Abstract
BackgroundHealthcare practitioners (HCPs) play a crucial role in recognising, responding to, and supporting female patients experiencing intimate partner abuse (IPA). However, research consistently identifies barriers they perceive prevent them from doing this work effectively. These barriers can be system-based (e.g. lack of time or training) or personal/individual. This review of qualitative evidence aims to synthesise the personal barriers that impact HCPs’ responses to IPA.MethodsFive databases were searched in March 2020. Studies needed to utilise qualitative methods for both data collection and analysis and be published between 2010 and 2020 in order to qualify for inclusion; however, we considered any type of healthcare setting in any country. Article screening, data extraction and methodological appraisal using a modified version of the Critical Appraisal Skills Program checklist for qualitative studies were undertaken by at least two independent reviewers. Data analysis drew on Thomas and Harden’s thematic synthesis approach.ResultsTwenty-nine studies conducted in 20 countries informed the final review. A variety of HCPs and settings were represented. Three themes were developed that describe the personal barriers experienced by HCPs: I can’t interfere (which describes the belief that IPA is a “private matter” and HCPs’ fears of causing harm by intervening); I don’t have control (highlighting HCPs’ frustration when women do not follow their advice); and I won’t take responsibility (which illuminates beliefs that addressing IPA should be someone else’s job).ConclusionThis review highlights the need for training to address personal issues in addition to structural or organisational barriers. Education and training for HCPs needs to: encourage reflection on their own values to reinforce their commitment to addressing IPA; teach HCPs to relinquish the need to control outcomes so that they can adopt an advocacy approach; and support HCPs’ trust in the critical role they can play in responding. Future research should explore effective ways to do this within the context of complex healthcare organisations.
Highlights
Healthcare practitioners (HCPs) play a crucial role in recognising, responding to, and supporting female patients experiencing intimate partner abuse (IPA)
The main focus of included studies needed to be on HCP-perceived personal barriers to addressing IPA against women; studies with minimal data on this topic were excluded
Health practitioners experience a range of personal barriers to providing support to patients experiencing IPA, in addition to structural and organisational issues such as lack of time and workload pressure identified in previous reviews of the literature
Summary
Healthcare practitioners (HCPs) play a crucial role in recognising, responding to, and supporting female patients experiencing intimate partner abuse (IPA). Intimate partner abuse (IPA) is a global epidemic which disproportionately affects women and their children. It is consistently associated with a range of serious negative physical, mental and reproductive health outcomes and is a major cause of injury, morbidity and mortality in women [1, 2]. Women who are experiencing IPA make more frequent use of healthcare services than women without a history of violence [8, 9] This is the case across all levels of the health system, including primary care, hospital emergency departments, sexual and reproductive health services and mental health services [8]. The World Health Organization strongly recommends that HCPs incorporate a response to IPA into their daily practice and has developed guidelines around how to do this effectively and sensitively [11]
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