Barbosa Estela Capelas, Pereira Stephanie, Bacchus Loraine J, Colombini Manuela, Feder Gene, Schraiber Lilia Blima, Pires Lucas d'Oliveira Ana Flávia
Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
Department of Preventive Medicine, School of Medicine, University of São Paulo, Av. Dr. Arnaldo, 455 Cerqueira César, São Paulo, 01246-903, Brazil.
Lancet Reg Health Am. 2025 May 8;47:101114. doi: 10.1016/j.lana.2025.101114. eCollection 2025 Jul.
Domestic violence against women (DVAW) is a public health issue and a breach of human rights, yet evidence on effective interventions remains limited, particularly in low-income and middle-income countries. This study aimed to evaluate changes in identification and referral to specialist support associated with system-level strategies implemented within Brazilian primary healthcare (PHC) to strengthen the response to DVAW. The strategies comprised an intervention called Healthcare Responding to Violence and Abuse (HERA).
Using a quasi-experimental design, HERA was implemented in eight PHC clinics, while 33 served as controls. Data on DVAW identification and referral were obtained from the national Epidemiological Surveillance System. Difference-in-differences analysis, using negative binomial regression, assessed HERA's impact, controlling for patient inflow, clinical supervision, COVID-19 lockdown, region, and clinic. Results are reported as marginal effects with 95% confidence intervals (CI).
There was an increase in the probability of DVAW identification (0.47; 95% CI 0.18-0.77) and referral to support services (0.38; 95% CI 0.03-0.73), when adjusting for panel effects and time. The results were even larger when further controlling for additional variables (0.82 for identification [95% CI 0.44-1.21] and 0.87 for referrals [95% CI 0.47-1.29]).
HERA strategies increased DVAW identification and referral in PHC settings. Clinics implementing HERA were already more likely to identify and refer cases before the implementation, suggesting that HERA's strategies may be more effective in clinics that find DVAW interventions more acceptable, at least in Brazil.
NIHR Global Health Research Group Award.
针对妇女的家庭暴力（DVAW）是一个公共卫生问题，也是对人权的侵犯，但关于有效干预措施的证据仍然有限，尤其是在低收入和中等收入国家。本研究旨在评估与巴西初级卫生保健（PHC）中实施的系统层面策略相关的对DVAW识别及转介至专科支持的变化，以加强对DVAW的应对。这些策略包括一项名为“医疗应对暴力与虐待（HERA）”的干预措施。
采用准实验设计，在8家初级卫生保健诊所实施HERA，33家作为对照。关于DVAW识别和转介的数据来自国家流行病学监测系统。使用负二项回归的差异分析评估HERA的影响，同时控制患者流入、临床监督、新冠疫情封锁、地区和诊所等因素。结果以边际效应及95%置信区间（CI）报告。
在调整面板效应和时间后，DVAW识别概率增加（0.47；95% CI 0.18 - 0.77），转介至支持服务的概率增加（0.38；95% CI 0.03 - 0.73）。在进一步控制其他变量后，结果更大（识别为0.82 [95% CI 0.44 - 1.21]，转介为0.87 [95% CI 0.47 - 1.29]）。
HERA策略增加了初级卫生保健环境中对DVAW的识别和转介。实施HERA的诊所在实施前就更有可能识别和转介病例，这表明HERA策略可能在那些认为DVAW干预措施更容易接受的诊所中更有效，至少在巴西是这样。
英国国家卫生研究院全球健康研究小组奖。
