马拉维对亲密伴侣暴力对心理健康的影响及卫生服务应对措施的认知
Perceptions of the mental health impact of intimate partner violence and health service responses in Malawi.
作者信息
Chepuka Lignet, Taegtmeyer Miriam, Chorwe-Sungani Genesis, Mambulasa Janet, Chirwa Ellen, Tolhurst Rachel
机构信息
Medical and Surgical Nursing department, Kamuzu College of Nursing, Blantyre, Malawi;
Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
出版信息
Glob Health Action. 2014 Sep 12;7:24816. doi: 10.3402/gha.v7.24816. eCollection 2014.
BACKGROUND AND OBJECTIVES
This study explores the perceptions of a wide range of stakeholders in Malawi towards the mental health impact of intimate partner violence (IPV) and the capacity of health services for addressing these.
DESIGN
In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted in three areas of Blantyre district, and in two additional districts. A total of 10 FGDs, 1 small group, and 14 IDIs with health care providers; 18 FGDs and 1 small group with male and female, urban and rural community members; 7 IDIs with female survivors; and 26 key informant interviews and 1 small group with government ministry staff, donors, gender-based violence service providers, religious institutions, and police were conducted. A thematic framework analysis method was applied to emerging themes.
RESULTS
The significant mental health impact of IPV was mentioned by all participants and formal care seeking was thought to be impeded by social pressures to resolve conflict, and fear of judgemental attitudes. Providers felt inadequately prepared to handle the psychosocial and mental health consequences of IPV; this was complicated by staff shortages, a lack of clarity on the mandate of the health sector, as well as confusion over the definition and need for 'counselling'. Referral options to other sectors for mental health support were perceived as limited but the restructuring of the Ministry of Health to cover violence prevention, mental health, and alcohol and drug misuse under a single unit provides an opportunity.
CONCLUSION
Despite widespread recognition of the burden of IPV-associated mental health problems in Malawi, there is limited capacity to support affected individuals at community or health sector level. Participants highlighted potential entry points to health services as well as local and national opportunities for interventions that are culturally appropriate and are built on local structures and resilience.
背景与目标
本研究探讨了马拉维众多利益相关者对亲密伴侣暴力（IPV）对心理健康的影响以及卫生服务机构应对这些问题的能力的看法。
设计
在布兰太尔区的三个地区以及另外两个地区进行了深入访谈（IDI）和焦点小组讨论（FGD）。共进行了10次焦点小组讨论、1次小组讨论以及对医疗服务提供者的14次深入访谈；对城乡社区的男性和女性进行了18次焦点小组讨论和1次小组讨论；对女性幸存者进行了7次深入访谈；对政府部门工作人员、捐助者、基于性别的暴力服务提供者、宗教机构和警察进行了26次关键信息访谈和1次小组讨论。对出现的主题采用了主题框架分析方法。
结果
所有参与者都提到了亲密伴侣暴力对心理健康的重大影响，并且认为社会上解决冲突的压力以及对评判态度的恐惧阻碍了人们寻求正式护理。提供者认为自己没有充分准备好应对亲密伴侣暴力的心理社会和心理健康后果；人员短缺、卫生部门职责不明确以及对“咨询”的定义和需求存在困惑使情况更加复杂。向其他部门寻求心理健康支持的转诊选择被认为有限，但卫生部进行重组，将预防暴力、心理健康以及酒精和药物滥用纳入一个单位，这提供了一个机会。
结论
尽管马拉维普遍认识到与亲密伴侣暴力相关的心理健康问题的负担，但在社区或卫生部门层面支持受影响个体的能力有限。参与者强调了卫生服务的潜在切入点以及在文化上合适且基于当地结构和恢复力的地方和国家干预机会。
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