Organizational and systems-level barriers and facilitators to health professionals’ readiness to address domestic and sexualized violence: a qualitative study from Nova Scotia, Canada
Bibliographic record
Abstract
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: = 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. Many participants reflected on how fragmented systems of support may increase the risk of survivors experiencing violence. Respondents expressed frustration as they recounted limited capacity to meet the needs of survivors without social and structural infrastructures. 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.011 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.024 | 0.010 |
| Scholarly communication | 0.005 | 0.002 |
| Open science | 0.003 | 0.005 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".