Introduction

Intimate partner violence (IPV), defined as psychological, physical, sexual, or economic violence committed by a current or former intimate partner, constitutes the single most prevalent form of violence against women (Oram et al., 2022). Approximately 44% (6.2 million) of Canadian women over the age of 15 have experienced IPV at least once in their lifetime (Cotter, 2021a, 2021b). As a gendered public health challenge, IPV has also been connected to an array of negative short- and long-term mental health outcomes for women, such as anxiety, post-traumatic stress disorder, eating disorders, depression, and suicidal ideation (Bacchus et al., 2018; Loxton et al., 2017; Sugg, 2015). Additionally, it has been associated with the onset of chronic diseases (e.g., cardiovascular disease and hypertension, elevated cortisol levels, sexually transmitted infections, cancer, and diabetes), a heightened reliance on health support services (e.g., sexual health), and substance use (e.g., drug and alcohol use), further exacerbating the negative impact on those affected (Stubbs & Szoeke, 2022). IPV, and specifically sexual and physical violence, has also been characterized by acute and chronic physical health issues including, but not limited to, fractures, acquired brain injuries, and lacerations (Antai, 2011; Hewitt et al., 2011; Stubbs & Szoeke, 2022).

The severe impact of IPV is highlighted by both its well-documented morbidity rates (e.g., Antai, 2011; Hewitt et al., 2011; Stubbs & Szoeke, 2022) and its significant contribution to mortality rates among women internationally (World Health Organization, 2013). In Canada, domestic homicides account for 1 in 5 murders and approximately 80% of domestic homicides are perpetrated by men against women; victimization from this form of homicide is four times higher among Canadian women compared to their male peers (i.e., 0.44 per 100,000 females versus 0.11 for males, aged 15 and over; Perreault, 2015). Notably, relative to other North American countries, Canada has comparatively lower rates of past-year physical and sexual IPV (Sardinha et al., 2022). However, there is clear and consistent evidence that the year following separation from an abusive partner is a period within which women are at greatest risk for more severe violence and domestic homicide (Campbell et al., 2017; Einiö et al., 2022).

Increased recognition of the prevalence and broad range of health problems associated with IPV on a national and international scale, has led to several primary (e.g., education and publicity campaigns) and secondary (e.g., protection orders, support and advocacy-based services, or offender treatment programs) approaches to IPV prevention being proposed, developed, and implemented. While such approaches have shown some degree of success, many lack the evidentiary support necessary to fully understand their effectiveness. For example, while secondary prevention initiatives have demonstrated harm reduction in specific populations, their efficacy in others remains uncertain. This underscores the imperative to investigate the suitability of preventive interventions for different populations and under varying conditions (Prenzler & Fardell, 2017). Moreover, further evaluation is needed to better understand the potential benefits (and shortcomings) of specific types of primary and secondary prevention efforts so as to better leverage evidence-based strategies that limit risk for victimization, recurrence, (i.e., revictimization) and associated harms (Prenzler & Fardell, 2017). Critically, further evaluation is essential to tailor intervention strategies to the diverse needs of survivors. Evidence suggests that several barriers, such as financial hardships and limited access to support resources, contribute to survivors opting to stay in the home known to the perpetrator during the year following separation and beyond.

Remaining Within the Home

For many reasons, some women may wish to remain in or return to the origin home after experiencing IPV and separating from an abusive partner, although this may pose unique risks and challenges including financial recalibration and instability, and revictimization (Ansara & Hindin, 2010). The “safe at home” principle posits that the IPV survivor, rather than the perpetrator, should have the right to remain within the origin home if they wish to. Interventions rooted in this philosophy have shown promise for preventing risk for the long-term repercussions associated with IPV victimization, such as homelessness, food insecurity, and unemployment (Diemer et al., 2016). Survey evidence from a US sample of 110 women who experienced IPV in their lifetime found that approximately 50% of women who experienced IPV also contended with overdue bill payments, 32% experienced food insecurity, 40% were unable to fulfill rent payments on time, and 25% reported needing to relocate within the first year of separation due to the continued harassment inflicted by the former partner and/or financial complexities (Baker et al., 2003). In particular, economic abuse, where the perpetrator exerts control and coercion by limiting women’s access to financial resources, often plays a critical role in these financial difficulties (Natalier, 2018). The Post-Separation Economic Power and Control Wheel framework, developed by Glinski (2021), illustrates how economic abuse can persist even after separation, further complicating a survivor’s ability to secure stable housing. Additionally, two conjoint Canadian studies conducted by Barata and Stewart (2010) utilized a mixed-methods approach to explore landlord beliefs and attitudes about IPV and found that landlords (n = 304) reported reluctance to rent their properties to women who had experienced IPV due to the perceived risk of attracting “problems” or “danger” to their rental unit. This finding suggests that even women who prefer to relocate after separating from an abusive partner may continue to encounter barriers to relocation, which can contribute to prolonged periods of continued residence at the origin home that is known to the IPV perpetrator. Thus, irrespective of level of desire to relocate upon separating from a partner, there is a need to consider in-home secondary prevention, such as structural safety interventions, as a potential standard IPV prevention response. This is particularly important when one considers the research indicating that many women report first-time financial and housing strain, coupled with continued threats, intimidation, and harm, such as verbal abuse, the weaponization of children, stalking, and economic abuse (Li, 2023), when separated from the perpetrator. Perhaps most critically, separation from one's abusive partner is associated with a significantly elevated risk for intimate partner homicide within the year following separation (Campbell et al., 2008; Einiö et al., 2022; Lindsay, 2014). Collectively, the evidence reaffirms the pivotal role of identifying and evaluating strategies to enhance a woman’s safety within the origin home. Improving home safety can be critical for reducing rates of morbidity and mortality associated with IPV, but also in mitigating incidents of post-separation IPV, which are common following separation (Li, 2023).

