Browsing by Author "Zweigenthal, Virginia"

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    Health sector responses to intimate partner violence : a literature review
    (AOSIS Publishing, 2014-11) Rees, Kate; Zweigenthal, Virginia; Joyner, Kate
    Background: Intimate partner violence (IPV) is a common and serious public health concern, particularly in South Africa, but it is not well managed in primary care. Aim: This review aims to summarise the current state of knowledge regarding health sector-based interventions for IPV, their integration into health systems and services and the perspectives of service users and healthcare workers on IPV care, focusing on the South African context. Method: PubMed, CINAHL, PsycINFO and Google Scholar were searched between January 2012 and May 2014. All types of study design were included, critically appraised and summarised. Results: Exposure to IPV leads to wide-ranging and serious health effects. There is sufficient evidence that intervening in IPV in primary care can improve outcomes. Women who have experienced IPV have described an appropriate response by healthcare providers to be non-judgmental, understanding and empathetic. IPV interventions that are complex, comprehensive and utilise systems-wide approaches have been most effective, but system- and society-level barriers hamper implementation. Gender inequities should not be overlooked when responding to IPV. Conclusion: Further evaluations of health sector responses to IPV are needed, in order to assist health services to determine the most appropriate models of care, how these can be integrated into current systems and how they can be supported in managing IPV. The need for this research should not prevent health services and healthcare providers from implementing IPV care, but rather should guide the development of rigorous contextually-appropriate evaluations.
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    Implementing intimate partner violence care in a rural sub-district of South Africa : a qualitative evaluation
    (Co-Action Publishing, 2014-09-12) Rees, Kate; Zweigenthal, Virginia; Joyner, Kate
    Background: Despite a high burden of disease, in South Africa, intimate partner violence (IPV) is known to be poorly recognised and managed. To address this gap, an innovative intersectoral model for the delivery of comprehensive IPV care was piloted in a rural sub-district. Objective: To evaluate the initiative from the perspectives of women using the service, service providers, and managers. Design: A qualitative evaluation was conducted. Service users were interviewed, focus groups were conducted amongst health care workers (HCW), and a focus group and interviews were conducted with the intersectoral implementation team to explore their experiences of the intervention. A thematic analysis approach was used, triangulating the various sources of data. Results: During the pilot, 75 women received the intervention. Study participants described their experience as overwhelmingly positive, with some experiencing improvements in their home lives. Significant access barriers included unaffordable indirect costs, fear of loss of confidentiality, and fear of children being removed from the home. For HCW, barriers to inquiry about IPV included its normalisation in this community, poor understanding of the complexities of living with violence and frustration in managing a difficult emotional problem. Health system constraints affected continuity of care, privacy, and integration of the intervention into routine functioning, and the process of intersectoral action was hindered by the formation of alliances. Contextual factors, for example, high levels of alcohol misuse and socio-economic disempowerment, highlighted the need for a multifaceted approach to addressing IPV. Conclusions: This evaluation draws attention to the need to take a systems approach and focus on contextual factors when implementing complex interventions. The results will be used to inform decisions about instituting appropriate IPV care in the rest of the province. In addition, there is a pressing need for clear policies and guidelines framing IPV as a health issue.
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    Intimate partner violence : how should health systems respond?
    (Health & Medical Publishing Group, 2014-08) Rees, Kate; Zweigenthal, Virginia; Joyner, Kate
    Intimate partner violence (IPV) is a common and serious public health concern, worldwide and in South Africa. Exposure to IPV leads to wide-ranging and serious health effects, and there is evidence that intervening for IPV in primary healthcare settings can improve outcomes. World Health Organization guidelines for responding to IPV and sexual violence recommend enquiring about violence when relevant in healthcare encounters and providing women-centred care. Women who have experienced IPV have described an appropriate response by healthcare providers to be non-judgemental, understanding and empathetic. Despite this, the evidence base informing the scale-up of IPV interventions and their integration into health systems is lacking. Further evaluations of health sector responses to IPV are needed to assist health services to determine the most appropriate models of care and how these can be integrated into current systems. The need for this research should not prevent health systems and healthcare providers from implementing IPV care, but rather should guide the development of rigorous, contextually appropriate evaluations. There is also an urgent need for policies and protocols that clearly frame IPV as an important health issue and support healthcare providers in enquiring about and responding to IPV.