Mechanisms that Trigger a Good Health-Care Response to Intimate Partner Violence in Spain. Combining Realist Evaluation and Qualitative Comparative Analysis Approaches

Background. Health care professionals, especially those working in primary health-care services, can play a key role in preventing and responding to intimate partner violence. However, there are huge variations in the way health care professionals and primary health care teams respond to intimate partner violence. In this study we tested a previously developed programme theory on 15 primary health care center teams located in four different Spanish regions: Murcia, C Valenciana, Castilla-León and Cantabria. The aim was to identify the key combinations of contextual factors and mechanisms that trigger a good primary health care center team response to intimate partner violence. Methods. A multiple case-study design was used. Qualitative and quantitative information was collected from each of the 15 centers (cases). In order to handle the large amount of information without losing familiarity with each case, qualitative comparative analysis was undertaken. Conditions (context and mechanisms) and outcomes, were identified and assessed for each of the 15 cases, and solution formulae were calculated using qualitative comparative analysis software. Results. The emerging programme theory highlighted the importance of the combination of each team’s self-efficacy, perceived preparation and women-centredness in generating a good team response to intimate partner violence. The use of the protocol and accumulated experience in primary health care were the most relevant contextual/intervention conditions to trigger a good response. However in order to achieve this, they must be combined with other conditions, such as an enabling team climate, having a champion social worker and having staff with training in intimate partner violence. Conclusions. Interventions to improve primary health care teams’ response to intimate partner violence should focus on strengthening team’s self-efficacy, perceived preparation and the implementation of a woman-centred approach. The use of the protocol combined with a large working experience in primary health care, and other factors such as training, a good team climate, and having a champion social worker on the team, also played a key role. Measures to sustain such interventions and promote these contextual factors should be encouraged.

Australian water mass variations from GRACE data linked to Indo-Pacific climate variability

Time-variable gravity data from the Gravity Recovery And Climate Experiment (GRACE) mission are used to study total water content over Australia for the period 2002–2010. A time-varying annual signal explains 61% of the variance of the data, in good agreement with two independent estimates of the same quantity from hydrological models. Water mass content variations across Australia are linked to Pacific and Indian Ocean variability, associated with El Niño-Southern Oscillation (ENSO) and the Indian Ocean Dipole (IOD), respectively. From 1989, positive (negative) IOD phases were related to anomalously low (high) precipitation in southeastern Australia, associated with a reduced (enhanced) tropical moisture flux. In particular, the sustained water mass content reduction over central and southern regions of Australia during the period 2006–2008 is associated with three consecutive positive IOD events.