Telemedicine and virtual healthcare for survivors of sexual assault and intimate partner violence: A qualitative study

Abstract

Background:

Survivors of sexual assault and intimate partner violence often face many challenges in seeking/receiving healthcare and are often lost to follow up.

Objectives:

Our study objectives are to evaluate the feasibility, acceptability, and satisfaction of using telemedicine technology among sexual assault and intimate partner violence patients who present to a Canadian Emergency Department.

Design:

Qualitative research was conducted using a thematic approach.

Methods:

Patients were identified from a case registry of all sexual assault and intimate partner violence cases seen between 1 April 2020 and 31 March 2022 from an emergency department of a large Canadian hospital. Qualitative trauma-informed interviews were conducted with consenting participants. Thematic qualitative analyses were performed to investigate barriers and drivers of telemedicine for follow-up care.

Results:

Of the 1007 sexual assault and intimate partner violence patients seen during the study timeframe, 180 (8%) consented to be contacted for future research, and 10 completed an interview regarding telemedicine for follow-up care. All participants were cisgendered women, 5 (50%) experienced sexual assault, 6 (60%) physical assault, and 3 (30%) verbal assault. All knew their assailant, and 6 (60%) were assaulted by a current or former intimate partner. Three themes emerged as drivers of telemedicine use: increased comfort, increased convenience, and less time required for the appointment. Three thematic barriers to telemedicine use included lack of privacy from others, lack of safety from their assailant, and pressure to balance competing tasks during the appointment.

Conclusion:

This study illustrated that telemedicine for sexual assault and intimate partner violence follow-up care is feasible, acceptable, and can improve patient satisfaction with follow-up care. Ensuring safety and privacy are key considerations when offering telemedicine as an appropriate option for survivors.

Plain Language Summary

A qualitative analysis of telemedicine and virtual healthcare for survivors of sexual assault and intimate partner violence

Why was the study done? Sexual assault and intimate partner violence are prevalent issues in our society. More than 3/10 Canadian women have been sexually assaulted at least once since the age of 15 years and more than 4/10 Canadian women have experienced IPV in their lifetime. Survivors face many obstacles to receiving care after sexual assault and intimate partner violence and are often lost to follow up.

What did the researchers do?

The researchers studied the acceptability, feasibility, and satisfaction of using telemedicine technology among sexual assault and intimate partner violence survivors who presented to a Canadian Emergency Department. Sexual assault and intimate partner violence survivors were interviewed individually about their experience receiving follow-up care via telemedicine. The interviews were done using a trauma-informed approach, and data analyses were done to explore the barriers and drivers of telemedicine for follow-up care.

What did the researchers find?

The total number of interviews was 10, and all participants were cisgendered women. All knew their assailant and six were assaulted by a current or former intimate partner. Survivors found that telemedicine was an accessible way to have a follow-up appointment and were mostly satisfied with their experience. Three major drivers to using telemedicine included increased comfort being at home in their own space, increased convenience as they did not have to leave their house to have the appointment, and less time required for the appointment. Three major barriers to using telemedicine included lack of privacy from others during the appointment, pressure to balance competing tasks during the appointment, and lack of safety from their assailant.

What do the findings mean?

This study has shown that follow-up care for sexual assault and intimate partner violence survivors using telemedicine can be feasible, acceptable, and can improve patient satisfaction. However, it is important to consider factors such as safety and privacy on an individual basis when offering telemedicine as an option for follow-up care for survivors.

Keywords

domestic violence emergency department gender-based violence intimate partner violence sexual assault telemedicine

Introduction

Sexual assault (SA) refers to any sexual contact or behaviour that occurs without consent.¹ Intimate partner violence (IPV) is defined as any physical, psychological, or sexual violence or harm from a current or past intimate partner.² Sexual assault and intimate partner violence (SA/IPV) are prevalent in our society, and it is estimated that over three in ten Canadian women have been sexually assaulted at least once since the age of 15 years.³ Meanwhile, more than four in ten Canadian women have experienced some form of IPV in their lifetime.⁴ Despite the ongoing presence of SA/IPV, only a fraction of survivors presents to the healthcare system for care following SA/IPV.^5,6 The stigma surrounding SA/IPV often keeps survivors from disclosing their experience and seeking care and support.

