NETWORK FOR COMBATING VIOLENCE AGAINST WOMEN: PERCEPTION OF PROFESSIONALS AT THE REFERENCE CENTERABSTRACT
Objective: To understand the functioning of the Network for Combating Violence Against Women, through the perception of professionals from a Reference Center for assisting women victims of violence.
Method: This qualitative research, grounded in the theoretical and methodological framework of the National Policy for Combating Violence Against Women, was conducted in the municipality of Campina Grande, Paraíba, between July and August 2023, using a semi-structured interview. For data analysis, the IRaMuTeQ software and the Content Analysis technique proposed by Bardin were used. The research was approved by the Research Ethics Committee of the Universidade Estadual da Paraíba.
Results: Difficulties in the flow of care through the referral and counter-referral process carried out between the institutions of the Support Network. There is a need to increase the number of Women's Reference Centers, provide professional training on combating violence against women, offer ongoing training for assisting women victims of violence, and implement public policies aimed at integrating women into the labor market.
Conclusion: The study highlights the absence of an Information System that could connect the professionals and institutions making up the Support Network, which would prevent the critical path and the victim’s revictimization. Moreover, it demonstrates the effectiveness of the Women's Reference Center in preventing and combating femicide.
DESCRIPTORS:
Violence against women; Professionals; Reference centers; Professional qualification; Professional training
RESUMO
Objetivo: Compreender o funcionamento da Rede de Enfrentamento à Violência Contra as Mulheres, por meio da percepção de profissionais de um Centro de Referência de atendimento à mulher vítima de violência.
Método: Pesquisa qualitativa, ancorada no referencial teórico-metodológico da Política Nacional de Enfrentamento à Violência Contra as Mulheres, realizada no município de Campina Grande-Paraíba, entre os meses de julho a agosto de 2023, por meio de uma entrevista semiestruturada. Para análise dos dados, utilizou-se o software IRaMuTeQ e a técnica de Análise de Conteúdo proposta por Bardin. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa da Universidade Estadual da Paraíba.
Resultados: Dificuldade no fluxo de atendimento por meio da referência e contrarreferência realizada entre as instituições da Rede de Enfrentamento. Necessidade de ampliação na quantidade de Centros de Referência da Mulher, de formação profissional no que diz respeito ao combate à violência contra a mulher, de capacitações contínuas para o atendimento das mulheres vítimas de violência e de políticas públicas direcionadas para a inserção da mulher no mercado de trabalho.
Conclusão: O estudo destaca a ausência de um Sistema de Informação que possa interligar os profissionais e instituições que compõem a Rede de Enfrentamento, o que evitaria a rota crítica e a revitimização da vítima. Além disso, mostra a eficácia do Centro de Referência da Mulher na prevenção e combate ao feminicídio.
DESCRITORES:
Violência contra a mulher; Profissionais; Centros de referência; Capacitação profissional; Formação profissional
RESUMEN
Objetivo: Comprender el funcionamiento de la Red para la Lucha contra la Violencia hacia las Mujeres, a través de la percepción de profesionales de un Centro de Referencia para la asistencia a mujeres víctimas de violencia.
Método: Esta investigación cualitativa, fundamentada en el marco teórico y metodológico de la Política Nacional de Lucha contra la Violencia hacia la Mujer, se llevó a cabo en el municipio de Campina Grande, Paraíba, entre julio y agosto de 2023, utilizando una entrevista semiestructurada. Para el análisis de datos se utilizó el software IRaMuTeQ y la técnica de análisis de contenido propuesta por Bardin. La investigación fue aprobada por el Comité de Ética en Investigación de la Universidade Estadual da Paraíba.
Resultados: Dificultades en el flujo de atención a través del proceso de derivación y contraderivación que se lleva a cabo entre las instituciones de la Red de Apoyo. Es necesario aumentar el número de Centros de Referencia para Mujeres, proporcionar formación profesional para combatir la violencia contra las mujeres, ofrecer formación continua para ayudar a las mujeres víctimas de violencia e implementar políticas públicas destinadas a integrar a las mujeres en el mercado laboral.
