Goicolea Isabel, Hurtig Anna-Karin, San Sebastian Miguel, Marchal Bruno, Vives-Cases Carmen
Unit of Epidemiology and Global Health, Department of Clinical Medicine and Public Health, Umeå University, Sweden; Grupo de Investigación de Salud Pública, Universidad de Alicante, Alicante, Spain.
Unit of Epidemiology and Global Health, Department of Clinical Medicine and Public Health, Umeå University, Sweden.
Gac Sanit. 2015 Nov-Dec;29(6):431-6. doi: 10.1016/j.gaceta.2015.08.005. Epub 2015 Sep 26.
Few evaluations have assessed the factors triggering an adequate health care response to intimate partner violence. This article aimed to: 1) describe a realist evaluation carried out in Spain to ascertain why, how and under what circumstances primary health care teams respond to intimate partner violence, and 2) discuss the strengths and challenges of its application.
We carried out a series of case studies in four steps. First, we developed an initial programme theory (PT1), based on interviews with managers. Second, we refined PT1 into PT2 by testing it in a primary healthcare team that was actively responding to violence. Third, we tested the refined PT2 by incorporating three other cases located in the same region. Qualitative and quantitative data were collected and thick descriptions were produced and analysed using a retroduction approach. Fourth, we analysed a total of 15 cases, and identified combinations of contextual factors and mechanisms that triggered an adequate response to violence by using qualitative comparative analysis.
There were several key mechanisms -the teams' self-efficacy, perceived preparation, women-centred care-, and contextual factors -an enabling team environment and managerial style, the presence of motivated professionals, the use of the protocol and accumulated experience in primary health care- that should be considered to develop adequate primary health-care responses to violence.
The full application of this realist evaluation was demanding, but also well suited to explore a complex intervention reflecting the situation in natural settings.
很少有评估对引发针对亲密伴侣暴力的适当医疗应对措施的因素进行过评估。本文旨在：1）描述在西班牙开展的一项现实主义评估，以确定初级卫生保健团队为何、如何以及在何种情况下对亲密伴侣暴力做出应对，以及2）讨论其应用的优势和挑战。
我们分四个步骤进行了一系列案例研究。首先，基于对管理人员的访谈，我们制定了一个初始项目理论（PT1）。其次，我们通过在一个积极应对暴力的初级卫生保健团队中对PT1进行测试，将其细化为PT2。第三，我们通过纳入同一地区的其他三个案例对细化后的PT2进行测试。收集了定性和定量数据，并采用追溯法进行了详细描述和分析。第四，我们总共分析了15个案例，并通过定性比较分析确定了引发对暴力做出适当应对的背景因素和机制的组合。
有几个关键机制——团队的自我效能感、感知到的准备情况、以女性为中心的护理——以及背景因素——有利的团队环境和管理风格、有积极性的专业人员的存在、协议的使用以及初级卫生保健方面的积累经验——在制定对暴力的适当初级卫生保健应对措施时应予以考虑。
这种现实主义评估的全面应用要求很高，但也非常适合探索反映自然环境情况的复杂干预措施。