There are many barriers and obstacles to seeking urgent and non-urgent care for survivors of SA/IPV.⁷ Several logistical barriers can limit access to services, including lack of transportation, lack of childcare, financial barriers, and concerns for safety, particularly if the survivor lives with a violent partner who controls when they leave the home or seek medical care.⁸ As not all SA/IPV cases involve life-threatening injuries, survivors may not want to present to Emergency Departments (EDs) for care, although this is often the only place where forensic evidence can be collected for legal action. Often survivors are not aware of the available services, and social stigma can inhibit reaching out for help.⁷ In addition, many may feel traumatized by the event, leading to a range of physical, emotional, and psychological symptoms that make it difficult to engage with services.

It is a priority that all those who are affected by SA/IPV receive the best possible care and support, particularly within the healthcare system.^9,10 In healthcare, delivering services via telemedicine, through both telephone and videoconferencing, is a means of diversifying access to care.¹¹ Telemedicine is defined as the use of medical information that is exchanged from one site to another through electronic communication to improve a patient’s health.¹² Telemedicine has shown consistent benefits related to improved follow-up broadly, remote monitoring for patients with chronic conditions, communication and counselling for chronic conditions, and psychotherapy for mental health.^13
–15 While it has been adopted for the care of survivors of SA/IPV, studies demonstrated only preliminary evidence for feasibility and acceptability.^16,17

A scoping review of telemedicine used for counselling and psychotherapy with survivors of sexual violence highlights the major advantage of improved access to services.¹⁸ However, there are concerns regarding safety, flexibility, anonymity, and providing survivors with choice for determining the best mode for care.¹⁸ A study in the United States of survivors who used a national SA hotline reported that mental health, safety, and limited access to support services were the most pressing concerns for survivors.¹⁹ While there is emerging knowledge of the survivor experience of receiving telemedicine care for SA, further assessment is required to determine whether telemedicine is an ideal modality of follow-up care for survivors who present to EDs. In addition, there is emerging knowledge of the provider experience of using telemedicine to provide support to IPV survivors;²⁰ however, there is a lack of data characterizing the IPV survivor experience of receiving care via telemedicine.

The aim of this study was to assess survivors’ perspective of telemedicine as a method to improve healthcare delivery for care following a hospital encounter for SA/IPV. The specific objectives were to: (1) evaluate the feasibility and acceptability of using telemedicine technology among SA/IPV survivors; (2) evaluate survivor satisfaction with telemedicine, and (3) explore barriers and drivers to use of telemedicine for SA/IPV survivors.

Methods

Setting and population

This study was conducted at The Ottawa Hospital (TOH), a large multicentre tertiary care facility located in Ontario, Canada. The Sexual Assault and Partner Abuse Care Program (SAPACP) resides in the ED at TOH and is a multidisciplinary team of specialized health professionals, physicians, nurse practitioners, SA nurse examiners, and social workers. The team provides private and confidential trauma-informed services to any person 16 years of age and older in the greater Ottawa region who has presented for emergency care following their SA/IPV.

After their initial ED visit, it is standard practice that SA/IPV patients have a follow-up appointment within 72 h. This follow-up appointment is conducted by SAPACP nurses and social workers and is delivered either as an in-clinic appointment or via telemedicine. Telemedicine uses virtual technology to connect patients directly to their healthcare provider via secure video or telephone platform from their own computer, tablet, or smartphone without having to attend a clinic.²¹ Patients were eligible for a telemedicine appointment if they had access to Internet, a smart phone/computer/tablet, had a safe and secure space to have the appointment, speak English or French, and were willing to use telemedicine for the follow-up. Patients were not eligible for telemedicine if they required an in-clinic follow-up visit for clinical re-assessment or additional forensic evidence collection.

