Program for increasing resident's physical activity at the women's home

Obesity and overweight has reached epidemic proportions in the United States, and the prevalence of overweight and obesity among residents of The Women's Home residents is high. This culminating experience is the result of my practicum at The Women's Home located in Houston, TX. The Women's Home is a rehabilitation center for victims of sexual assault, drug abuse, family violence, or a combination. A needs assessment including focus groups and a literature review was conducted to design a a physical activity intervention for the residents. Results from focus group data showed the resident's average BMI was 32, which is termed clinically obese by American standards. The focus groups determined a strong interest (92%) in engaging in more physical activity to combat their weight problem. As well, they expressed interest in using pedometers as a mechanism to increase physical activity. This planned program, “Every Step Counts”, uses reactivity to pedometers in conjunction with goal setting and increased awareness to increasing steps each day. “Every Step Counts” was developed with support and input from stakeholders, with theoretical constructs and previous evidence based studies. Included in this report are recommendations for implementation, program materials, scope and sequence of program activities, and methods for periodic evaluation.^

PTSD, Depression, and Substance Abuse Symptoms in Women Exposed to Intimate Partner Abuse

The present study explores relationships among several established correlates of trauma in women exposed to intimate partner abuse (IPA), including PTSD, depression, and dissociation symptoms as well as alcohol use as well as other trauma-related variables, such as social support and violence exposure. Two analysis methods were utilized: variable-oriented methods, which examine relationships between variables, and person-oriented analysis methods, which examine groupings of participants within a larger sample (N = 233). Results of the variable-oriented analyses indicated positive links among depression, PTSD, dissociation, and alcohol use in women exposed to IPA, as well as positive links between the aforementioned psychological symptoms and exposure to violence. Social support was related to decreased psychological symptoms. Person-oriented analyses indicated the presence of four unique profiles of women within the larger study sample: Profile 1 (n = 21), which was labeled High Dissociation, Low Depression/PTSD; Profile 2 (n = 150), which was labeled Low Symptoms, High Social Support, Profile 3 (n = 41); which was labeled Low Dissociation, High Depression/PTSD; and Profile 4 (n = 22), which was labeled High Symptoms, Low Social Support. This research supports previous findings about the relationships among several variables related to IPA as well as suggests the need for careful consideration of differences among women within the larger context of research, advocacy, and clinical interventions related to IPA.

Mental health literacy of Latina women in the United States for their school-aged children

Despite known mental health (MH) disparities faced by Latino children relative to children from other minority groups of similar socioeconomic status (SES), little is known about how Latina mothers make MH decisions for their children. The present study examined links between Latina mothers' mental health literacy (MHL), including the recognition of and response to child psychiatric symptoms, and maternal acculturation factors as well as interpersonal violence (IPV) related symptomatology. Participants were 80 Latina mothers from Denver, Colorado and Modesto, California with at least one child between the ages of 8-12 years. Mothers were presented vignettes depicting child internalizing and externalizing disorders as well as interviewed about their help seeking behaviors. Maternal acculturation was not related to identification of disorders, but was related to more symptoms recognized for child internalizing and externalizing symptoms. Acculturation predicted use of formal source of care for child internalizing and externalizing disorder. Women demonstrated a preference for informal source of care, with the exception of IPV-related child symptoms, where women demonstrated a preference for formal source of care. IPV-related symptoms did not moderate the relationship between acculturation and MHL. The relationship between maternal acculturation, IPV related symptomatology and their combined effect on MHL for child psychiatric disorders are discussed.

Women Who Kill Women

This article focuses on the phenomenon of women who kill women in the context of India’s dowry murders. Killing by females is rare, and killing of other females is rarer still. India’s dowry deaths, where mothers-in-law are, next to husbands, the most accused and convicted, represents a unique opportunity to examine the mechanics around women who kill, especially in the context of a gender violence crime. The article examines both the roots of the dowry system and the current anti-dowry and dowry-violence legislation to demonstrate the implicit and accepted gender inequities within marriage that serve to under gird an overall system of female oppression within the marital relationship. This inequity is understood to be a positive aspect within marriage, but ironically negative within public Indian society. The article then considers various theories of agency and motivation from social science and feminist literature to answer why some women participate in oppressing other women in Indian society. Finally, the article notes some of the ways in which Indian courts are contributing to the oppressive power structure by limiting the application of the anti-dowry and dowry-violence laws.

Social determinants and health effects of low and high severity intimate partner violence

PURPOSE: We sought to analyze whether the sociodemographic profile of battered women varies according to the level of severity of intimate partner violence (IPV), and to identify possible associations between IPV and different health problems taking into account the severity of these acts. METHODS: A cross-sectional study of 8,974 women (18-70 years) attending primary healthcare centers in Spain (2006-2007) was performed. A compound index was calculated based on frequency, types (physical, psychological, or both), and duration of IPV. Descriptive and multivariate procedures using logistic regression models were fitted. RESULTS: Women affected by low severity IPV and those affected by high severity IPV were found to have a similar sociodemographic profile. However, divorced women (odds ratio [OR], 8.1; 95% confidence interval [CI], 3.2-20.3), those without tangible support (OR, 6.6; 95% CI, 3.3-13.2), and retired women (OR, 2.7; 95% CI, 1.2-6.0) were more likely to report high severity IPV. Women experiencing high severity IPV were also more likely to suffer from poor health than were those who experienced low severity IPV. CONCLUSIONS: The distribution of low and high severity IPV seems to be influenced by the social characteristics of the women involved and may be an important indicator for estimating health effects. This evidence may contribute to the design of more effective interventions.

