{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T02:26:03Z","timestamp":1792117563231,"version":"4.4.0"},"reference-count":43,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2024,5,17]],"date-time":"2024-05-17T00:00:00Z","timestamp":1715904000000},"content-version":"vor","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"crossref","award":["17\/63\/125"],"award-info":[{"award-number":["17\/63\/125"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"crossref","award":["17\/63\/125"],"award-info":[{"award-number":["17\/63\/125"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,6,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Domestic violence (DV) is a global prevalent health problem leading to adverse health consequences, yet health systems are often unprepared to address it. This article presents a comparative synthesis of the health system\u2019s pre-conditions necessary to enable integration of DV in health services in Brazil, Nepal, Sri Lanka and occupied Palestinian Territories (oPT). A cross-country, comparative analysis was conducted using a health systems readiness framework. Data collection involved multiple data sources, including qualitative interviews with various stakeholders; focus-group discussions with women; structured facility observations; and a survey with providers. Our findings highlight deficiencies in policy and practice that need to be addressed for an effective DV response. Common readiness gaps include unclear and limited guidance on DV, unsupportive leadership coupled with limited training and resources. Most providers felt unprepared, lacked guidance and felt unsupported and unprotected by managers and their health system. While in Brazil most providers felt they should respond to DV cases, many in Sri Lanka preferred not to. Such organizational and service delivery challenges, in turn, also affected how health providers responded to DV cases leaving them not confident, uncertain about their knowledge and unsure about their role. Furthermore, providers\u2019 personal beliefs and values on DV and gender norms also impacted their motivation and ability to respond, prompting some to become \u2018activists\u2019 while others were reluctant to intervene and prone to blame women. Our synthesis also pointed to a gap in women\u2019s use of health services for DV as they had low trust in providers. Our conceptual framework demonstrates the importance of having clear policies and highlights the need to engage leadership across every level of the system to reframe challenges and strengthen routine practices. Future research should also determine the ways in which women\u2019s understanding and needs related to DV help-seeking are addressed.<\/jats:p>","DOI":"10.1093\/heapol\/czae032","type":"journal-article","created":{"date-parts":[[2024,5,17]],"date-time":"2024-05-17T14:52:59Z","timestamp":1715957579000},"page":"552-563","source":"Crossref","is-referenced-by-count":13,"title":["Comparing health systems readiness for integrating domestic violence services in Brazil, occupied Palestinian Territories, Nepal and Sri Lanka"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7487-9634","authenticated-orcid":false,"given":"Manuela","family":"Colombini","sequence":"first","affiliation":[{"name":"Department of Global Health and Development, London School of Hygiene and Tropical Medicine , London WC1H 9RA, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satya","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Kathmandu University School of Medical Sciences, Nepal and Faculty of Health Sciences , Dhulikhel 45209, Nepal"},{"name":"University of Bristol , Bristol BS81UD, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Pereira","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of S\u00e3o Paulo Institute of Biomedical Sciences, Sao Paulo , Sao Paulo CEP 01246 903, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz","family":"Kalichman","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Faculty of Medicine , Sao Paulo CEP 01246 903, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prabhash","family":"Siriwardhana","sequence":"additional","affiliation":[{"name":"Department of Social Sciences, Rajarata University of Sri Lanka , Mihintale 50300, Sri Lanka"},{"name":"South Asian Clinical Toxicology Research Collaboration, University of Peradeniya , Peradeniya 20400, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tharuka","family":"Silva","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Faculty of Medicine , Kandy, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rana","family":"Halaseh","sequence":"additional","affiliation":[{"name":"Occupied Palestinian Territories, An-Najah National University , Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Flavia","family":"d\u2019Oliveira","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of S\u00e3o Paulo Institute of Biomedical Sciences, Sao Paulo , Sao Paulo CEP 01246 903, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Poonam","family":"Rishal","sequence":"additional","affiliation":[{"name":"Kathmandu University School of Medical Sciences, Dhulikhel Hospital , Dhulikhel 45209, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pusp Raj","family":"Bhatt","sequence":"additional","affiliation":[{"name":"Kathmandu University School of Medical Sciences, Dhulikhel Hospital , Dhulikhel 45209, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amira","family":"Shaheen","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences, Occupied Palestinian Territories, An-Najah National University , Nablus, Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nagham","family":"Joudeh","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences, An-Najah National University , Nablus, Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thilini","family":"Rajapakse","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Faculty of Medicine , Kandy, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2663-9836","authenticated-orcid":false,"given":"Abdulsalam","family":"Alkaiyat","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences, Occupied Palestinian Territories, An-Najah National University , Nablus, Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gene","family":"Feder","sequence":"additional","affiliation":[{"name":"University of Bristol, Centre for Academic Primary Care , Bristol BS81UD, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia Garcia","family":"Moreno","sequence":"additional","affiliation":[{"name":"Formerly at Department of Reproductive Health and Research, World Health Organisation , Geneva 1211, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loraine J","family":"Bacchus","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development, London School of Hygiene and Tropical Medicine , London WC1H 9RA, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,5,4]]},"reference":[{"key":"2024060311460383000_R2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12992-022-00798-5","article-title":"Transforming Nepal\u2019s primary health care delivery system in global health era: addressing historical and current implementation challenges","volume":"18","author":"Adhikari","year":"2022","journal-title":"Globalization & Health"},{"key":"2024060311460383000_R3","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/S0140-6736(09)61827-4","article-title":"Association between exposure to political 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Exploring the readiness of Brazilian primary healthcare to respond to domestic violence against women","volume":"11","author":"D\u2019Oliveira","year":"2020","journal-title":"International Journal of Health Policy Management"},{"key":"2024060311460383000_R13","article-title":"Understanding Masculinities: Results from the International Men and Gender Equality Survey (IMAGES) \u2013 Middle East and North Africa","author":"El Feki","year":"2017"},{"key":"2024060311460383000_R14","first-page":"1","article-title":"The health-systems response to violence against women","volume":"6736","author":"Garc\u00eda-Moreno","year":"2014","journal-title":"The Lancet"},{"key":"2024060311460383000_R15","article-title":"National plan of action for \u201cYear Against Gender Based Violence, 2010\u201d","author":"Government of Nepal","year":"2009"},{"key":"2024060311460383000_R16","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0174801","article-title":"Intimate partner violence in the post-war context: women\u2019s experiences and community leaders\u2019 perceptions in the Eastern Province of Sri Lanka","volume":"12","author":"Guruge","year":"2017","journal-title":"PloS One"},{"key":"2024060311460383000_R17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pone.0234067","article-title":"Health practitioners\u2019 readiness to address domestic violence and abuse: a qualitative meta-synthesis","volume":"15","author":"Hegarty","year":"2020","journal-title":"PLoS One"},{"key":"2024060311460383000_R18","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-022-07491-8","article-title":"Health practitioners\u2019 perceptions of structural barriers to the identification of intimate partner abuse: a qualitative meta-synthesis","volume":"22","author":"Hudspeth","year":"2022","journal-title":"BMC Health Services Research"},{"key":"2024060311460383000_R19","first-page":"3","article-title":"Medical care in Palestine: working in a conflict zone","volume":"85","author":"Keelan","year":"2016","journal-title":"The Ulster Medical Journal"},{"key":"2024060311460383000_R20","volume-title":"The World Bank","author":"Klugman","year":"2014"},{"key":"2024060311460383000_R21","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1080\/23288604.2015.1032475","article-title":"What governs district manager decision making? 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