Design

Participants were identified from a clinical case registry of all SA/IPV cases that presented for urgent care between 1 April 2020 and 31 March 2022. The case registry includes information concerning admissions details (e.g. date of admission, method of arrival, etc.), assault characteristics (e.g. type of assault, location of assault, etc.), in-hospital medical treatment (e.g. post-exposure prophylaxis (PEP), sexually transmitted infection (STI) testing, etc.), and information on follow-up visits.^22
–24

Patients who consented to TOH Permission to Contact Program for research purposes were contacted at the safe email address they provided, and for those who participated in the study, verbal consent was obtained from each patient prior to the interview. Participants were never asked to recount the experience of their assault, and all clinical information was extracted from the registry. The interviews ranged from 12 to 51 min (average of 28 min).

The qualitative interviews guide was informed by the consolidated criteria for reporting qualitative studies (COREQ) checklist.²⁵ They were conducted using a secure Microsoft Teams platform (release 1.5.00.17261) by O.M. and R.P. Verbatim transcripts were automatically generated. Immediately following the interview, a researcher (O.M., R.P.) edited the transcript for accuracy. During the interview, participants were told they could skip any question they did not feel comfortable answering and if they needed to change the topic of conversation abruptly, they could use a safe word (e.g. coffee). Prior to the interview, demographic data were collected from their electronic medical record, and afterwards, participants were offered a $10 gift card to a local grocery store or coffee shop of their choice.

Data analysis

All interview files were recorded and transcribed verbatim using Microsoft Teams (release 1.5.00.17261). Interview transcripts were uploaded to NVivo Software (release 1.6.2). Thematic analyses were utilized for descriptive inference and to organize the interviews into themes.²⁶ All thematic analyses were performed by O.M..

To analyse the feasibility of telemedicine, interviews were coded based on ease of use of telemedicine technology, challenges with Internet connection, or discomfort using the technology services. Acceptability was coded based on positive or negative attitudes towards telemedicine use. Furthermore, medical, emotional, and forensic care were coded based on satisfaction with care received during the appointment, including whether patients felt their needs were met.

All barriers and drivers of telemedicine mentioned over the course of the interviews were coded. Then, commonalities of the barriers and drivers mentioned were condensed to reflect themes.

This study received ethical approval from The Ottawa Health Sciences Network Research Ethics Board (protocol no. 20200277-01H).

Results

Between 1 April 2020 and 31 March 2022, 1007 SA/IPV patients were seen in TOH ED. Of those, 180 (8%) patients consented to the patient programme to be contacted for research purposes, and 10 out of 180 (5.56%) patients consented to be interviewed. The descriptive characteristics of participants are presented in Table 1. All participants were English speaking, cisgendered women (biological females), and the median age was 30 years (min: 18, max: 57). As identified from the case registry, 40% of participants were IPV survivors (i.e. they were assaulted by a current or former intimate partner), and 60% of participants were SA survivors (i.e. they were sexually assaulted by someone who was not their intimate partner). Many survivors experienced multiple types of violence: SA (50%) and physical assault (60%) were most common.

Table 1.

Patient demographics and clinical chart characteristics (n = 10).

Variables	N (%)
Ciswomen vs men/trans	10 (100%)
Age (years)
Median, (min–max)	30 (18-57)
Type of assault
Physical assault	6 (60%)
Verbal assault	3 (30%)
Sexual assault	5 (50%)
Known assailant	10 (100%)
Current or former intimate partner	6 (60%)
Mode of arrival: walk-in vs ambulance	9 (90%)
Police involvement	4 (40%)
Use of weapon	-
Location
Survivor home	8 (80%)
Friend or assailant home	-
Strangulation	3 (30%)
Mental health concerns
Depression	6 (60%)
Anxiety	4 (40%)
Afraid of experiencing further violence from assailant	5 (50%)
Experienced violence from assailant since first visit	3 (30%)
Told any friends or family members about the assault	9 (90%)
Care for sexual assault cases (n = 5)^a
Eligible for sexual assault evidence kit	5 (50%)
Completed SAEK	5/5 (100%)
Eligible for PEP	-
Started PEP	-

Small cells below 3 are suppressed.

