Title: Healthcare provider experiences interacting with survivors of intimate partner violence:
A qualitative study to inform survivor-centered approaches
Version: 1 Date: 21 Aug 2023
Reviewer's report:
Healthcare provider experiences interacting with survivors of intimate partner violence: A
qualitative study to inform survivor-centered approaches - Reviewer's Comments.
Intimate partner violence is one of the most common forms of violence and is a pervasive public
health problem. Exploring perspectives of a variety of reproductive health care providers is a
major strength of this study. The authors also provided evidence of challenges IPV survivors
health, pertinent information that can inform public health strategies to support survivors in
Uganda.
However, I have a number of concerns/suggestions.
Major Concerns/Suggestions
1. The authors have not provided a sufficient review of available literature on the topic.
The scant literature review does not lay the groundwork to appreciate what is known about
factors associated with non-disclosure of IPV. For instance, the authors state in Line 63 that
“Non-disclosure of IPV…presents methodological and ethical challenges…. What are these
challenges? How is this associated with the subsequent statements on survivors’ safety concerns.
There is some disconnection here.
2. A similar disconnection between main points raised is also found in the third paragraph. The
authors state that “Survivor-centered approaches seek to empower individuals….” But have not
explained how. They however identify how to improve survivor recovery without providing
information on the challenges or inadequacies of current survivor-centered approaches.
3. The authors have identified a dearth of literature on IPV disclosure during routine antenatal
care visits. However, the authors can strengthen their introduction by reviewing available
literature on non-ANC healthcare visits i.e., review providers’ perspectives on patients’
awareness, access and utilization of IPV services.
4. Line 81: The authors have stated that voices of survivors are often not heard but have not
explained why. Again, this underlines the need for a more comprehensive review of available
literature on the topic.
5. Line 154: The authors state that “Financial empowerment efforts enable survivors to become
more independent…” Is this a specific finding from the study or the authors opinions? If not
specific finding, this information should be included in introduction and then reiterated here.
6. The authors need to review the presentation of their findings. Some of the themes and sub-
themes appear to be miss-characterized. There is repetition of findings and miss-categorization
of relevant findings. See examples below:
a. Quotes 2 and 3 included under the theme on economic empowerment do not have any
information related to this theme. I suggest the authors re-name theme or move these quotes to
a different theme. Maybe create a new one on supplementary support services for survivors.
b. Line 194: The authors state that “Providers stated that some survivors …while some survivors
were anxious about seeking care…” Being unaware of available services and anxiety utilizing
these services are important findings and should be assessed as separate themes.
c. Some of the sub-themes need to be re-categorized. Also, some of the findings can be presented
under fewer sub-themes. For instance, the sub-theme on “persistent safety concerns” can be
grouped with the theme “fear of disclosure of abuse”. Also, the sub-theme on fear of losing their
marriage can be combined with information on losing financial support from partner OR move
to the sub-theme on economic empowerment. These findings can be presented under the theme
on the fear of disclosure. It appears that factors associated with the fear of disclosure include
safety concerns, fear of losing marriage, fear of being stigmatized etc.
d. Line 330: The quote here should be moved to the sub-theme on: abuse as an expression of
affection.
7. Some of the study findings identify factors that affects health care provider’s ability to help
survivors. See Line 230: This quote on a lack of training is a notable finding - that seems to be
glossed over and/or embedded in different themes. Study findings on a lack of adequate training,
distrust of health care providers etc., are critical factors that need to be addressed to increase IPV
disclosure in healthcare settings.  I suggest the authors create a theme on provider’s perceptions
on their ability to support their patients.
8. Also related to the comments above, the authors find that more than half of their study
respondents do not routinely screen for IPV. Did the authors probe the providers on reasons
why this is not a wide-spread practice? This is another finding of the study which needs to be
highlighted. These results can be presented under the theme on healthcare providers perceptions
on challenges they face in delivering care to IPV survivors.
9. There are 2 sub-themes on distrust of healthcare providers.
10. The authors have alluded to survivors’ preferences for survivor-centered approaches but
have provided no evidence to support this and very little evidence on survivors’ rights. The
authors need to provided additional information to strengthen these study objectives or revise
their objectives.
11. In the discussion of their findings, the authors state that their investigation shows how “the
needs of IPV survivors are interconnected and reinforce each other”. This interconnection and
reinforcement is not evident from the presentation of study findings. This reiterates the need to
re-write this section of the manuscript.
12. Line 458: The authors refer to prior research that IPV survivors are less likely to report
to healthcare workers. Why? Need to explain. Also, this information should be connected to
specific findings from this present study.
13. There is a disconnection between the study objectives and findings with study implications.
The authors seem to highlight health care worker’s awareness of IPV and facility infrastructure
to support IPV detection, giving the impression that the focus of the study is on health
care providers and not IPV survivors i.e., assessing providers perspective of IPV survivors’
perceptions, knowledge, experience etc.
14. See also Line 510: the authors highlight the need for adequate consultation time. This is not a
study finding and provides the impression that the focus of the study was on healthcare provider
perspectives on the challenges they (the health care workers) face. This is entirely different from
the objectives of the study i.e., identifying ways to improve IPV disclosure from healthcare
providers perspectives on survivors – their needs, preferences and rights.
15. The authors need to identify other limitations of their study and discuss implications of these
limitations to the interpretation of their findings.
16. The authors conclude that their findings provide evidence to “inform efforts to re-frame
GBV prevention…”. It is not clear what the authors mean by “re-framing GBV”.
Minor concerns/suggestions
1. Line 28: The objective of the study i.e., to understand how to improve IPV disclosure, is not
clearly stated. I suggest authors include in the background language that identifies the study
objectives.
2. Line 30: The authors conclude the need to prioritize survivors’ preferences but some details
about these preferences have not been identified in the results section.
3. Line 49: I suggest substituting “responsive” for “conducive” in Line 49.
4. Line 51: It is not clear what the authors mean by “Re-framing GBV prevention”. This is
vague. Need to rephrase.
5. Line 57: Need to provide a reference for this sentence.
6. Line 457: Need to provide references for this prior research.
7. Line 495: Need to spell out the acronym VAGW.
8. Line 498: The policy authors refer to here is not clear. This statement is vague, need to
rephrase.
9. Line 553: Data associated with datasets referred to here have not been provided.