Barriers to domestic violence disclosure in healthcare settings: a scoping review of victim and provider perspectives

TL;DR

This review explores why victims of domestic violence often don't disclose abuse in healthcare settings, focusing on both male and female victims and diverse cultural contexts.

Contribution

The study expands on prior work by including male victims and studies from Asian countries, offering a more inclusive and culturally diverse perspective.

Findings

Victim barriers include fear of retaliation, stigma, mental health issues, and lack of privacy.

Male victims face societal disbelief and stigma about being victims.

Healthcare professionals cite inadequate training and lack of standardized protocols as barriers.

Abstract

Domestic violence (DV) is a global public health issue with far-reaching physical, psychological, and social consequences. Although prior reviews have identified barriers to DV disclosure in healthcare settings, these have predominantly focused on female victims in Western contexts. This scoping review builds on the work of Heron and Eisma (2021) by including male victims, along with females, and studies from Asian countries, along with western countries, offering a more inclusive and culturally diverse understanding of disclosure barriers.

A thorough search of four databases: PubMed, Scopus, Embase, and the Cochrane Database, was conducted to identify relevant studies published between January 2018 and April 2023. Studies were included if they examined barriers to DV disclosure in healthcare settings from the perspectives of either victims or healthcare professionals (HCPs). Title and abstract screening, full-text review, and data extraction were performed independently by two reviewers. A thematic analysis was conducted to synthesise victim- and HCP-related barriers.

Fifteen studies met the inclusion criteria. Victim-reported barriers included fear of retaliation, social stigma, low self-esteem, mental health challenges, and lack of privacy during healthcare encounters. Male victims highlighted societal disbelief and stigma around male victimhood. In Asian countries, cultural norms around family honour and obedience were particularly influential in discouraging disclosure. Practical barriers, such as the presence of abusers and limited access to services, were common in both high-income and low- and middle-income settings. HCP-reported barriers included inadequate training, absence of standardised protocols, time constraints, and a lack of culturally sensitive tools.

This review identifies complex, context-specific barriers to DV disclosure, especially for male victims and individuals in non-Western healthcare systems. Addressing these barriers requires gender-sensitive training, culturally appropriate interventions, and systemic improvements to healthcare delivery. These findings call for inclusive, evidence-based strategies to support disclosure and improve care for all DV survivors in healthcare settings.

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