Health practitioners’ perceptions of structural barriers to the identification of intimate partner abuse: a qualitative meta-synthesis

Background Health care practitioners (HCPs) play a critical role in identifying and responding to intimate partner abuse (IPA). Despite this, studies consistently demonstrate a range of barriers that prevent HCPs from effectively identifying and responding to IPA. These barriers can occur at the individual level or at a broader systems or organisational level. In this article, we report the findings of a meta-synthesis of qualitative studies focused on HCPs’ perceptions of the structural or organisational barriers to IPA identification. Methods Seven databases were searched to identify English-language studies published between 2012 and 2020 that used qualitative methods to explore the perspectives of HCPs in relation to structural or organisational barriers to identifying IPA. Two reviewers independently screened the articles. Findings from the included studies were analysed using Thomas and Hardin’s method of using a thematic synthesis and critiqued using the Critical Appraisal Skills Program tool for qualitative studies and the methodological component of the GRADE-CERQual. Results Forty-three studies conducted in 22 countries informed the review. Eleven HCP settings were represented. Three themes were developed that described the structural barriers experienced by HCPs: The environment works against us (limited time with patients, lack of privacy); Trying to tackle the problem on my own (lack of management support and a health system that fails to provide adequate training, policies and response protocols and resources), Societal beliefs enable us to blame the victim (normalisation of IPA, only presents in certain types of women, women will lie or are not reliable). Conclusion This meta-synthesis highlights the need for structural change to address these barriers. These include changing health systems to enable more time and to improve privacy, training, policies, and referral protocols. On a broader level IPA in health systems is currently not seen as a priority in terms of global burden of disease, mortality and morbidity and community attitudes need to address blaming the victim.