Risk factors associated with experiences of violence and its consequences for women’s health: a scoping review protocol

Abstract

Introduction

Violence against girls and women (VAWG) is a public health problem and a violation of human rights. The prevalence of different forms of VAWG indicates that this is a recurring global issue that provokes economic, social and health consequences. In this paper, we outline a scoping review protocol to characterise risk factors for VAWG from an intersectional and intergenerational perspective and discuss the consequences of such experiences for women’s health.

Methods and analysis

The protocol will be conducted according to the Joanna Briggs Institute Methodology for Scoping Reviews and will involve six consecutive steps: (1) formulating the research question, (2) search strategy, (3) study selection, (4) eligibility criteria, (5) data extraction, (6) data analysis and presentation of results and (7) stakeholder consultation. The search strategy will include eight indexed databases (PubMed, BVS, Scopus, Web of Science, EMBASE, Cinahl, Cochrane Library and PsycInfo) and recommendations from professional organisations and international agencies. The search will be limited to publications in English, Spanish and Portuguese, according to the Health Sciences Descriptors/Medical Subject Headings and free terms. Two independent researchers will select articles based on the inclusion criteria, and a third author will be consulted to establish consensus. Data extraction will involve a form with information on study characteristics, methodological issues and main results from the sources of evidence. Extracted data will be analysed using descriptive and content analysis. The NVIVO 14 software will be used to organise and validate the data. The protocol was registered in the Open Science Framework (DOI 10.17605/OSF.IO/P6H2S).

Ethics and dissemination

Ethical approval is not required as data from publicly available literature sources will be used. The results will be disseminated through publications in scientific journals and presentations of the evidence to stakeholders.

Correspondence to Dr Fernanda G Surita; [email protected]

STRENGTHS AND LIMITATIONS OF THIS STUDY

• Comprehensive search strategy across multiple databases, including government documents and international agency sources.

• Inclusion of the female population and those of reproductive age from different geographic regions and healthcare settings.

• The inclusion will be limited to studies published in English, Portuguese and Spanish, which may result in the exclusion of relevant evidence published in other languages.

Introduction

Violence against girls and women (VAWG) is a public health problem and a violation of human rights. According to the United Nations, this term covers “any act of gender-based violence that results or may result in physical, sexual or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether in public life or private”.¹

The WHO estimates that, in the USA, 25% of women aged between 15 and 49 who have been in a relationship have experienced sexual and/or physical violence during their lifetimes.² Among women, it stands as a significant cause of morbidity and death.³

Globally, it is estimated that up to one billion children and adolescents have experienced physical, sexual and emotional violence or neglect.⁴ Experiences of violence, whether as victims or witnesses, can begin in childhood, making it necessary to examine the intersections between violence against women and adolescents and its short- and long-term impacts.

Past and current experiences of violence cause serious consequences for women’s health and well-being, directly impacting sexual and reproductive health outcomes, increasing the risk of unplanned pregnancies, sexually transmitted infections, abortion and gynaecological and mental health problems.^5–7

The impacts of violence on women’s lives include fatal and non-fatal consequences that can negatively affect them throughout their lives. In addition to the effects of violence on women’s physical integrity, the relationship between exposure to violence and adverse mental health outcomes has been identified. Experiences of violence have been linked to conditions such as depression, anxiety, post-traumatic stress disorder, sleep disturbances, eating disorders, substance abuse and suicidal behaviour.⁸

Women in situations of violence frequently use health services. In most cases, they seek these services not specifically for the violence itself, but rather for its consequences.⁹ In this regard, health institutions have been identified as crucial entry points for identifying survivors, particularly within services that are commonly accessed by women, such as those focused on sexual and reproductive healthcare.¹⁰

While VAWG occurs across all demographic groups, some are disproportionately affected. According to the WHO, based on data from several countries, some factors, such as alcohol abuse, cohabitation with a partner, being young, presence of attitudes that support violent behaviour in marital relationships, suffering abuse in childhood, history of domestic violence and experiencing or perpetrating other forms of violence in adulthood, increase the risks of intimate partner violence (IPV).¹¹ However, concerning socio-demographic characteristics as risk factors for experiences of domestic violence, there are still inconsistent findings.^{12 13}

