Factors affecting women's disclosure of domestic abuse and healthcare professionals' preparedness to identify and respond: a systematic literature review.

PURPOSE: Domestic abuse (DA) is a significant public health and human rights issue with profound physical, psychological, and social consequences. Healthcare settings provide important opportunities for identification and support; however, disclosure by women remains inconsistent, and healthcare professionals' readiness to identify and respond varies widely. This qualitative systematic review synthesised evidence examining factors influencing women's disclosure of DA within healthcare contexts and healthcare professionals' preparedness to respond.

METHODS

A systematic search of MEDLINE, Embase, CINAHL, PsycINFO, and Scopus was conducted for studies published between 2000 and 2023. Additional studies were identified through reference searching. The review followed PRISMA guidance and was informed by the SPIDER framework. Qualitative and mixed-methods studies with extractable qualitative findings were included. Methodological quality was appraised using the Critical Appraisal Skills Programme checklist. Findings were synthesised narratively and interpreted using a socio-ecological model to capture multilevel influences on disclosure and response.

RESULTS

Disclosure emerged as a relational and socially mediated process shaped by trust, perceived safety, validation, confidentiality, and continuity of care. Forms of "borrowed trust," mediated through social networks, influenced women's willingness to engage. Healthcare professionals' preparedness was determined by competence, confidence, emotional readiness, clarity of safeguarding responsibilities, and access to referral pathways. Structural factors, including limited consultation time, workload pressures, and organisational ambiguity, constrained effective response. Importantly, disclosure alone did not ensure improved outcomes where system readiness was inadequate.

CONCLUSION

Improving responses to DA requires multilevel strategies extending beyond individual training. Sustainable progress depends on organisational leadership, protected time, clear referral systems, and alignment across relational and structural domains to support safe disclosure and meaningful intervention.