Using realist evaluation to assess primary healthcare teams’ responses to intimate partner violence in Spain

Objective: Few evaluations have assessed the factors triggering an adequate health care response to intimate partner violence. This article aimed to: 1) describe a realist evaluation carried out in Spain to ascertain why, how and under what circumstances primary health care teams respond to intimate partner violence, and 2) discuss the strengths and challenges of its application. Methods: We carried out a series of case studies in four steps. First, we developed an initial programme theory (PT1), based on interviews with managers. Second, we refined PT1 into PT2 by testing it in a primary healthcare team that was actively responding to violence. Third, we tested the refined PT2 by incorporating three other cases located in the same region. Qualitative and quantitative data were collected and thick descriptions were produced and analysed using a retroduction approach. Fourth, we analysed a total of 15 cases, and identified combinations of contextual factors and mechanisms that triggered an adequate response to violence by using qualitative comparative analysis. Results: There were several key mechanisms —the teams’ self-efficacy, perceived preparation, women-centred care—, and contextual factors —an enabling team environment and managerial style, the presence of motivated professionals, the use of the protocol and accumulated experience in primary health care—that should be considered to develop adequate primary health-care responses to violence. Conclusion: The full application of this realist evaluation was demanding, but also well suited to explore a complex intervention reflecting the situation in natural settings.

Trends and Disparities in Mortality Among Spanish-Born and Foreign-Born Populations Residing in Spain, 1999–2008

Spain’s immigrant population has increased 380 % in the last decade, accounting for 13.1 % of the total population. This fact has led her to become during 2009 the eighth recipient country of international immigrants in the world. The aim of this article is to describe the evolution of mortality and the main causes of death among the Spanish-born and foreign-born populations residing in Spain between 1999 and 2008. Age-standardised mortality rates (ASRs), average age and comparative mortality ratios among foreign-born and Spanish-born populations residing in Spain were computed for every year and sub-period by sex, cause of death and place of birth as well as by the ASR percentage change. During 1999–2008 the ASR showed a progressive decrease in the risk of death in the Spanish-born population (−17.8 % for men and −16.6 % for women) as well as in the foreign-born one (−45.9 % for men and −35.7 % for women). ASR also showed a progressive decrease for practically all the causes of death, in both populations. It has been observed that the risk of death due to neoplasms and respiratory diseases among immigrants is lower than that of their Spanish-born counterparts, but risk due to external causes is higher. Places of birth with the greater decreases are Northern Europe, Eastern Europe, Western Europe, Southern Europe, and Latin America and the Caribbean. The research shows the differences in the reduction of death risk between Spanish-born and immigrant inhabitants between 1999 and 2008. These results could contribute to the ability of central and local governments to create effective health policy. Further research is necessary to examine changes in mortality trends among immigrant populations as a consequence of the economic crisis and the reforms in the Spanish health system. Spanish data sources should incorporate into their records information that enables them to find out the immigrant duration of permanence and the possible impact of this on mortality indicators.

Validation of a Spanish version of the Distance Education Learning Environments Survey (DELES) in Spain

The aim of this study was to examine the validity of the Spanish version of the Distance Education Learning Environments Survey (Sp-DELES). This instrument assesses students’ perceptions of virtual learning environments using six scales: Instructor Support, Student Interaction and Collaboration, Personal Relevance, Authentic Learning, Active Learning, and Autonomy. Further, the Sp-DELES includes an additional scale that assesses students’ Satisfaction with their classes. The original DELES has been used in at least 27 independent studies with strong reliability and validity. For this study, we sampled 265 students from the University of Alicante enrolled in various hybrid and distance education courses taught by the Department of Health Psychology. We analysed the Sp-DELES for validity using principal component factor analysis with varimax rotation, and for reliability using Cronbach’s alpha. The Sp-DELES exhibited good reliability (Cronbach’s alpha for the scales ranging from 0.86 to 0.97) and the original six-factor structure was replicated and accounted for 72.9 % of the total variance. Overall the results are consistent with those of the original English-language version of the instrument. The Sp-DELES has proven to be a reliable and valid instrument for assessing psychosocial learning environments in tertiary-level hybrid and distance-education settings.

The regulation of professional advertising practices in Spain, 1988–2013

From the perspective of the sociology of professions, every professional activity should have its own clearly circumscribed and regulated sphere of action. Such an articulation facilitates the regulation of the production of a given profession as well as the way in which it is practiced. The purpose of the research reported here was to provide a comprehensive review and evaluation of the regulatory framework governing the advertising sector in Spain. To this end, the authors analysed external regulatory legislation and self-regulatory codes extracted from the data base of the Asociación para la Autoregulación de la Comunicación Comercial (Autocontrol) that had been enacted or adopted between 1988, the year that Law 11/1998 on General Telecommunications entered into force, and 2003 as well as other relevant documents retrieved from the Boletin Oficial del Estado (BOE) pertaining to the same period. Findings indicate that although there has been a groundswell of legislation governing advertising practices in Spain since 1988, especially at the regional level, lawmakers have focused on the content of advertising messages and shown very little interest in regulating the professions of advertising and public relations. Furthermore, Spanish legislation enacted in 2003 and EU policies appear to have encouraged the adoption of voluntary codes of ethics. Sectors traditionally subject to mandatory advertising regulation, either due to the vulnerability of their target audiences or the potential impact of their commercial messages on public health or the environment, are more likely to develop self-regulatory codes of conduct than others