Conclusión: El estudio pone de relieve la ausencia de un sistema de información que conecte a los profesionales e instituciones que conforman la Red de Apoyo, lo que evitaría la ruta critica y la revictimización de la víctima. Además, demuestra la eficacia del Centro de Referencia para Mujeres en la prevención y lucha contra el feminicidio.
DESCRIPTORES:
Violencia contra las mujeres; Profesionales; Centros de referencia; Capacitación profesional; Formación profesional
INTRODUCTION
Violence against women is defined as "any act or conduct based on gender that causes death, harm, or physical, sexual, or psychological suffering to women, both in the public and private spheres", regardless of class, race or ethnic group, income, culture, educational level, age, or religion1.
According to the Brazilian Public Security Forum (2026), 1,568 cases of femicide were recorded, a growth of 4.7% compared to 2024. Furthermore, in the last five years, there has been a 14.5% increase in reported femicides in the country2. This is the highest number ever recorded since the publication of Law No. 13.104/2015, which defines the crime.
Estimates of violence against women indicate that approximately one in three women worldwide has already experienced physical and/or sexual violence from an intimate partner, or sexual violence from a non-partner, during their lifetime. Nearly a third (27%) of women aged 15 to 49 worldwide have been in a relationship where they were exposed to some form of violence from their intimate partners.3
Considered a major public health problem in Brazil, since 2003, with the creation of the Secretariat for Policies for Women, the government has been implementing specific policies to combat this type of health issue. One of these instruments for protecting women is the National Policy for Combating Violence Against Women (PNEVCM).4
Therefore, in 2011, the Network for Combating Violence Against Women (REVCM) was launched, with the objective of implementing the four pillars provided for by the PNEVCM: prevention, assistance, combating violence against women, and guaranteeing rights, thus addressing the complexity of the phenomenon of violence against women.5
Despite the legal protections established by the PNEVCM in Brazil, which redefines the guidelines for preventing and combating violence against women, it is recognized that the Coordination of Care directed at this target audience presents challenges in the management of REVCM, considering the need for professional behaviors aimed at comprehensive care for women and the articulation between the services of the Protection Network2,6-7, besides the demand for qualified professionals, the need to redesign existing workflows, improvement of the physical structure of services to ensure privacy during appointments, and continuous investment in professional development.8
Therefore, it is important to understand how the professionals who make up the Women's Reference Center (CRM) in a Brazilian municipality perceive how women victims of violence access the aforementioned Protection Network. This institution fulfills the four pillars outlined in the Policy for Combating Violence Against Women.
Therefore, the question arises: how do the professionals at CRM perceive the organization of the Network for Combating Violence against Women in the municipality of Campina Grande? Thus, the study aimed to understand the functioning of the REVCM, through the perception of professionals from a Reference Center for assisting women victims of violence.
METHOD
The theoretical framework used was based on the assumptions of the National Policy for Combating Violence Against Women, which has as its structuring axes prevention, assistance, combat against violence and guarantee of women's rights, axes implemented in the Network for Combating Violence Against Women.
This descriptive study, with a qualitative approach, is grounded in the theoretical and methodological framework of the National Policy for Combating Violence Against Women and guided by the tool Consolidated criteria for reporting qualitative research (COREQ).9
The research was conducted at a CRM in the city of Campina Grande, Paraíba. The aforementioned municipality has a structured and integrated REVCM, described as follows: Specialized Police Station for Women, Regular Police Station, Public Defender's Office, Public Prosecutor's Office, Trauma Hospital, Instituto de Saúde Elpídio de Almeida (ISEA), Primary Health Care Unit, Specialized Social Assistance Reference Center (CREAS), Social Assistance Reference Center (CRAS), Child Protective Services, State and Municipal Women's Reference Center, Maria da Penha Patrol (specialized Brazilian police units dedicated to protecting women, monitoring compliance with restraining orders, and preventing domestic violence), Support and Shelter Homes, and Safe Houses.
The population consisted of all professionals working at the Center, totaling seven professionals, whose sample was determined by a census sample10. Therefore, the professional category of the interviewees was not specified, to respect the participants’ anonymity.
