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Exploring the complex pathway of the primary health care response to intimate partner violence in New Zealand

机译：探索初级医疗保健反应的复杂途径，对新西兰的亲密合作伙伴暴力

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Integrating sustainable responses to intimate partner violence in health care is a persistent and complex problem internationally. New Zealand holds a leading role, having established national health system infrastructure for responding to intimate partner violence within hospital and selected community settings. However, resources for, and engagement with, the primary health care sector has been limited. The present study focuses on what affects a sustainable response to intimate partner violence within New Zealand primary health care settings. Utilising complexity theory, we reconceptualised a sustainable primary health care response to intimate partner violence as a complex adaptive system. To explore interactions between agents, we analysed the function(s) of key policy, strategy, guideline and evaluation documents informing intimate partner violence responsiveness in health care. We chronologically threaded these documents together by their function(s) to show how discourse influencing intimate partner violence responsiveness emerges from agent interactions. This paper presents a complexity informed implementation narrative of the New Zealand health system response to intimate partner violence across the last two decades, focused on the participation of the primary health care sector. We demonstrate how competing discourses have contributed to system gaps and unintended consequences over time. Our findings consider implications for a sustainable response to intimate partner violence in primary health care and call attention to system interactions that challenge a whole health system approach in New Zealand. Use of complexity theory facilitates an innovative perspective of a persistent and complex problem. Given the complexity of the problem and New Zealand's leadership, sharing the lessons learnt is critical for the international community involved in developing health care system approaches to intimate partner violence.
机译：将可持续反应整合在医疗保健中的亲密合作伙伴暴力是一个持续和复杂的问题。新西兰担任主导作用，拥有建立国家卫生系统基础设施，用于应对医院内的亲密合作伙伴暴力和选定的社区环境。但是，资源为和参与，主要卫生保健部门受到限制。本研究重点介绍，对新西兰初级医疗保健环境中的亲密合作伙伴暴力的可持续反应影响了什么。利用复杂性理论，我们重新重读了可持续的初级医疗保健反应，以与复杂的自适应系统为亲密的合作伙伴暴力。为了探讨代理商之间的互动，我们分析了关键政策，战略，指南和评估文件的职能，告知亲密的合作伙伴暴力反应能力。我们按照职能按照职能进行了按照这些文件，以表明如何影响亲密的合作伙伴暴力响应性的话语互动。本文介绍了新西兰卫生系统的复杂性实现叙述，在过去二十年中，致力于对初级卫生保健部门的参与的参与。我们展示了竞争致命的话语如何为系统差距以及随着时间的推移产生意外的后果。我们的调查结果考虑对初级医疗保健的贴心伴侣暴力的可持续反应的影响，并呼吁注意在新西兰挑战整个卫生系统方法的系统互动。使用复杂性理论有助于一种持久性和复杂问题的创新视角。鉴于问题和新西兰领导的复杂性，分享所吸取的经验教训对于参与制定医疗保健系统涉及亲密伴侣暴力的卫生系统方法的国际社会至关重要。

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