Identification of Intimate Partner Violence, and Support for Victim-Survivors by Rural and Remote Primary Healthcare Clinicians: a Scoping Review

Purpose: Intimate partner violence (IPV) is a pervasive public health issue, with disproportionately higher rates outside of urban and metropolitan areas. Primary healthcare (PHC) services are the first point of contact into the healthcare system and where many victim-survivors present. However, regional, rural and remote PHC clinicians face unique challenges that hinder effective identification and support of IPV. Methods: The PRISMA-ScR and Arksey and O’Malley (2005)’s five-stage framework was followed to map existing research. CINAHL, MEDLINE, Embase, PsycINFO, Web of Science, and ProQuest were searched for papers describing strategies used by PHC clinicians in regional, rural and remote areas to identify IPV and provide support to victim-survivors. Data were extracted into summary tables and analysed in a process informed by thematic analysis. Results: From the 932 papers identified, 44 were reviewed in full-text review, and 6 met the inclusion criteria. Most studies (n = 5, 83%) focused solely on rural areas, with one (17%) study reporting on rural, remote and urban areas. No included studies focused on regional and very remote areas. Identification of IPV in included papers was typically informal and opportunistic, with limited structured screening. Clinicians employed covert strategies to support patients experiencing IPV, often maintaining confidentiality around disclosures. Limited structured training and a lack of referral pathways influenced clinicians’ identification practices due to the perceived inability to offer tangible, ongoing support following a formal disclosure. Conclusions: The ways in which IPV is identified and victim-survivors are supported in rural and remote PHC settings are often complex and variable. This scoping review highlights the absence of structured context-appropriate training to inform effective sensitive-inquiry strategies in the early identification of IPV; and inconsistent referral pathways that consider the unique contexts of rural and remote areas. Strengthening rural and remote PHC responses to IPV will require coordinated efforts to build workforce capacity through education and training, intersectoral collaboration, and culturally safe, trauma-informed systems. Future research should consider exploring strong health-promotion efforts in rural and remote communities around violence primary prevention to shift community-wide attitudes and responses to IPV.