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UBC Theses and Dissertations

Building capacity for trauma and violence-informed care and deconstructing oppression in women's health care Brcic, Vanessa

Abstract

Rationale: Experiences of oppression, trauma, daily discrimination, and structural violence are ubiquitous among people cared for within primary care. The unique impacts of these experiences on women – in particular on mothers, racialized and Indigenous women, and early childhoods – have been clearly demonstrated, including in the gendered impacts of the COVID-19 pandemic. These experiences can be perpetuated or mitigated within the health care system. Trauma and violence-informed (TVI) care acknowledges these impacts, yet its integration into the fabric of women’s health care and primary care services is limited. The landscape of women’s health services offers an important opportunity to learn about the implementation of TVI care across a continuum of services with variable orientations towards equity-oriented care. Objectives: 1. To describe the environments in which TVI care is practiced within a web of interdisciplinary women’s health care services centered within primary care, and the contextual, structural, and individual factors influencing the care provided; 2. To generate insights about the implementation of equity-oriented, trauma and violence-informed care at a critical time of primary care renewal in Canada, including in the COVID-19 pandemic recovery. Research Question: How do diverse ways of enacting TVI care for women expand understandings of how to implement and scale up TVI care in primary health care more broadly? Study Design: We conducted 23 qualitative, in-depth interviews with diverse practitioners of TVI care within a web of women’s health care services centered within primary care. We engaged in collaborative thematic analysis of the data, guided by interpretive description, and conducted by three women with dual experiences as trauma survivors and providers of TVI care. This study was informed by intersectional feminism, decolonizing and critical theories, and a social justice lens. Findings: Participants described: 1. Contextual and system-level factors influencing TVI implementation in women’s health care; 2. Process knowledge of how to enact and implement TVI care; and, 3. Clinical knowledge and approaches in TVI practice. The focus of this analysis is on the first two areas, which are described as: Oppressive systems – the landscape of trauma and violence-informed practice; and, Deconstructing oppression – the work of resistance and connection.

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