Factors Associated With Women’s Reporting of Intimate Partner Violence in Spain

In Spain, in 2013, the 20% of women who were murdered by their partner had reported him previously. We analyze the 2011 Spanish-Macrosurvey on Gender Violence to identify and analyze the prevalence of and the principal factors associated with reporting a situation of intimate partner violence (IPV) and the main reasons women cite for not filing such reports, or for subsequently deciding to withdraw their complaint. Overall, 72.8% of women exposed to IPV did not report their aggressor. The most frequent reasons for not reporting were not giving importance to the situation (33.9%), and fear and lack of trust in the reporting process (21.3%). The main reasons for withdrawing the complaint were cessation of the violence (20.0%), and fear and threats (18.2%). The probability of reporting increased among women with young children who were abused, prevalence ratio (95% confidence interval [CI]): 2.14 [1.54, 2.98], and those whose mother was abused, prevalence ratio (95% CI): 2.25 [1.42, 3.57]. Always focusing on the need to protect women who report abuse, it is necessary to promote the availability of and access to legal resources especially among women who use them less: women who do not have children and women who do not have previous family exposure to violence.

Estimation of the Proportion of Underachieving Students in Compulsory Secondary Education in Spain: An Application of the Rasch Model

There are very few studies in Spain that treat underachievement rigorously, and those that do are typically related to gifted students. The present study examined the proportion of underachieving students using the Rasch measurement model. A sample of 643 first-year high school students (mean age = 12.09; SD = 0.47) from 8 schools in the province of Alicante (Spain) completed the Battery of Differential and General Skills (Badyg), and these students' General Points Average (GPAs) were recovered by teachers. Dichotomous and Partial credit Rasch models were performed. After adjusting the measurement instruments, the individual underachievement index provided a total sample of 181 underachieving students, or 28.14% of the total sample across the ability levels. This study confirms that the Rasch measurement model can accurately estimate the construct validity of both the intelligence test and the academic grades for the calculation of underachieving students. Furthermore, the present study constitutes a pioneer framework for the estimation of the prevalence of underachievement in Spain.

The SAAS-R: A New Instrument to Assess the School Attitudes of Students with High and Low Academic Achievement in Spain

We examined the psychometric properties of the School Attitude Assessment Survey–Revised in a Spanish population (n = 1,398). Confirmatory factor analysis procedures supported the instrument’s five-factor structure. The results of discriminant analysis demonstrated the predictive power of the School Attitude Assessment Survey–Revised scales as regards academic performance. Implications for education and assessment are discussed.

Health-related quality of life and determinant factors in celiac disease. A population-based analysis of adult patients in Spain

Background: Celiac disease (CD) has a negative impact on the health-related quality of life (HRQL) of affected patients. Although HRQL and its determinants have been examined in Spanish CD patients specifically recruited in hospital settings, these aspects of CD have not been assessed among the general Spanish population. Methods: An observational, transversal study of a non-randomized, representative sample of adult celiac patients throughout all of Spain's Autonomous Regions. Subjects were recruited through celiac patient associations. A Spanish version of the self-administered Celiac Disease-Quality of Life (CD-QOL) questionnaire was used. Determinant factors of HRQL were assessed with the aid of multivariate analysis to control for confounding factors. Results: We analyzed the responses provided by 1,230 patients, 1,092 (89.2%) of whom were women. The overall mean value for the CD-QOL index was 56.3 ± 18.27 points. The dimension that obtained the most points was dysphoria, with 81.3 ± 19.56 points, followed by limitations with 52.3 ± 23.43 points; health problems, with 51.6 ± 26.08 points, and inadequate treatment, with 36.1 ± 21.18 points. Patient age and sex, along with time to diagnosis, and length of time on a gluten-free diet were all independent determinant factors of certain dimensions of HRQL: women aged 31 to 40 expressed poorer HRQL while time to diagnosis and length of time on a gluten-free diet were determinant factors for better HRQL scores. Conclusions: The HRQL of adult Spanish celiac subjects is moderate, improving with the length of time patients remain on a gluten-free diet.

Handing Down and Adaption: The Construction of the Material World of Health Care Technology in Spain (1855-1955)

This historical study uses qualitative methods to analyze and describe the components of the material world of nursing care in Spain between 1855 and 1955 based on the analysis of eight nurse training manuals. A total of 360 objects and 45 procedures were recorded. Manual analysis was carried out concurrently with data collection based on the Grounded Theory approach. Findings show that the material world of health care was composed of objects that were handed down by the medical profession to health care professionals and adapted objects, improvised mainly out of everyday household items. While the handing down of medical tools and instruments could be said to be a theoretical and technical achievement, it is not clear whether it was also a scientific accomplishment. The improvisation of objects out of everyday household items promoted by the manuals highlights the artisan-like and ingenious nature of nursing practice, which should be explored further in future studies to provide a greater understanding and promote the recognition of these objects as a health care technology.