{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T06:42:24Z","timestamp":1792737744652,"version":"4.5.0"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,2,10]],"date-time":"2021-02-10T00:00:00Z","timestamp":1612915200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,2,10]],"date-time":"2021-02-10T00:00:00Z","timestamp":1612915200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Public Health"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Violence against healthcare personnel is a major public health problem. Healthcare personnel are at the frontline dealing with people in stressful and unpredictable situations. Therefore, this study was conducted to determine the prevalence and associated factors of violence against health care personnel.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross sectional study was conducted in the district Peshawar. Healthcare personnel from public and private sectors working in both the primary and tertiary levels of healthcare were invited to participate. Violence was assessed through a structured questionnaire previously used in Pakistan and was defined as experiencing and\/or witnessing any form of violence in the last 12\u2009months. Mental health was assessed through the General Health Questionnaire. Logistic regression was used to estimate the association of violence against healthcare personnel with psychological distress and demographic characteristics. Data entry and analysis were conducted in STATA 14.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 842 healthcare personnel participated in the study. The prevalence of violence experienced and\/or witnessed by healthcare personnel in Peshawar was 51%. Verbal violence remained the predominant form of violence and almost half of the healthcare personnel (45%) were exposed to it. A quarter of the respondents (24%) reported physical violence alone or in combination with other forms of violence. In almost two third of the incidents the perpetrators were either attendants, relatives or the patients. The emergency unit and wards within healthcare facilities were the most common places where violent events took place. The major factors responsible for the violent incidents were communication failure, unreasonable expectations and perceived substandard care. No uniform policy\/procedure existed to manage the incidents and the healthcare personnel adopted different responses in the wake of violent events targeting health care. Working in public healthcare facilities and having a larger number of co-workers\/colleagues significantly increased the risk of violence in the healthcare settings while being a paramedic significantly reduced the risk as compared to physicians.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Violence against healthcare personnel is a serious public health issue and the prevalence is quite high. A holistic effort is needed by all stakeholders including healthcare community, the administration, lawmakers, law enforcement, civil society, and international organizations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12889-021-10243-8","type":"journal-article","created":{"date-parts":[[2021,2,10]],"date-time":"2021-02-10T14:54:11Z","timestamp":1612968851000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["Prevalence and determinants of violence against health care in the metropolitan city of Peshawar: a cross sectional study"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0484-0985","authenticated-orcid":false,"given":"Muhammad Naseem","family":"Khan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zia Ul","family":"Haq","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirwais","family":"Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadia","family":"Wali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faryal","family":"Baddia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaista","family":"Rasul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salman","family":"Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maciej","family":"Polkowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica Yohana","family":"Ramirez-Mendoza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,2,10]]},"reference":[{"key":"10243_CR1","unstructured":"World report on violence and health. Violence and Injury Prevention. [Cited 2020 Mar 14]. Available from: https:\/\/www.who.int\/violence_injury_prevention\/violence\/world_report\/en\/"},{"key":"10243_CR2","unstructured":"Definition and typology of violence. Violence Prevention Alliance. [Cited 2020 Mar 20]. Available from: https:\/\/www.who.int\/violenceprevention\/approach\/definition\/en\/"},{"key":"10243_CR3","volume-title":"Framework guidelines for addressing workplace violence in the health sector","author":"World Health Organization","year":"2002","unstructured":"World Health Organization. Framework guidelines for addressing workplace violence in the health sector. Geneva: International Labour Office; 2002."