All patients presenting for a sexual assault were eligible for the SAEK and STI testing and completed them.

Feasibility of telemedicine for SA/IPV follow-up care

All participants were able to use the telemedicine technology to attend their follow-up appointment, and nearly all participants used a telephone to complete the appointment. No participants expressed discomfort with technology or challenges with Internet connection. Only one participant noted challenges with the telemedicine technology; however, they expressed that the issues encountered were solvable and did not hinder their ability to complete the appointment:

Sometimes . . . I have the issue, like today, with the microphone sometimes not working . . . that was annoying, but I always figure out a way around it . . . I just use my phone if anything, so it’s okay. (age 23 years, SA survivor)

In addition, many participants expressed satisfaction with the flexibility of the telemedicine modality for their follow-up appointment:

The travel time [to the hospital] is about 30 minutes. It takes an hour to get there and back, not including the appointment. Being able to fit [the telemedicine appointment] into a tight schedule works a lot better. (age 18 years, SA survivor)

Acceptability of telemedicine for SA/IPV follow-up care

Many participants found telemedicine to be an acceptable follow-up mode. Importantly, almost all felt personally and physically safe during the virtual follow-up appointment. Participants noted how SAPACP staff were caring and warm during their appointment, which increased their feelings of safety and comfort. Participants also discussed how the video conferencing aspect of telemedicine allowed the staff to identify any safety concerns that occurred during the appointment. In addition, most participants did not have any concerns about the confidentiality or cyber security of a virtual follow-up appointment. However, some participants noted that they felt concerned about the possibility that details about their case would be shared with the police without their consent.

Most participants found the telemedicine appointment easier to attend compared to an in-person appointment. Participants were also asked whether they would prefer a future follow-up appointment to be a telemedicine or in-hospital appointment. Most participants stated that in the future, they would choose to do telemedicine again:

All my needs were met. I felt cared about. . . I didn’t feel like I was by myself, [but had a full health care] team behind me. (age 37 years, IPV survivor)

The [staff] I interacted with on the phone . . . were very . . . open and . . . asking me how I was . . . they genuinely care . . . It made me feel more safe and comfortable. (age 29 years, SA survivor)

Patient satisfaction with telemedicine

The study participants reported high satisfaction with the medical care received during the telemedicine appointment. Participants described how their medical needs were met, and that each process (e.g. assessment of physical injuries) was explained well. Participants also described how the appointment stopped them from feeling forgotten, and the follow-up was thorough, timely, and caring:

I had a couple of follow up calls because it was related to trying to track down results I was waiting for, for STI testing . . . [the staff] called me and kept me updated by saying . . . either we don’t have an update yet, but we’re working on it. We haven’t forgotten about you . . . They kept following up, which was nice. (age 29 years, SA survivor)

However, some participants expressed dissatisfaction with the follow-up medical care they received. One participant, who was prescribed medication for mental health reasons following her assault, was dissatisfied with the follow-up care to monitor the effectiveness and side effects of the medication.

