Quality of Care for Intimate Partner Violence in South African Primary Care: Qualitative Study

Wednesday, 24 July 2013: 9:10 AM

Kate Joyner, DPhil, MSocSci, BSocSci, DipNsgMidwifery
Department of Nursing, Stellenbosch University, Tygerberg, South Africa

Learning Objective 1: The learner will be able to improve recognition and clinical management of women experiencing intimate partner violence within scarcely-resourced health contexts.

Learning Objective 2: The learner will appreciate the value and importance of a biopsychosocial and forensic approach to addressing the global public health problem of intimate partner violence.

Purpose: To explore the current quality of care for intimate partner violence (IPV) in South African public sector primary care facilities of the Western Cape.

Methods: This is a subsection of a larger project which implemented, modified and evaluated a screening and management protocol for IPV in South African primary care. In the larger study, 168 women were identified as having lived with IPV while attending primary care for the previous two years. Yet only 11 (9.6%) were recognized. A structured record of the protocol consultation and semi-structured follow up interview captured each patient’s story verbatim or paraphrased it in a narrative style. This qualitative data was triangulated with an inspection of their medical records to construct detailed case studies of their experience of IPV, health seeking behavior and experience of health care. A thematic content analysis of the case studies was performed using Atlas.ti software.

Results: Only 10% of women who attended primary health care, while suffering from IPV, were recognized. Their care tended to be superficial, fragmented and mostly involved referral to other service providers. Key themes for exploration are poor recognition of mental health problems and quality of counseling; recognition of IPV without action; inadequate suicide prevention; poor record keeping, continuity and coordination of care; cultural entrapment; and intimate terrorism.  

Conclusion:  Despite lip service to holistic care, the training and subsequent practice of South African primary care practitioners remains biomedical and task-oriented. Providers struggle to provide a patient-centred approach, with significant repercussions for the provision of IPV care. By implication, training of clinical nurse and medical practitioners should focus on developing a biopsychosocial approach so that relevant psychological and social problems can be identified and a response initiated.