Prevalence, Characteristics, and Associated Factors of Workplace Violence Against Healthcare Professionals in India: A Systematic Review and Meta-analysis

Abstract

Background: Workplace violence (WPV) against doctors, nurses, and other healthcare professionals is a growing public health concern affecting health systems in low- and middle-income countries. In India, incidents of WPV against health workforce have become common in recent years. However, there is no synthesized evidence on the nationwide burden of WPV in healthcare. This study aims to systematically evaluate the current evidence on the prevalence, characteristics, and associated factors of WPV against healthcare professionals in India. Methods: We systematically searched seven major databases and additional sources to retrieved published literature on WPV in India. We included empirical studies without any time restriction, which reported the prevalence of WPV against healthcare professionals in India. Following data extraction, we estimated the pooled prevalence of WPV using random-effects model in meta-analysis. The characteristics and associated factors of WPV were narratively synthesized from these empirical studies. Results: Among 1065 articles retrieved from multiple sources, 15 studies met our inclusion and exclusion criteria. The pooled prevalence of WPV among 2849 participants in those 15 studies was 63% (95% confidence interval [CI], 54%-72%). In the subgroup analyses, the pooled prevalence for male and female was 64% (95% CI, 51%-78%) and 54% (95% CI, 47%-62%) respectively. Moreover, pooled prevalence in 12-months and lifetime was 55% (95% CI, 43%-67%) and 69% (95% CI, 61%-78%) respectively. Among the participants, the prevalence of verbal violence (52%; 95% CI, 45%-60%) was higher than physical violence (8%; 95% CI, 5%-11%). The emergency department was a common location of WPV, whereas the patients' attendants were perpetrators in most studies. Major factors associated with WPV included ineffective patient-provider communication, less experience of the healthcare professionals, overcrowding, shortage of resources, long waiting hours, lack of security measures, dissatisfaction about health services, high cost of care, the negative role of media, and other socio-behavioral problems among the patients and healthcare professionals. Conclusion: WPV is highly prevalent among healthcare professionals in India. Critical challenges within the healthcare and social context necessitate further research, better policymaking, and multipronged interventions to address the same and prevent WPV against healthcare professionals in India.

Strengthening primary care to address workplace violence against doctors in India

“…In the journal's earlier issue, the editorial “Death of a doctor - Ek Doctor Ki Maut—Time to boost the ailing and failing public health system in India“,[ 1 ] rightfully presses upon the need to strengthen India's ailing primary healthcare system to prevent workplace violence (WPV) against doctors in India. The severity mentioned in this editorial coincides with the findings of a recent meta-analysis,[ 2 ] which found that the pooled prevalence of WPV among 2849 healthcare providers in India was 63% (95% confidence interval [CI], 54–72%). Moreover, the prevalence of verbal violence (52%; 95% CI, 45–60%) was higher than physical violence (8%; 95% CI, 5–11%),[ 2 ] which highlights the death of a doctor or similar news reporting physical injuries are the tip of the iceberg, where the actual magnitude of WPV is much higher in reality.…”

“…The severity mentioned in this editorial coincides with the findings of a recent meta-analysis,[ 2 ] which found that the pooled prevalence of WPV among 2849 healthcare providers in India was 63% (95% confidence interval [CI], 54–72%). Moreover, the prevalence of verbal violence (52%; 95% CI, 45–60%) was higher than physical violence (8%; 95% CI, 5–11%),[ 2 ] which highlights the death of a doctor or similar news reporting physical injuries are the tip of the iceberg, where the actual magnitude of WPV is much higher in reality. A robust primary care system can decongest the over-burdened tertiary care hospitals, preventing their overcrowding—a major precipitating factor for WPV against doctors and other healthcare professionals.…”

“…First, ensuring optimum structural and functional capacities and improving the security management of primary healthcare facilities are essential. [ 2 3 ] Preventing discomfort and impatience among patients and healthcare professionals, which may arise due to poor and unsafe infrastructure is critical for avoiding violent scenarios, especially in resource-constrained settings. Additionally, advanced security and surveillance systems can provide security oversight over primary care facilities and help make decisions to avoid potential conflicts.…”

“…Second, strengthening emergency management and referral services at primary care centers is indispensable. [ 1 2 ] Several strategies can be adopted for this purpose, such as institutionalizing trauma management protocols to promptly refer patients to pre-specified healthcare facilities depending upon the type of injuries sustained, ensuring around the clock ambulance services, setting up hotlines for communication during rapid response emergency cases, and establishing a centralized information system between patients and health services organizations for better coordination of emergency and referral care.…”

“…Third, building capacities of those involved in delivering primary care would be necessary to avoid any sort of conflict. [ 2 ] It is essential to ensure the availability of optimal human resources who are adequately trained to deliver services upholding professional dignity and autonomy. Also, ensuring efficient patient-provider communication is critical; therefore, psychosocial and educational interventions may help by enabling healthcare providers to better communicate with their patients and help them with empathy and devotion, which are the soon-to-be-lost arts of medicine globally.…”