Preventing IPV Revictimization: Structural Home Intervention

Several secondary interventions have been proposed, developed, and implemented at the community level (e.g., community-based support and advocacy services) and within criminal justice settings (e.g., court issued protection orders, offender treatment programs) to prevent repeat victimization and ultimately reduce harm (Prenzler & Fardell, 2017). However, evidence suggests that perpetrator reform rates remain low (offender treatment programs have shown 5–15% reductions in IPV re-offense rates; Babcock et al., 2004, 2017) and risk of harm remains high (the rate of breached protection orders can range from between 67–90%; Peltzer & Pengpid, 2016). In-home structural safety improvements (e.g., reinforced exterior doors, reinforced double-glazed windows, fire retardant letter boxes, extra door and window locks, motion detectors, video entry systems) may significantly contribute to reductions in IPV recurrence and related morbidity and mortality among IPV survivors and households at elevated risk of revictimization.

While lacking in extensive study in Canada and more broadly, structural interventions as a strategy to prevent revictimization in response to IPV have garnered increasing international attention. One Australian meta-evaluation by Breckenridge et al. (2016) synthesized the efficacy of home-based structural interventions across 154 resources (i.e., peer-reviewed articles, grey literature, website materials) and found that the provision of in-home security measures worked to promote physical safety and reduce the exacerbation of mental health difficulties among survivors. Among the IPV prevention models evaluated, one program out of the United Kingdom (UK), called Sanctuary Schemes, has generated promising preliminary evidence (Clarke & Wydall, 2015; Netto et al., 2009). The aim of Sanctuary Schemes is to assist with protecting IPV survivors from revictimization by providing households at risk of violence with security measures (e.g., security features, a safe room). This approach was conceptualized and initially implemented in the UK, yielding important findings (Clarke & Wydall, 2015; Netto et al., 2009), and was subsequently adopted in Australia where it is in the early stages of formal evaluation. To date, work by Breckenridge et al. (2016) has shown that the introduction of Sanctuary Schemes in the Australian context not only promoted physical safety but resulted in increases in survivor self-confidence as well as engagement with formal and informal support systems, and decreases in perceived social isolation. These findings suggest that while structural safety interventions such as Sanctuary Schemes were designed to offer immediate physical security, they may indirectly provide survivors with a level of mental and emotional assurance, better supporting them to exercise “the safe at home” principle. While preliminary evidence for this strategy in the United Kingdom and Australia illustrates a range of potential short- and long-term benefits (Clarke & Wydall, 2015; Netto et al., 2009), parallel programs being implemented in Canada, identified as Safe Doors, Safe Homes (SDSH), have yet to be formally evaluated for their acceptability, feasibility, and scalability in the Canadian context.

Purpose

The overall objective of our study was to evaluate the acceptability and feasibility of the SDSH intervention in the Canadian context from the perspective of three groups: 1) survivors of intimate partner violence (IPV), 2) providers, and 3) police officers (collectively hereafter referred to as intervention stakeholders). The specific research questions for the perspective of intervention stakeholders included: (1) what are the potential barriers and facilitators, as well as safety risks and benefits of implementing the SDSH program for female survivors of IPV; and (2) what adaptations, if any, are required to increase: (a) the feasibility of the SDSH intervention to meet the safety needs of female survivors of IPV, as well as (b) the acceptability of the intervention among all intervention stakeholders?

Methods

Design

To address our research questions, we used an inductive, naturalistic research design that was informed by the principles of exploratory case study methodology (Yin, 2018). Exploratory case study methodology is ideally suited for situations, phenomena, and interventions where there is limited information and diverse outcomes are possible and may be of interest (e.g., safety, psychological wellbeing, quality of life; Yin, 2018). Importantly, via an intentional inclusion of multiple data sources, exploratory case study methodology allows for the systematic harvesting of the independent and shared experiential knowledge of stakeholders invested in or affected by the phenomena. In this regard, this design approach is methodologically congruent with our aims to evaluate the acceptability and feasibility of the SDSH intervention from the perspective of multiple stakeholders in the Canadian context. This study was approved by and conducted in adherence to the principles and protocols of the Hamilton Integrated Research Ethics Board (#3049).

Participants

In line with our research question and the methodological guidelines of exploratory case study methodology, we collected data from multiple informants (i.e., data sources) who have in-depth insight into the tenability of the SDSH intervention in the Canadian context, including: 1) female survivors of IPV, 2) health and social service providers delivering IPV services, and 3) police officers specializing in IPV response. We worked in partnership with leadership from a charitable, non-profit social service agency serving families affected by family violence (including IPV) and a police service within the same Southern Ontario community to recruit stakeholders for participation. The specific Southern Ontario community was selected as our ‘Canadian case’ given (a) established relationships between the research team and both the social service agency and police service within the community; and (b) that the implementation and sustainability of the SDSH intervention would warrant collaboration between social service and police sectors and IPV survivors. Recruitment posters and emails were developed in collaboration with our community partners and distributed to police officers belonging to the domestic violence and victim services units of the police force, with posters displayed at the local social service agency to recruit IPV survivors and IPV service providers; recruitment posters were also distributed via the staff email listserv at the social service agency and through the email listserv of the Ontario Women’s Health Network. All recruitment posters and emails encouraged potentially interested participants to contact the research team to discuss eligibility, study details, and to arrange a time to complete consent processes and data collection activities (described below). Additional eligibility criteria included the ability to speak English, being greater than 18 years of age, and for survivors, having separated from an abusive partner within the last 5 years regardless of whether they had lived with the partner during the relationship. Both women who had lived with their partner and those who had not were included in the study. This inclusion criterion allows for a comprehensive understanding of the experiences of survivors with diverse living arrangements. Notably, there are no definitive sample size requirements for qualitative exploratory case studies; rather, anticipated sample sizes are made based on the complexity of the case and phenomenon under study, the research design, a pragmatic logic that considers the expertise of and burden to research participants, and the data collection strategy (Yin, 2018). To this end, we grounded our sample size goals with the construct of ‘information power’ and aimed to recruit 20 IPV survivors, 10 IPV service providers, and 10 police officers working the in area of IPV response (Malterud et al., 2016).

