Sexual workplace violence in the health sector in Saudi Arabia: a cross sectional study

Abstract

Background Sexual workplace violence occurs worldwide with increasing prevalence, causing psychological and physical injuries. However, only few reports from the Kingdom of Saudi Arabia have investigated the most involved health specialty and its association with other factors, such as working and sociodemographic conditions. The aim of this study was to determine the prevalence of workplace sexual violence over 12 months, from May 2018 to May 2019, circumstances related to the event, and consequences for the perpetrator and survivor and to identify associated factors among all healthcare workers (HCWs) in Saudi Arabia. Methods This cross-sectional study included all HCWs registered with the Saudi Commission for Health Specialties who worked for > 1 year in the health sector (government or private) in Saudi Arabia until May 2019. A non-probability convenient sampling technique was used. A modified self-administered questionnaire sent via email was utilized to assess workplace violence. Descriptive statistics were used to report percentages and frequencies, while advanced statistics, such as bivariate analysis, were used to determine associations. Multivariate logistic binary regression analysis was used to assess the combined and individual associations between relevant predictors of exposure of HCWs to recent sexual violence at the workplace. Results In total, 7,398 (male, 51.3%; female, 48.7%) HCWs were electively enrolled in the study (mean age 40 ± 8.62 years). Most were non-Saudi (60%). Overall, 3.9% were sexual violence survivors. Approximately 60.7%, 51.4%, 48.3%, and 65.9% of female workers, nurses, Saudi natives, and night shift workers (18:00 to 07:00), respectively, were significantly exposed to sexual violence. Furthermore, approximately 54.8% of those with direct physical contact with patients had a higher rate of exposure to sexual harassment (p = 0.001). Conclusions The prevalence of sexual violence is low but remains a risk to HCWs, especially those working night shifts and having direct physical contact with patients. Thus, more support, specific strategies, and policies are needed to reduce the rate of occurrence, protect HCWs, and prevent such events. The underreporting of cases may be skewing the magnitude of the problem; thus, more education and additional research in Saudi Arabia are needed regarding sexual violence experienced by HCWs.

A gender-based review of workplace violence amongst the global health workforce—A scoping review of the literature

“…The professional hierarchy among midwives, nurses, physicians, and others [ 13 , 47 , 51 , 83 , 87 , 90 , 96 , 105 , 110 , 134 , 140 , 143 , 159 , 165 , 169 – 172 , 183 , 189 , 198 , 205 , 224 ] and the organizational hierarchy within or between different professionals [ 47 , 80 , 95 , 116 , 152 , 165 , 184 , 194 , 204 , 226 , 230 , 242 ] was found to contribute to various forms of workplace violence. Some studies reported a higher prevalence of WPV among women across the workforce; they reported that female nurses’ experience of WPV was higher than female physicians in Australia [ 83 ], Brazil [ 96 ], Canary Island [ 189 ], France [ 197 ], Kenya [ 183 ], Italy [ 31 , 105 ], Japan [ 110 ], Turkey [ 138 ], Ghana [ 36 ], and India [ 146 ].…”

“…Some studies reported a higher prevalence of WPV among women across the workforce; they reported that female nurses’ experience of WPV was higher than female physicians in Australia [ 83 ], Brazil [ 96 ], Canary Island [ 189 ], France [ 197 ], Kenya [ 183 ], Italy [ 31 , 105 ], Japan [ 110 ], Turkey [ 138 ], Ghana [ 36 ], and India [ 146 ]. Verbal abuse was prevalent for female nurses in the Caribbean [ 13 ], Norway [ 224 ], and Cyprus [ 231 ] from patients or relatives; aggression from staff and colleagues was prevalent in England [ 90 ], from patients and visitors in Switzerland [ 205 ], and from patients in Poland [ 51 ], Israel [ 176 ] and Italy [ 159 ]; mobbing was found to be prevalent for female nurses in Turkey [ 140 ] and Cyprus [ 165 ], and sexual harassment was found to be prevalent among female nurses in Nepal [ 143 ] and Saudi Arabia [ 172 ]. A smaller number of studies reported a higher prevalence of violence for males in Colorado, USA [ 134 ], Turkey [ 141 ], China [ 155 ], Jordan [ 169 ] and Saudi Arabia [ 170 , 171 ].…”

“…Workplace routines for all health workers were found to be risk factors for exposure to violence, including longer working hours [ 5 , 151 , 156 , 161 , 171 , 226 ], shifting duties, particularly night shifts [ 14 , 30 , 55 , 56 , 69 , 76 , 124 , 139 , 141 , 155 , 156 , 167 , 172 , 175 , 188 , 219 , 243 ], and direct patient care [ 153 , 159 , 172 ]. Night shifts were found to be a risk factor for WPV among male nurses in Bangladesh [ 30 ], Iran [ 69 ], Lebanon [ 219 ], Turkey [ 76 ], Korea [ 139 ], and China [ 155 , 167 , 243 ].…”

“…Additionally, hours of work and type of position were found to be risk factors for WPV in several studies for women. Working full-time [ 153 ], shifting duties [ 124 ], overtime/more hours of work [ 226 ], and direct patient care [ 153 , 159 , 172 ] were all associated with higher rates of exposure to violence among female nurses. In the case of medical personnel, male GPs in Australia who worked full-time experienced higher levels of verbal abuse than part-time GPs [ 12 ].…”

“…Several studies examined specific clinical settings and the risk for physical and non-physical violent incidences. Most incidents occurred in the emergency department (ED) and psychiatric settings [ 72 , 76 , 89 , 105 , 110 , 111 , 138 , 153 , 166 , 169 – 172 , 178 , 181 , 188 , 202 , 203 , 221 , 232 , 243 ]. Several studies reported female nurses suffering non-physical violence in EDs in China [ 89 , 208 ] and Ethiopia [ 111 ] and in psychiatric units in the USA [ 153 ]; physical violence was experienced in pediatric clinics in Turkey [ 138 ] and China [ 208 ], psychiatric units in USA [ 203 ], and in the primary/secondary care facilities in Brazil [ 151 ].…”