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.

Keywords: access to care; domestic abuse; domestic violence; family violence; health care; health service; intimate partner violence; qualitative.