Materials and Procedure

Interview guides were developed for each stakeholder group to elicit their perspective about the acceptability and feasibility of the SDSH program and to triangulate responses. The guides can be seen in Appendix A.

Data collection occurred between October 2017 and February 2018. Interviews lasted approximately 45 to 90 min and took could take place in-person at a confidential space within our partnering organization, the research team’s office, or at a mutually agreed upon location in the community (e.g., private space at a local library) requested by and/or approved by the participant. Interviews were conducted by a graduate-level trained research assistant with debriefing and support provided by the senior author (MK). To ensure data accuracy and integrity, each interview was audio recorded and transcribed verbatim. During the interview, participants received a document outlining the range of safety measures available for installation as part of the SDSH intervention strategy. Participants were instructed to review the list of measures and subsequently respond to a series of questions probing the participants’ perspective of the perceived benefits, safety risks, barriers, facilitators, and potential adaptations required for the implementation and sustainability of the SDSH intervention. Participants were informed that the SDSH intervention was still in the conceptualization phase, signifying that it had not been implemented with the participants of the current study or other Canadian survivors. As is customary in qualitative methods, integrity and credibility of data collection were considered and maintained using an audit trail of amendments, compiling any relevant field notes, and investigator and community-partner debriefing following interview completion, where needed and relevant. Similarly, semi-structured interview guides were allowed to be amended to refine question probes throughout the interview process. In consultation with community partners, we identified the following protocol of compensation and expression of appreciation: a $35 e-gift card honorarium for service providers, $50 in cash for survivors, and a ‘thank you’ card for police officers given the support of the police force for officers to participate in project activities during work hours.

Data Analysis

Data analysis was completed following the conclusion of all interviews and managed in the NVivo Version 1.7.1 (Release 2023) platform. Conventional and summative content analyses (Hsieh & Shannon, 2005) were used to identify, code, and categorize the attributes and qualities of the SDSH intervention that participants perceived facilitated (or served as barriers to) its acceptability and feasibility to meet the safety needs of women survivors of IPV, as well as to identify, code, and categorize any adaptations perceived as needed to implement and sustain the intervention in the Canadian context. Content analysis was led by the first author (KA), a PhD trainee with experience in qualitative research. The first author brings research- and community-based experience in the design and execution of youth programs, alongside providing support for youth affected by family-based violence and mental health challenges. Furthermore, she serves as a research trainee specializing in child maltreatment and mental health. Her background includes developing, implementing, and assessing preventative interventions specifically tailored for underserved children and families who have experienced adversity and/or are at-risk of experiencing adversity. These experiences contribute to her interpretive lens in research. Integrity and credibility of data analysis were considered and maintained using analytical memoing by the first author, as well as investigator triangulation with the senior author (MK) who reviewed a subset of interview transcripts from each participant stakeholder group. The senior author is a front-line service provider with expertise and experience in the family violence and mental health service sector; she is also a researcher in the family violence and mental health fields, as well as develops, implements, and evaluates health professions education interventions and programs in this area. The senior author is a cis-gender, heterosexual woman with lived-experience of gender-based violence and this experience intersects with and contributes to her interpretive lens in research. Regular meetings between the first and senior author throughout the duration of the first author’s completion of data analysis activities supplemented the dual coding process; during analytical meetings, both investigators reflected on and shared, as comfortable, how their interpretations of the data was influenced by their respective identities and personal and professional experiences. Finally, the presentation and organizational coherence of the qualitative categories was additionally vetted via independent meetings between the first and second author, the latter of whom was external to the core research team and is an experienced, PhD-trained qualitative researcher in the field of IPV.

Results

A total of 47 individuals participated in this case study; including IPV survivors (n = 21; 100% female, 0% male and gender diverse; Mage = 40), IPV service providers (n = 12; 92% female, 8% male, and 0% gender diverse; Mage = 43), and police officers with expertise and experience in IPV response (n = 14; 50% female, 50% male, 0% gender diverse; Mage = 42). Informed by our research questions and analytical process, our data were grouped into two overarching categories: perceived value and acceptability of the program and perceived feasibility of program implementation, with the latter category encompassing several sub-codes relevant to adoption, implementation, and sustainability of the SDSH program within the Canadian context. Tables 1, 2, and 3 provide more detail about the categories and codes generated from our data, including illustrative quotes from stakeholder participants.

Table 1 Perceived Program Value and Acceptability: Benefits of Intervention Implementation (N = 47)
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Table 2 Perceived Program Feasibility: Barriers to Intervention Adoption, Implementation, and Sustainability (N = 47)
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Table 3 Perceived Program Feasibility: Facilitators of Intervention Adoption, Implementation, and Sustainability (N = 47)
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Perceived Value and Acceptability of the Program

All participants – inclusive of IPV survivors, service providers specializing in IPV services, and police officers specializing in IPV response – uniformly emphasized the importance of implementing the SDSH structural intervention as a strategy for IPV prevention, and more specifically, enhancing survivor safety within the home:

“I wouldn’t rank anything [as more important] than in-home interventions, because that’s where people mostly fall victim… so, I’d still say this is number one” (IPV survivor 104).

“…I think this is something that should definitely happen” (service provider 108).

“I think that if it can be done, it should be done” (police officer 103).