For those who had forensic evidence collected, many described their satisfaction with the follow-up regarding the forensic care. They appreciated being told their options regarding referral to police without feeling pressured to pursue legal action. Participants also mentioned their satisfaction with the connection to community services:

I liked [the legal support]. I got referred to a third-party report phone number . . . because I didn’t wanna go . . . after [my assailant]. So, they gave me a number to be able to report it anonymously, which I liked. (age 18 years, SA survivor)

However, some participants expressed dissatisfaction with the forensic care they received. These participants shared that no third-party referrals were made on their behalf:

[The SAPACP] didn’t link me to anything. Had I not had [the police services information from other past experience], I don’t think I’d be sitting [here] . . . It’s not that [the SAPACP] aren’t doing their job . . . it’s that they’re trying to run [a program] and don’t have enough people and resources. (age 36 years, IPV survivor)

Overall, many participants felt satisfied with the support they were provided, felt the emotional care was thorough, and that staff were caring. In addition, participants were pleased that counselling services were covered financially:

I highly recommend to anyone who goes through this to go to the hospital and get access to the counseling services that follow. That was really great that [the SAPACP staff] were able to set that up. (age 31 years, IPV survivor)

Drivers to telemedicine use

Three major themes regarding drivers to telemedicine use emerged: (1) increased comfort, (2) increased convenience, and (3) less time required for the appointment.

As trauma survivors, participants described how they felt increased comfort having their follow-up appointment virtually. When discussing traumatic experiences such as SA, participants felt they could be more open during the appointment if they were at home in their safe space:

I felt more comfortable because I was in my own safe space. I didn’t have to go to a place I didn’t know . . . When it’s something that’s really intimate . . . a traumatic experience . . . you can actually talk about it more comfortably [via telemedicine]. (age 23 years, SA survivor)

Participants often described the increased convenience of having a virtual follow-up appointment. In addition, participants felt increased difficulty leaving their safe space to attend an in-person appointment following their assault. As a result, virtual appointments were easier to attend:

During the weeks afterwards, I didn’t really want to go outside, so that made it a lot easier to attend virtually. (age 31 years, IPV survivor)

Participants shared how less time was required for the telemedicine appointment as compared to an in-hospital appointment without commuting. In addition, participants noted that it is easier to fit a virtual appointment into a busy schedule, as time is saved:

It’s just so much more time efficient . . . You don’t have to drive [to the hospital], you don’t have to find parking . . . It’s just a better use of time. (age 57 years, IPV survivor)

It was just quicker, more convenient . . . I didn’t have to take the bus or . . . walk there. (age 28 years, SA survivor)

Barriers to telemedicine use

Three major themes regarding barriers to telemedicine use emerged: (1) lack of privacy from others, (2) pressure to balance competing tasks during the appointment, and (3) lack of safety from their assailant.

Participants often noted lack of privacy from others due to the virtual nature of their follow-up appointment. Some could not find a private place, either because of living with roommates or sharing an office with co-workers. Participants noted discomfort with discussing intimate topics without the assurance of a private environment to do so:

I had to be at work to have [the appointment] rather than being at home . . . I tried to find privacy and I couldn’t find [any]. (age 28 years, IPV survivor)

If you’re living with roommates or something . . . you’re not in the best situation. I was lucky that my roommates weren’t there at the time or, for example, I’m spending time with people I trust [who] know about what happened. And I don’t feel bad about talking about [the sexual assault], so I’m OK to talk about these things. But I know for some people [lack of privacy from roommates] might be an issue. (age 23 years, SA survivor)

Participants also shared how they felt pressure to balance competing tasks during their appointment. Participants expressed difficulty blocking time during work hours to do a virtual medical appointment, and some struggled to attend their appointment outside of work hours:

Since I work from home, I had to make sure the phone call is coming in at a time when I wasn’t working as well . . . whereas if it’s a non-virtual appointment, your work . . . knows that you’re not physically there. (age 31 years, IPV survivor)

When you go to an in-person appointment, you leave [work] and you know you can’t be bothered . . . With the virtual platform . . . I’m trying to [do] too much at once. (age 57 years, IPV survivor)

Participants also described how lack of safety from their assailant was a major barrier to the telemedicine format. One patient described how her assailant had tracking devices on her electronics, including Global Positioning System (GPS) and audio tracking on her cell phone. As a result, taking a virtual follow-up was dangerous:

I don’t think I would ever . . . do anything virtual [if I was living with my assailant] . . . If a woman is at home and let’s say [she’s] doing a follow up. . . you just can’t guarantee that she’s gonna live to see tomorrow . . . If you stay at home, you won’t make it. You will die. Whether it’s at the cost of your partner, whether it’s at the cost of yourself, you will die. (age 36 years, IPV survivor)

The patient continued to describe the true danger survivors of IPV are faced with every day, if they remain in a relationship with their assailant. Survivors who are still living with their assailant require additional attention paid to their safety during all forms of follow-up, including follow-up via telemedicine.

