Mantler Tara, Wolfe Barat
H121C Health Sciences Addition, London Ontario.
Suny Canton, New York.
Rural Remote Health. 2017 Jan-Mar;17(1):3987. doi: 10.22605/rrh3987. Epub 2017 Mar 16.
Intimate partner violence is a significant public health problem, with shelters offering the predominant community-based solution. Shelters in Canada are mandated to provide a safe place, protection planning, advocacy and counseling among other services. Recently it has been noted the role of the shelter was shifting from an inpatient to outpatient model with a focus on increased integration of health and social services. This changing role of the shelter is amplified within the rural context where resources and cultural norms may be limited or incompatible with help-seeking behaviors. Women's shelters located in rural settings provide services within a specific cultural context that can be at odds with the needs of women who have experienced abuse, because cultural values such as rural pride, lack of anonymity, and lack of services may inhibit access to health and social services.
The purpose of this in-depth qualitative case study was to examine and explore how one rural Canadian women's shelter role was changing and how the shelter was adapting to achieve the changing role. The theoretical framework utilized was a feminist intersectional lens. Qualitative interviews (averaging 60 minutes) were conducted with shelter service providers (=6) and women staying in the shelter or utilizing shelter services (=4). Throughout semi-structured interviews, data-trustworthy steps were taken including member-checking and paraphrasing to ensure data were an accurate representation of participants' experiences. Inductive content analysis of all interviews and field notes was conducted independently by two researchers.
Analysis revealed the shelter's role was changing to include filling gaps, case management, and system navigation. To achieve the changing role, relationship building, community mobilization (both education and empowerment), and redesigning delivery were implemented as adaptation strategies. Together both the changing role of the shelter and the adaptation strategies being implemented were found to be working toward a larger goal of transformation of cultural and structural norms related to violence against women.
This study uniquely identified the specific changes to the role of one rural Canadian shelter and the adaptations strategies utilized to adapt to the changing needs of women. The changing role of the shelter and the adaptation strategies being utilized have significant implications for the health of women given the increased use of healthcare services for women who have experienced violence. Specifically, the changing role of the shelter has the potential to decrease healthcare service use while increasing the potential fit of services. Further research is required to assess the impact of the changing role of the shelter on the healthcare needs and outcomes for women who have experienced intimate partner violence.
亲密伴侣暴力是一个重大的公共卫生问题，庇护所是基于社区的主要解决方案。加拿大的庇护所被要求提供一个安全的场所、保护计划、宣传和咨询等服务。最近有人指出，庇护所的角色正在从住院模式向门诊模式转变，重点是加强卫生和社会服务的整合。在农村地区，资源和文化规范可能有限或与求助行为不相容，庇护所角色的这种变化更加明显。农村地区的妇女庇护所在特定的文化背景下提供服务，这可能与遭受虐待的妇女的需求不一致，因为农村自豪感、缺乏匿名性和服务不足等文化价值观可能会阻碍她们获得卫生和社会服务。
本深入定性案例研究的目的是考察和探索加拿大一个农村妇女庇护所的角色是如何变化的，以及该庇护所如何进行调整以适应不断变化的角色。所采用的理论框架是女性主义交叉视角。对庇护所服务提供者（=6）以及住在庇护所或使用庇护所服务的妇女（=4）进行了定性访谈（平均时长60分钟）。在整个半结构化访谈过程中，采取了确保数据可信的步骤，包括成员核对和释义，以确保数据准确反映参与者的经历。两位研究人员独立对所有访谈和实地记录进行了归纳式内容分析。
分析表明，庇护所的角色正在发生变化，包括填补空白、个案管理和系统导航。为了实现角色的转变，实施了建立关系、社区动员（包括教育和赋权）以及重新设计服务提供方式等适应策略。研究发现，庇护所角色的变化和所实施的适应策略都朝着改变与暴力侵害妇女行为相关的文化和结构规范这一更大目标努力。
本研究独特地确定了加拿大一个农村庇护所角色的具体变化以及为适应妇女不断变化的需求而采用的适应策略。鉴于遭受暴力的妇女对医疗服务的使用增加，庇护所角色的变化和所采用的适应策略对妇女健康具有重要意义。具体而言，庇护所角色的变化有可能减少医疗服务的使用，同时提高服务的适配性。需要进一步研究来评估庇护所角色的变化对遭受亲密伴侣暴力的妇女的医疗需求和结果的影响。