Stakeholders identified two primary benefits of the SDSH intervention, including increased peace of mind for survivors and reduced survivor burden (i.e., the onus of IPV impact and change that is borne by survivors in the aftermath of IPV; see Table 1). Strikingly, peace of mind was identified as a primary benefit by 85% of participants (n = 40) and indicative of the acceptability of structural safety interventions as an important prevention approach. Resoundingly, participants reflected on the possibility of the intervention to serve as fulcrum to positive change in other domains of survivors’ lives, as illustrated by one survivor (120) stating, “I think it brings back a sense of normalcy to the victim’s life ‘cause instead of worry about [IPV revictimization], you can start worrying about your life and getting yourself on track”. Another survivor (118) similarly reflected on the possible benefits of the SDSH intervention by saying, “I would feel a lot safer having all of [these measures] because when your safety is compromised, it ruins your whole life… to not have to be worried so much about my safety would be huge because then I could focus on other things. But my focus, still to this day, number one, is safety. Everything else takes a backseat…” and another (114), “just having that peace of mind your door can’t be broken into because it’s reinforced… will help that anxiety go away for that woman.” Collectively, survivors described that the measures implemented through the SDSH intervention may serve as a valuable instrument in cultivating feelings of safety and security, consequently fostering peace of mind. Likewise, service providers also recognized peace of mind as a key advantage of the intervention, expressing, “I think [the intervention] will give [survivors] mental or emotional peace to begin with and I think there are great benefits to it…the more safety you can put in place, the better” (service provider 100) and “Peace of mind [is a potential benefit], even if nothing ever happens, you’re safe in your mind and you know that all these things are here to protect you” (service provider 108). Similarly, police officers highlighted the significance of the intervention in alleviating safety concerns. This, in turn, supports survivors in redirecting cognitive energy towards their everyday lives. Police officers went on to say, “… the victim and their family would have a lot more peace of mind with these kinds of [measures]… they can have enough peace of mind that they feel like they can safely continue on with their style of living that they had prior to this issue” (police officer 107) and “the benefits of this [intervention] would be peace of mind. Right off the bat” (police officer 110), with some even stating that the intervention brought them peace of mind as law enforcement professionals, “being able to do something – like, just to do something right away – not only is it peace of mind – obviously, safety, depending on what you’re doing – but it’s sort of peace of mind for the victims” (police officer 114).

Stakeholders additionally identified reduced survivor burden (as it pertains to rehousing) as a second primary benefit of the intervention. Participants reported that the implementation of the SDSH structural intervention would be vital in allowing survivors to remain within the origin home, in turn, mitigating the level of burden typically associated with the rehousing process (e.g., disrupting their lives, accruing financial strain, reluctantly relocating). Reflecting on survivor burden, one survivor (114) expressed, “you have your kids. Your kids, that's their home. I promised them I wouldn't ever move or leave. Now, why should the woman be the one to leave the home when she's not the abuser? He should get out”. For this survivor, the implication that IPV survivors are the ones that must move homes in favour of safety considerations ultimately exacerbates survivor burden such as impacts on children, including having to uproot children’s lives. Importantly, each participant group underscored the need to provide survivors with the choice and necessary resources, (like the SDSH intervention) to stay in their original homes, with one survivor noting “having this put in place would enable women to at least have some normalcy, because when there’s too many changes, some women end up giving up… and they do end up going back and end up being revictimized. But if this was in place, you could go back and feel, within your own home, safe” (IPV survivor 117). Collectively, participants also reflected that even in situations where the survivor reunites with an abusive partner, the inclusion of a safe room, may offer structural security within the home and improve the ‘felt sense’ of safety within a previously unsafe space. Service providers affirmed the possibility of the SDSH intervention for reducing survivor burden among women, as well as children, with service provider participants noting that the intervention allows the possibility of maintaining broader connections with their community: “the benefit is for her to be able to stay in her own home and the kids to be able to stay in their own neighbourhood” (service provider 103). Relative to other stakeholder groups, it is worth noting that a smaller proportion of police officers explicitly described home relocation as a source of survivor burden. Police officers that aligned with this perspective described the ability for survivors to safely stay in their origin home as an important element of healing from violence, which is reflected in the words of one police officer with the following: “it allows them to stay in their home – as little disruption as possible … that they feel safe in their home, I think that’s a big step … Instead of them having to uproot and go somewhere else, some of these ideas give them as much reassurance in their safety as possible” (police officer 110). Some police officers, however, described home relocation as a reasonable strategy for preventing IPV revictimization.

Perceived Feasibility of Program Implementation

Barriers

Stakeholders described safety risks, temporary housing, indiscretion of the intervention, and installation and maintenance as primary barriers to program implementation (see Table 2).

Safety Risks

Respondents described possible safety risks such as a compromised exit strategy (i.e., a premeditated plan to exit the house in the event of an emergency) and the possibility of reuniting with the/a perpetrator as potential factors which could paradoxically increase safety risks for women who receive the SDSH intervention. Primarily raised by police officers and service providers, a major proportion of survivors (60%) also raised possible safety concerns with the SDSH intervention, underscoring the significance of safety considerations for intervention implementation, going forward. In the event of an emergency, for example a fire or intruder (among others), participants reflected that the SDSH intervention components could compromise the ability to exit the residence swiftly, where needed; one IPV survivor (114) expressed, “what happens if you had to run and then you have to worry about a gate being padlocked and you can’t get out fast enough? Some of [the measures] are a little bit extreme in the sense that it might actually hinder your safety more”. Similarly, service providers conveyed different variants of this perspective, “say you had a kitchen fire or something… if your house is so secure that you can’t get out, that’s a bit of a concern too” (109) and “the police would have an interesting time trying to get in. That would be something” (111). Of similar concern, participants described the possibility of survivors reuniting with the/a perpetrator of IPV, noting that such a reunification may lead to increased harm if perpetrators become cognizant of the intervention and opt to leverage these measures to further harm or control the survivor within their home. The majority of police officers described concerns about the possibilities and impacts of reunification, which is aptly illustrated by one participant: “…if she lets him back into the relationship, he then knows, [and] he’s in the home. I wouldn’t want an offender to know what steps she’s taken… we want to lock him out, but have we locked her in?” (police officer 102). Several service providers described similar concerns and noted the possibility for more severe violence and control, “they would know where all of the measurements are in place, they would know probably how to stop the alarms because they would check that out… if they have access to these measures, it could even be more dangerous for women” (104). While acknowledging the potential risk of these concerns, several survivors also offered the possibility of prioritizing the SDSH safety measures for survivors with a history that was free of reunification, “you get back with the guy, so now he’s gonna use these against you… is he gonna lock you in the house? People [who reunite with their partner] shouldn’t be getting this [intervention] then…they should be going through more extensive counselling” (114). Other survivors reflected on the possibility of having the SDSH components removed from their home, should they consider reuniting with their partner, “I might consider taking them off because I wouldn’t want to offend him… he would probably [want me] to get them removed” (108).

