Table 5

Thematic synthesis of barriers and enablers of the OSC model to implementation and achieving intended results

Output levelOutcome level
Increased staff trainings on trauma-informed careB: Increased healthcare worker time constraints MAccessibilityE: Community awareness raising activities L
B: Harmful staff attitudes on IPV/SV HE: Focal person to assist user with navigation of OSC L
B: Staff burnout LE: Affordable medical services and support L
Reduced number of survivor interviewE: Standardised policies and procedures ME: Minimised points of care for survivors L
B: Lack of standardised policies and procedures MB: Transportation cost M
B: Inadequate training on trauma-informed care and OSC operations HB: Lack of rural access M
B: Unclear, uncontextualised or unavailable OSC policies and procedures MB: Lack of services on night and weekends H
B: Out-of-pocket user costs H
B: Long wait times M
B: Lack of community awareness H
B: Navigation challenges within facility L
Reduced number of survivor interviewsE: Standardised policies and procedures MAcceptabilityB: Hostile and sceptical community beliefs L
B: Lack of standardised policies and procedures MB: Non-representative staff L
B: Inadequate training on trauma-informed care and OSC operations H
B: Unclear, uncontextualised or unavailable OSC policies and procedures M
More services provided at one place and all hoursE: Available, on-site psychosocial services and support MQualityE: Sensitive staff attitudes and behaviours L
B: Lack of basic medical supplies, facility equipment, survivor comfort items HE: Sensitive staff referrals L
B: Insufficient staff HE: Champion, dedicated OSC staff leaders M
B: Lack of psychosocial services HB: Failure to provide health information L
B: Lack of security at OSC LB: Harmful behaviours of healthcare staff towards survivors L
B: Lack of designated budgets and budget transparency LB: Mistreatment by police H
B: Unsustainable, donor-dependent funding sources MB: Lack of staff knowledge on IPV/SV M
B: Operation costs not feasible in many low-resource settings MB: Lack of long-term support and follow-up M
B: Compromised confidentiality and privacy H
B: Lack of child friendly environments L
Increased evaluations and researchB: Poor data management systems HMultisectoral coordinationE: Strong interprofessional staff relationships L
B: Lack of oversight and supervision ME: Regular interagency meetings M
B: Lack of facility-level monitoring mechanisms HB: Weak multi-sectoral networks H
B: Unclear staff roles L
B: Fragmented services M
B: Poor transfers of management L
B: Lack of information sharing between sites L
B: Weak referral networks H
B: Unclear responsibilities of implementing partners M
B: Ineffective advisory committees L
  • H indicates high-confidence evidence. M moderate-confidence evidence. L low-confidence evidence. F, indicates enabler. E, indicates enabler.

  • IPV, intimate partner violence; OSC, one stop centre; SV, sexual violence.