Professionals’ Perceptions of Support Resources for Battered Immigrant Women Chronicle of an Anticipated Failure

The aim of this study was to explore the experience of service providers in Spain regarding their daily professional encounters with battered immigrant women and their perception of this group’s help-seeking process and the eventual abandonment of the same. Twenty-nine in-depth interviews and four focus group discussions were conducted with a total of 43 professionals involved in providing support to battered immigrant women. We interviewed social workers, psychologists, intercultural mediators, judges, lawyers, and public health professionals from Spain. Through qualitative content analysis, four categories emerged: (a) frustration with the victim’s decision to abandon the help-seeking process, (b) ambivalent positions regarding differences between immigrant and Spanish women, (c) difficulties in the migratory process that may hinder the help-seeking process, and (d) criticisms regarding the inefficiency of existing resources. The four categories were cross-cut by an overarching theme: helping immigrant women not to abandon the help-seeking process as a chronicle of anticipated failure. The main reasons that emerged for abandoning the help-seeking process involved structural factors such as economic dependence, loss of social support after leaving their country of origin, and limited knowledge about available resources. The professionals perceived their encounters with battered immigrant women to be frustrating and unproductive because they felt that they had few resources to back them up. They felt that despite the existence of public policies targeting intimate partner violence (IPV) and immigration in Spain, the resources dedicated to tackling gender-based violence were insufficient to meet battered immigrant women���s needs. Professionals should be trained both in the problem of IPV and in providing support to the immigrant population.

How Does Intimate Partner Violence Differ Depending on Level of Rurality of Residential Area in Spain?

Intimate partner violence (IPV) is recognized as a worldwide public health problem. Most theories ascribe IPV to individual, family, or cultural factors. Authors analyzed different residential areas in Spain in terms of IPV frequency as well as its impact on health and the use of services. A standardized self-administered cross-sectional survey was administered to ever-partnered adult women ages 18 to 70 years receiving care at primary health care centers (N = 10,322). Logistic regression analyzed the association between the level of rurality and health indicators, IPV, and use of services. The lowest frequency of IPV among women is reflected in higher rurality. Women of medium and low rurality presented a poorer self-perceived health and more physical health problems. Women from medium and low rurality areas declared seeking health services more frequently. These results show the importance of the environment in health and indicate the need for research on urban–rural differences in health problems to develop specific public health programs for each country.

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.

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.

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.

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.

Health-Sector Responses to Intimate Partner Violence Fitting the Response Into the Biomedical Health System or Adapting the System to Meet the Response?

This study aims to analyze how middle-level health systems’ managers understand the integration of a health care response to intimate partner violence (IPV) within the Spanish health system. Data were obtained through 26 individual interviews with professionals in charge of coordinating the health care response to IPV within the 17 regional health systems in Spain. The transcripts were analyzed following grounded theory in accordance with the constructivist approach described by Charmaz. Three categories emerged, showing the efforts and challenges to integrate a health care response to IPV within the Spanish health system: “IPV is a complex issue that generates activism and/or resistance,” “The mandate to integrate a health sector response to IPV: a priority not always prioritized,” and “The Spanish health system: respectful with professionals’ autonomy and firmly biomedical.” The core category, “Developing diverse responses to IPV integration,” crosscut the three categories and encompassed the range of different responses that emerge when a strong mandate to integrate a health care response to IPV is enacted. Such responses ranged from refraining to deal with the issue to offering a women-centered response. Attempting to integrate a response to nonbiomedical health problems as IPV into health systems that remain strongly biomedicalized is challenging and strongly dependent both on the motivation of professionals and on organizational factors. Implementing and sustaining changes in the structure and culture of the health care system are needed if a health care response to IPV that fulfills the World Health Organization guidelines is to be ensured.

Quand la réadaptation blesse? Éducateurs victimes de violence

Cette étude vise à comprendre le phénomène de la violence physique vécue par les éducateurs oeuvrant dans dix Centres Jeunesse (CJ) du Québec. Pour ce faire, un sondage de victimisation a été administré à 586 éducateurs en internat. En premier lieu, la prévalence de cette problématique sera établie. Par la suite, les facteurs individuels et environnementaux prédisposant aux agressions physiques seront identifiés. Des éducateurs sondés, 53,9 % rapportent avoir été victimes de violence physique au cours de la dernière année. Sur le plan individuel, être affecté par les manifestations agressives des clients et la fréquence des violences psychologiques subies augmentent les risques de victimisation physique. Quant au contexte, l’âge de la clientèle et le motif de l’intervention (basé sur la loi justifiant le placement) auprès de l’enfant ou de l’adolescent influencent l’occurrence des actes violents dirigés contre les éducateurs. Nos analyses montrent également que les violences physiques dont sont victimes les éducateurs affectent autant l’individu que l’institution. L’identification de facteurs permettant de prédire les risques de victimisation pourrait notamment servir à orienter les programmes de prévention de la violence dans les CJ, mais aussi à cibler les éducateurs les plus à risque afin de leur fournir un soutien adapté.

Elizabethan England in gentle and simple life.: Being I. England's address to her three daughters, the Universities of Cambridge and Oxford, and Lincoln's Inn: from Polimanteia, 1595. II. A quest of enquirie by women to know whether the tripe-woman was trimmed, 1595.

The dedication to Polimanteia is signed W.C., and the work has been ascribed to William Clerke or Clarke.

Programs providing services to battered women /

Description based on: 3rd ed., 2nd revision (June 1980)