Bristol Medical School (PHS), University of Bristol Faculty of Health Sciences, Bristol, UK
Bristol Medical School (PHS), University of Bristol Faculty of Health Sciences, Bristol, UK.
BMJ Open. 2022 Feb 22;12(2):e051924. doi: 10.1136/bmjopen-2021-051924.
To synthesise evidence on the effectiveness, cost-effectiveness and barriers to responding to violence against women (VAW) in sexual and reproductive health (SRH) services in low/middle-income countries (LMICs).
Mixed-methods systematic review.
Medline, Embase, Psycinfo, Cochrane, Cinahl, IMEMR, Web of Science, Popline, Lilacs, WHO RHL, ClinicalTrials.gov, Google, Google Scholar, websites of key organisations through December 2019.
Studies of any design that evaluated VAW interventions in SRH services in LMICs.
Concurrent narrative quantitative and thematic qualitative syntheses, integration through line of argument and mapping onto a logic model. Two reviewers extracted data and appraised quality.
26 studies of varied interventions using heterogeneous outcomes. Of ten interventions that strengthened health systems capacity to respond to VAW during routine SRH consultation, three reported no harm and reduction in some types of violence. Of nine interventions that strengthened health systems and communities' capacity to respond to VAW, three reported conflicting effects on re-exposure to some types of VAW and mixed effect on SRH. The interventions increased identification of VAW but had no effect on the provision (75%-100%) and uptake (0.6%-53%) of referrals to VAW services. Of seven psychosocial interventions in addition to SRH consultation that strengthened women's readiness to address VAW, four reduced re-exposure to some types of VAW and improved health. Factors that disrupted the pathway to better outcomes included accepting attitudes towards VAW, fear of consequences and limited readiness of the society, health systems and individuals. No study evaluated cost-effectiveness.
Some VAW interventions in SRH services reduced re-exposure to some types of VAW and improved some health outcomes in single studies. Future interventions should strengthen capacity to address VAW across health systems, communities and individual women. First-line support should be better tailored to women's needs and expectations.
CRD42019137167.
综合评估在中低收入国家（LMICs）性与生殖健康（SRH）服务中应对针对妇女的暴力（VAW）的有效性、成本效益和障碍。
混合方法系统评价。
Medline、Embase、Psycinfo、Cochrane、Cinahl、IMEMR、Web of Science、Popline、Lilacs、WHO RHL、ClinicalTrials.gov、Google、Google Scholar、2019 年 12 月前的关键组织网站。
评估 LMICs 中 SRH 服务中 VAW 干预措施的任何设计的研究。
同时进行叙述性定量和主题定性综合，通过论证线进行整合，并映射到逻辑模型上。两位审查员提取数据并评估质量。
26 项研究采用不同的干预措施，使用不同的结局。在十项加强常规 SRH 咨询中应对 VAW 的卫生系统能力的干预措施中，有三项报告无伤害和某些类型暴力的减少。在九项加强卫生系统和社区应对 VAW 的能力的干预措施中，有三项报告对某些类型的 VAW 再暴露产生冲突的效果，并对 SRH 产生混合效果。这些干预措施增加了对 VAW 的识别，但对 VAW 服务的转介提供（75%-100%）和接受（0.6%-53%）没有影响。除了 SRH 咨询外，还有七项心理社会干预措施加强了妇女处理 VAW 的准备情况，四项措施减少了某些类型的 VAW 再暴露，并改善了健康状况。破坏通往更好结果的途径的因素包括对 VAW 的接受态度、对后果的恐惧以及社会、卫生系统和个人的有限准备。没有研究评估成本效益。
SRH 服务中的一些 VAW 干预措施减少了某些类型的 VAW 再暴露，并在单项研究中改善了一些健康结局。未来的干预措施应加强整个卫生系统、社区和个别妇女应对 VAW 的能力。第一线支持应更好地满足妇女的需求和期望。
PROSPERO 注册号：CRD42019137167。
