Developing a Serbian Strategy to improve implementation of primary family violence care

Snežana Knežević, Nell Van Hansewyck, Bosiljka Đikanović, Raquel Gomez Bravo, Filiz Ak, Carmen Fernandez Alonso, Lodewijk Pas

Keywords: Primary health care, family violence, barriers, facilitators, implementation

Background:
Family violence is in Serbia recognized as a criminal act since 2002. Health professionals at primary care level are in a unique position to create safe and confidential environments for facilitating disclosure of violence.

Research questions:
How to improve implementation for primary health care tasks of family violence?

Method:
Key-person inquiries, developed within the IMOCAFV project, resulted in 26 useful answers about detection, barriers, facilitators, risk-assessment and monitoring. Open-ended responses were coded independently by two readers. Participants were recruited equally from PHC physicians, public health doctors, paediatricians, nurses, midwives, psychologist, forensic, social worker, NGO representatives. We submitted related questions to nominal group discussions. Conclusions will be submitted to further broad analysis using Delphi online questionnaires.

Results:
Barriers highlighted were lack of time assessment, suitable infrastructure, insufficient funding and data collection, lack of staff to assess, respond and perform case management; legislation gaps at justice and policy level as well as poor coordination of individual services limit efficacy. Facilitators identified were: public policy for awareness, clearly defined tasks, continuous medical education, knowledge transfer as well as incentives for collaboration. Positive factors are: Public policy in Serbia including the gender perspective; detection, risk-assessment and monitoring are included in protocols. Local implementation could be promoted by prevention and intervention programs, targeted on increasing detection, better management of coordination, incentives for individual efforts; at regional level improved data collection and development of guidance as well as partnerships between health-care sector and statutory bodies, preventive campaigns and emergency measures would enhance performance and efficacy. Further enhancement might result from survivor follow-up, assessment of services’ quality with feedback and financial support for Primary health care multidisciplinary collaboration.

Conclusions:
Nominal groups concentrate on raising public and professional awareness, capability for a systematic approach, risk assessment and orientation from health care to statutory bodies and NGO’s embedded in a public policy approach.

Points for discussion:
What is the usefulness of collection key person views to start up consensus development on implementation?

How can Nominal groups contribute to development of a broadly based consensus on local implementation?

Is prioritizing nominal group finding by a broader Delphi study sufficient to develop a good implementation strategy?