Temporary Housing

Stakeholders noted the challenges of implementing the SDSH security measures in temporary or precarious housing settings, such as in rented accommodation. Barriers identified by participants included the instability of housing, resistance from the landlords governing rental properties, and challenges with the portability of the intervention measures. Participants reported that landlords would not permit in-home structural safety measures and may even treat the request as grounds for eviction, in favour of limiting the potential for violence on their properties. In raising these concerns, service providers and police officers reflected on their experience negotiating with landlords, “landlords sometimes put up a real fuss. They don’t want anyone messing with their house, so the biggest challenge so far is with landlords…most landlords don’t want trouble in their building or their house or whatever…and they don’t understand that whole ‘we just want to make her safe’” (service provider 100). Moreover, stakeholders discussed the immobility of the intervention measures within the context of precarious housing. Many respondents expressed that IPV survivors are often compelled to frequently relocate due to constantly shifting circumstances such as financial insecurity or threats from the perpetrator. In turn, participants expressed concerns that survivors might fully benefit from an in-home structural intervention only if they remain in one residence for an extended period. One provider noted, “some do move a lot because of different partners, or they have to move to different housing and it’s not always the safest so they stay there a little bit and move” (111). A police officer (108) shared: “I think the biggest thing is the repeat. You have to implement something…they can take with them, like maybe it’s a door jamb instead of a new door… so something that’s more mobile because these people are in and if they’re not going back, they’re in a change of life and they’re gonna be moving. Most of them, there are very few that, long term I think, would stay in their residences.”

Indiscretion of the Intervention

Indiscretion of the intervention also surfaced as a primary concern and potential barrier to implementation across survivors. Concerns included potential for stigmatization and discrimination by neighbours and the local community. Survivor participants primarily described concerns with potential embarrassment: “some people might have a feeling of embarrassment … because that feeling of your neighbours looking at you like, ‘why does she need all this security? What’s going on over at their house’… that stigma put on them for having all of [those measures]” (IPV survivor 105). Across stakeholder groups, participants also described concerns related to feelings of being barricaded and/or incarcerated (e.g., window bars), “you don’t want her to feel like she’s in jail, in her own house too” (police officer 103), and, lastly, the risk of inducing fear and anxiety in survivors’ children which was, widely reported across each stakeholder group, “I’d be really worried about a child in the home … now there are bars on the windows and all, and the child is going to think there is a reason to fear” (police officer 102) and “safety is the most important thing, but, yeah, it would freak kids out … it would freak my kids out, for sure … they would be worried” (IPV survivor 118). However, several service providers also offered an opposing view, “I don’t think it would cause [children] anxiety… [children are] very much aware of ‘I need to be safe. I don’t feel safe … so what can I do?’ and it helps them as well” (service provider 105) and “[survivor] will be feeling safe and protected, and she can pass that on to her kids, and her kids won’t have to say, ‘mommy, why are you so upset?’” (service provider 103).

Installation and Maintenance

Finally, installation and maintenance were identified as barriers to implementation of the SDSH intervention. Nearly all stakeholders discussed cost as a limitation of the intervention, generally reporting that the measures would be costly and potentially burdensome to install and maintain. Similarly, they expressed concern regarding the source(s) and level of sustainability of potential funding source(s). Furthermore, all stakeholders described the intervention as “high maintenance”, going on to say that sustainability of the intervention and measures, to prevent malfunction, may be particularly challenging for survivors from lower socioeconomic backgrounds.

Facilitators

Stakeholders identified reducing safety risks, ensuring flexibility to accommodate temporary housing, increasing discretion of the intervention (i.e., installation, placement, apparatus), and acquiring funding as key facilitators to program implementation (see Table 3).

Reducing Safety Risks

Stakeholders collectively agreed that the feasibility of the intervention could be improved by minimizing safety risks to mitigate the potential for additional harm. Specifically, several police officers and service providers suggested prioritizing collaboration and integration across local authorities to monitor which survivors within the community have these features in their home. This practice may better equip first responders to respond to calls originating from these homes and enable a safe exit strategy for survivors with one survivor (120) noting, “if you’re given that little memo or the little notion beforehand… ‘hey I think there is a domestic violence situation going on here’ … you’d be ahead of time, that is something to look out for”. Moreover, stakeholders requested that education and counselling resources be provided and/or referred to SDSH intervention users in order to deter reunion with the perpetrating partner, noting that the intervention appeared best suited for those without a pattern of reunification. One survivor (106) summarized it as such, “it would almost be like a contract…when she agrees for help and [to] have all these safety measures, to also agree to continued support and therapy through an outreach program”. Lastly, survivors, service providers, and police officers all concurred that survivors should have the autonomy to select the safety measures installed in their homes expressing that employing measures that do not align with their needs may pose additional harm and stress, “not everything [on this list] is going to be feasible or reasonable for every case, so I think it would [need to] be very tailored to the specific individual” (police officer 102). This recognition stems from the understanding that survivors possess diverse and unique needs, rendering it impractical to employ a one-size-fits-all approach to harm reduction.

