| Colombini et al. 2012
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Lack of support at management level. Clinical guidelines were developed, but not always used. Referral options were limited, coordination was dysfunctional, little clarity on roles of different actors. Training availability was limited; too focused on sexual violence, forensic evidence, and medical treatment; lacked focus on intimate partner violence. Lack of health worker supervision.
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Comprehensive services such as counseling, medical care, support services, police and collection of forensic evidence, legal aid, and temporary shelter were provided. Internal referral systems and interagency network‐facilitated referrals and collaboration. In some instances, “IPV champions” (e.g., head of emergency department) supported the response.
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| Cripe et al. 2010
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Ineffective justice and police systems leading to low uptake of community resource referral and abused women seeking help from informal sources. IPV laws and policies have not been fully implemented or enforced.
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Not documented |
| Guedes et al. 2002
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Despite training, certain health care professionals were disrespectful of women because of professional, class, ethnic, or gender hierarchies. Sustaining costs for lawyers in‐house and for staff time to accompany women to legal services.
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Clients’ privacy and confidentiality was respected through improved physical infrastructure, adjusting client flow, and revising policies to protect client records. Training that addressed participants’ own beliefs and concerns regarding IPV (taking human rights perspective). Management support on IPV (e.g. policies on recruitment changed—new staff asked about IPV). Referrals: strengthened referrals to legal services, and some clinics hired a lawyer in‐house. Women found it helpful when clinic staff accompanied them to legal services. External support from other GBV networks: joined local‐ and national‐level networks to advocate for legal and judicial reforms on IPV.
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| Joyner and Mash 2012a
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Providers were equipped with a laminated list of possible screening questions. Easy access to on‐site support via “IPV champions.” Training of all staff (including managers) led to increased management support for implementing the intervention. Referrals from study nurses increased women's chances of accessing legal services.
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| Joyner and Mash 2012b
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Reluctance to screen because of: possible personal experiences with IPV; could take extra time; fear of invading clients’ privacy and being targeted by partners; perception of IPV as a social not biomedical problem; busy and heavy workload; lack of knowledge and skills to manage mental health issues. |
Demonstrated commitment of some health providers. |
| Rees, Zweigenthal, and Joyner 2014
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Limited availability: Intervention provided only once a month due to a lack of resources, with one service provider having ten days a month to dedicate to the intervention. Timing of the intervention was also problematic for the same reason, leading to long wait (up to a month) from time of referral. Poor intersectoral collaboration due to lack of resources and support. Lack of management support; organizational limitations. Lack of structured follow‐up system. Negative attitudes of health workers toward IPV, and limited mental health knowledge and skills among social workers.
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Referrals to mental health services were high (although referral pathways were not always effective). Existence of formal structures of intersectoral collaboration (e.g., intersectoral committee), informal relationships and communication, as well as shared ownership, were found significant.
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| Turan et al. 2013
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Some male health workers and community volunteers were criticized by other community members for involvement in GBV services. Most participants stressed the need for repeated refresher trainings and sensitization for service providers and local partners (including local administration and police) as well as additional counseling skills for community volunteers and health workers. Criminal and legal proceedings could not be completed in this area, but in the next town, causing delays in pressing charges. Screening declined over time and clinicians used “case finding” (assessing some clients and not others) instead. Limited funds were available to: support transport costs for clients and community volunteers to reach referral agencies in the nearest town; cover cell phone costs for health workers and volunteers so they could communicate with each other, and for referral agencies and biweekly meetings of volunteers.
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Community‐level collaboration to increase awareness of services for and harms of GBV. Community involvement increased potential support available in a low‐resource and rural setting. All clinic staff were trained, including administrators, increasing the acceptance of the program and delivery of services. Nonclinicians were also involved in giving information and support. Supported referrals were available through community volunteers who escorted women to services and provided emotional support.
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