Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia.
Centre for Family Violence Prevention, The Royal Women Hospital, Parkville, Victoria, Australia.
BMC Health Serv Res. 2021 Jun 9;21(1):567. doi: 10.1186/s12913-021-06582-2.
Healthcare practitioners (HCPs) play a crucial role in recognising, responding to, and supporting female patients experiencing intimate partner abuse (IPA). However, research consistently identifies barriers they perceive prevent them from doing this work effectively. These barriers can be system-based (e.g. lack of time or training) or personal/individual. This review of qualitative evidence aims to synthesise the personal barriers that impact HCPs' responses to IPA.
Five databases were searched in March 2020. Studies needed to utilise qualitative methods for both data collection and analysis and be published between 2010 and 2020 in order to qualify for inclusion; however, we considered any type of healthcare setting in any country. Article screening, data extraction and methodological appraisal using a modified version of the Critical Appraisal Skills Program checklist for qualitative studies were undertaken by at least two independent reviewers. Data analysis drew on Thomas and Harden's thematic synthesis approach.
Twenty-nine studies conducted in 20 countries informed the final review. A variety of HCPs and settings were represented. Three themes were developed that describe the personal barriers experienced by HCPs: I can't interfere (which describes the belief that IPA is a "private matter" and HCPs' fears of causing harm by intervening); I don't have control (highlighting HCPs' frustration when women do not follow their advice); and I won't take responsibility (which illuminates beliefs that addressing IPA should be someone else's job).
This review highlights the need for training to address personal issues in addition to structural or organisational barriers. Education and training for HCPs needs to: encourage reflection on their own values to reinforce their commitment to addressing IPA; teach HCPs to relinquish the need to control outcomes so that they can adopt an advocacy approach; and support HCPs' trust in the critical role they can play in responding. Future research should explore effective ways to do this within the context of complex healthcare organisations.
医疗保健从业者（HCPs）在识别、应对和支持遭受亲密伴侣虐待（IPA）的女性患者方面发挥着至关重要的作用。然而，研究一致表明，他们认为存在一些障碍会阻止他们有效地开展这项工作。这些障碍可能是系统层面的（例如缺乏时间或培训），也可能是个人层面的。本次对定性证据的综述旨在综合影响 HCP 对 IPA 反应的个人障碍。
2020 年 3 月，对五个数据库进行了搜索。研究需要同时使用定性方法进行数据收集和分析，并在 2010 年至 2020 年期间发表，才有资格纳入；但是，我们考虑了任何国家任何类型的医疗保健环境。至少由两名独立评审员进行了文章筛选、数据提取和使用批判性评估技能计划定性研究检查表进行的方法学评估。数据分析借鉴了托马斯和哈登的主题综合方法。
29 项在 20 个国家进行的研究为最终综述提供了信息。研究涵盖了各种 HCP 和环境。描述 HCP 经历的个人障碍的三个主题如下：我不能干预（描述 IPA 是“私人事务”，HCP 担心干预会造成伤害的信念）；我无法控制（突出 HCP 对女性不遵循其建议感到沮丧）；我不会承担责任（阐明解决 IPA 应该是别人的工作的信念）。
本次综述强调了除了结构性或组织性障碍外，还需要培训来解决个人问题。HCP 的教育和培训需要：鼓励反思自己的价值观，以加强他们解决 IPA 的承诺；教导 HCP 放弃控制结果的需求，以便他们能够采用倡导方法；并支持 HCP 对他们在应对过程中可以发挥的关键作用的信任。未来的研究应该探索在复杂的医疗保健组织背景下有效实施这些措施的方法。