},{"key":"10243_CR4","first-page":"3","volume-title":"Country case studies Brazil, Bulgaria, Lebanon, Portugal, South Africa, Thailand and an additional Australian study Ginebra: Organizaci\u00f3n Internacional del Trabajo","author":"V Di Martino","year":"2002","unstructured":"Di Martino V, Workplace violence in the health sector. Country case studies Brazil, Bulgaria, Lebanon, Portugal, South Africa, Thailand and an additional Australian study Ginebra: Organizaci\u00f3n Internacional del Trabajo; 2002. p. 3\u201342."},{"issue":"4","key":"10243_CR5","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1002\/rnj.20","volume":"37","author":"D Hartley","year":"2012","unstructured":"Hartley D, Ridenour M, Craine J, Costa B. Workplace violence prevention for healthcare workers\u2014an online course. Rehab Nurs. 2012;37(4):202\u20136.","journal-title":"Rehab Nurs"},{"issue":"10","key":"10243_CR6","first-page":"159","volume":"112","author":"F Vorderw\u00fclbecke","year":"2015","unstructured":"Vorderw\u00fclbecke F, Feistle M, Mehring M, Schneider A, Linde K. Aggression and violence against primary care physicians\u2014a nationwide questionnaire survey. Dtsch \u00c4rztebl Int. 2015;112(10):159.","journal-title":"Dtsch \u00c4rztebl Int"},{"issue":"4","key":"10243_CR7","doi-asserted-by":"publisher","first-page":"211","DOI":"10.5539\/gjhs.v5n4p211","volume":"5","author":"M Khademloo","year":"2013","unstructured":"Khademloo M, Moonesi FS, Gholizade H. Health care violence and abuse towards nurses in hospitals in north of Iran. Global J Health Sci. 2013;5(4):211.","journal-title":"Global J Health Sci"},{"key":"10243_CR8","doi-asserted-by":"publisher","first-page":"730","DOI":"10.1016\/j.psychres.2018.12.177","volume":"272","author":"CT Seun-Fadipe","year":"2019","unstructured":"Seun-Fadipe CT, Akinsulore AA, Oginni OA. Workplace violence and risk for psychiatric morbidity among health workers in a tertiary health care setting in Nigeria: prevalence and correlates. Psychiatry Res. 2019;272:730\u20136.","journal-title":"Psychiatry Res"},{"issue":"6","key":"10243_CR9","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1016\/j.jemermed.2011.01.029","volume":"42","author":"NM Mirza","year":"2012","unstructured":"Mirza NM, Amjad AI, Bhatti ABH, Shaikh KS, Kiani J, Yusuf MM, et al. Violence and abuse faced by junior physicians in the emergency department from patients and their caretakers: a nationwide study from Pakistan. J Emerg Med. 2012;42(6):727\u201333.","journal-title":"J Emerg Med"},{"issue":"1","key":"10243_CR10","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/j.jemermed.2015.02.049","volume":"50","author":"W Zafar","year":"2016","unstructured":"Zafar W, Khan UR, Siddiqui SA, Jamali S, Razzak JA. Workplace violence and self-reported psychological health: coping with post-traumatic stress, mental distress, and burnout among physicians working in the emergency departments compared to other specialties in Pakistan. J Emerg Med. 2016;50(1):167\u201377.","journal-title":"J Emerg Med"},{"issue":"4","key":"10243_CR11","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1016\/j.jemermed.2017.12.047","volume":"54","author":"LA Baig","year":"2018","unstructured":"Baig LA, Shaikh S, Polkowski M, Ali SK, Jamali S, Mazharullah L, et al. Violence against health care providers: a mixed-methods study from Karachi, Pakistan. J Emerg Med. 2018;54(4):558\u201366.","journal-title":"J Emerg Med"},{"issue":"3","key":"10243_CR12","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1016\/j.jemermed.2012.02.056","volume":"43","author":"T Kowalenko","year":"2012","unstructured":"Kowalenko T, Cunningham R, Sachs CJ, Gore R, Barata IA, Gates D, et al. Workplace violence in emergency medicine: current knowledge and future directions. J Emerg Med. 2012;43(3):523\u201331.","journal-title":"J Emerg Med"},{"issue":"2","key":"10243_CR13","doi-asserted-by":"publisher","first-page":"288","DOI":"10.4172\/1522-4821.1000112","volume":"16","author":"A Baydin","year":"2014","unstructured":"Baydin A, Erenler AK. Workplace violence in emergency department and its effects on emergency staff. Int J Emerg Ment Health. 