JMIR Publications

ABSTRACT

Background:

Women who are impacted by diverse forms of violence and structural disadvantage such as poverty, health inequities, and precarious housing experience significant barriers to health care. Outreach is a promising strategy to mitigate barriers to care. Until recently, outreach has focused on women’s behaviours with less attention paid to the intersecting systemic inequities inclusive of stigma and discrimination, poverty, and compartmentalized health service delivery models that impact care engagement and access.

Objective:

Here we describe a protocol to explore women’s participation in a novel one-year outreach intervention and trends in their trust within the program, safety planning, and engagement with care over time.

Methods:

This study will include an exploratory outreach intervention, conducted in two Canadian mid-size cities in partnership with community-based services focused on housing security and victim support. Participants will be women eligible for these services who are experiencing barriers to timely and appropriate health and social services commensurate with their self-identified needs. The analysis will adopt a convergent mixed methods design in which quantitative and qualitative data will be collected concurrently and subsequently analysed in parallel and then merged for data integration to fully contextualize study findings. Data will include surveys conducted at up to four time points and qualitative interviews with participants concerning their experiences in the project. Case notes will be recorded for all outreach engagement with participants. Descriptive statistics and data visualization analytic techniques will be used to document demographic characteristics and trends in trust, safety planning and access and engagement with care over time. Interview data will be thematically analysed to note contextual factors associated with safety, engagement, and trust. Data integration will be carried out to examine how observed trends are influenced by contextual features and to identify nuance in variation over time.

Results:

Intervention implementation began in the first of two study hubs in October 2023 and the second hub in October 2024, and participant enrollment was open from November 2023 to June 2025. Though enrollment has now closed, data collection is ongoing and is expected to continue through January 2026. Data analysis will commence in February 2026, and results will be shared beginning in 2026.

Conclusions:

Study results will be presented at community forums within study settings, at international conferences and submitted for publication in relevant journals. This study presents an opportunity to explore impacts of a novel outreach approach with a unique population of women experiencing structural and interpersonal violence. Clinical Trial: NCT06144216