背景:美国几乎一半的女性在其一生中经历亲密伴侣暴力(IPV)。美国预防服务工作组建议对育龄妇女进行IPV筛查并进行干预。我们的目标是了解有益的临床实践和政策,有害的,或不足以在安全网医疗保健系统中支持IPV幸存者。
方法:我们抽取了45名18-64岁的女性样本,在前一年内经历过IPV,并且是旧金山健康网络的患者。我们进行了深入,半结构化访谈,以引出他们对披露IPV和在医疗保健系统内获得支持的看法。我们使用主题分析和以生态系统理论为依据的扎根理论实践来分析我们的数据。
结果:我们确定了四个主题,这些主题涉及阻碍或促进在人际关系和系统层面上讨论和解决IPV的因素,尊重,自主权和资源。(1)人际关系障碍包括对人际关系建设重视不够,对幸存者情况缺乏尊重或关注,并感到有压力披露IPV或遵守临床医生建议的干预措施。(2)人际促进者包括以患者为中心的IPV询问,专心倾听,关于保密的基于力量的咨询和透明度。(3)系统性障碍,如访问时间限制,临床医生翻身,担心政府系统的参与会导致与儿童分离或伤害伴侣的自主权丧失,对人际动态产生负面影响。(4)系统促进者通过IPV普及教育提供资源,现场访问IPV服务,和社区伙伴关系。
结论:在我们的研究中,经历IPV的女性报告说,建立关系,尊重,自主性,与IPV相关的资源是提供支持的重要组成部分,促进安全,并在医疗保健环境中实现治愈。医疗系统成功的创伤信息转型必须优化人际关系和系统因素,以改善幸存者的福祉,同时消除障碍。
BACKGROUND: Almost half of all women in the US experience intimate partner violence (IPV) in their lifetime. The US Preventive Services Task Force recommends IPV screening paired with intervention for women of reproductive age. We aim to understand clinical practices and policies that are beneficial, detrimental, or insufficient to support survivors of IPV in a safety-net healthcare system.
METHODS: We sampled 45 women who were 18-64 years old, had experienced IPV within the prior year and were patients in the San Francisco Health Network. We conducted in-depth, semi-structured interviews to elicit their perspectives on disclosing IPV and obtaining support within the healthcare system. We analyzed our data using thematic analysis and grounded theory practices informed by ecological systems theory.
RESULTS: We identified four themes regarding factors that impeded or facilitated discussing and addressing IPV across interpersonal and systemic levels relating to relationship-building, respect, autonomy and resources. (1) Interpersonal barriers included insufficient attention to relationship-building, lack of respect or concern for survivor circumstances, and feeling pressured to disclose IPV or to comply with clinicians\' recommended interventions. (2) Interpersonal facilitators consisted of patient-centered IPV inquiry, attentive listening, strength-based counseling and transparency regarding confidentiality. (3) Systemic barriers such as visit time limitations, clinician turn-over and feared loss of autonomy from involvement of governmental systems leading to separation from children or harm to partners, negatively affected interpersonal dynamics. (4) Systemic facilitators involved provision of resources through IPV universal education, on-site access to IPV services, and community partnerships.
CONCLUSIONS: Women experiencing IPV in our study reported that relationship-building, respect, autonomy, and IPV-related resources were essential components to providing support, promoting safety, and enabling healing in the healthcare setting. Successful trauma-informed transformation of healthcare systems must optimize interpersonal and systemic factors that improve survivor wellbeing while eliminating barriers.