Obstacles and Limitations in the Use of Protocols Responding Intimate Partner Violence Against Women from the Health System in Spain

Intimate partner violence against women (IPVAW) is a public health problem that affects women worldwide. Consequently, victims frequently go to healthcare centers, usually with a cover reason. To address this problem, national and autonomic protocols to respond to IPVAW in health systems have been developed in Spain. In this regard, the role of primary care physicians (PCPs) will be essential for addressing IPVAW, but they could encounter obstacles in doing so. The purpose of this study was to explore how IPVAW is addressed in healthcare centers in Spain. This study synthesized the information available in the protocols to address IPVAW among health care workers in Spain and analyzed it according to World Health Organization (WHO) guidelines. Additionally, PCPs’ perspectives on these protocols and the nature of IPVAW attention from healthcare centers were explored through a focus group. The findings displayed that, although the protocols mostly conform to WHO guidelines, they are insufficient to address IPVAW. Generally, PCPs were unaware of the existence of the protocols and referred to the lack of training in IPVAW and protocol use as one of the main obstacles to intervening, along with a lack of time and feelings as well as cultural, educational, and political factors. The adoption of measures to ensure that PCPs apply these protocols correctly and to approach PCPs’ obstacles for addressing IPVAW in consultations will be crucial for the care of victims. (AU)

Obstacles and Limitations in the Use of Protocols Responding Intimate Partner Violence Against Women from the Health System in Spain.

Intimate partner violence against women (IPVAW) is a public health problem that affects women worldwide. Consequently, victims frequently go to healthcare centers, usually with a cover reason. To address this problem, national and autonomic protocols to respond to IPVAW in health systems have been developed in Spain. In this regard, the role of primary care physicians (PCPs) will be essential for addressing IPVAW, but they could encounter obstacles in doing so. The purpose of this study was to explore how IPVAW is addressed in healthcare centers in Spain. This study synthesized the information available in the protocols to address IPVAW among health care workers in Spain and analyzed it according to World Health Organization (WHO) guidelines. Additionally, PCPs' perspectives on these protocols and the nature of IPVAW attention from healthcare centers were explored through a focus group. The findings displayed that, although the protocols mostly conform to WHO guidelines, they are insufficient to address IPVAW. Generally, PCPs were unaware of the existence of the protocols and referred to the lack of training in IPVAW and protocol use as one of the main obstacles to intervening, along with a lack of time and feelings as well as cultural, educational, and political factors. The adoption of measures to ensure that PCPs apply these protocols correctly and to approach PCPs' obstacles for addressing IPVAW in consultations will be crucial for the care of victims.

Spanish Adaptation and Validation of the World Health Organization's Violence Against Women Instrument

BACKGROUND: The World Health Organization (WHO) developed an instrument to detect violence against women that has been widely used in several countries. Despite this instrument's importance in identifying intimate partner violence against women (IPVAW), it has not been adapted for the Spanish population. The aim of this study was to adapt and validate the WHO violence against women instrument in a sample in Spain, facilitating the detection of IPVAW in this context and comparisons between countries. METHOD: After the instrument was translated and adapted into Spanish, 532 women from the general population in Spain completed it. The initial instrument consisted of 28 items. We deleted three items due to low internal consistency, resulting in 25 items in the final version. RESULTS: Suitable internal consistency was obtained through Confirmatory Factorial Analysis for physical (α = .92), psychological (α = .91), sexual (α = .86), and control behaviors subscales (α = .91) as well as for the total scale (α = .95). The instrument revealed highly prevalent IPVAW in our sample (79.7%). CONCLUSIONS: The use of the Spanish version of the WHO violence against women instrument in Spain seems justified.

Spanish Adaptation and Validation of the World Health Organization’s Violence Against Women Instrument / Adaptación y Validación Española del Instrumento de Violencia Contra las Mujeresde la Organización Mundial de la Salud

Background: The World Health Organization (WHO) developed an instrument to detect violence against women thathas been widely used in several countries. Despite this instrument’s importance in identifying intimate partner violenceagainst women (IPVAW), it has not been adapted for the Spanish population. The aim of this study was to adaptand validate the WHO violence against women instrument in a sample in Spain, facilitating the detection of IPVAWin this context and comparisons between countries. Method: After the instrument was translated and adapted intoSpanish, 532 women from the general population in Spain completed it. The initial instrument consisted of 28 items.We deleted three items due to low internal consistency, resulting in 25 items in the final version. Results: Suitableinternal consistency was obtained through Confirmatory Factorial Analysis for physical (α = .92), psychological (α =.91), sexual (α = .86), and control behaviors subscales (α = .91) as well as for the total scale (α = .95). The instrumentrevealed highly prevalent IPVAW in our sample (79.7%). Conclusions: The use of the Spanish version of the WHOviolence against women instrument in Spain seems justified.(AU)

