Jan 9;166(1):22-37. doi: 10.1001/archinte.166.1.22.
The appropriate response of health care professionals to intimate partner violence is still a matter of debate. This article reports a meta-analysis of qualitative studies that answers 2 questions: (1) How do women with histories of intimate partner violence perceive the responses of health care professionals? and (2) How do women with histories of intimate partner violence want their health care providers to respond to disclosures of abuse?
Multiple databases were searched from their start to July 1, 2004. Searches were complemented with citation tracking and contact with researchers. Inclusion criteria included a qualitative design, women 15 years or older with experience of intimate partner violence, and English language. Two reviewers independently applied criteria and extracted data. Findings from the primary studies were combined using a qualitative meta-analysis.
Twenty-nine articles reporting 25 studies (847 participants) were included. The emerging constructs were largely consistent across studies and did not vary by study quality. We ordered constructs by the temporal structure of consultations with health care professionals: before the abuse is discussed, at disclosure, and the immediate and further responses of the health care professional. Key constructs included a wish from women for responses from health care professionals that were nonjudgmental, nondirective, and individually tailored, with an appreciation of the complexity of partner violence. Repeated inquiry about partner violence was seen as appropriate by women who were at later stages of an abusive relationship.
Women's perceptions of appropriate and inappropriate responses partly depended on the context of the consultation, their own readiness to address the issue, and the nature of the relationship between the woman and the health care professional.
医疗保健专业人员对亲密伴侣暴力的恰当应对仍是一个有争议的问题。本文报告了一项对定性研究的荟萃分析，该分析回答了两个问题：（1）有亲密伴侣暴力史的女性如何看待医疗保健专业人员的应对？（2）有亲密伴侣暴力史的女性希望其医疗保健提供者如何应对虐待披露？
检索了多个数据库，时间跨度从建库至2004年7月1日。通过引文追踪和与研究人员联系对检索进行补充。纳入标准包括定性设计、年龄在15岁及以上且有亲密伴侣暴力经历的女性以及英文文献。两名评审员独立应用标准并提取数据。使用定性荟萃分析合并了主要研究的结果。
纳入了29篇报告25项研究（847名参与者）的文章。不同研究中出现的构建在很大程度上是一致的，且不因研究质量而异。我们根据与医疗保健专业人员咨询的时间结构对构建进行排序：在讨论虐待之前、披露时以及医疗保健专业人员的即时和后续反应。关键构建包括女性希望医疗保健专业人员做出非评判性、非指导性且个性化定制的反应，并认识到伴侣暴力的复杂性。处于虐待关系后期的女性认为反复询问伴侣暴力是合适的。
女性对恰当和不恰当反应的认知部分取决于咨询的背景、她们自己处理该问题的意愿以及女性与医疗保健专业人员之间关系的性质。