Some studies have addressed the prevalence of violence in specific groups. In this sense, we highlight recent studies that explore experiences of violence in women living with HIV,¹⁴ trans women,¹⁵ indigenous women,^{16 17} Brazilian Quilombola women,¹⁸ adolescents,¹⁹ as well as in specific periods such as pregnancy and postpartum.²⁰ Furthermore, studies indicate that during periods of health emergencies, such as the recent COVID-19 pandemic, factors that put women at greater risk of exposure to violence are exacerbated.²¹

The evidence produced in these contexts demonstrates the importance of understanding the intersections that render women in a vulnerable situation as an expression of various oppressions that they experience in their daily lives. An intersectional approach enables a deeper understanding of multiple inequalities and how they intersect to create a distinct experience of violence.

Additionally, the development and implementation of preventive measures and effective responses to combat this phenomenon require evidence to identify vulnerable groups, analyse the risks related to experiences of violence and, particularly, understand its impacts on women’s health. Furthermore, contextualising the findings by identifying the geographic regions where the evidence is produced will help pinpoint research gaps and areas for future studies. This will also provide support for the development of public policies tailored to the needs of these groups and their specific contexts.

According to the available evidence, we highlight that VAWG is a complex and multi-causal phenomenon. Therefore, there is still a need to improve the knowledge about violence against women dynamics, including studies that provide an in-depth approach to factors associated with violence based on analyses of individual and interpersonal factors, as well as those linked to the particularities of community and social contexts. In this sense, the WHO recognises the ecological model as an alternative for a holistic understanding of violence against women.²²

Likewise, it is necessary to analyse the consequences of exposure to different forms of violence on women’s health at different moments in the life cycle, whether perpetrated by an intimate partner, family member or strangers. The identification of evidence in this topic aims to understand the impacts of violence on women’s lives and how to discuss alternatives for confronting this phenomenon by health services, stakeholders and healthcare professionals.

Furthermore, a commonly observed issue is the under-reporting of violent incidents within domestic environments, making it challenging to accurately estimate the actual number of cases. Addressing this requires an understanding of the multidimensionality of the violence that girls and women experience daily, in order to develop strategies to identify diverse forms of violence and reduce the barriers that survivors face in reporting violence occurring within emotional, cohabitation and/or familial relationships.

The rationale for conducting a scoping review on risk factors and health consequences in girls and women at this point in time, especially given the existing robust foundation of evidence that exists for both the risk factors that increase the likelihood of VAWG/IPV as well as well-substantiated short- and long-term health effects associated with experiences of violence, there is a need at this time to adopt an intersectional and intergenerational approach to better understand the dynamics of violence.

Despite several primary studies addressing this topic, research evidence often highlights individual and relational risk factors associated with violence.¹² In this sense, the WHO report highlights that “future analysis will explore whether and how these factors interact to increase or decrease a woman’s risk of partner violence”.¹²

Our proposed review will add new evidence on the intersection of individual, relational, community and societal factors in the experiences of violence among the studied population. We will focus on the nuances that arise from the interplay of these different dimensions, while considering the specific contexts highlighted in the studies, such as healthcare services.

In this scenario, the concept of intersectionality has emerged as a key analytical framework for understanding how gender interacts with other forms of inequality and oppression—such as sexuality, gender identity, ethnicity, indigeneity, immigration status and disability—to shape distinct experiences of violence.²³ This has become a central topic in recent years, with international organisations such as UN women producing evidence that highlights the relevance of this approach for addressing complex and layered dynamics of violence.^{23 24}

Another significant aspect of our study is the emergence of research conducted during the COVID-19 pandemic. In this context, recent evidence published since the onset of the COVID-19 pandemic will be included. Incorporating discussions about the pandemic experience and the associated restrictive measures, as well as the post-pandemic period, will allow for a broader exploration of how VAWG has intensified. This approach will facilitate discussions about the additional vulnerabilities these populations have faced within the already complex dynamics of violence.

Additionally, it is important to examine experiences of violence across the life course among diverse groups of women of reproductive age. This approach facilitates a deeper understanding of the intergenerational nature of violence. By adopting a life course perspective, we can explore how exposure to violence during childhood and adolescence impacts health and well-being throughout the reproductive years.

