Exploring sustainable primary care responses to intimate partner violence in New Zealand: Qualitative use of complexity theory

Abstract

OBJECTIVE: To explore what affects sustainable responses to intimate partner violence within New Zealand primary care settings using complexity theory. DESIGN: Primary care professional interviews on intimate partner violence as a health issue are analysed using a complexity theory-led qualitative research methodology grounded in poststructuralism. SETTING: Four general practices in one region of the North Island of New Zealand, two serving a general patient population and two adopting an indigenous approach. PARTICIPANTS: Seventeen primary care professionals and management from the four recruited general practices. RESULTS: The complex adaptive system approach the 'Triple R Pathway', calls attention to system interactions influencing intimate partner violence responsiveness across health system levels. Four exemplars demonstrate the use of the Triple R Pathway. Two key system areas challenge the emergence of primary care responsiveness: (1) Non-recognition of intimate partner violence as a key determinant of ill-health. (2) Uncertainty and doubt. CONCLUSIONS: The relationship between intimate partner violence and ill-health is not well recognised, or understood in New Zealand, at both policy and practice levels. Inadequate recognition of socioecological determinants of intimate partner violence leads to a simple health system response which constrains primary care professional responsiveness. Constant intervention in system interactions is needed to promote the emergence of sustainable responses to intimate partner violence.