Due to the research design, a pilot test was not conducted. The data collection period was between July and August 2023. The interviews were conducted individually, after signing the Free Informed Consent Form and the Voice Recording Form, at the institution, and were recorded using an MP3 audio recorder, with an average duration of 38 minutes. The instruments used for data collection were an individual form and a semi-structured interview guide. It should be noted that there were no refusals from the participants, nor were any repeat interviews conducted.
This was led by the principal investigator, a nurse and lecturer in the Women's Health course of the Nursing school at a university in Campina Grande, with experience in the subject matter and participation in practical classes through technical visits to the service mentioned. It is also important to emphasize the researcher's prior knowledge of the Center physical space and service flow, as well as her dialogue with the professionals.
The interviews were transcribed in full, organized into a textual corpus, and the analytical processing was performed using the software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRaMuTeQ)11. The processing and grouping of the textual corpus generated the class diagram, whose regrouping supported the coding of the final thematic categories, which were submitted to content analysis in the modality of Thematic Analysis12.
Importantly, the feedback and participants’ agreement with the interviews, as well as the fact that no artificial intelligence tools were used during the preparation of this article should be highlighted.
The research complied with the ethical requirements of Resolution 466/2012, and was initiated after approval by the Research Ethics Committee of the Universidade Estadual da Paraíba. To preserve the participants’ anonymity, the professionals were coded with the letter P, followed by the numerical order in which they appear in the transcript of their interview (e.g., P1, P2, P3...).
RESULTS
Of the seven professionals participating in the research, the majority were in the 40-49 age range (4.57%), identified as white (3.42%), were married (5.71%), and had more than 10 years of experience in their field (4.57%). Regarding length of service at the CRM, most had more than 10 years (3, 42%), only one (14%) had worked with women victims of violence before working at the Center, and no professional had participated in training prior to starting activities at the service.
The corpus analyzed by the software IRaMuTeQ included seven interviews, in a monothematic analysis. The processing of the corpus derived from these interviews yielded 13,600 word occurrences, distributed across 1,787 distinct forms. Through Descending Hierarchical Classification (DHC), 357 (91.30%) of 391 text segments were analyzed to elucidate the classes, and the retention rate was considered satisfactory.
After processing and grouping according to word occurrences, the classes generated from the DHC analysis are presented in a dendrogram. This way, seven classes emerged, grouped according to the correlation between them, which were related to aspects concerning violence against women. As verified, Axis 1 encompasses Classes 6, 5, 1, and 3, and is related to the dimensions of "Articulation of the Network for combating violence", "Referral and Counter-referral," "Revictimization," and "Logistics and Flow System in the Network". In Axis 2, Classes 2, 4, and 7 are included, referring to the dimensions "(De)humanized Embracement", "Difficulties and Potentialities of the Women's Reference Center", and "Changes in the Primary Education Curriculum for the Prevention and Combat of Violence Against Women"; see Figure 1.
Diagram of the component classes of the Dendrogram of the textual corpus extracted from IRaMuTeQ, referring to interviews with professionals from the Women's Reference Center, Campina Grande, Paraíba, Brazil - 2024.
Furthermore, the thematic categories supported by Bardin's Content Analysis were produced following the classes and text segments presented by the DHC and were based on the theoretical framework of the PNEVCM, as can be seen in Chart 1.
Organization of Thematic Categories based on the Axes of the National Policy to Combat Violence Against Women and association with the Classes derived from the Descending Hierarchical Classification.
Category 1 - Education as a pillar for the prevention of violence against women
Class 7 - Changes to the educational curriculum to combat violence against women.
The first category emerged from Class 7, related to the inclusion of the theme of prevention and combating violence against women in the primary education curriculum. In the interviews, the need for in-depth knowledge on this topic was mentioned in all areas of higher education, enabling future academic professionals to work in assisting victims.
Everyone should receive training on the issue of gender inequalities, on women's empowerment and patriarchy, to denaturalize this violence (P5).
University courses should include topics in their curriculum focused on addressing gender-based violence and domestic violence, because when we are in universities, we realize in the debates how much violence women suffer (P6).
Category 2 - Challenges and potentials in healthcare to the woman victim of violence
Class 1 - Revictimization
This category resulted from Class 1, which refers to the revictimization of women who are victims of violence. In other words, women are once again suffering violence, this time at the hands of professionals from the institutions they seek to defend themselves or report an assault they have suffered.
