Assessing COVID-19 and Intimate Partner Violence Care in Jamaica: A Syndemic Approach 公开
Stephens, Shannon (Spring 2023)
Abstract
Background: Since its emergence in late 2019, the novel coronavirus (SARS-CoV-2) has spread COVID-19 globally. Simultaneously, global health institutions have indicated that global rates of IPV are rising. There have been few studies on IPV in Jamaica in recent years, especially regarding IPV services and care at SRH clinics. Thus, there is a need to assess the impact of COVID-19 on critical IPV services and care, as told by healthcare providers in Jamaica.
Methods: This facilities-based study utilized a retrospective cross-sectional concurrent mixed method (qualitative and quantitative) to assess IPV services and care in the context of COVID-19 in Jamaica. In the summer of 2022, 29 in-depth interviews and 51 surveys with SRH providers were conducted in partnership with the AIDS Healthcare Foundation. The survey included demographics and the prevalence and availability of IPV screenings both before and during the COVID-19 pandemic. In-depth interviews asked participants to share their experience with service delivery prior to and during the pandemic as it related to IPV care. Descriptive and bivariate analyses were calculated from quantitative data using SAS software v.9.4. Qualitative interview data were fidelity checked, de-identified, and coded using a deductive codebook, thematic analysis, and a consistent comparative method via MAXQDA v.22.
Results: The data revealed three key themes: 1) IPV is a significant issue in Jamaica and providers believed it increased nationally during the pandemic, 2) infrastructural and social challenges led to inconsistent IPV screening, inadequate provider training, and insufficient privacy and confidentiality within clinics, and 3) a subsequent conflation existed between inconsistent screenings for IPV and perceived prevalence of it. Contrary to existing literature, participants identified challenges with IPV screening due to a lack of training, protocol, and space to do so privately rather than as a result of personal biases.
Conclusion: It is imperative to standardize comprehensive and validating care across the Jamaican health clinics to increase IPV case identification and ensure patients feel safe to disclose. Further, the MoH should focus on improving capacity, establishing IPV training programs, investing in onboarding psychosocial teams, and developing the infrastructure for private, confidential, and safe IPV care across health clinics.
Table of Contents
INTRODUCTION 1
Introduction and Rationale 1
Research Question 4
Significance Statement 7
LITERATURE REVIEW 9
Background 9
IPV Risk Factors and Consequences 11
Social Influences on IPV 12
IPV Policy Measures 14
IPV Screening and Care Delivery 16
COVID-19 and IPV 18
Conclusion 21
METHODS 22
Introduction 22
Research Partners and Support 22
Setting 23
Research Questions 23
Research Design 24
Recruitment, Population, and Procedure 25
Consent 28
Instruments 28
Analysis 29
Institutional Review Board (IRB), Consent, and Ethical Considerations 31
RESULTS 32
Introduction 32
Quantitative Results 32
Qualitative Results 37
Pandemic-Related Changes in IPV Service Accessibility and Frequency 38
IPV Protocols and Services Across Clinics 41
Provider Perception of Current and Pre-Pandemic Clinic Practices for IPV 48
Privacy and Confidentiality 50
DISCUSSION 53
Discussion 53
Pandemic-Related Changes in IPV Service Accessibility and Frequency 53
IPV Protocols and Services Across Clinics 56
Provider Perception of Current and Pre-Pandemic Clinic Practices for IPV 62
Privacy and Confidentiality 64
Importance 66
Limitations 67
CONCLUSION 69
Suggestions for Further Research 69
Conclusions and Public Health Implications 70
REFERENCES 75
APPENDIX 84
About this Master's Thesis
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