This review is aligned with the Sustainable Development Goals, goals set by countries with the UN to achieve, among others, the eradication of any type of violence. Specifically, this study was designed in line with Goal 5 Achieve gender equality and empower all women and girls, Goal 3 Ensure healthy lives and promote well-being for all at all ages and Goal 10 Reduce inequalities.

Therefore, we intend to undertake a scoping review to characterise risk factors for VAWG from an intersectional and intergenerational perspective and discuss the consequences of such experiences for women’s health. Through a scoping review, this study will identify methodological approaches and gaps in evidence production, ultimately informing recommendations for future research, public policy and clinical practice.

Methods and analysis

This proposed scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) method for scoping reviews.²⁵ Within the field of health services research, scoping review methodology has been widely used to systematically map existing literature on the social or human phenomenon of interest being studied. This facilitates the identification and analysis of evidence produced from a variety of data sources.

We aim to summarise and disseminate the results of research produced concerning VAWG to offer subsidies to decision-makers and health professionals for the development of public policies.

The review will be structured in the following steps: (1) formulating the research question, (2) search strategy, (3) study selection, (4) eligibility criteria, (5) data extraction, (6) data analysis and presentation of the results and (7) stakeholder consultation. The protocol was registered in the Open Science Framework (DOI 10.17605/OSF.IO/P6H2S).

Formulating the research question

For the scoping review, the following research questions were developed based on the Population, Concept and Context framework²⁵ :

• How does the available evidence from healthcare service settings reflect the intersection of individual, relational, community and societal factors that contribute to the risk of gender-based VAWG?

• What forms of violence are addressed in the studies?

• How do histories of gender-based violence impact experiences of violence in adulthood?

• Among women who have experienced multiple forms of violence across the life course trajectory, including child maltreatment, exposure to IPV in childhood, dating violence and IPV, what is the long-term impact on their physical and mental health outcomes?

• What methodological approaches and theoretical frameworks have been used in primary studies conducted in healthcare service settings to examine the intersection of micro-, meso- and macro-level factors related to gender-based violence?

Search strategy

The search strategy will follow a four-step process. The first step included an initial limited search of EMBASE that was undertaken in June 2024 to identify articles on the topic. The second step will be conducted based on terms extracted from the titles and abstracts of the retrieved articles. A comprehensive search will be carried out in the following databases: PubMed, BVS, Scopus, Web of Science, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library and PsycINA full search strategy for MEDLINE (PubMed) is included in online supplemental material 1. An updated search across all databases is scheduled for August 2025 to ensure the inclusion of the most current available evidence.

The search terms will be defined based on the descriptors according to Descriptors in Health Sciences/Medical Subject Headings and free terms. Search terms for this review will include combinations and variations of the following terms and phrases: ‘Domestic Violence’, ‘Violence against Women’, ‘Gender-Based Violence’, ‘Intimate Partner Violence’, ‘Sex Offenses’, ‘Ethnic Violence’, ‘Battered Women’, ‘Spouse Abuse’, ‘Child Abuse’, ‘Exposure to Violence’, ‘Risk Factors’, ‘Women’s Health’, ‘Mental Health’, ‘Child’, ‘Adolescent’, ‘Young Adult’, ‘Adult’, ‘Middle-Aged’, ‘Women’ and ‘Female’.

The databases defined by the research team are platforms in which health studies are included. Boolean operators (AND/OR) and search strategies adapted to the peculiarities of each database and the objective of the review will be used.

In the third step of the process, reference lists and bibliographies of the identified articles will also be searched for citations not identified by the database search. The search will be limited to publications in English, Spanish and Portuguese. The inclusion of these languages is justified by their importance in regional academic production and by the research team’s linguistic competencies, which ensure accurate interpretation and analysis. No date limit will be set. Searches are scheduled for August 2025, with study completion expected in September 2025.

The fourth step will include a web search for grey literature by a review of websites focused on gender-based violence policy documents and guidelines. A manual search will be developed to identify recommendations, manuals and public policies from professional organisations, government documents and international studies in the health area that address recommendations for addressing gender-based violence within health services.

To identify global analyses on the prevalence of this phenomenon and its consequences on women’s health, health recommendations for addressing VAWG, government documents and recommendations from international agencies will be explored, such as evidence produced by the United Nations organisations (eg, WHO/OPS, UN Women, United Nations Population Fund).