Because sometimes she takes the critical path. Wherever she goes, she always has to say that she is suffering violence. She is revictimized in these spaces. We try to minimize this situation and ensure that this woman does not suffer institutional violence (P2).
To prevent revictimization from happening. This service always aims to support women if they are feeling very vulnerable. Sometimes she already comes from a critical path (P5).
Class 2 - (De)humanized Embracement
The content related to the second category came from Class 2. In the statements of the interviewees, it was possible to identify the difficulties that women victims of violence face during the reporting process, with the most frequent complaint being the lack of humane support. The professionals reported that, depending on the institution, victims receive different levels of care.
We've already received many women who went to a police station or other institution first, who say, "If I had come here first, things would have been different" (P1).
There are institutions that treat her differently when she goes alone. We had one of our patients who had to be referred to the Trauma Hospital by one of our technicians; if the technician hadn't been there to facilitate the conversation, I believe she wouldn't have received treatment (P4).
But when the institution is represented by a technician, we notice that the service is different. Sometimes even the users themselves post this. When they go alone, it's a service. And when they go together, it's different (P5).
We've already noticed a difference, because when we reverse the process, we take these women back to the services and we realize that the care provided is different. The women who come here report that the way they were treated made them give up on continuing their journey (P6).
Class 4 - The difficulties and potentials of CRM
This category originated from Class 4, which relates to the difficulties, strategies, and potentials found in CRM. Regarding the problems, reports included the revictimization of women, the need for training for professionals in the network, difficulties in obtaining emergency protective measures and issues of child custody, the financial strain on women to travel between institutions, the reduced CRM team (both internal and external activities), and the fact that victims do not have access to the job market, which hinders breaking away from the abuser.
We face difficulties when we need a woman to have an emergency protective order; there is a lack of sensitivity on the part of the professionals. We face these barriers because of male chauvinism itself (P1).
The biggest difficulty lies in the legal proceedings, some of which present challenges, particularly regarding custody issues. Access to CRM is difficult because there are significant financial challenges (P3).
The issue is our small team, the services that can't stop, and the fact that we can't be giving lectures outside the office while neglecting internal support, nor can we focus solely on internal operations and stop promoting our services (P4).
In addition, they need rent and staple food items. It's a difficulty we have. The assistance that should be happening is not being provided (P5).
Provide her with a job, placing her directly in a company (P7).
In the professionals' accounts, strategies were identified that can resolve some of the difficulties encountered, such as: meetings among professionals from the Network's institutions to address urgent and more complicated cases of violence, as well as the creation of public policies aimed at enabling women's entry into the labor market.
The team is open to dialogue, so much so that it always schedules meetings with professionals from the Network who are in other protection services to discuss the case, which are more delicate and difficult (P3).
The economic situation presents a challenge to breaking the cycle of violence. Even though the service has the potential to empower and encourage women to leave their victim status, specific public policies addressing this need are still lacking (P6).
Regarding the potential of the CRM, the interviewees stated that since its implementation, no registered woman has been a victim of attempted femicide or femicide, and that they receive ongoing care, helping the victim in the process of strengthening themselves to break the cycle of violence. They are qualified professionals who also train professionals within the Network for Combating Violence Against Women, in addition to conducting monthly activities (courses, workshops, lectures) with the women assisted by the Center.
The support provided by the Women's Reference Center is continuous, and the women go through a whole empowerment process. It's about preparing this woman so that she can move on after the violence (P1).
None of the women we assisted were victims of femicide; it's as if we work not only on prevention, but also on combating women becoming victims (P2).
This service has a very well-organized team (P5).
The work involves not only providing support to these women, but also showing them that there are ways for them to break free from the cycle of violence. The work of the Women's Reference Center gives new meaning to many life stories (P6).
What works well is the team, which is very committed to the women. We've been in service for 11 years and there has never been a single case of femicide involving a woman (P7).
Category 3 - Institutional organization for combating violence against women
Class 3 - Logistics and network flow system
The third category emerged from Class 3 and relates to the instruments used in the registration
n, assistance, and referral of victims among the institutions that make up the Response Network. Regarding the instruments, the technicians mentioned that the CRM has its own instrument model, and some institutions do as well, such as the Public Defender's Office.
