Family approach in Primary Health Care with families experiencing violence

perceptions of preceptors in Family Practice Residency

Abstract

Introduction: Violence is a severe and frequent public health issue. It has an impact on the health and lives of individuals, families, and communities, whether physically, psychologically, or socially. Among types of violence, domestic violence has a high prevalence; it has a systemic character, meaning all family members are somehow involved. In Primary Health Care (PHC), families experiencing violence are often attended to by professionals from the Family Health Strategy. However, there is an observed absence or little space in medical education addressing the issue. Objective: To understand the perspective of Family Practice Physicians (FPP), preceptors of Residency Programs in FPP, on the Family Approach in contexts of domestic violence in PHC. Methods: This is a qualitative study with a descriptive and exploratory character. A survey on the topic was applied to active preceptors in Rio de Janeiro at the time of the research, followed by interviews with 15 of these preceptors. Results: There were identified potentials and challenges for the daily practice of the Family Approach with families in violent situations in PHC. As advantages/ potentials, the following stood out: strengthening of the bond between the professional and the family; expanding therapeutic resources and intervention effectiveness; promoting comprehensive care; networking across sectors; promoting reflection and self-care within families. Among the challenges reported were gaps in medical education and lack of practical experience in addressing the problem; silenced violence and fear of addressing domestic violence situations; lack of specific guidelines for PHC health professionals; poor working conditions, excessive designated population, care overload, difficulties in intersectoral networking, and management undervaluing the importance of the approach. Conclusions: The importance of the Family Approach by FPP was highlighted by the respondents as strategic in addressing domestic violence. However, there are many challenges to its practical application. Efforts and guidelines are needed for FPP and other professionals working in PHC to be valued, enabled, and trained to systematically and regularly address both family issues and domestic violence, considering its high prevalence and severity.