在初级保健中接受亲密伴侣暴力护理：参与“编织”随机对照试验的女性所面临的障碍与促成因素
Receiving care for intimate partner violence in primary care: Barriers and enablers for women participating in the weave randomised controlled trial.
作者信息
O'Doherty Lorna, Taket Ann, Valpied Jodie, Hegarty Kelsey
机构信息
Centre for Research in Psychology, Behaviour and Achievement, Coventry University, Priory Street, Coventry CV1 5FB, UK; General Practice and Primary Care Academic Centre, The University of Melbourne, 200 Berkeley Street, Carlton, Victoria, Australia.
School of Health and Social Development, Deakin University, Victoria, Australia.
出版信息
Soc Sci Med. 2016 Jul;160:35-42. doi: 10.1016/j.socscimed.2016.05.017. Epub 2016 May 10.
BACKGROUND
Interventions in health settings for intimate partner violence (IPV) are being increasingly recognised as part of a response to addressing this global public health problem. However, interventions targeting this sensitive social phenomenon are complex and highly susceptible to context. This study aimed to elucidate factors involved in women's uptake of a counselling intervention delivered by family doctors in the weave primary care trial (Victoria, Australia).
METHODS
We analysed associations between women's and doctors' baseline characteristics and uptake of the intervention. We interviewed a random selection of 20 women from an intervention group women to explore cognitions relating to intervention uptake. Interviews were audio-recorded, transcribed, coded in NVivo 10 and analysed using the theory of planned behaviour (TPB).
RESULTS
Abuse severity and socio-demographic characteristics (apart from current relationship status) were unrelated to uptake of counselling (67/137 attended sessions). Favourable doctor communication was strongly associated with attendance. Eight themes emerged, including four sets of beliefs that influenced attitudes to uptake: (i) awareness of the abuse and readiness for help; (ii) weave as an avenue to help; (iii) doctor's communication; and (iv) role in providing care for IPV; and four sets of beliefs regarding women's control over uptake: (v) emotional health, (vi) doctors' time, (vii) managing the disclosure process and (viii) viewing primary care as a safe option.
CONCLUSIONS
This study has identified factors that can promote the implementation and evaluation of primary care-based IPV interventions, which are relevant across health research settings, for example, ensuring fit between implementation strategies and characteristics of the target group (such as range in readiness for intervention). On practice implications, providers' communication remains a key issue for engaging women. A key message arising from this work concerns the critical role of primary care and health services more broadly in reaching victims of domestic violence, and providing immediate and ongoing support (depending on the healthcare context).
背景
在卫生环境中针对亲密伴侣暴力（IPV）的干预措施日益被视为应对这一全球公共卫生问题的一部分。然而，针对这一敏感社会现象的干预措施复杂且极易受环境影响。本研究旨在阐明在澳大利亚维多利亚州开展的“编织初级保健试验”中，女性接受家庭医生提供的咨询干预的相关因素。
方法
我们分析了女性和医生的基线特征与干预措施接受情况之间的关联。我们从干预组女性中随机抽取20名进行访谈，以探究与接受干预相关的认知。访谈进行了录音、转录，在NVivo 10中编码，并运用计划行为理论（TPB）进行分析。
结果
虐待严重程度和社会人口学特征（当前恋爱状况除外）与咨询接受情况无关（137名中有67名参加了咨询）。良好的医患沟通与参与咨询密切相关。出现了八个主题，包括四组影响接受态度的信念：（i）对虐待的认知和寻求帮助的意愿；（ii）编织计划作为获得帮助的途径；（iii）医生的沟通；以及（iv）在提供IPV护理方面的作用；还有四组关于女性对接受干预的控制的信念：（v）情绪健康，（vi）医生的时间，（vii）管理披露过程，以及（viii）将初级保健视为安全选择。
结论
本研究确定了可促进基于初级保健的IPV干预措施实施和评估的因素，这些因素在卫生研究环境中具有相关性，例如确保实施策略与目标群体特征（如干预准备程度范围）相匹配。关于实践意义，提供者的沟通仍然是吸引女性参与的关键问题。这项工作产生的一个关键信息是，初级保健和更广泛的卫生服务在接触家庭暴力受害者并提供即时和持续支持（取决于医疗保健环境）方面发挥着关键作用。
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