Antecedentes: La Organización Mundial de la Salud (OMS) desarrolló un instrumento para detectar la violenciade género (VG) que ha sido ampliamente utilizado en varios países. A pesar de la importancia del instrumento paraidentificar la VG, éste no ha sido adaptado en población española. El objetivo de este estudio fue adaptar y validarel instrumento de VG de la OMS en España, facilitando la detección de la VG en este contexto y la comparaciónentre países. Método: 532 mujeres de la población general en España completaron el instrumento tras su traducción yadaptación al español. El instrumento inicial constaba de 28 ítems. Se eliminaron tres ítems debido a su baja consistenciainterna, resultando un total de 25 ítems en la versión final. Resultados: Se obtuvo una adecuada consistencia internamediante el análisis factorial confirmatorio para las subescalas de violencia física (α = .92), psicológica (α = .91), sexual(α = .86) y en conductas de control (α = .91), así como en la escala total (α = .95). El instrumento reveló alta prevalenciade VG (79,7%). Conclusiones: El uso de la versión española del instrumento de VG contra las mujeres de la OMS,justifican su uso en España.(AU)

Impacto de la pandemia por COVID-19 y el confinamiento en los homicidios por violencia de género en España / Impact of COVID-19 pandemic and lockdown on gender-based violence homicides in Spain

La situación creada por la pandemia por COVID-19 y el confinamiento han dado lugar a una disminución del número de homicidios por violencia de género en 2020 con 45 homicidios, el número más bajo de toda la serie histórica. El análisis de las circunstancias generadas por el confinamiento y la limitación de la movilidad en las fases posteriores, unidas al deterioro de la situación económica, son factores relacionados con el aumento de la violencia durante el segundo trimestre (meses del confinamiento), expresado en un incremento del 49,6% en el número de llamadas al 016, y en una disminución de las denuncias del 14,6% en esos mismos meses. Esta situación refleja el aumento del control y la disminución de oportunidades para salir de la violencia, que ha incidido en la disminución del número de homicidios, con 4 homicidios durante los meses de confinamiento, un número que nunca había sido tan bajo para un trimestre. La situación surgida es compatible con un incremento del riesgo de letalidad, factor que puede estar relacionado con el aumento de homicidios limitado al mes de agosto, coincidiendo con la recuperación de las circunstancias de movilidad y oportunidades socio-laborales. El estudio de las circunstancias sociales ocasionadas por la pandemia a lo largo de 2020 permite describir 3 patrones de impacto sobre la violencia de género. (AU)

Circumstances under COVID-19 pandemic and lockdown have reduced the number of gender-based violence homicides in 2020, with a total number of 45, the lowest in the historical statistics. Analysis of these circumstances generated by the lockdown and mobility reduction, together the economical negative impact, has produced an increment of 49.6% in the number of calls to 016 (telephone for victims’ assistance), and a reduction of 14.6% in the complaints of violence during the months of lockdown. This situation reflects a higher control of victims and more difficulties to exit from violence, that has decreased the number of homicides to 4 during these months, the lowest within Spanish statistics. These circumstances are compatible with an increment of risk of aggressions and lethality, factor that can be related with the increment of homicides limited to August, when the mobility and socio-labor opportunities were recovered. The study of the social circumstances originated by the pandemic allows to describe three different patterns in the impact on gender-based violence. (AU)

Violencia de género en tiempos de pandemia y confinamiento / Gender-based violence during the pandemic and lockdown

Las circunstancias del confinamiento potencian los factores de riesgo de violencia de género (VG) a nivel individual y social, al aumentar el aislamiento y las barreras que dificultan la solicitud de ayuda y la denuncia. Esta situación tiene como consecuencia directa el aumento de esta violencia. Sin embargo, una primera aproximación puede llevar al error al entender que la VG disminuye debido al descenso de las denuncias y del número de homicidios. El estudio médico-legal de la VG bajo el confinamiento debe tener un sentido evolutivo que contemple las consecuencias en sus dos fases: Durante el confinamiento, con el aumento en todas sus formas (física, psicológica y sexual), y tras el confinamiento, centrándose en la valoración del riesgo de letalidad, el cual se incrementa debido la percepción de pérdida de control por parte del agresor

