Facilitadores de la Violencia de Pareja Percibidos por Víctimas y Victimarios: Estudio Exploratorio en el Contexto de la Teoría del Aprendizaje Social / Facilitators of Intimate Partner Violence as Perceived by Victims and Perpetrators: An Exploratory Study in the Context of Social Learning Theory

Resumen Pocos estudios han documentado la percepción de víctimas y victimarios con respecto a los factores facilitadores e instigadores de la violencia de pareja. El objetivo del presente estudio fue evaluar la percepción de víctimas y victimarios de violencia de pareja con respecto a factores facilitadores e instigadores de la violencia. Participaron 27 víctimas de violencia de pareja con edades entre 18 y 71 años (media = 34.25) y 27 victimarios jurídicamente confirmados, con edades entre 19 y 62 años (media = 40), quienes respondieron un cuestionario integrado por una lista sobre factores facilitadores e instigadores de la violencia de pareja y de datos sociodemográficos. Ambos grupos coincidieron en señalar al estrés y consumo de sustancias como propiciadoras de violencia, así como a la madre de su pareja como instigadoras. El diseño de intervenciones para tratar o prevenir violencia de pareja requieren identificar los factores que la facilitan, incluyendo a las familias circundantes ya que podrían no sólo tolerar o justificar la violencia, sino incluso inducirla. Finalmente, se discuten algunas diferencias notorias entre perpetradores y víctimas respecto de otras variables propiciadoras de violencia en el contexto de la teoría del aprendizaje social.

Abstract Few studies have documented the opinion of victims and perpetrators regarding the facilitating and instigating factors of intimate partner violence. The objective of this study was to evaluate the perception of victims and perpetrators of intimate partner violence regarding facilitating and instigating factors of violence. Participants were 27 victims of intimate partner violence aged between 18 and 71 years (mean = 34.25) and 27 legally confirmed offenders, aged between 19 and 62 years (mean = 40), who answered a questionnaire consisting of a list of facilitating factors and instigators of intimate partner violence and sociodemographic data. Both groups agreed in pointing to stress and substance use as propitiators of violence, as well as the mother of their partner as instigators. The design of interventions to treat or prevent intimate partner violence requires identifying the factors that facilitate it, including the surrounding families, since they may not only tolerate or justify the violence, but even induce it. Finally, some notorious differences between perpetrators and victims are discussed with respect to other variables that promote violence in the context of social learning theory.

Perceptions of Community Health Workers (CHW) on barriers and enablers to care for people with psychosis in rural Mozambique: findings of a focus group discussion study using the Capability, Opportunity, Motivation and Behaviour framework (COM-B framework).

BACKGROUND: Psychotic disorders contribute significantly to the global disease burden by causing disability, impaired quality of life, and higher mortality in affected people compared with the general population. In rural settings, where there is limited or no access to healthcare, individuals living with psychotic disorders often seek support from Community Health Workers (CHWs). However, little is known about what CHWs know about psychosis and how they manage such cases. This study aimed to explore the CHWs perception of psychosis and their experiences and beliefs about the factors that might enable or hinder care-taking for patients with psychosis in rural settings in Mozambique. METHODS: A qualitative study was conducted in rural districts of Maputo Province, a southern region of Mozambique, using six focus group discussions with participation of 79 CHWs. Thematic analysis was used informed by the Capabilities, Opportunities, Motivation and Behaviour framework (COM-B). RESULTS: Nine primary themes were identified. Overall, CHWs perceived psychosis as treatable medical conditions and held a positive attitude about being part of the care-taking process of patients with psychosis in rural settings. Partnerships with key-stakeholders such as traditional healers, health care workers, and families, were perceived by CHWs as enablers to improve access to care in rural areas. However, stigma, myths, and lack of competencies to treat people with psychosis were perceived by CHWs as barriers for appropriate care. CONCLUSION: CHWs, with adequate support, could play an important role in the care of patients with psychosis in rural settings, including identifying patients requiring care and referring them to appropriate healthcare professionals, and following up medicated patients with psychosis. Training of CHWs should consider inclusion of basic mental health care competencies.

Challenges of implementing a primary health care strategy in a context of a market-oriented health care system: the experience of Bogota, Colombia.

BACKGROUND: Although Colombia has a health system based on market and neoliberal principles, in 2004, the government of the capital-Bogota-took the decision to formulate a health policy that included the implementation of a comprehensive primary health care (PHC) strategy. This study aims to identify the enablers and barriers to the PHC implementation in Bogota. METHODS: The study used a qualitative multiple case study methodology. Seven Bogota's localities were included. Eighteen semi-structured interviews with key informants (decision-makers at each locality and members of the District Health Secretariat) and fourteen FGDs (one focus group with staff members and one with community members) were carried out. Data were analysed using a thematic analysis approach. RESULTS: The main enablers found across the district and local levels showed a similar pattern, all were related to the good will and commitment of actors at different levels. Barriers included the approach of the national policies and a health system based on neoliberal principles, the lack of a stable funding source, the confusing and rigid guidelines, the high turnover of human resources, the lack of competencies among health workers regarding family focus and community orientation, and the limited involvement of institutions outside the health sector in generating intersectoral responses and promoting community participation. CONCLUSION: Significant efforts are required to overcome the market approach of the national health system. Interventions must be designed to include well-trained and motivated human resources, as well as to establish available and stable financial resources for the PHC strategy.