Discussion

The results of this study provide encouraging support for the use of telemedicine as an acceptable and feasible mode of health care for SA/IPV survivors, reflected by high levels of ease of use by participants and positive views towards future use. Most participants expressed satisfaction with the medical and emotional care they received during telemedicine follow-up, demonstrating effectiveness of the services provided. The three major drivers were increased comfort, increased convenience, and less time required for the appointment. The main barriers to telemedicine were lack of privacy, pressure to balance competing tasks during the appointment, and lack of safety from their assailant. These barriers reveal the life-threatening consequences for survivors who live with their assailant may face when seeking care for themselves.

The telemedicine platform was usable for all participants, and participants were satisfied with the flexibility of the virtual format. Participants expressed satisfaction with the care they received via telemedicine, including medical, forensic, and emotional care. Our results are similar to a study conducted in the United States that evaluated a partnership connecting three rural SA/IPV crisis centres with university-based mental healthcare professionals via telemedicine, where patients reported high levels of satisfaction with the psychological services provided via telemedicine, using measures including confidentiality of services, ease of equipment use, and helpfulness of the therapist.²⁷ These findings indicate that provision of emotional services is highly effective through a virtual modality.

This study revealed that one important driver of telemedicine use is increased convenience, which has been previously documented in the literature.²⁸ This driver is closely tied to the sensitive nature of the appointments as well as the trauma responses many SA/IPV survivors experience following assault, including an inability to leave their home. These unique benefits were also described in a scoping review evaluating the delivery of virtual counselling to survivors of sexual violence.¹⁸ Leroux et al.¹⁸ described several unanticipated therapeutic benefits of virtual counselling for this population, including how survivors felt more comfortable and in control in their own space and valued the flexibility the virtual appointments allowed. Implementation of this telemedicine programme occurred concurrently with the beginning of the COVID-19 pandemic. It is possible that the option to receive care via telemedicine may have become favoured because of the pandemic. However, the characteristics of patients who presented to the ED for SA/IPV during the pandemic do not differ from those who presented prior to the pandemic.²²

Lack of privacy was a main barrier to telemedicine use in this study. The participants were primarily concerned about having a private space for the follow-up appointment without others around (e.g. roommates, co-workers, assailant), rather than feelings of lack of privacy related to technology (e.g. cyber safety) as identified in other evaluations of telemedicine.²⁹ Safety concerns specific to the survivor’s assailant are consistently a major challenge as outlined recently in a study describing provider perspectives on experiences of IPV during the COVID-19 pandemic.³⁰ Some participants described this as a life-threatening concern because they were certain that if their assailant were to discover their efforts to seek help, they would be severely physically assaulted.

It is important that follow-up care for SA/IPV survivors is tailored to their needs and the resources available to them. Telemedicine can be appropriate for survivors of SA who do not live with their assailant; however, there are other accessibility, cultural, and personal factors that may make it inappropriate for some. Caution is needed for survivors who currently live with their assailant, as the risks may outweigh the benefits. All patient populations should be given the choice to engage in either an in-person or telemedicine appointment and be provided with the information needed to make an informed decision concerning their follow-up care.