We have our referral tools in place. The Public Defender's Office uses a specific set of tools. When the institution doesn't require anything specific, we provide our basic referral outlining the request we want fulfilled (P1).
For the Maria da Penha Patrol, which is already being forwarded by email, it is understood that this woman needs to be included in the program as a priority (P2).
It includes the referral guidelines, the report form, and the Terms of Agreement as well. We draw up the Term of Agreement, explain the importance of shelter, but if she doesn't want it, that's her right, but she signs the Term of Agreement saying she doesn't want it (P5).
With regard to the Information System, it is an important tool for collecting, archiving, and disseminating data among institutions, especially REVCM, since it would have greater effectiveness due to rapid access to information and would reduce the victim’s revictimization, in addition to facilitating referral and counter-referral between services. However, the professionals reported the absence of this feature.
Unfortunately, there is no information system. We resolve everything by phone, email, or through these correspondences (P1).
We use our referrals and only include what is necessary. Either we accompany this woman to other services, taking not only the woman but also the referral, and we bring back a receipt for that referral (P2).
Our data is not systematized by the internet. The only thing we do here in relation to that is the cases that the lawyer has access to (P4).
An information system would be essential to facilitate these referrals, so that information from the Women's Reference Center can reach the police station and ISEA more quickly, but unfortunately, it doesn't exist yet (P6).
Reports on CRM techniques highlighted the importance of an Information System for strengthening interaction among professionals within the Network, as well as reducing revictimization.
An integrated, computerized system would be perfect. If this entire Network for Combating Violence could access it in real time, that would be wonderful. Every time the woman repeats it, she relives it. It's a difficult time, a source of suffering for her. She needs to be chasing after information (P1).
With this information system, we enter a woman's name and we can see all the paths she has taken. It would avoid revictimizing this victim because, if she has already been to the police station, we would only be requesting some information or passing on information (P6).
Category 4 - Elements of the protection network for the effective enforcement of the rights of women victims of violence
Class 5 - Referral and Counter-referral
Regarding the fourth category, which refers to the ongoing dialogue between professionals and services that assist victims of violence, there is no clearly established concept of referral and counter-referral, since most women seek out the CRM spontaneously, as we will see below.
Most of the time there is free demand. The police stations are already referring cases; they know the process begins at the Women's Reference Center (P1).
Women come both spontaneously and through referrals from the Maria da Penha Patrol, the Domestic Violence Court, and hospitals (P3).
Most come spontaneously because they've seen the building or viewed it on television (P4).
The majority, 75%, of women who come to the CRM either found the service online or were referred by someone. As for requests that come through referrals, we always try to provide feedback, to offer a counter-referral of the information (P6).
Class 6 - Coordination of the Network to Combat Violence Against Women
The content related to this category emerged from Class 1. This refers to the organization of the Care Network, presenting its evolution, challenges, and weaknesses. The professionals identified progress within the Network; however, they revealed the difficulties encountered in providing care to victims.
Overall, I see progress. I would add a further reservation regarding the DEAM (Specialized Police Station for Assisting Women), because women are not always welcomed as they should be when they arrive there (P3).
It could be better. The Women's Reference Center operates in one way, but when women arrive at the services, the reality is quite different (P4).
The participation of the Women's Reference Center has been somewhat diminished, distanced, in this current administration; it doesn't have the same level of activity it had before. There is this distancing in the municipality (P5).
Specialized services are very committed. In non-specialized services, there may be a lack of this more attentive approach to the issue of domestic violence (P6).
However, during the interviews, the professionals presented strategies that can improve the coordination of the Care Network, contributing to the assistance provided by the services that make up the Network, as observed in the following excerpts:
More training. Not being in isolated services, constant debate (P1).
More information. To make the flow less sluggish (P2).
Maintaining the need to strengthen this dialogue. It has to be continuous (P3).
A matter of humanization. Understand that this isn't politics. We're dealing with lives; we're here to make a difference in these women's lives (P4).
In other services, we observe staff turnover. They don't know what happened before. This woman may experience a process of revictimization (P6).
