Applying the WHO recommendations on health-sector response to violence against women to assess the Spanish health system. A mixed methods approach

This methodological note describes the development and application of a mixed-methods protocol to assess the responsiveness of Spanish health systems to violence against women in Spain, based on the World Health Organization (WHO) recommendations. Five areas for exploration were identified based on the WHO recommendations: policy environment, protocols, training, accountability/monitoring, and prevention/promotion. Two data collection instruments were developed to assess the situation of 17 Spanish regional health systems (RHS) with respect to these areas: 1) a set of indicators to guide a systematic review of secondary sources, and 2) an interview guide to be used with 26 key informants at the regional and national levels. We found differences between RHSs in the five areas assessed. The progress of RHSs on the WHO recommendations was notable at the level of policies, moderate in terms of health service delivery, and very limited in terms of preventive actions. Using a mixed-methods approach was useful for triangulation and complementarity during instrument design, data collection and interpretation.

Esta nota metodológica describe el desarrollo de un protocolo de investigación que utiliza métodos mixtos para evaluar la respuesta del sistema sanitario español a la violencia contra las mujeres, partiendo de las recomendaciones de la Organización Mundial de la Salud (OMS). A partir de estas recomendaciones, se definieron cinco áreas para su evaluación: políticas, protocolos, formación, rendición de cuentas/monitoreo, y acciones de prevención y promoción. Se desarrollaron dos instrumentos — un conjunto de indicadores para orientar la revisión sistemática de fuentes secundarias, y una guía de entrevista, que se utilizó con 26 informantes clave — y se aplicaron en los 17 sistemas sanitarios autonómicos. Se evidenciaron diferencias entre autonomías y entre las cinco áreas evaluadas: notable progreso en políticas, menos destacado en la prestación de servicios y muy limitados en acciones preventivo-promocionales. Combinar métodos permitió lograr triangulación, complementariedad y desarrollo, durante el diseño de los instrumentos, la recogida de información y su interpretación.

This study has been funded by a COFAS grant (supported by COFUND action within the Marie Curie Action People, in the Seventh Framework programme and the Swedish Council for Working Life and Social Research/FAS-Forskningsradet för arbetsliv och socialvetenskap).