Strengths and limitations

Our study was designed with trauma-informed principles. Participants were not asked to recount any details related to their assault during their interview. We used a multi-methods approach and extracted all assault-related information from their clinical charts and the case registry. However, it is possible that speaking about their assault follow-up care may have triggered a variety of emotional reactions for the participants. At the end of each interview, researchers offered information about community services in the area that could provide support. Study recruitment for survivors of SA/IPV is challenging; however, we were able to have conversations with 10 brave people about their health care experiences with telemedicine.

We have information on age, gender identity, gender/sex, and primary language; however, a limitation of our study is that we do not have information on other diversity-related characteristics including race, ethnicity, newcomer status, socio-economic status, or ability. These are all factors that shape SA/IPV that are not routinely collected in hospital charts and were not asked as part of the questionnaire. It is likely that the participants in this study will differ from those who did not consent to the hospital programme for contact or specifically those invited to take part in the study. It is likely that key groups including those with limited access to technology, unstably housed, and those living with their assailant would be less likely to participate in this study.

Conclusion

Our study has shown that telemedicine can be a feasible and acceptable option for follow-up care after an ED encounter for SA/IPV. Survivors reported that it was convenient to have their follow-up via telemedicine and felt more comfortable discussing trauma in their home or other safe space. Safety, privacy, and protecting uninterrupted time were key challenges for having a follow-up via telemedicine. Where clinically appropriate and with careful consultation with survivors, these results provide support for offering telemedicine as an acceptable option for survivors of SA/IPV.

Supplemental Material

sj-docx-1-whe-10.1177_17455057241252958 – Supplemental material for Telemedicine and virtual healthcare for survivors of sexual assault and intimate partner violence: A qualitative study

Supplemental material, sj-docx-1-whe-10.1177_17455057241252958 for Telemedicine and virtual healthcare for survivors of sexual assault and intimate partner violence: A qualitative study by Olivia Mercier, Rabea Parpia, Justin Presseau, Katherine A Muldoon and Kari Sampsel in Women's Health

Footnotes

Acknowledgements

AcknowledgementsThe authors thank the SAPACP staff for their incredible work and SA/IPV survivors for their strength and willingness to share their stories.

Declarations

ORCID iDs

Olivia Mercier

Katherine A Muldoon

Supplemental material

Supplemental material for this article is available online.

References

World Health Organization. Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines, https://apps.who.int/iris/handle/10665/85240 (2013, accessed 16 November 2022).

Khatib

Sampsel

Canadian Association of Emergency Physicians position statement: where is the love? Intimate partner violence (IPV) in the emergency department (ED). CJEM 2022; 24: 691–694.

Government of Canada SC. Gender-based violence and unwanted sexual behaviour in Canada, 2018: initial findings from the Survey of Safety in Public and Private Spaces, https://www150.statcan.gc.ca/n1/pub/85-002-x/2019001/article/00017-eng.htm (2019, accessed 20 October 2022).

Government of Canada SC. Intimate partner violence in Canada, 2018: an overview. https://www150.statcan.gc.ca/n1/pub/85-002-x/2021001/article/00003-eng.htm (2021, accessed 20 October 2022).

Johnson

. Improving the police response to crimes of violence against women: Ottawa women have their say. University of Ottawa Faculty of Social Sciences, https://arcs-atom.uottawa.ca/index.php/improving-the-police-response-to-crimes-of-violence-against-women-ottawa-women-have-their-say (2015, accessed 5 October 2022).

Amstadter

McCauley

Ruggiero

, et al. Service utilization and help seeking in a national sample of female rape victims. Psychiatr Serv 2008; 59(12): 1450–1457.

Munro

ML.

Barriers to care for sexual assault survivors of childbearing age: an integrative review. Womens Health Doylestown 2014; 2(4): 19–29.

Fugate

Landis

Riordan

, et al. Barriers to domestic violence help seeking: implications for intervention. Violence Against Women 2005; 11(3): 290–310.

Breiding

Basile

Smith

, et al. Intimate partner violence surveillance: uniform definitions and recommended data elements, version 2.0. Report, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 2015.

10.