DISCUSSION
In order for professionals from various fields working at REVCM to offer humane and comprehensive care, it is of utmost importance that the change occurs during their professional training and that the curriculum is focused on combating violence against women. This study mentioned the need for in-depth knowledge during undergraduate studies.
Thus, since 2006, Law No. 11,340, known as the Maria da Penha Law, has included, as integrated prevention measures, the inclusion in school curricula at all levels of education of content related to gender and racial or ethnic equality and the problem of domestic and family violence against women13. Initially, through Interministerial Ordinance No. 2, of March 26, 2026, the Ministry of Education established the inclusion of content on preventing and combating violence against girls and women in the primary education curricula14.
Therefore, the university environment is fertile ground for stimulating debate about violence against women, demystifying judgments and beliefs, as well as promoting knowledge of gender equality. Given that this is a complex issue and part of the Sustainable Development Goals, there is a need to include the topic of "Gender and violence against women" in the curricula of technical and higher education courses.
In respect of revictimization, the participants stated that, to avoid the critical path, they accompany the women when they refer them to other institutions. Furthermore, they mentioned the reverse path, returning with the victims to the services they had previously used. As the violence escalates, there comes a point when a neighbor or family member advises victims to seek help from the CRM, arriving with a report of revictimization.
As a further result, they point out how important specialized public policies are and that humanized care makes women feel welcomed and encourages them to follow through with their complaints. This differentiated service should exist in all services that the victim uses.
However, military police officers reported difficulties in identifying psychological violence against women, as a consequence of notifying and prosecuting the aggressor. Violence is considered to be an argument or disagreement between the couple. This circumstance contributes to the normalization and perpetuation of a culture of violence15.
Furthermore, male chauvinism influences police service practices, which are permeated by prejudice and judgmental comments towards women. Therefore, a protocol for standardized service and to train security agents on issues of violence against women should be implemented16.
Just as important as preventing revictimization is promoting humane treatment for victims of violence. However, depending on the institution, women who arrive at the CRM report being questioned as if they were to blame for the situation they were experiencing, and often they do not return, either because they did not feel supported, or because they became just a statistic, whether due to a new attack or even femicide.
Victims may take years to decide to seek help if they don't receive the necessary assistance. Therefore, it is in embracement and assistance for these women at the CRM that professionals need to dismantle the negative impression some professionals and their respective institutions make them have. However, the team's lack of knowledge regarding REVCM and the failure to complete the notification form result in negative consequences, such as the underreporting of violence against women17.
Regarding the difficulties encountered at the CRM, the following were mentioned: women’s revictimization, a point already discussed; difficulty in granting emergency protective measures; the financial situation of women, hindering their travel to institutions; the reduced staff of the Center; and the difficulty for women to break away from their abusers due to lack of access to the job market.
Supporting this idea, nursing staff working in the emergency department of a hospital located in a large city in the state of Santa Catarina shared their difficulties in providing quality care: professionals are overworked, there are limited physical resources, there is high staff turnover, there is difficulty in identifying the victim, there is a lack of preparedness or psycho-emotional support, and there is insufficient training on clinical protocols-factors that compromise the effectiveness of nursing care18.
For the proper functioning of the REVCM service flow, coordination between services is necessary. Additionally, this care extends to the organization of health services and professional training, whether through professional education and/or continuing qualification.
As a potential benefit of the CRM, it is important to confirm that no woman registered with this Center has been a victim of attempted and/or completed femicide. Regarding the professionals' training, it was observed that all of them are qualified and conduct training sessions for professionals from other institutions in the municipalities of Paraíba. They also strengthen and empower women who are victims of violence through ongoing support, including monthly meetings with the professionals.
Moreover, the research reveals the need for a tool to refer victims of violence within the institutions, to combat women’s revictimization in these services. The Public Defender's Office has a specific instrument because it has a separate registry, while the CRM has had such an instrument since its inception. These instruments can be sent by email and delivered by the technician accompanying the victim to the designated service.
Furthermore, the number of reported cases of violence against women is insufficient. Therefore, the integration of a database would be important for producing information and addressing violence against women, allowing for the monitoring of cases and the provision of more humane and comprehensive care, contributing to the prevention of extreme events such as femicide19.