Accommodation of Temporary Housing and Needs

Offering supplementary evidence against the one-size-fits-all approach, several stakeholders pointed out that enhancing flexibility, particularly in accommodating temporary housing, would support the implementation of the SDSH program. Several stakeholders proposed improving the mobility and portability of safety measures to facilitate easy and seamless relocation when survivors move to new residences, simultaneously allowing providers to curb re-installation costs. Moreover, stakeholders expressed concerns surrounding the maintenance and sustainability of apparatuses. Police officers and providers identified measure malfunction as a primary area of focus while survivors identified everchanging satisfaction and maintenance as a primary concern. All stakeholders conveyed that they deem the intervention feasible if continued monitoring, follow-up, and maintenance services are provided in addition to initial installation. Survivors emphasized the importance of follow-up and monitoring services for their satisfaction and to address their individual safety needs, even despite evolving circumstances, noting, “… there probably needs to be somebody that you can call once you have these things in place – like, for repair or, ‘hey, you know what? I don’t think I really need this camera’ … it may have met their needs at the time, and maybe something else needs to be put in place” (IPV survivor 108). In contrast, police officers and service providers stressed that maintenance would be crucial to ensuring the ongoing functionality and utility of the safety measures noting, “you need a dedicated person at the very least within the service that would regularly follow up and say, have you checked your batteries? Let’s make sure the monitors are working properly” (police officer 106). Ultimately, all groups converged in their emphasis on the need for monitoring, follow-up, and maintenance, post-installation. This ensures that the intervention consistently and appropriately addresses the evolving personal and housing needs of survivors, which may differ both among and within individuals over time.

Increased Discretion

Stakeholders also identified discretion as a primary stipulation of program implementation. Survivors voiced concern surrounding the potential for stigmatization and discrimination perpetrated by neighbours and landlords, noting that such ostracization may even extend to their children, “ … their friend’s parents don’t want their kids to go over there because they recognize that there is something serious going on, so then, you know, little Billy can’t play with little Johnny anymore and I have seen that before” (100). Thus, discretion was highlighted as a key condition of the installation process as well as the physical placement and appearance of the safety measures. Similarly, the discretion of measures was underscored by many as a requirement to prevent or reduce feelings of being barricaded in and “incarcerated”. To this end, stakeholders expressed that women should not need to compromise the integrity of their home to reduce the potential for harm. Lastly, a few stakeholders recommended that inconspicuous measures would assist women in ensuring that the interventions remain unseen, particularly in the context of immediate community (e.g., neighbours) or situations where the perpetrator may be invited back into the home. The intervention, they emphasized, should strive to be minimally intrusive:

“I mean I still think that the bars on the windows, I have a hard time with that. To me, it’s jail. But a lot of these other supports, the panic alarms, the intercom systems, even the double-glazed windows, nobody would know any different about that. Who would know if it’s a fire-retardant letterbox? All those inconspicuous things I think would be fantastic in another house” (service provider 103).

Funding

Finally, nearly the entire sample identified financial backing as a key facilitator of intervention implementation. Stakeholders emphasized that, due to the extensive nature of the intervention, substantial funding would be required to support installation expenses. One police officer (110) summarized this position: “Don’t get me wrong; I think it’s great… I don’t actually have our home audit checklist, but it’s definitely not as comprehensive as this, right? So, I think it’s good. I just didn’t know how… I’m looking at all these things going, ‘oh that’s expensive. That’s expensive. Who can afford this, right? But I think it’s all great.” Despite acknowledging cost, stakeholders also expressed the belief that the intervention’s benefits and importance justified the financial investment. Furthermore, stakeholders reflected that waiving installation and maintenance fees for intervention users would enhance feasibility, particularly recognizing that many survivors are dependent on a single income. Lastly, the predominant viewpoint among survivors was that the intervention could be viable with the provision of complimentary education and training on safety measures. One survivor (119) expressed, “[I suggested] there’s another, maybe, education side to it. You have to know how to use all this and what to do with it should you need to use it”. Incorporating the essential addition of education and formal training would empower survivors to autonomously manage and uphold the measures to their full capacity, consequently reducing the risk of harm and revictimization without incurring additional costs for survivors.

Discussion

The present study triangulated the perspectives of Canadian survivors of IPV, police officers, and IPV service providers who reported that the SDSH intervention is important and necessary in the Canadian context. There was consensus across stakeholder groups that the intervention was an important secondary prevention strategy to reduce the possibility of physical and sexual IPV revictimization and should be implemented alongside counselling and education. Feedback from IPV survivors underscored the significance of in-home interventions, describing these interventions as crucial to reducing revictimization. Two primary benefits of the intervention were identified: increased peace of mind for survivors and reduced survivor burden. Overall, each stakeholder group underscored the perceived value of the SDSH intervention, offering statements to support its potential as a secondary prevention approach in the context of IPV via reducing the potential risk of revictimization, but also associated impairments related to IPV experiences.

Barriers

Several barriers to implementation of the SDSH intervention were identified. A relatively novel finding, safety risks such as compromised exit strategies and the potential for perpetrators to exploit the intervention, were mentioned by police officers and service providers, albeit echoed by a notable proportion of survivors. Concerns were also raised about the extreme nature of some measures (e.g., London bars) hindering quick exits amid emergencies, and the possibility of perpetrators leveraging the intervention against survivors if reintegrated into the home. However, survivors did not cite this barrier as a primary concern noting that the intervention may be best suited for those without a shared history of reunification with the perpetrator.

