29 research outputs found
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Multiple inequity in health care: An example from Brazil
The paper develops and illustrates a new multivariate approach to analysing inequity in health care. We measure multiple inequity in health care relating to multiple equity-relevant variables – including income, gender, ethnicity, rurality, insurance status and others – and decompose the contribution of each variable to multiple inequity. Our approach encompasses the standard bivariate approach as a special case in which there is only one equity-relevant variable, such as income. We illustrate through an application to physician visits in Brazil, using data from the Health and Health Care Supplement of the Brazilian National Household Sample Survey, comprising 391,868 individuals in the year 2008. We find that health insurance coverage and urban location both contribute more to multiple inequity than income. We hope this approach will help researchers and analysts shed light on the comparative size and importance of the many different inequities in health care of interest to decision makers, rather than focus narrowly on income-related inequity
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The Concept and Measurement of Interpersonal Violence in Specialist Services Data: Inconsistencies, Outcomes and the Challenges of Synthesising Evidence
Interpersonal violence comprises a variety of different types of violence that occur between individuals, including violence perpetrated by strangers and acquaintances, intimate partners and family members. Interpersonal violence is a leading cause of death, particularly among young adults. Inconsistencies in definitions and approaches to the measurement of interpersonal violence mean it is difficult to clearly understand its prevalence and the differences and similarities between its different subcategories and contexts. In the UK, specialist services provide support for victim-survivors and also perpetrators of violence. As well as delivering frontline services, specialist services collect data on interpersonal violence, both routinely and for the purpose of research and evaluation. This data has the potential to greatly improve understanding of violence in the UK; however, several issues make this challenging. This review describes and discusses some of the key challenges facing the two types of data collected by specialist services. Key inconsistencies regarding conceptualisation and measurement are identified, along with the implications of these for the synthesis of data, including implications for researchers, service providers, funders and commissioners. Recommendations are proposed to improve practice, the quality of data and, therefore, the understanding of interpersonal violence in the UK
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Costing the long-term health harms of trafficking: why a gender-neutral approach discounts the future of women
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Determinants of Referral Outcomes for Victim–Survivors Accessing Specialist Sexual Violence and Abuse Support Services
Sexual violence and abuse (SVA) is highly prevalent globally, has devastating and wide-ranging effects on victim-survivors, and demands the provision of accessible specialist support services. In the UK, Rape Crisis England & Wales (RCEW), a voluntary third sector organization, is the main provider of specialist SVA services. Understanding the profile of victim-survivors who are referred to RCEW and their referral outcomes is important for the effective allocation of services. Using administrative data collected by three Rape Crisis Centres in England between April 2016 and March 2020, this study used multinomial regression analysis to examine the determinants of victim-survivors’ referral outcomes, controlling for a wide range of potentially confounding variables. The findings demonstrate that support needs, more so than the type of abuse experienced, predicted whether victim-survivors were engaged with services. Particularly, the presence of mental health, substance misuse and social, emotional, and behavioral needs were important for referral outcomes. The referral source also influenced referral outcomes, and there were some differences according to demographic characteristics and socioeconomic factors. The research was co-produced with stakeholders from RCEW, who informed interpretation of these findings. That victim-survivors’ engagement with services was determined by their support needs, over and above demographic characteristics or the type of abuse they had experienced, demonstrates the needs-led approach to service provision adopted by RCEW, whereby resources are allocated effectively to those who need them most
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The Concept and Measurement of Violence and Abuse in Health and Justice Fields: Toward a Framework Aligned with the UN Sustainable Development Goals
Violence reduction is a United Nations (UN) sustainable development goal (SDG) and is key to both public health and criminology. The collaboration between these fields has the potential to create and improve prevention strategies but has been hampered by the usage of different definitions and measurements. This paper explores the definitions and measurements of violence by the World Health Organization, UN, and Council of Europe to arrive at a harmonized framework aligned with the SDGs. Violence and abuse are defined by these organizations as intentional actions that (are likely to) lead to harm, irrespective of physicality or legality. When recording violence and abuse, health- and justice-based administrative systems use different codes which cannot directly be translated without resorting to broad overarching categories. Additionally, the identification of the number of victims, perpetrators, and events is challenging in these systems due to repeat victimization/offending, multiple victims/perpetrators, and multiple engagements with services associated with a single event. Furthermore, additional information on the victims (e.g., ethnicity) and events needs to be registered to evaluate progress toward the SDGs. We propose a framework to record violence that includes individual and event identifiers, forms of violence and abuse (including physical, sexual, and psychological), harm, and individual and event characteristics
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Challenges of using specialist domestic and sexual violence and abuse service data to inform policy and practice on violence reduction in the UK
Specialist domestic and sexual violence and abuse support services routinely collect administrative data about victim-survivors’ experiences of violence, interventions, and individual- and service-level outcomes. When used effectively, such information has the potential to enhance understanding of patterns of violence in society and ensure that responses are evidence-based. However, the extent to which insights from specialist services’ administrative data can inform policy and practice on violence reduction is limited by three interrelated challenges: different approaches to the measurement of violence and abuse; the issue of disproportionate funding and capacity of services, and the practicalities of multi-agency working. This article contributes to a gap in knowledge by explicitly addressing the challenges of using such data. It is hoped that it will encourage further discussions into how services collect and use data, which would greatly enhance knowledge in this area. To gain a more accurate picture of violence and abuse, their consequent harms in society, and where resources and interventions should be targeted, it is vital that specialist services data is integrated with other sources of data on violence
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General practice as a place to receive help for domestic abuse during the COVID-19 pandemic: a qualitative interview study in England and Wales
Background: General practice is an important place for patients experiencing or perpetrating domestic violence and abuse (DVA), and for their children to seek and receive help. While the incidence of DVA may have increased during the COVID- 19 pandemic, there has been a reduction in DVA identifications and referrals to specialist services from general practice. Concurrently there has been the imposition of lockdown measures and a shift to remote care in general practices in the UK.