Corroborating this, the participants stated that it would be essential to create an information system for REVCM, linking all institutions, to facilitate referrals and counter-referrals between services and to achieve greater efficiency through quick access to information. This would prevent the victim from being assaulted again. Despite limitations in terms of coverage, completeness, and lack of interoperability between systems, their data have been fundamental in providing visibility to the problem and in policy planning, aiming to improve actions to combat violence19.
It is worth mentioning that most women seek CRM services spontaneously, through recommendations from friends and family, or information found on the internet. Regarding the CRM, the professionals both provide care and counter-referral for women referred to the Center, and also accompany women who are referred from the CRM to other institutions.
Reinforcing the research findings, the lack of standardization in care provided by Primary Health Care (PHC) services, coupled with a lack of clear protocols, flows, and guidelines to where victims should be referred, makes the victims feel helpless within the healthcare system20. This situation requires fostering collaboration across the entire assistance network, including healthcare, education, justice, public safety, and social services, establishing a logic of shared responsibility permeated by networked collaboration21.
In addition, when it comes to care in PHC, women are often considered to be complaining excessively, and professionals are not attentive to the signs and symptoms of violence, failing to offer comprehensive and humane care, leading the victim to fragmented care, suffering, and revictimization.
Also in this study, a professional reported that although the municipality has several services necessary for the REVCM, it currently presents weaknesses by not incorporating the CRM, which is a state service, into the organization, mobilization, and structuring of the municipal network. Another interviewee mentioned the commitment of specialized services; however, non-specialized services should place greater emphasis on the issue of violence against women.
However, even in the face of the difficulties encountered in REVCM, the techniques presented possible strategies that can contribute to the assistance provided to victims of violence. For example, it is essential to update and train professionals, as well as standardize protocols and flowcharts in the care of victims of violence within the REVCM; strengthen inter-institutional dialogue; avoid staff turnover in services, which could revictimize women due to a lack of continuity of care, besides causing disbelief in the team's potential; promote better coordination between services; and above all, the humanization of professionals is critical.
One limitation of this study is that data collection was conducted exclusively at a Women's Reference Center, involving only healthcare professionals working in that setting. This characteristic may limit the generalizability of the results to other health services, especially those that do not have a specialized structure for handling cases of violence. Furthermore, the experience and perception of these professionals may differ from those of workers who operate at other levels of care or in services without a specific focus on this topic. This selection may constitute a sampling bias related to the institutional context and the participants’ profile.
CONCLUSION
This research allows us to see that although the PNEVCM establishes guidelines and actions to prevent and combat this type of violence, the professionals at CRM agree that the technicians from the institutions that make up REVCM need continuous training for the comprehensive and humane care of victims of violence. Likewise, difficulties were observed in the flow of care through the referral and counter-referral process between institutions, since most women arrive at the CRM spontaneously, and many have already faced both the critical path and revictimization in other institutions. There is still differentiated treatment for these women at REVCM, both when they seek treatment at another institution on their own and when they need to return together with a CRM technician.
There is a clear need for public policies aimed at training and integrating women into the labor market. These measures can enhance support for women in breaking away from their abuser, freeing themselves from the cycle of violence.
Correspondingly, one of REVCM biggest challenges, identified by CRM technicians, was the urgent need for an Information System that would bring together all the professionals and institutions that make up the Network. In this way, the critical path would be avoided, which is the path taken by women seeking to break free from violence, often leading to the revictimization of women and increasing the risk of femicide when these women do not feel supported and no longer seek help from REVCM institutions.
Among the strengths of CRM, we find professionals who have been dedicated to the institution for a long time, fostering connections with the women they assist; a compassionate team that accompanies the women to the designated institutions and helps strengthen and empower them. The team also provides training for professionals who make up REVCM in the municipalities of Paraíba and provides workshops for undergraduate students from public and private universities, expanding information on the topic of violence against women.
ACKNOWLEDGEMENT
To the Graduate Program in Public Health of the Universidade Estadual da Paraíba. To the Universidade Federal de Campina Grande. To the State Secretariat for Women and Human Diversity.
REFERENCES
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Legend: The words in the Dendrogram were selected based on the chi-square test of (χ²)