Study selection

The search and selection of articles will be conducted by researchers experienced in developing this type of study, before consultation with a Health Sciences librarian. For the selection process, search results will be downloaded and imported into the Rayyan software. This software will assist in the detection of duplicates, as well as independent and blind evaluation by two researchers. Initially, to pre-select the materials, the titles, keywords and abstracts will be read.

The selection criteria will be tested through a pilot test in which a sample of 25 titles/abstracts will be selected and will be evaluated by the team according to the eligibility criteria, the research question and elements described in the protocol. Afterwards, the team will meet to identify discrepancies and re-evaluate eligibility criteria and definitions. A consensus greater than 75% must be reached to begin screening and selecting articles.²⁵

The selected articles will be read in full by two researchers, evaluating their correspondence, according to the relevance of the publications and the inclusion criteria. In case of divergences in the selection process, a third author will be consulted.

Eligibility criteria

The publications selected for the evidence synthesis will be those addressing risk factors and consequences associated with experiences of violence on women’s health.

Population

This review will examine studies that explore the intersection of individual, relational, community and societal factors contributing to the vulnerability of girls and women aged 10–49 years to gender-based violence.

Concept

This review will consider evidence that explores VAWG perpetrated by family members and/or partners, with attention to intergenerational patterns of gender-based violence. It includes both direct and indirect antecedents of violence across the life course, such as child maltreatment, exposure to IPV in childhood and dating violence, as well as recent experiences of domestic and IPV during the reproductive years and their associated health consequences.

Context

This scoping review will consider evidence produced in any region/country and location (eg, urban/rural). Evidence or policy documents originating from healthcare settings will be considered according to the level of care (primary, secondary or tertiary), with attention given to how the intersection of risk factors and health outcomes related to experiences of gender-based violence is examined within each specific setting.

Type of sources

This scoping review will consider peer-reviewed quantitative, qualitative and mixed-method study designs. Secondary sources, such as literature reviews (eg, scoping reviews, systematic reviews, narrative reviews), will be included if they meet the inclusion criteria. In addition, policy documents and guidelines will be prepared by professional organisations and health agencies on the approach to gender-based violence by health services providers.

The inclusion and exclusion criteria are summarised in table 1.

Table 1

Eligibility criteria

	Inclusion	Exclusion
Population	Female age group 10–49 years.	Other population groups, such as the elderly and men.
Phenomenon of interest	Risk factors for domestic, family and partner violence and health consequences.	Self-directed violence, collective violence, obstetric violence and school violence.
Outcomes	High-risk groups for violence. Symptoms and clinical signs associated with violence, consequences on sexual and reproductive health and mental health.
Type of evidence sources	Primary and secondary sources including literature reviews. Guidelines prepared by professional organisations and health agencies on the approach to domestic violence by health services providers.	Research protocols. Grey literature of dissertations/theses and abstracts published in conference proceedings. Editorials and opinion articles.
Type of study	Literature reviews. Primary studies include mixed methods and quantitative and qualitative methodological approaches.	Clinical case studies.
Context	Recommendations produced in the context of women’s health and evidence at the levels of healthcare (primary, secondary and tertiary).

Data extraction

Data extraction will be based on the recommendations established in the JBI manual.²⁵ To assist in data extraction, the following information will be identified:

• Authors, year, and location of the study.

• Location of authors.

• Study design: primary research including quantitative (eg, observational studies, clinical trials), qualitative (eg, ethnographic studies) and mixed methods (eg, multiphase designs); as well as literature reviews (eg, systematic reviews, scoping reviews, narrative reviews) and non-empirical evidence.

• Theoretical frameworks: set of interrelated concepts, models or theories that guide the study (eg,intersectionality theory, ecological model, syndemic approach).

• Aims/objectives.

• Participants/target population: number of participants, mean age and demographic and contextual characteristics of the studied population (eg, pregnant/postpartum women, sexuality, gender identity, ethnicity, immigration status and disability).

• Risk factors associated with experiences of violence: factors at the individual, relational, community and societal levels;

• Forms of violence addressed in the study: experiences of child maltreatment, exposure to IPV during childhood, dating violence and recent experiences of domestic and IPV.

• Levels of healthcare: primary, secondary and tertiary care.

