Women’s experiences and expectations after disclosure of intimate partner abuse to a healthcare provider: A qualitative meta-synthesis

Abstract

ObjectiveTo identify and synthesise the experiences and expectations of women victim/survivors of intimate partner abuse (IPA) following disclosure to a healthcare provider (HCP).MethodsThe databases MEDLINE, Embase, CINAHL, PsychINFO, SocINDEX, ASSIA and the Cochrane Library were searched in February 2020. Included studies needed to focus on women’s experiences with and expectations of HCPs after disclosure of IPA. We considered primary studies using qualitative methods for both data collection and analysis published since 2004. Studies conducted in any country, in any type of healthcare setting, were included. The quality of individual studies was assessed using an adaptation of the Critical Appraisal Skills Programme checklist for qualitative studies. The confidence in the overall evidence base was determined using Grading of Recommendations, Assessment, Development and Evaluations (GRADE)-Confidence in the Evidence from Reviews of Qualitative Research methods. Thematic synthesis was used for analysis.ResultsThirty-one papers describing 30 studies were included in the final review. These were conducted in a range of health settings, predominantly in the USA and other high-income countries. All studies were in English. Four main themes were developed through the analysis, describing women’s experiences and expectations of HCPs: (1) connection through kindness and care; (2) see the evil, hear the evil, speak the evil; (3) do more than just listen; and (4) plant the right seed. If these key expectations were absent from care, it resulted in a range of negative emotional impacts for women.ConclusionsOur findings strongly align with the principles of woman-centred care, indicating that women value emotional connection, practical support through action and advocacy and an approach that recognises their autonomy and is tailored to their individual needs. Drawing on the evidence, we have developed a best practice model to guide practitioners in how to deliver woman-centred care. This review has critical implications for practice, highlighting the simplicity of what HCPs can do to support women experiencing IPA, although its applicability to low-income and-middle income settings remains to be explored.

Personal barriers to addressing intimate partner abuse: a qualitative meta-synthesis of healthcare practitioners’ experiences

“…They suggested that, rather than seeking to take control, HCPs could “lessen their discomfort if they recognize that their role is as validator, listener, and advisor” (p.772). This certainly resonates with the findings of our recent meta-synthesis of women’s expectations of HCPs in the context of IPA [ 17 ]. We found that women wanted HCPs to facilitate choice and control in their interactions, and to provide advocacy and action that was guided by the woman’s individual needs and wishes [ 17 ].…”

“…This certainly resonates with the findings of our recent meta-synthesis of women’s expectations of HCPs in the context of IPA [ 17 ]. We found that women wanted HCPs to facilitate choice and control in their interactions, and to provide advocacy and action that was guided by the woman’s individual needs and wishes [ 17 ]. Hegarty and McKibbin’s review [ 21 ] similarly identifies that adopting an advocacy approach rather than a controlling one is central to practitioner readiness to address IPA.…”

“…For some HCPs in low-and-middle-income countries, there are legitimate concerns for personal safety, although it is possible that these fears stem from the assumption that they might be required to help a woman to leave an abusive relationship or confront the perpetrator. However; the literature suggests that there are many practical yet unobtrusive ways that a HCP can support women experiencing IPA that do not involve leaving the relationship [ 17 ] and need not endanger themselves or the patient. For other HCPs, not wanting to interfere appears to be related to the mistaken belief that women will be upset or offended if asked about IPA, and that this perceived harm outweighs the potential benefits.…”

“…These issues mirror those found by Sprague and colleagues [ 12 ], which is concerning to us given that 10 years have now passed. The findings also suggest that HCP perspectives are misaligned with what women actually want [ 17 , 59 ]. In fact, studies consistently highlight that women are keen for HCPs to enquire about IPA and are unlikely to be offended as long as the practitioner asks in a sensitive and non-judgemental way [ 59 ].…”

“…Despite the existence of clinical guidelines [ 11 ], and the development of promising training programs [ 15 , 16 ], many of these barriers persist. This is problematic given the harmful impacts on women’s wellbeing when their expectations for care are not met by HCPs [ 17 ].…”