@article{ref1,
title="Adaptive work in the primary health care response to domestic violence in occupied Palestinian territory: a qualitative evaluation using Extended Normalisation Process  Theory",
journal="BMC family practice",
year="2021",
author="Halaseh, Rana and Owda, Heba and Alkhayyat, Ahmed S. and Jeries, Ibrahim and Sandouka, Rihab and Feder, Gene and Colombini, Manuela and Shaheen, Amira and Alkaiyat, Abdulsalam and Bacchus, Loraine J.",
volume="22",
number="1",
pages="e3-e3",
abstract="BACKGROUND: A health system response to domestic violence against women is a global priority. However, little is known about how these health system interventions work  in low-and-middle-income countries where there are greater structural barriers. Studies have failed to explore how context-intervention interactions affect  implementation processes. Healthcare Responding to Violence and Abuse aimed to  strengthen the primary healthcare response to domestic violence in occupied  Palestinian territory. We explored the adaptive work that participants engaged in to  negotiate contextual constraints. <br><br>METHODS: The qualitative study involved 18  participants at two primary health care clinics and included five women patients,  seven primary health care providers, two clinic case managers, two Ministry of  Health based gender-based violence focal points and two domestic violence trainers. Semi-structured interviews were used to elicit participants' experiences of engaging  with HERA, challenges encountered and how these were negotiated. Data were analysed  using thematic analysis drawing on Extended Normalisation Process Theory. We  collected clinic data on identification and referral of domestic violence cases and  training attendance. <br><br>RESULTS: HERA interacted with political, sociocultural and  economic aspects of the context in Palestine. The political occupation restricted  women's movement and access to support services, whilst the concomitant lack of  police protection left providers and women feeling exposed to acts of family  retaliation. This was interwoven with cultural values that influenced participants'  choices as they negotiated normative structures that reinforce violence against  women. Participants engaged in adaptive work to negotiate these challenges and  ensure that implementation was safe and workable. Narratives highlight the use of  subterfuge, hidden forms of agency, governing behaviours, controls over knowledge  and discretionary actions. The care pathway did not work as anticipated, as most  women chose not to access external support. An emergent feature of the intervention  was the ability of the clinic case managers to improvise their role. <br><br>CONCLUSIONS:  Flexible use of ENPT helped to surface practices the providers and women patients  engaged in to make HERA workable. The findings have implications for the  transferability of evidenced based interventions on health system response to  violence against women in diverse contexts, and how HERA can be sustained in the  long-term.<p /> <p>Language: en</p>",
language="en",
issn="1471-2296",
doi="10.1186/s12875-020-01338-z",
url="http://dx.doi.org/10.1186/s12875-020-01338-z"
}