Temporary housing also emerged as an obstacle, with resistance from landlords and concerns about the portability of the intervention measures being particularly voiced by service providers and police officers. Survivors also expressed concerns about the physical compatibility of measures with apartment-style homes. Additionally, the immobility of intervention measures posed challenges for survivors who frequently relocate due to shifting circumstances. This concern emerges as no surprise, as IPV survivors are significantly more likely to experience housing insecurity relative to non-IPV survivors (Dichter et al., 2017). Many police officer and service provider respondents noted that, consequently, they are often tasked with mediating conflict between IPV survivors and their landlords. Relatedly, mixed methods research by Barata and Stewart (2010) exploring landlord beliefs and attitudes toward IPV further substantiates these results, having yielded similar findings to reinforce the notion that landlords may refrain from accepting and retaining IPV survivors as their tenants. Thus, conceptually, forthcoming research should give precedence to comprehensive investigations into landlords’ beliefs and attitudes concerning IPV. On a pragmatic level, ensuring both accessible and mandatory IPV education for landlords, particularly those providing housing in high-needs neighbourhoods and complexes, is imperative. This approach aims to augment the IPV and trauma awareness of housing providers, thereby alleviating the post-separation risk of survivors experiencing homelessness due to landlord discrimination. Alternatively, a practical safety strategy may involve establishing emergency housing specifically designated for women survivors of IPV and their families. Such shelters would be pre-fortified with SDSH security measures and governed by landlords well-versed in IPV and related concerns.

The indiscretion of the intervention raised concerns among survivors about potential stigmatization and discrimination from neighbours and community members who are unfamiliar or uncomfortable with a need for heightened security. This finding aligns with the qualitative literature from IPV survivors which collectively reports that survivors are disproportionately at-risk of being subjected to several forms of stigmatization and discrimination based on their IPV experience (e.g., Crowe & Murray, 2015). In our study, we affirm these concerns from a sample of IPV survivors in the Canadian context, but also reiterate these concerns from the perspectives of IPV service providers and police officers who bear some of the responsibility for advocacy in this regard. Findings warrant, therefore, a needed emphasis on discretion in the domains of installation, maintenance, and the design of structural safety measures more generally, as well as in the implementation and maintenance of the SDSH intervention, more specifically. To address these concerns, discrete installation and maintenance could be promoted by making safety measures more mobile and compact, scheduling work during times of lower foot traffic, disguising installations as routine landscape maintenance, and ensuring discretion in the design of logos and the appearance of personnel and vehicles involved in the process.

Finally, the installation and maintenance of safety measures emerged as a significant barrier identified by participants, with cost implications (identified by police officers and service providers) and concerns about sustainability for survivors due to financial constraints (identified by survivors) collectively pinpointed as a primary pitfall of the intervention. This finding aligns with the prevailing sentiment across the literature that financial considerations are consistently recognized as potentially the most significant factor, and obstacle, to reducing IPV-related harm (Breckenridge et al., 2015; Gezinski & Gonzalez-Pons, 2021). However, relative to the substantial cost of relocating survivors and expanding shelter services, dedicated funds to the SDSH intervention may alleviate financial burdens for survivors and financial stakeholders alike. The intervention’s cost-effectiveness, in comparison to other IPV responses, warrants thorough examination and should be a focal point for stakeholders across both private and public sectors. While federal or provincial funding is crucial for integrating the SDSH intervention into the IPV prevention framework, it’s imperative to recognize that private investments can also play a significant role in funding the intervention, contributing to its sustainability within the private sphere. Yakubovich et al. (2023) put forward twelve recommendations for the Canadian federal government’s National Action Plan to End Gender-Based Violence, and explicitly, four of these proposals underscore the essential role of funding as a necessary component of primary and secondary prevention efforts.

Facilitators

Several key facilitators were identified by stakeholders as important for program implementation. Stakeholders unanimously identified reducing safety risks as a fundamental facilitator for implementing the SDSH intervention. Specifically, police officers and service providers proposed that the successful implementation of the intervention necessitates the collaboration and integration of emergency response services to effectively mitigate any potential safety risks linked to fortifying the home, including ensuring a secure exit strategy for those undergoing the intervention and the readiness of local authorities to respond to calls originating from these residences. Concerns about obfuscating the possibility of an ‘emergency exit’ is both a novel and critical finding of the present work that has not been previously reported by evaluations of the SDSH intervention (i.e., Sanctuary Schemes) in the UK and Australia. To this end, prioritizing collaboration, and service integration across emergency and IPV response services, and those who are responsible for organizing and administering the SDSH intervention is warranted. It would be prudent to ensure that exit strategies and emergency response protocols, tailored to residences fortified by the SDSH safety measures, are devised as a standard part of the installation and maintenance processes. Additionally, participants emphasized the importance of introducing counselling and education to the SDSH intervention protocol. They expressed that while the intervention might serve as a preventative measure against revictimization, its efficacy potentially relies on survivors receiving the necessary counselling and education that accounts for reunification cycles and strategies that promote sustained personal recovery or survivorship. Without appropriate support, there is a risk that reunification and the return of the perpetrator to the survivor’s home could undermine the effectiveness of the intervention, and even pose further harm. This finding largely aligns with the broad literature, as many interventions constructed to target IPV, reduce harm, and prevent revictimization have historically been centered around cognitive behavioural intervention and psychoeducation, with significantly fewer interventions being tailored toward structural safety in comparison (Trabold et al., 2020). Thus, it is evident that the SDSH intervention’s emphasis on structural and physical safety deviates quite drastically from the traditional framework for targeting IPV revictimization and it may be worth considering extending its scope to incorporate cognitive behavioural and psychoeducational services to facilitate effective intervention implementation.

In alignment with existing literature on IPV and housing instability (e.g., Dichter et al., 2017), our participants reported frequent housing relocation and residence in rental accommodations characterized by precarious conditions, with participants aptly reflecting on the implications of these conditions for the tenability and sustainability of the SDSH intervention. This finding points to a need to prioritize the portability and mobility of in-home safety measures to ensure they are transferable across housing options, congruent with the demonstrated needs of IPV survivors. Furthermore, it implies that perhaps safety measures that are temporary and adaptable in nature (e.g., do not require drilling, can be attached via non-invasive methods) may warrant additional consideration as a strategy for accommodating evolving needs. Thus, a universal SDSH model is likely not optimal; rather aligning the intensity of the intervention in response to survivors’ diverse needs and preferences is likely to support wider adoption and sustainability of the SDSH intervention protocol within and across contexts in Canada.

