Table 4B

Summary of findings: enablers

Third order themesSecond order themesFirst order themes
enablers
Contributing studiesCERQual confidence levelConfidence assessment
explanation
Illustrative examples
Leadership and governanceLaws, policies and proceduresSupportive laws and policies on VAW9 10 25–27ModerateFive studies with minor to significant methodological limitations. Fairly thick data from five countries. Moderate coherence.‘The 1994 domestic violence Law gave IPV what policy theorists in the literature refer to as ‘legitimacy.’ OSCCs acquired national credibility as a feasible policy solution to the VAW problem, resulting in official MOH support on the issue.’
(Malaysia, 15)
Standardised policies and procedures13 18 21 27 29 31–33ModerateSeven studies with minor to significant methodological limitations. Thick data from 19 countries. High coherence.‘The example of Timor-Leste shows how protocol development in line with the local context has been effective.’
(Timor-Leste, 11)
Governing bodiesRegular interagency meetings to coordinate services and support, address challenges, and delegate tasks9 10 23 29 30 33–36ModerateThree studies with minor to significant methodological limitations. Thick data from 14 countries. Fairly high coherence.Regular interagency meetings with partners from the police, social welfare, legal aid and NGOs, helped improve OSCC services, and, indirectly, forced the government agencies to monitor services.’
(Malaysia, 15)
Political willSupport from higher leadership9–11 23 29 30 33–35 38 43ModerateSeven studies with minor to significant methodological limitations. Thick data from 14 countries, mostly Asia. Fairly high coherence.‘The fact that the initial implementation process was government-led added credibility to the request for specific services for abused women and to the entire process, and made it acceptable.’
(Malaysia, 15)
Service deliveryQuality of careAvailable, on-site psychological services and support groups10 15 27 30 34 43 45ModerateSeven studies with minor to significant methodological limitations. Thick data from seven countries. High coherence.‘Throughout their interviews, women reported on the benefits of the counselling sessions … many used the terms ‘relieved’ to express how they felt following their meetings with counsellors.’
(India, 50)
Minimised return visits and points of care to receive necessary diagnostics and medications13 32LowTwo studies with moderate to significant methodological limitations. Thick data from seven countries. High coherence.‘Patients given a full course of drugs on first visit were much more likely than those given a starter pack with follow-up appointments to have taken PEP for 28 days.’
(South Africa, 40)
AccessibilityAffordable medical services15 30 33 38LowFour studies with minor to significant methodological limitations. Thick data from four countries. High coherence.‘To me, I had no money. Then I thought, hospital=money. I just went home. So later, after a suicide attempt, my friend told me that there are counselling services at Kenyatta (National Hospital) and they are free.’
(Kenya and Zambia, 12)
Community awareness activities13 32 34 43 46LowFive studies with minor to significant methodological limitations. Thick data from 10 countries. High coherence.‘A 10-site GBV programme in Zambia utilised community radio programme… 82% of respondents reported having been informed about the GBV programme from the radio phone-in programme.’
(Zambia, 53)
Contextual variations of OSC modelsHospital-based OSCs better equipped to provide full range of services, including medical services11 15 27–29 34 35 43 45 46 60Moderate10 studies with minor to significant methodological limitations. Thick data from 18 countries. High coherence.‘Emergency cases and women in need of urgent care come to the hospital for treatment and so steps can be taken immediately to assist those women.’
(India, 50)
Hospital-based OSCs more accessible to larger sectors of the population including minority groups34 43 45 46LowFour studies with minor to significant methodological limitations. Fairly thick data from four countries. Moderate coherence.‘I particularly liked the fact that it is located within a hospital…since childhood I am seeing all the women coming here.’ ‘It (the location) is good. Women come to the hospital and come to know about this centre, so it is popular.’
(India, 51)
Hospital-based OSCs better allow multisectoral collaboration10LowOne study with significant methodological limitations. Thin data. Unable to asses coherence.‘The hospital-based OSCCs have particularly good working relationships with the police and public prosecutors and conduct complex case conferences with internal and external partners to ensure effective coordination.’
(Thailand, 10).
NGO-run OSCs provide better psychosocial support15 27 34 38 43LowFive studies with moderate to significant methodological limitations. Fairly thin data from three countries. Fairly high coherence.‘The NGO brings skills in research, documentation and training and most importantly, in feminist counselling.’
(India, 50)
CoordinationInterprofessional collaborationStrong interprofessional staff relationships10 11 30 33 35 36LowSix studies with minor to significant methodological limitations. Thick data from four countries. High coherence.‘The site coordinator had gone out of her way to include all parties in its working and management. It therefore felt more collaborative… and this had helped build trust between parties.’
(South Africa, 43)
Human workforce and developmentKnowledge, attitudes and behavioursSensitive staff attitudes, and behaviours11 30 43 44 59LowFive studies with minor to moderate methodological limitations. Thick data from four countries. High coherence.‘I had no idea (about Dilaasa at first). But after talking to them (the counsellors) I felt that I have their support. They are ready to help me.’
(India, 50)
Referral by sensitive healthcare worker43LowOne study with minor methodological limitations. Relatively thick data but only from one county, India. Unable to assess coherence as only one contributing study.‘The level of sensitivity and care taken (by the physician) to provide this woman with crucial information seems to have been an important factor in facilitating her access to necessary care.’
(India, 50)
Staffing and conditionsChampion, dedicated OSC staff leaders10 13 27 30 36 43 44ModerateSeven studies with minor to significant methodological limitations. Thick data from 13 countries, mostly Asia. High coherence.‘The assessment found that, in most cases, OSSCs operated thanks to the hard work of a few dedicated staff members in collaboration with other partners on a very limited budget.’
(India, 50)
  • The key barriers and enablers emerging from the review are discussed below by theme.

  • CERQual, Confidence in the Evidence from Reviews of Qualitative Research; GBV, gender-based violence; IPV, intimate partner violence; MOH, Ministry of Health; NGO, non-governmental organisation; OSC, one stop centre; OSCC, one stop crisis centre; PEP, pre-exposure prophylaxis; VAW, violence against women.