Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Department of Reproductive Health and Research, WHO, Geneva, Switzerland.
BMJ Glob Health. 2020 Mar 30;5(3):e001883. doi: 10.1136/bmjgh-2019-001883. eCollection 2020.
Many low- and middle-income countries have implemented health-system based one stop centres to respond to intimate partner violence (IPV) and sexual violence. Despite its growing popularity in low- and middle-income countries and among donors, no studies have systematically reviewed the one stop centre. Using a thematic synthesis approach, this systematic review aims to identify enablers and barriers to implementation of the one stop centre (OSC) model and to achieving its intended results for women survivors of violence in low- and middle-income countries.
We searched PubMed, CINAHL and Embase databases and grey literature using a predetermined search strategy to identify all relevant qualitative, quantitative and mixed methods studies. Overall, 42 studies were included from 24 low- and middle-income countries. We used a three-stage thematic synthesis methodology to synthesise the qualitative evidence, and we used the CERQual (Confidence in the Evidence from Reviews of Qualitative Research) approach to assess confidence in the qualitative research. Meta-analysis could not be performed due heterogeneity in results and outcome measures. Quantitative data are presented by individual study characteristics and outcomes, and key findings are incorporated into the qualitative thematic framework.
The review found 15 barriers with high-confidence evidence and identified seven enablers with moderate-confidence evidence. These include barriers to implementation such as lack of multisectoral staff and private consultation space as well as barriers to achieving the intended result of multisectoral coordination due to fragmented services and unclear responsibilities of implementing partners. There were also differences between enablers and barriers of various OSC models such as the hospital-based OSC, the stand-alone OSC and the NGO-run OSC.
This review demonstrates that there are several barriers that have often prevented the OSC model from being implemented as designed and achieving the intended result of providing high quality, accessible, acceptable, multisectoral care. Existing OSCs will likely require strategic investment to address these specific barriers before they can achieve their ultimate goal of reducing survivor retraumatisation when seeking care. More rigorous and systematic evaluation of the OSC model is needed to better understand whether the OSC model of care is improving support for survivors of IPV and sexual violence.The systematic review protocol was registered and is available online (PROSPERO: CRD42018083988).
许多中低收入国家已经实施了基于卫生系统的一站式中心,以应对亲密伴侣暴力(IPV)和性暴力。尽管这种模式在中低收入国家和捐助者中越来越受欢迎,但尚无研究系统地审查过一站式中心。本系统评价采用主题综合方法,旨在确定在中低收入国家为暴力女性幸存者实施一站式中心(OSC)模式及其实现预期结果的促进因素和障碍。
我们使用预定的搜索策略在 PubMed、CINAHL 和 Embase 数据库和灰色文献中进行了搜索,以确定所有相关的定性、定量和混合方法研究。总体而言,我们从 24 个中低收入国家中纳入了 42 项研究。我们使用三阶段主题综合方法对定性证据进行综合,并使用 CERQual(对定性研究证据的信心)方法评估定性研究的信心。由于结果和结果测量存在异质性,因此无法进行荟萃分析。定量数据按个别研究特征和结果呈现,关键发现纳入定性主题框架。
本评价发现了 15 项具有高可信度证据的障碍,并确定了 7 项具有中等可信度证据的促进因素。这些障碍包括实施障碍,例如缺乏多部门工作人员和私人咨询空间,以及由于服务分散和实施伙伴的责任不明确,导致多部门协调的预期结果无法实现。不同的 OSC 模式(如医院为基础的 OSC、独立的 OSC 和非政府组织运营的 OSC)也存在促进因素和障碍的差异。
本评价表明,存在一些障碍,这些障碍经常阻止 OSC 模式按设计实施,并实现提供高质量、可及、可接受、多部门护理的预期结果。现有的 OSC 可能需要战略投资来解决这些具体障碍,然后才能实现减少幸存者在寻求护理时再次创伤的最终目标。需要更严格和系统地评估 OSC 模式,以更好地了解 OSC 护理模式是否正在改善对 IPV 和性暴力幸存者的支持。本系统评价方案已在网上注册并可获取(PROSPERO:CRD42018083988)。