Abstract
OBJECTIVES: Domestic violence and abuse (DVA) is highly prevalent, with severe adverse consequences to the health and well-being of survivors. There is a smaller evidence base on the health of DVA perpetrators and their engagement with healthcare services. This review examines the experiences of perpetrators of DVA of accessing healthcare services and the barriers and facilitators to their disclosure of abusive behaviours in these settings. DESIGN: A systematic review and meta-synthesis of qualitative studies. DATA SOURCES: A systematic search was conducted in Cochrane, MEDLINE, Embase, PsycINFO, HMIC, BNID, CINAHL, ASSIA, IBSS, SSCI (peer-reviewed literature) and NDLTD, OpenGrey and SCIE Online (grey literature). Each database was searched from its start date to 15 March 2020. Eligibility criteria required that studies used qualitative or mixed methods to report on the experiences of healthcare use by perpetrators of DVA. A meta-ethnographic method was used to analyse the extracted data. RESULTS: Of 30,663 papers identified, six studies (n=125 participants; 124 men, 1 woman) met the inclusion criteria. Barriers to disclosure of DVA to healthcare staff included perpetrators' negative emotions and attitudes towards their abusive behaviours; fear of consequences of disclosure; and lack of trust in healthcare services' ability to address DVA. Facilitators of disclosure of DVA and engagement with healthcare services were experiencing social consequences of abusive behaviours; feeling listened to by healthcare professionals; and offers of emotional and practical support for relationship problems by healthcare staff. CONCLUSIONS: DVA perpetration is a complex issue with multiple barriers to healthcare engagement and disclosure. However, healthcare services can create positive conditions for the engagement of individuals who perpetrate abuse. PROSPERO REGISTRATION NUMBER: CRD42017073818.