Aim: To understand the patient perspective of seeking and receiving help for DVA in general practice during the COVID-19 pandemic. This was then compared with experiences of general practice healthcare professionals.
Design and setting: A qualitative interview study in seven urban general practices in England and Wales, as part of a feasibility study of IRIS+, an integrated primary care DVA system-level training and support intervention.
Method: Semi-structured interviews with 21 patients affected by DVA and 13 general practice healthcare professionals who had received IRIS+ training. Analysis involved a Framework approach.
Results: Patients recounted positive experiences of seeking help for DVA in general practice during the pandemic. However, there have been perceived problems with the availability of general practice and a strong preference for face-to-face consultations, over remote consultations, for the opportunities of non- verbal communication. There were also concerns from healthcare professionals regarding the invisibility of children affected by DVA.
Conclusion: Perspectives of patients and their families affected by DVA should be prioritised in general practice service planning, including during periods of transition and change
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The gendered dimensions of defences to homicide: a systematic review protocol
Various partial and complete defences to homicide are available globally. If successful, these defences can have the effect of fully absolving the accused of criminal liability (in the case of a complete defence, such as self defence) or reducing a charge and attendant sentencing (i.e. reducing a murder conviction to a lesser conviction, such as manslaughter, via a partial defence.) Gender discrimination in homicide defences persist, despite reforms (Fitz-Gibbon & Horder, 2015; Fitz-Gibbon & Pickering, 2011). For example, intimate partner homicides (IPH) comprise a sizeable proportion of homicides against women (Stöckl et. al., 2013; UNODC 2018). One study reports that the content and application of homicide defences in cases of intimate partner homicides (IPH) is associated with the commission of male homicide of female partners and gender biased criminal sentences for women who kill abusive partners (Howes, 2021). These outcomes could be driven by gender bias (Cutroni & Anderson, 2020; Penal Reform International and LinkLaters 2016). This review will provide a multi-country analysis of existing gender bias regarding both the content and application of the law of homicide defences. Ensuring that criminal law and criminal justice are free from bias is a perennial need for liberal democracies. Providing fair and unbiased sentencing in which the severity of the sentence matches the gravity of the crime is also a high priority. Further, establishing appropriate criminal justice responses to homicide and to violence against women and girls are chief policy concerns. The review can form the basis of law reform and criminal justice practice reform suggestions to remove gender bias in homicide defences and to assess why previous attempts to do so have not yet worked to plan
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A Board Level Intervention to Develop Organisation-Wide Quality Improvement Strategies: Cost-Consequences Analysis in 15 Healthcare Organisations.
BACKGROUND: Hospital boards have statutory responsibility for upholding the quality of care in their organisations. International research on quality in hospitals resulted in a research-based guide to help senior hospital leaders develop and implement quality improvement (QI) strategies, the QUASER Guide. Previous research has established a link between board practices and quality of care; however, to our knowledge, no board-level intervention has been evaluated in relation to its costs and consequences. The aim of this research was to evaluate these impacts when the QUASER Guide was implemented in an organisational development intervention (iQUASER). METHODS: We conducted a 'before and after' cost-consequences analysis (CCA), as part of a mixed methods evaluation. The analysis combined qualitative data collected from 66 interviews, 60 hours of board meeting observations and documents from 15 healthcare organisations, of which 6 took part on iQUASER, and included direct and opportunity costs associated with the intervention. The consequences focused on the development of an organisation-wide QI strategy, progress on addressing 8 dimensions of QI (the QUASER challenges), how organisations compared to benchmarks, engagement with the intervention and progress in the implementation of a QI project. RESULTS: We found that participating organisations made greater progress in developing an organisation-wide QI strategy and became more similar to the high-performing benchmark than the comparators. However, progress in addressing all 8 QUASER challenges was only observed in one organisation. Stronger engagement with the intervention was associated with the implementation of a QI project. On average, iQUASER costed ÂŁ23 496 per participating organisation, of which approximately 44% were staff time costs. Organisations that engaged less with the intervention had lower than average costs (ÂŁ21 267 per organisation), but also failed to implement an organisation-wide QI project. CONCLUSION: We found a positive association between level of engagement with the intervention, development of an organisation-wide QI strategy and the implementation of an organisation-wide QI project. Support from the board, particularly the chair and chief executive, for participation in the intervention, is important for organisations to accrue most benefit. A board-level intervention for QI, such as iQUASER, is relatively inexpensive as a proportion of an organisation's budget
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Prevalence of violence experienced by people with insecure immigration status, and perceptions of association with immigration control (protocol)
What is the prevalence of violence experienced by people with insecure immigration status? Violence causes injury and is related to mental health conditions such as post-traumatic stress and depression. The World Health Organization's 2002 Report of Violence and Health states 'where violence persists, health is compromised.' Sub questions of the review ask: 1. What is the reported prevalence of different types of violence experienced by people with insecure migration statuses? 2. What types of violence do people in insecure immigration status report experiencing? 3. Do people in insecure migration status who experience violence perceive that to be a consequence of their migration status