Social determinant factors and access to health care for women experiencing domestic and family violence: Qualitative synthesis

Abstract

Aims The aim of this study was to explore the social determinant factors and access to health care for women with lived experience of domestic and family violence. Design Qualitative synthesis. Data Sources A search of CINHAL, Embase, Medline and PubMed, was conducted between December 2021 and March 2022. Review Methods Primary qualitative studies published in English from 2000 to 2021 were included. Findings were thematically analysed using the Levesque et al. (2013) access to healthcare framework. Study design was assessed using the Critical Appraisal Skills Programme for qualitative research. Results Twenty‐eight studies were included. Findings related to the Levesque domains of approachability, appropriateness and availability of health services. Social determinants included perceived stigma and fear of discrimination leading to a lack of trust in healthcare professionals and fear of disclosure, which prohibits disclosure. Women reported their limited awareness of available support services, an absence of health professional screening and insufficient response when they disclosed presence of domestic and family violence, which collectively reduced their healthcare access. Conclusion Findings advance our understanding of how social determinant factors influence women's ability to access health care. The determinants related to discrimination and stigma, which prohibited the establishment of trust, were the most influential factors on access to care. Impact Women experiencing domestic and family violence are hesitant to disclose, and violence continues in secret. Social determinant factors of stigma and trust prohibit women's disclosure and therefore their access to health care. Findings hold implications for nurses' consciousness of these social determinant factors. Raising nurses' awareness to curiously question the presence of domestic and family violence may build trust that leads to disclosure and improves access to health care. No Patient or Public Contribution The authors intend to present the findings to people with lived experience in the next phase of this programme of research.

Domestic violence against women has increased during the COVID‐19 pandemic: A perspective paper about the need for change to current and future practice

“…DV is any act that occurs within a domestic home where power and violence are used to dominate and control (Adams et al, 2022; Bradbury‐Jones & Isham, 2020; Hollingdrake et al, 2022; Ogbe et al, 2020), most commonly perpetrated by either a current or ex‐partner of the victim (Bradbury‐Jones & Isham, 2020; Bradbury‐Jones & Nikupeteri, 2021; Kourti et al, 2021; Papas et al, 2023). DV can involve a constellation of physical violence, harassment, sexual violence, coercion, stalking, financial control, emotional abuse and coercive control (Bradbury‐Jones & Isham, 2020; Gracia et al, 2020; Hollingdrake et al, 2022; Ogbe et al, 2020; World Health Organization, 2012).…”

“…As previously stated, victims of DV often do not disclose incidences because they are afraid or reluctant to reveal DV; however most women will have attended a health service for unrelated conditions (Papas et al, 2023). This reluctance to disclose can be associated with various factors, including lack of support, stigma (internalized, anticipated stigma, enacted and perpetrator stigma), shame, fear of disclosure or retaliatory consequences, scepticism, negative judgement from health care providers, concerns about cultural safety and attracting the negative attention of family and other government services (Franklin et al, 2020; Ogbe et al, 2020; Papas et al, 2023; Wilson et al, 2021).…”

“…The Australian Institute of Health and Welfare reported that while the numbers of female deaths attributed to DV in Australia increased in 2020, they actually decreased in 2021 (Australian Institute of Health Welfare, 2022). Of interest, reports of sexual assaults (SA) in Australia increased markedly in 2020 and again in 2021, with one in five women and 1 in 21 men reporting having experienced sexual violence (SV) since the age of 15 and 2.2 million people experiencing a form of DV (physical or sexual) (Australian Institute of Health Welfare, 2022; Papas et al, 2023).…”

“…Yet despite the clear impact on mental health, women experiencing DV often face significant barriers to accessing mental health services (Keynejad et al, 2020). Unfortunately, these challenges mean women may not receive necessary treatment for their condition or their issue may not be recognized (Papas et al, 2023).…”

What is the feasibility of using WAST-Short domestic abuse screening tool in primary care? An exploratory cross-sectional study in Northwest London

“…Multiple social determinants of health in uence patients' experiences of DA and their willingness to disclose, seeking access to health and other services (17). Understanding such characteristics would help develop policies and guidance to tackle this growing societal concern.…”