Health practitioners’ perceptions of structural barriers to the identification of intimate partner abuse: a qualitative meta-synthesis

Abstract

Background Health care practitioners (HCPs) play a critical role in identifying and responding to intimate partner abuse (IPA). Despite this, studies consistently demonstrate a range of barriers that prevent HCPs from effectively identifying and responding to IPA. These barriers can occur at the individual level or at a broader systems or organisational level. In this article, we report the findings of a meta-synthesis of qualitative studies focused on HCPs’ perceptions of the structural or organisational barriers to IPA identification. Methods Seven databases were searched to identify English-language studies published between 2012 and 2020 that used qualitative methods to explore the perspectives of HCPs in relation to structural or organisational barriers to identifying IPA. Two reviewers independently screened the articles. Findings from the included studies were analysed using Thomas and Hardin’s method of using a thematic synthesis and critiqued using the Critical Appraisal Skills Program tool for qualitative studies and the methodological component of the GRADE-CERQual. Results Forty-three studies conducted in 22 countries informed the review. Eleven HCP settings were represented. Three themes were developed that described the structural barriers experienced by HCPs: The environment works against us (limited time with patients, lack of privacy); Trying to tackle the problem on my own (lack of management support and a health system that fails to provide adequate training, policies and response protocols and resources), Societal beliefs enable us to blame the victim (normalisation of IPA, only presents in certain types of women, women will lie or are not reliable). Conclusion This meta-synthesis highlights the need for structural change to address these barriers. These include changing health systems to enable more time and to improve privacy, training, policies, and referral protocols. On a broader level IPA in health systems is currently not seen as a priority in terms of global burden of disease, mortality and morbidity and community attitudes need to address blaming the victim.

Improving health system readiness to address violence against women and girls: a conceptual framework

“…The integration of an IPV response within healthcare requires establishing procedures and building specific skills (such as empathic listening, validation and assisting with referrals to other services) that may require more time than is allocated per patient [ 11 ]. It also requires a change in the institutional medical culture (from ‘treat’ to ‘care and support’) [ 10 ] and in the structural factors (from normalisation to unacceptance) [ 12 ]. Furthermore, when new programmes to improve response to VAW are implemented, it is important to first assess the readiness of the receiving health system [ 10 , 13 ].…”

Understanding the dynamics of support seeking in women with lived experience of non‐physical intimate partner violence (IPV) and the service responses—A qualitative study

“…Similar to previous research (Sprague et al, 2014), we found that majority of women in our study contacted a healthcare professional before the violence turned physical as they were seeking help for the mental health conditions that resulted from the non‐physical violence. Research indicates a lack of adequate training and education amongst healthcare professionals to screen for IPV and refer appropriately (Al‐Natour, Qandil, & Gillespie, 2016; Hudspeth, Cameron, Baloch, Tarzia, & Hegarty, 2022; Swailes, Lehman, & McCall‐Hosenfeld, 2017). Our study builds upon this with participants reporting a lack of recognition of non‐physical forms of abuse amongst healthcare professionals, thereby leaving the women without support and at risk of further harm (Djikanovic, Celik, Simic, Matejic, & Cucic, 2010).…”

“…depression) to take time to identify the root cause (such as IPV), and together develop an intervention or referral pathway that meets the woman's needs (Marsden, Humphreys, & Hegarty, 2021). As recognised in a meta‐synthesis, health systems require improved training, policies and referral protocols and we would highlight that the training needs to appropriately identify non‐physical IPV, intervention or referral pathways (Hudspeth et al, 2022).…”

Transforming health settings to address gender‐based violence in Australia

“…There are many barriers to inquiry by health practitioners and disclosure by victims/survivors 19‐21 . A systematic review of 35 quantitative studies suggested low rates of routine domestic violence screening by practitioners (with the majority reporting between 10% and 20%) 22 From meta‐syntheses of qualitative studies, we know that health practitioners experience personal and structural barriers to domestic violence inquiry and response.…”

“…Personal barriers include practitioners feeling they “can’t interfere” as domestic and sexual violence are private issues, “don’t have control” over outcomes for victims/survivors, and “won’t take responsibility” as it is someone else’s role 20 . At the structural level, practitioners perceive that “the environment works against us” with lack of time and spaces, they are “trying to tackle the problem on their own” without a team behind them, and “societal beliefs enable us to blame the victim” 19 . System‐level barriers, such as the presence of the partner in consultations or a lack of training or referral services, can impede practitioners even further 23 .…”