Barriers to Care After Intimate Partner Violence Acquired Brain Injury: Current Systems Silence Survivors and Providers.

Objective: A qualitative meta-synthesis was conducted to answer the following question-What barriers are experienced by survivors of intimate partner violence and service providers when seeking or providing resources or care after experiencing brain injury (BI)?

Setting: This approach was completed through 2 main phases-a systematic search and literature appraisal and reciprocal translation with interpretive triangulation of the extracted data. The databases searched were PubMed, CINAHL, and PsycInfo.

Participants: The initial search yielded 559 articles. The final synthesis included 16 articles for the qualitative meta-synthesis.

Design: After data extraction, a qualitative exploratory design evaluated the experiences of survivors and service providers when connecting with resources.

Results: The findings highlight larger systemic barriers preventing smooth relationships between survivors and providers. Survivor barriers include risk-driven safety mechanisms and a lack of awareness and understanding of BI. Provider barriers are a lack of clarity within providers' scope and training limitations, diagnosis complexity, first responder's initial response to survivors, lack of open discussion, screening limitations, financial barriers, infrastructure barriers, and lack of resources. Systemic barriers include stigmatization, BI symptoms mistaken as other diagnoses like mental health, access and awareness of resources, and navigation of complex systems.

Conclusion: This qualitative meta-synthesis demonstrates that survivors and providers face multiple individual and systemic barriers when seeking and providing resources after BI. Future research is needed to understand survivors' help-seeking behaviors and assistance needs and providers' education about BI and organizational relationships and networks. Recommendations are made for future research to understand how to reduce barriers for providers working with survivors, from trauma-informed education and communication to connecting with resources, where to concentrate, and initiatives for collaboration to increase the network of resources yet improve its accessibility.