How do primary health care teams learn to integrate intimate partner violence (IPV) management? A realist evaluation protocol

Background: Despite the existence of ample literature dealing, on the one hand, with the integration of innovations within health systems and team learning, and, on the other hand, with different aspects of the detection and management of intimate partner violence (IPV) within healthcare facilities, research that explores how health innovations that go beyond biomedical issues—such as IPV management—get integrated into health systems, and that focuses on healthcare teams’ learning processes is, to the best of our knowledge, very scarce if not absent. This realist evaluation protocol aims to ascertain: why, how, and under what circumstances primary healthcare teams engage (if at all) in a learning process to integrate IPV management in their practices; and why, how, and under what circumstances team learning processes lead to the development of organizational culture and values regarding IPV management, and the delivery of IPV management services. Methods: This study will be conducted in Spain using a multiple-case study design. Data will be collected from selected cases (primary healthcare teams) through different methods: individual and group interviews, routinely collected statistical data, documentary review, and observation. Cases will be purposively selected in order to enable testing the initial middle-range theory (MRT). After in-depth exploration of a limited number of cases, additional cases will be chosen for their ability to contribute to refining the emerging MRT to explain how primary healthcare learn to integrate intimate partner violence management. Discussion: Evaluations of health sector responses to IPV are scarce, and even fewer focus on why, how, and when the healthcare services integrate IPV management. There is a consensus that healthcare professionals and healthcare teams play a key role in this integration, and that training is important in order to realize changes. However, little is known about team learning of IPV management, both in terms of how to trigger such learning and how team learning is connected with changes in organizational culture and values, and in service delivery. This realist evaluation protocol aims to contribute to this knowledge by conducting this project in a country, Spain, where great endeavours have been made towards the integration of IPV management within the health system.

Developing a programme theory to explain how primary health care teams learn to respond to intimate partner violence: a realist case-study

Background: Despite the progress made on policies and programmes to strengthen primary health care teams’ response to Intimate Partner Violence, the literature shows that encounters between women exposed to IPV and health-care providers are not always satisfactory, and a number of barriers that prevent individual health-care providers from responding to IPV have been identified. We carried out a realist case study, for which we developed and tested a programme theory that seeks to explain how, why and under which circumstances a primary health care team in Spain learned to respond to IPV. Methods: A realist case study design was chosen to allow for an in-depth exploration of the linkages between context, intervention, mechanisms and outcomes as they happen in their natural setting. The first author collected data at the primary health care center La Virgen (pseudonym) through the review of documents, observation and interviews with health systems’ managers, team members, women patients, and members of external services. The quality of the IPV case management was assessed with the PREMIS tool. Results: This study found that the health care team at La Virgen has managed 1) to engage a number of staff members in actively responding to IPV, 2) to establish good coordination, mutual support and continuous learning processes related to IPV, 3) to establish adequate internal referrals within La Virgen, and 4) to establish good coordination and referral systems with other services. Team and individual level factors have triggered the capacity and interest in creating spaces for team leaning, team work and therapeutic responses to IPV in La Virgen, although individual motivation strongly affected this mechanism. Regional interventions did not trigger individual and/ or team responses but legitimated the workings of motivated professionals. Conclusions: The primary health care team of La Virgen is involved in a continuous learning process, even as participation in the process varies between professionals. This process has been supported, but not caused, by a favourable policy for integration of a health care response to IPV. Specific contextual factors of La Virgen facilitated the uptake of the policy. To some extent, the performance of La Virgen has the potential to shape the IPV learning processes of other primary health care teams in Murcia.

A "Know-How vs. Know-What" Approach in the Teaching-Learning of Competences in Physical Chemistry

The methodological approach a teacher uses in the competence teaching-learning process determines the way students learn. Knowledge can be acquired from a series of perspectives, mainly: “know-what” (concept), where facts and descriptions of (natural or social) phenomena are pursued; “know-how” (procedure), where methods and procedures for their application are described; and “know-why” (competence), where general principles and laws that explain both the facts and their applications are sought. As all the three cases are interconnected, the boundaries between them are not fully clear and their application uses shared elements. In any case, the depth of student’s acquired competences will be directly affected by the teaching-learning perspective, traditionally aiming to a “know-why” approach for full competence acquisition. In this work, we discuss a suitable teaching-learning methodology for evaluating whether a “know-how”, “know-what” or combined approach seems better for enhancing competence learning in students. We exemplify the method using a selection of formative activities from the Physical Chemistry area in the Grades of Chemistry and Chemical Engineering.

Changes in how prospective teachers anticipate secondary students’ answers

This study focuses on how prospective teachers learn about students’ mathematical thinking when (i) anticipating secondary students’ answers reflecting different characteristics of understanding and (ii) propose new activities in relation to the classification of quadrilaterals. The data were collected from forty-eight prospective secondary school teachers enrolled in an initial training programme. The results indicate three changes in how the prospective teachers anticipate secondary students’ answers in relation to the role given to a perceptual or relational perspective of the classification of quadrilaterals. These changes are described considering how prospective teachers grasp the students’ understanding of the inclusive relation among quadrilaterals as a conceptual advance. We argue that prospective teachers’ learning was promoted after participating in a structured environment where they had the opportunity to discuss how to recognize the features of student’s understanding.