Temmerman

Research priorities to address violence against women and girls. Lancet Lond Engl 2015; 385(9978): E38–E40.

11.

Bhatia

Chu

Pang

, et al. Virtual care use before and during the COVID-19 pandemic: a repeated cross-sectional study. Can Med Assoc Open Access J 2021; 9(1): E107–E114.

12.

American Telemedicine Association. Telehealth: defining 21st century care, https://www.americantelemed.org/resource/why-telemedicine/ (2022, accessed 24 October 2022).

13.

Bashshur

Reardon

Shannon

GW.

Telemedicine: a new health care delivery system. Annu Rev Public Health 2000; 21: 613–637.

14.

Totten

Womack

Eden

, et al. Telehealth: mapping the evidence for patient outcomes from systematic reviews. Report, Agency for Healthcare Research and Quality, US Department of Health and Human Services, June 2016.

15.

Agboola

Bates

Kvedar

JC.

Digital health and patient safety. JAMA 2016; 315(16): 1697–1698.

16.

Miyamoto

Thiede

Dorn

, et al. The Sexual Assault Forensic Examination Telehealth (SAFE-T) Center: a comprehensive, nurse-led telehealth model to address disparities in sexual assault care. J Rural Health 2021; 37(1): 92–102.

17.

Bloom

Glass

Case

, et al. Feasibility of an online safety planning intervention for rural and urban pregnant abused women. Nurs Res 2014; 63(4): 243–251.

18.

Leroux

Johnston

Brown

, et al. Delivery of distance counselling to survivors of sexual violence: a scoping review of promising and best practices. Inquiry 2022; 59: 469580221097427.

19.

Elliott

Bardwell

Kamke

, et al. Survivors’ concerns during the COVID-19 pandemic: qualitative insights from the national sexual assault online hotline. J Interpers Violence 2022; 38(1–2): NP84–NP107.

20.

Fatabhoy

Zhu

Lajaunie

, et al. Intimate partner violence and telemedicine usage and satisfaction early in the COVID-19 pandemic. J Am Board Fam Med 2023; 36(5): 755–765.

21.

Ontario Telemedicine Network. OTN annual report 2017-2018. Toronto, ON, Canada: Ontario Telemedicine Network, 2018.

22.

Muldoon

Denize

Talarico

, et al. COVID-19 pandemic and violence: rising risks and decreasing urgent care-seeking for sexual assault and domestic violence survivors. BMC Med 2021; 19(1): 20.

23.

Muldoon

Galway

Reeves

, et al. Geographies of sexual assault: a spatial analyses to identify neighborhoods affected by sexual and gender-based violence. J Interpers Violence 2021; 36(17–18): 8817–8834.

24.

Muldoon

Drumm

Leach

, et al. Achieving just outcomes: forensic evidence collection in emergency department sexual assault cases. Emerg Med J 2018; 35(12): 746–752.

25.

Tong

Sainsbury

Craig

Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007; 19(6): 349–357.

26.

Kiger

Varpio

. Thematic analysis of qualitative data: AMEE Guide No. 131. Med Teach 2020; 42(8): 846–854.

27.

Gray

Hassija

Jaconis

, et al. Provision of evidence-based therapies to rural survivors of domestic violence and sexual assault via telehealth: treatment outcomes and clinical training benefits. Train Educ Prof Psychol 2015; 9(3): 235–241.

28.

Polinski

Barker

Gagliano

, et al. Patients’ satisfaction with and preference for telehealth visits. J Gen Intern Med 2016; 31(3): 269–275.

29.

Cowan

McKean

Gentry

, et al. Barriers to use of telepsychiatry: clinicians as gatekeepers. Mayo Clin Proc 2019; 94(12): 2510–2523.

30.

Leigh

Peña

Anurudran

, et al. ‘Are you safe to talk?’ Perspectives of service providers on experiences of domestic violence during the COVID-19 pandemic. J Fam Violence 2023; 38: 215–225.

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