Mapping the role of structural and interpersonal violence in the lives of women: implications for public health interventions and policy.

BACKGROUND: Research on interpersonal violence towards women has commonly focused on individual or proximate-level determinants associated with violent acts ignores the roles of larger structural systems that shape interpersonal violence. Though this research has contributed to an understanding of the prevalence and consequences of violence towards women, it ignores how patterns of violence are connected to social systems and social institutions. METHODS: In this paper, we discuss the findings from a scoping review that examined: 1) how structural and symbolic violence contributes to interpersonal violence against women; and 2) the relationships between the social determinants of health and interpersonal violence against women. We used concept mapping to identify what was reported on the relationships among individual-level characteristics and population-level influence on gender-based violence against women and the consequences for women's health. Institutional ethics review was not required for this scoping review since there was no involvement or contact with human subjects. RESULTS: The different forms of violence-symbolic, structural and interpersonal-are not mutually exclusive, rather they relate to one another as they manifest in the lives of women. Structural violence is marked by deeply unequal access to the determinants of health (e.g., housing, good quality health care, and unemployment), which then create conditions where interpersonal violence can happen and which shape gendered forms of violence for women in vulnerable social positions. Our web of causation illustrates how structural factors can have negative impacts on the social determinants of health and increases the risk for interpersonal violence among women. CONCLUSION: Public health policy responses to violence against women should move beyond individual-level approaches to violence, to consider how structural and interpersonal level violence and power relations shape the 'lived experiences' of violence for women.

The value of frameworks as knowledge translation mechanisms to guide community participation practice in Ontario CHCs.

The community participation literature has produced numerous frameworks to guide practice and evaluation of community participation strategies in the health sector. These frameworks are useful starting points for differentiating the approaches for involving people in planning and decision-making for health services, but have been critiqued for being too generic and ignoring that community participation is highly contextual and situational. Health service organizations across Canada and internationally have begun to respond to address this limitation by developing more context-specific community participation frameworks; however, such frameworks do not exist for Ontario Community Health Centres (CHCs)-local primary health care organizations with a mandate to engage marginalized groups in planning and decision-making for health services. We conducted a series of focus groups with staff members from four Ontario CHCs to: (1) examine the factors that would influence their use of a generic framework for community participation with marginalized populations; and (2) improve the "context-specificity" of this framework, to enhance its relevance to CHCs. Participants described the difficulty of organizing the contextual, multi-faceted and situational process of community participation that they experienced with marginalized populations into a single framework, which led them to question the value of using frameworks as a resource for guiding the design, implementation and evaluation of their community participation initiatives. Instead, participants revealed that tacit knowledge, in the form of professional and personal experience and local knowledge of a marginalized population, had a greater influence on guiding participation activities in Ontario CHCs. Our findings suggest that tacit knowledge is an essential feature of community participation practice and requires further exploration regarding its role in the community participation field.