• Health consequences related to gender-based violence: including mental health issues, sexual and reproductive health impacts, physical injuries and general symptoms.

• Interventions (whether to proceed).

• Main results.

• Limitations.

• Recommendations: for practice, policy and future research.

For data extraction, the articles to be included in the review will be exported to a Microsoft Excel Windows database where the information previously established by the team will be collected. To ensure the consistency and reliability of the extracted data, one of the reviewers will perform the data extraction and a second will verify the process. The data extraction form will be reviewed, discussed and validated by the team and the relevant modifications will be made.

Data analysis and presentation of the results

The synthesis will include quantitative analysis through a descriptive numerical summary of data related to characteristics of the studies (eg, type of design, theoretical frameworks, distribution of studies found by year of publication), settings (eg, countries of the studies, level of healthcare at which the study was conducted), demographic and contextual characteristics of the studied population (eg, age, sexuality, gender identity, ethnicity, immigration status and disability), as well as forms of violence most frequented addressed in the studies and health outcomes reported in the studies related to gender-based violence. To report these results, matrices, word clouds and diagrams/graphs will be employed to identify, characterise and summarise this evidence, as well as to identify relationships between the findings (eg, health outcomes per type of violence experienced).

Content analysis will provide an overview of data related to the intersection of individual, relational, community and societal factors related to gender-based violence within healthcare services. The Nvivo 14 software will assist the researchers in the procedures for organising and analysing the material, developing codes and their relationships, and construction of categories based on the procedures for content analysis. This analysis will provide insights into how the existing evidence has addressed the intersection of micro-, meso- and macro-level factors related to gender-based violence.

The data collected regarding risk factors will be organised using a synthesis matrix that will facilitate the elaboration of considerations around gaps, implications of studies/public policies/recommendations, as well as their limitations and strengths, which will be discussed by the team of researchers, collaborators and peers.

Reporting quality appraisal

Two authors will conduct an independent assessment of the methodological quality of the reviews using the JBI Critical Appraisal Tools according to the studies design (https://jbi.global/critical-appraisal-tools). The purpose of this assessment is to assess the trustworthiness, relevance and findings of published papers.

The final scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews to enhance reporting and publication transparency.²⁶

Stakeholder consultation

Considering the phenomenon studied and its potential contributions to public policies and/or recommendations for healthcare services and professionals, the results will be presented and discussed with stakeholders and health policymakers. This is an important stage for providing insights beyond what is reported in the literature. One of the strategies for disseminating knowledge will be through the articulation of key aspects of both the literature review and the stakeholder insights. The results of the review will be presented at project-based collaboration meetings and through the presentation of executive summaries.

Discussion

This scoping review will contribute to identifying vulnerable groups to violence as well as analyse the evidence to identify patterns in VAWG across geographic regions and healthcare settings. The findings will be discussed based on the analysis of theoretical and empirical data, referring to the factors associated with experiences of violence and its various consequences on women’s health based on the ecological model and the intersectional perspective.

Additionally, it intends to identify trends in the production of evidence by regions, observe characteristics of the population exposed to situations of violence and their main impacts on health and explore gaps in the study of this complex issue.

In this sense, this review will provide relevant information to policymakers about patterns of VAWG based on the available evidence. It will contribute to the production of evidence that informs the formulation of public policies addressing the studied phenomenon.

Ethics and dissemination

Ethical approval for this secondary study is not required as data from publicly available literature sources will be employed; however, the review will be conducted following established ethical guidelines for literature reviews. The results will be disseminated through publications in scientific journals and presentations of the evidence to stakeholders and public health policymakers.

The authors would like to acknowledge the Reproductive Health and Healthy Habits (SAR₃HAS) research group.

Ethics statements

Patient consent for publication

Not applicable.

Footnote

Contributors OdRS and FGS conceived the idea. OdRS, LR, EZ and FGS wrote the draft. FGS, OdRS, LR and EZ reviewed the manuscript. OdRS is the guarantor of this study. FGS supervised and provided overall direction for the study. All authors approved the final version.

Funding This work is being supported by the National Council for Scientific and Technological Development–CNPq and the Department of Science and Technology of Secretariat of Science, Technology, Innovation and Health Complex of Ministry of Health of Brazil–MoH. Project number 444414/2023 -1.

Competing interests None declared.

Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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