Finally, nearly all stakeholders identified funding as a primary facilitator to intervention implementation. Remarkably, all participants emphasized the importance of the SDSH intervention with the caveat that that IPV survivors should be exempt from installation and maintenance expenses, which are instead incurred by philanthropic or government representatives at the municipal, provincial, or federal levels. This finding points to a need for additional funding which can be allocated to secondary IPV intervention geared toward preventing revictimization and re-instilling a sense of normalcy in survivors’ lives. Furthermore, it highlights a fundamental flaw in IPV response infrastructure, as funds are typically channeled towards addressing cases perceived as severe (e.g., those involving physical harm), rather than directing resources to preventing the recurrence or escalation of victimization (Department of Justice Canada, 2009).

Limitations and Future Directions

The current study addresses a critical gap in the literature by undertaking the first-ever acceptability and feasibility study of the SDSH intervention in Canada. This novel approach offers valuable insights into the potential efficacy of the intervention in the Canadian context. A key strength of our exploratory case study methodology was a cohesive collation and triangulation of perspectives from three stakeholder groups critical to understanding the tenability of structural home interventions, including survivors of IPV, social service providers specializing in IPV services, and police officers specializing in IPV response.

Despite the identified strengths of this work, several limitations and potential avenues for future research should be acknowledged. Our sample participants were recruited in the Southern Ontario region of Canada, which is the most densely populated and southern-most region of Canada. Despite all regions of Canada being governed under a national funding framework for health care and social service responses, as well as a criminal code that informs policing response to IPV, provincial and regional variation in funding and service administration contributes to important differences in the experiences of IPV and associated service responses. Thus, the current findings may reflect perspectives shared by those in other urban samples and regions. Subsequent investigations could expand on these insights in other geographical regions, particularly in low-income settings where evidence is sparse, considering variations in legal frameworks and social norms would contribute to a more culturally relevant and sensitive understanding of IPV intervention implementation. Next, this study is limited in its capacity to delineate the preference for specific components within the SDSH intervention. Therefore, future research should aim to elucidate which aspects of the SDSH intervention are favoured among particular populations and under what circumstances. By focusing on target investigations, future studies can enhance our understanding of which components of the SDSH intervention are most suitable for different demographics and situations among IPV survivors, thus contributing to a more nuanced understanding of intervention acceptability. Nonetheless, the findings from this study underscore a clear demand for both comprehensive and scaled versions of the SDSH intervention measures. Finally, the cross-sectional nature of the interviews captures a snapshot in time and, therefore, the current study was unable to monitor variability in views on acceptability and feasibility across time. Future studies could benefit from use of a longitudinal study design to initiate an iterative process in collaboration with stakeholders, whereby the intervention is modified and evaluated in real-time and across several timepoints.

Implications for Practice and Policy

This study has several important implications for the field of IPV prevention. First, the prioritization of training for individuals responsible for administering the SDSH intervention is recommended. This training should increase awareness of how to create a supportive and safe environment for survivors during the safety measure installation and maintenance processes. Additionally, there is a need to standardize such procedures and protocols by involving survivors in the establishment of an agreed-upon process of installation to prevent additional distress to survivors and their families. Second, it is vital that the SDSH intervention maintain adaptability, and consider incorporating an approach that is sensitive to the dynamics of IPV and that centers on the needs of survivors related to installation and maintenance. Moreover, a standardized emergency response protocol tailored toward SDSH intervention users should be developed and may necessitate further investment in first response training to ensure local authorities are better equipped to respond to these residences, and IPV survivors broadly, amid emergencies. Finally, while the introduction of the SDSH intervention strategy represents a progressive stride toward supporting IPV survivors by accounting for dimensions where IPV infrastructure has failed to appropriately intervene and implement effective safeguards (i.e., the onus should not be placed on women to protect themselves and their families; Clarke & Wydall, 2015; Netto et al., 2009), the SDSH intervention should be interpreted as a small part of a larger strategy for implementing effective IPV protection and prevention. This recommendation emphasizes the need to mobilize IPV intervention to be an iterative and flexible process whereby intervention efficacy and IPV survivor needs are assessed frequently, as the dynamics of IPV are often evolving.

Conclusion

This study aimed to deepen our understanding about the tenability of a home-based structural safety intervention, SDSH, as a secondary IPV prevention strategy in the Canadian context. Our participants were female IPV survivors, healthcare and social service providers specializing in IPV prevention programming, and police officers with specialized expertise and experience in IPV response. Informed by their lived experience in the ‘IPV space’, participants shared perspectives that can be conceptualized by the phrase of ‘cautionary potential’: they were clear and consistent in their reflections that structural safety interventions are a critical component of IPV prevention and yet, important provisos and considerations were identified. Further investment in and implementation of the SDSH intervention is warranted alongside intentional cross-sectoral collaboration that ensures adequate emergency and safety response protocols. In parallel, robust longitudinal evaluation of the impacts of the SDSH, and related structural safety interventions, are urgently needed, with specific attention to ensuring the monitoring of reductions in direct and indirect forms of IPV-related harm. Moving forward, our work also suggests the importance of strategic adaptations to structural interventions that integrate cognitive-behavioural and psychoeducational IPV prevention, providing in-depth training on IPV-related emergency response to local authorities, and establishing clear guidelines for temporary housing accommodations. Our study lays the groundwork for advancing the SDSH intervention both conceptually and practically and contributes valuable considerations for refining IPV interventions on practical and systemic levels.