A Qualitative Evaluation of Healthcare Providers’ Perspectives and Experiences in the Application of the “Responding to Gender-based Violence” Training in Timor-Leste

Abstract

Introduction: Gender-based violence (GBV) is a pervasive and deeply rooted issue in TimorLeste, where nearly 59% of women experience intimate partner violence in their lifetime. Despite the existence of national policies, the health sector’s capacity to provide effective, survivor-centered GBV care remains limited. In response, a training program was developed to strengthen healthcare providers’ knowledge, attitudes, confidence, and communication skills for GBV response. This study evaluated the implementation of the GBV training program to understand its effect and identify key facilitators and barriers to sustained integration within the health system. Method: This study used a qualitative study design informed by the Consolidated Framework for Implementation Research (CFIR), which includes the five domains: (1) Intervention Characteristics, (2) Outer Setting, (3) Inner Setting, (4) Characteristics of Individuals, and (5) Implementation. A total of 34 healthcare providers who engaged in the GBV training participated in the study. Data collection involved 19 in-depth interviews (IDIs) and four focus group discussions (FGDs) with trained health providers at ten community health centers in Liquica and Ermera municipalities. All interviews were conducted in Tetum by the principal investigator and transcribed verbatim. We conducted a thematic analysis using a combination of deductive coding, based on selected CFIR constructs, and inductive coding to capture unanticipated insights emerging from the data. Coding and data organization were facilitated using ATLAS.ti software. Results: Findings revealed several facilitators and barriers across the CFIR domains. In the innovation domain, the training was widely perceived as a valuable transformative improvement to providers’ clinical practice to respond to GBV. Within the individual characteristic domain, providers reported enhanced confidence and strengthened survivor-centered care following the training. However, in the process domain, the absence of ongoing learning hindered the retention and consistent application of GBV response skills. The inner setting domain highlighted persistent barriers, including limited health resources and inadequate safe space infrastructure, which constrained effective service delivery. Finally, under the outer setting domain, cultural norms and community stigma discouraged survivors from seeking care, while a lack of legal protections posed significant challenges to providers’ ability to respond safely and confidently to GBV cases. Conclusion: This study highlights that GBV training can significantly improve healthcare providers’ confidence, knowledge, and clinical practices in responding to GBV. However, sustainable implementation requires more than individual-level change. It depends on addressing systemic barriers. Aligning continuous capacity building with supportive infrastructure, legal protections, and multisectoral coordination is essential to strengthen GBV response and ensure accessible, survivor-centered care in Timor-Leste.