School of Population Health, UNSW, Sydney, Australia.
The George Institute for Global Health, UNSW, Sydney, Australia.
Trauma Violence Abuse. 2022 Oct;23(4):1204-1219. doi: 10.1177/1524838020985571. Epub 2021 Feb 12.
It is imperative that access to primary health care services is equitable as health care practitioners are often the first responders to women who experience violence. This is of particular importance for First Nations women who disproportionately experience interpersonal and structural violence when compared to non-First Nations women, as well as the ongoing impact of colonization, racism, and intergenerational trauma. To understand how primary health care services can provide equitable and effective care for First Nations women, we explored how trauma and violence informed care is integrated in primary health care settings through the lens of an equity-oriented framework. A systematic search of electronic databases included Medline (via Ovid), Scopus, Informit, and PubMed and grey literature. Six studies were included in the review and we undertook a narrative synthesis using the equity-oriented framework to draw together the intersection of trauma and violence informed care with culturally safe and contextually tailored care. This review demonstrates how equity-oriented primary health care settings respond to the complex and multiple forms of violence and intergenerational trauma experienced by First Nations women and thus mitigate shame and stigma to encourage disclosure and help seeking. Key attributes include responding to women's individual contexts by centering family, engaging elders, encouraging community ownership, which is driven by a culturally competent workforce that builds trust, reduces retraumatization, and respects confidentiality. This review highlights the importance of strengthening and supporting the workforce, as well as embedding cultural safety within intersectoral partnerships and ensuring adequate resourcing and sustainability of initiatives.
必须确保初级卫生保健服务的可及性是公平的，因为卫生保健从业者通常是遭受暴力的妇女的第一反应者。这对于第一民族妇女尤为重要，与非第一民族妇女相比，她们遭受人际和结构性暴力的比例过高，而且还受到殖民主义、种族主义和代际创伤的持续影响。为了了解初级卫生保健服务如何为第一民族妇女提供公平有效的护理，我们从以公平为导向的框架的角度探讨了创伤和暴力信息如何融入初级卫生保健环境。通过对电子数据库（包括 Medline（通过 Ovid）、Scopus、Informit 和 PubMed）和灰色文献进行系统搜索，共纳入了 6 项研究。我们使用以公平为导向的框架进行叙述性综合，以将创伤和暴力信息护理与文化安全和背景定制护理联系起来。这项审查表明，以公平为导向的初级卫生保健环境如何应对第一民族妇女所经历的复杂和多种形式的暴力和代际创伤，从而减轻羞耻感和污名化，鼓励披露和寻求帮助。关键属性包括通过以家庭为中心、让长者参与、鼓励社区所有权来回应妇女的个人背景，这是由一支文化能力强的劳动力推动的，他们建立信任、减少再创伤和尊重保密性。这项审查强调了加强和支持劳动力以及在部门间伙伴关系中嵌入文化安全并确保倡议的充足资源和可持续性的重要性。
