Browsing by Author "Rees, Kate"

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    Implementing intimate partner violence care in a rural sub-district of South Africa: a qualitative evaluation
    (2015) Rees, Kate; Zweigenthal, Virginia; Joyner, Kate
    Background: Despite a high burden of disease, in many health districts in the Wes tern Cape, South Africa, intimate partner violence is known to be poorly recognised and managed. To address this gap in service an innovative intersectoral model for the delivery of comprehensive intimate partner violence (IPV) care was piloted in the Witzenberg, a rural, agricultural sub - district known to have a high incidence of IPV. It was not known whether the initiative was a success from the perspective of the women using the service, from the service providers or from the managers. Methods: A qualitative evaluation was conducted. Ten service users were interviewed to explore their experience of the intervention. Two focus groups were conducted amongst health care workers, and one focus group and six interviews were conducted with the intersectoral implementation team, to understand their experience of implementing the intervention. Documents relating to the pilot were also analysed. A contextualized thematic content analysis approach was used, triangulating the various sources of data, and utilising inductive as well as deductive approaches. Results: Over the pilot period 75 women received the intervention. Study participants described their experience of it 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 health care workers, barriers to inquiry about intimate partner violence 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 impacted on the pilot, affecting 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 socioeconomic disempowerment highlighted the need for a multifaceted approach to addressing intimate partner violence. Conclusion: The results of this qualitative evaluation draw attention to the need to take a health systems approach and focus on contextual factors when implementing complex interventions. They will be used to inform decisions about instituting appropriate intimate partner violence care in the rest of the province. Additionally, there is a pressing need for clear policies and guidelines framing intimate partner violence as a health issue.