Trends in Trust, Safety, and Health Service Access Among Women Participating in an Antiviolence Outreach Program: Protocol for a Mixed Methods Study

Abstract BackgroundWomen 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 behaviors, 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. ObjectiveThe research study aims to (1) describe the demographic characteristics, baseline health status, and care access among diverse women impacted by gender-based violence; (2) explore preliminary changes in trust in the outreach program over time; (3) explore trends in participants’ access to health and social care services and safety planning over time; and (4) explore the contextual factors impacting trends in trust, service access, and safety. MethodsAn exploratory outreach intervention will be conducted in 2 Canadian cities in partnership with community-based service organizations 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 analyzed in parallel and then merged for data integration to fully contextualize study findings. Data will include surveys conducted at up to 4 time points to assess service access, trust and safety planning, and qualitative interviews with participants detailing sociostructural and individual factors impacting service access and trust and safety planning. 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 to and engagement with care over time. Interview data will be thematically analyzed 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. ResultsThe study was funded in April 2019. Intervention implementation began in the first of 2 study hubs in October 2023 and in the second hub in October 2024, and participant enrollment was open from November 2023 to June 2025. A total of 86 women were enrolled during that time; though enrollment has now closed, data collection is ongoing and is expected to continue through January 2026. Data analysis will commence in February 2026. Results are expected in late spring 2026. ConclusionsStudy results will be presented at community forums within study settings and at international conferences and will be submitted for publication in relevant journals. This study is expected to generate insight into interpersonal and structural factors shaping trends observed, extending beyond behavioral investigation with new insights into how intersecting inequities can impact trust, engagement in care, and women’s safety.