Circumstances under lockdown increase the risk factors for gender-based violence (GBV) at the individual and social level due to isolation and barriers to victims in seeking help and reporting their situation. This has the direct consequence of an increase in this violence. Initially, due to the reduced number of reports and homicides, it could be mistakenly understood that there has been a decrease in GBV. The medico-legal study of GBV under lockdown must be an evolving process that contemplates its consequences in two phases: during lockdown, with the increase in all its forms (physical, psychological and sexual), and after lockdown, focusing on fatality risk assessment, which increases due to perceived loss of control on the part of the perpetrator

Violencia y maltrato de género (I). Aspectos generales desde la perspectiva sanitaria / Gender violence and mistreatment (I). Global aspects from the health care perspective

Las consecuencias sobre la salud de la violencia de género (VG) con frecuencia se han agrupado en forma de diferentes cuadros y achaques, del mismo modo que la VG se ha invisibilizado en la sociedad alrededor de justificaciones y contextualizaciones. La transformación social y el posicionamiento crítico ante la violencia está produciendo un afloramiento de los casos, hecho que se ha traducido en un significativo aumento de las denuncias, que en los últimos cinco años ha sido del 43,5%. Estas circunstancias se han traducido en una mayor demanda de asistencia en los servicios de urgencias (SU).Sin embargo, a pesar de este incremento, la prevalencia general de la VG, establecida por la OMS alrededor del 30% de las mujeres, contrasta con la incidencia de estos casos en los SU, situada entorno al 17%, hecho que unido a que las mujeres víctimas de violencia acuden un 30% más a los servicios sanitarios que las mujeres que no sufren violencia, indica que muchos de los casos se presentarán con una sintomatología diferente a las lesiones físicas ocasionadas por las agresiones, y sin que sean relacionadas con la VG. En el presente trabajo se trata de destacar las consecuencias de la VG más allá de las agresiones puntuales y de analizar la actitud de los profesionales sanitarios ante la VG, de manera especial la de los urgenciólogos. Se pretende resaltar las limitaciones y obstáculos existentes con vista a mejorar la respuesta sin que ésta venga condicionada por las consecuencias sociales derivadas del hecho violento, ni limitadas a la acción puntual de la agresión. La actuación de los profesionales sanitarios debe centrarse en la salud de la mujer que ha sufrido la VG, y en ningún caso supeditar la asistencia clínica a otro tipo de factores (parte judicial, creencias y prejuicios,…). Los urgenciólogos deben tomar conciencia de que “no hacer es hacer mal”, porque supone permitir que la mujer continúe bajo los efectos de la VG con el consecuente deterioro progresivo de su salud. Las referencias aportadas pueden facilitar el posicionamiento de los profesionales sobre el principio de responsabilidad, y llevar una actuación sobre la VG alrededor de dos criterios muy simples: actuar como se hace ante cualquier otro problema de salud con consecuencias sociales, y hacerlo teniendo en cuenta que detrás de una agresión hay un problema de salud ocasionado por la exposición a la violencia, que en muchos casos será el que caracterice el cuadro (AU)

The consequences of gender violence on health have frequently been disguised in the form of various clinical pictures and disorders, in the same way that violence is overlooked in society through justifications and rationalizations. Social transformation and critical thought regarding violence is favouring the rise of new cases, which have translated into a significant increase in domestic violence reports filed; reaching 43.5% in the last five years. These circumstances have resulted in a higher demand for emergency healthcare services. Nevertheless, in spite of this increase, the global prevalence of gender violence (30% of women as documented by the WHO) is inconsistent with the number of cases presented to emergency department, which is approximately 17%. Besides, female victims of violence require medical services 30% more often than women who do not suffer violence indicating that many of the cases show a symptomatology not related to the physical injuries resulting from violent aggressions. The objective of the present study was to point out the consequences of violence beyond the specific aggression and to assess the view of the medical professionals with respect to gender violence, specifically that of emergency physicians and highlight the limitations and difficulties they face. This will help to ensure that physician response is not influenced by the personal consequences derived from the violent aggression and limited to that specific aggression. Medical professionals must focus on the health of the woman who suffered the violence and should in no case, provide clinical assistance based on other types of factors(police report, beliefs and prejudices,…). Emergency physicians must be aware that “to do nothing is to do harm “because otherwise, women will continue to suffer violence and their health will further deteriorate. The data reported may help professionals maintain a code of conduct and respond to cases of gender violence following two very simple criteria: to act in the same way as they would in other health situations that have personal consequences, and to bear in mind that behind an aggression there is health problem caused by violence, which in many cases will characterize the clinical picture (AU)