"This is not within the scope of our tasks or even duties"—barriers in the identification of domestic violence by healthcare workers
Authors: Wieczorek Łukasz , Dąbrowska Katarzyna , Łukowska Katarzyna 
Published: August 2024

Abstract
Background
Individuals experiencing violence often complain about physical and mental health problems and make more frequent use of healthcare services. Therefore, healthcare workers play a crucial role both in recognizing violence and in treating its effects. The aim of this article is to identify barriers in recognizing domestic violence by healthcare workers—primary care physicians, specialists, and addiction therapists.

Methods
The study was qualitative; semi-structured interviews with a list of sought information were conducted. The research (N = 60) was carried out among primary care physicians employed in Primary Health Care facilities (N = 20), specialists in psychiatry, gynecology, emergency department workers (N = 20), and Addiction Therapy Specialists (N = 20). The selection of participants for the study was purposive.

Results
The barriers to recognizing domestic violence identified in our study can be classified into three dimensions: related to the organization of healthcare, the workers employed in the system and their readiness to recognize the phenomenon, and those related to the victims of violence. Among the barriers related to the organization of healthcare, we highlighted the short visit time, extensive bureaucracy, waiting queue, lack of continuity of care, and poor communication between different institutions, lack of screening tests, local conditions preventing the assurance of privacy, lack of support from superiors for doctors and therapists who feel left alone if they identify violence. Among the barriers on the side of professionals, we identified a lack of readiness and competencies to identify the phenomenon of violence. Doctors are not sensitive to signals indicating violence, ignore and trivialize this phenomenon, and believe that its identification is beyond their competencies. Workers fear for their safety. It happens that their personal beliefs also hinder them from identifying the phenomenon. Among the barriers that can be linked to individuals experiencing violence, we identified fear of stigmatization, shame, fear of inadequate reaction from healthcare workers, fear of retaliation, further exploitation and "taking away" children, loss of home and social status, normalization of violence, rationalization of the perpetrator's behaviors and belief in the ubiquity of the phenomenon, lack of knowledge about different types of violence, personal acquaintances in the local community, and a lack of trust in specialists.

Conclusions
Some of the barriers on the side of professionals stem from the functioning of the healthcare system, e.g., lack of competence in recognizing the phenomenon, reluctance to take responsibility for its identification. Introducing changes in the system can reduce the occurrence of barriers on the side of professionals. Barriers on the side of individuals experiencing violence seem harder to overcome. Some of these barriers could be overcome through various types of preventive actions at the universal level.