Organizational and systems-level barriers and facilitators to health professionals' readiness to address domestic and sexualized violence: a qualitative study from Nova Scotia, Canada

Enrique Villacis Alvarez¹Janine Noorloos²Susan Wilson²Robert Green²Shelley Fashan³Christine Pritchett⁴Alexa Yakubovich^1,2*

• ¹Dalhousie University, Halifax, Canada
• ²Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
• ³Health Association of African Canadians, Halifax, Canada
• ⁴IWK Health, Halifax, Nova Scotia, Canada

Introduction: Domestic and sexualized violence, including intimate partner violence, are an increasing public health concern across Canada. Beginning with the province of Nova Scotia, several jurisdictions have now declared this violence to be 'an epidemic,' with renewed calls for health systems to be part of prevention efforts. Recent research has shown that while many health professionals are seeing cases of violence in their work, their training, resources, and workplace supports are inadequate. The current paper aimed to qualitatively analyze how discourses around domestic and sexualized violence affect health professionals' readiness to respond. Methods: From November 2023 to February 2024, we conducted an online, mixed-methods survey of professionals working in health-related fields in Nova Scotia (N=1,649). We qualitatively analyzed responses from 828 participants who answered at least one open-ended question using reflexive thematic analysis within a feminist poststructuralist framework. Results: We generated two themes in our analysis. The first theme, "inconsistent approaches to addressing violence," described how many participants were aware of the impacts of violence on their patients but relied on different discourses for whether (or not) the issue falls within their scope of practice. Participants highlighted key organizational challenges limiting their potential responses to violence (e.g., protocols, training, staffing, time constraints). The second theme, "the limits of downstream health responses amid structural barriers," highlighted how individual health professionals experienced their positions as too "downstream" to provide significant responses to an issue rooted in structural factors (e.g., housing insecurity) that has only exacerbated since the onset of the COVID-19 pandemic. Conclusion: Our results provide important insights into current organizational and systems-level barriers and facilitators for responding to domestic and sexualized violence among Canadian health professionals. Government and organizational policy should more clearly define how domestic and sexualized violence is within scope of practice for different health professionals, with appropriate, ongoing training and resourcing. Likewise, structural causes of violence must be recognized, both in terms of identifying and supporting patients and communities at greatest risk and creating opportunities for the health sector to be a part of primary prevention efforts.