An insight into institutional responses to intimate partner violence against women in Spain

Background Intimate Partner Violence (IPV) has been widely acknowledged as a major public health issue and a human rights concern. The international burden of this type of violence have lead countries to develop institutional responses to address the consequences for women as well as to reduce its prevalence. With this aim, the Spanish government enacted in 2004 one of the most comprehensive laws in the world. Among all sectors, the role of health care professionals in the identification, management and prevention of IPV becomes essential. Thus, this thesis analyses institutional responses to intimate partner violence against women in Spain, focusing on the public health-care sector. Methods This thesis is based on three qualitative papers and one mixed methods paper. Data collection was conducted through in-depth interviews in the two first papers, documentary review and in-depth interviews in the third paper and focus groups in the fourth paper. In the first paper I used thematic analysis to explore the perceptions of professionals working in different sectors regarding institutional responses to IPV with special attention to prevention campaigns aimed at young people. In the second paper we used grounded theory to develop a conceptual model representing the diverse responses generated when attempting to integrate a response to IPV into a biomedical health system. The third paper mapped and explored the training in IPV that nursing students receive at the undergraduate level in Spain through the revision of public documents and individual in-depth interviews. The fourth paper explored nursing students’ perceptions of, and attitudes towards, IPV after having received specific training in the topic. Main findings One of the main findings in Paper I was that the sustainability of programmes to address IPV was always jeopardized by politicians and colleagues that did not considered that IPV should be prioritized. Concerning prevention campaigns, participants in that study perceived that they sent messages that did not fit young people’s needs and thus were ineffective. Besides, they stressed that institutional responses failed to focus on on men to discourage violence. The main finding of Paper II was the coexistence of a range of responses in the health sector that included avoidance, voluntariness, medicalization and comprehensiveness. Attitudes and beliefs of health-care professionals about IPV were strongly related with the development of this variety of