2014;16(2):288\u201390.","journal-title":"Int J Emerg Ment Health"},{"key":"10243_CR14","unstructured":"Dean AG, Sullivan KM, Soe MM. Open Source Epidemiologic Statistics for Public Health. OpenEpi. [cited 2018 Feb 15]. Available from: http:\/\/www.openepi.com\/Menu\/OE_Menu.htm"},{"key":"10243_CR15","unstructured":"International Labor Office, World Health Organization, International Council of Nurses, Public Services International. Workplace violence in the health sector country case studies research instruments. (Joint Programme on Workplace Violence in the Health Sector)."},{"key":"10243_CR16","volume-title":"User\u2019s guide to the general health questionnaire. Windsor","author":"DP Goldberg","year":"1988","unstructured":"Goldberg DP. User\u2019s guide to the general health questionnaire. Windsor; 1988."},{"key":"10243_CR17","first-page":"133","volume":"6","author":"FA Minhas","year":"1996","unstructured":"Minhas FA, Mubbashar MH. Validation of general health questionnaire in a primary care setting of Pakistan. J Coll Physicians Surg Pak. 1996;6:133\u20136.","journal-title":"J Coll Physicians Surg Pak"},{"issue":"3","key":"10243_CR18","doi-asserted-by":"crossref","first-page":"188","DOI":"10.4103\/jfcm.JFCM_170_17","volume":"25","author":"SA Alsaleem","year":"2018","unstructured":"Alsaleem SA, Alsabaani A, Alamri RS, Hadi RA, Alkhayri MH, Badawi KK, et al. Violence towards healthcare workers: a study conducted in Abha City, Saudi Arabia. J Fam Community Med. 2018;25(3):188.","journal-title":"J Fam Community Med"},{"issue":"9","key":"10243_CR19","first-page":"698","volume":"24","author":"MY-I Nayyer-ul-Islam","year":"2014","unstructured":"Nayyer-ul-Islam MY-I, Farooq MS. Workplace violence experienced by doctors working in government hospitals of Karachi. J Coll Physicians Surg Pak. 2014;24(9):698\u20139.","journal-title":"J Coll Physicians Surg Pak"},{"issue":"1","key":"10243_CR20","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1186\/1472-6963-12-245","volume":"12","author":"AW Cashmore","year":"2012","unstructured":"Cashmore AW, Indig D, Hampton SE, Hegney DG, Jalaludin BB. Workplace violence in a large correctional health service in New South Wales, Australia: a retrospective review of incident management records. BMC Health Serv Res. 2012;12(1):245.","journal-title":"BMC Health Serv Res"},{"issue":"5","key":"10243_CR21","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1016\/j.jemermed.2013.04.049","volume":"45","author":"W Zafar","year":"2013","unstructured":"Zafar W, Siddiqui E, Ejaz K, Shehzad MU, Khan UR, Jamali S, et al. Health care personnel and workplace violence in the emergency departments of a volatile metropolis: results from Karachi, Pakistan. J Emerg Med. 2013;45(5):761\u201372.","journal-title":"J Emerg Med"},{"issue":"1","key":"10243_CR22","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1186\/s13584-017-0183-y","volume":"6","author":"S Shafran-Tikva","year":"2017","unstructured":"Shafran-Tikva S, Chinitz D, Stern Z, Feder-Bubis P. Violence against physicians and nurses in a hospital: how does it happen? A mixed-methods study. Isr J Health Policy Res. 2017;6(1):59.","journal-title":"Isr J Health Policy Res"},{"key":"10243_CR23","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1136\/bmjopen-2014-006719","volume":"5","author":"M Jiao","year":"2015","unstructured":"Jiao M, Ning N, Li Y, Gao L, Cui Y, Sun H, et al. Workplace violence against nurses in Chinese hospitals: a cross-sectional survey. BMJ Open. 2015;5:3.","journal-title":"BMJ Open"},{"issue":"1","key":"10243_CR24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12913-020-05104-w","volume":"20","author":"Y Du","year":"2020","unstructured":"Du Y, Wang W, Washburn DJ, Lee S, Towne SD, Zhang H, et al. Violence against healthcare workers and other serious responses to medical disputes in China: surveys of patients at 12 public hospitals. BMC Health Serv Res. 2020;20(1):1\u201310.","journal-title":"BMC Health Serv Res"},{"issue":"4","key":"10243_CR25","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1111\/inr.12059","volume":"60","author":"M Albashtawy","year":"2013","unstructured":"Albashtawy M. Workplace violence against nurses in emergency departments in J ordan. Int Nurs Rev. 2013;60(4):550\u20135.","journal-title":"Int Nurs Rev"},{"issue":"1\u20132","key":"10243_CR26","doi-asserted-by":"publisher","first-page":"e116","DOI":"10.1111\/jocn.13884","volume":"27","author":"F Najafi","year":"2018","unstructured":"Najafi F, Fallahi-Khoshknab M, Ahmadi F, Dalvandi A, Rahgozar M. Antecedents and consequences of workplace violence against nurses: a qualitative study. J Clin Nurs. 2018;27(1\u20132):e116\u201328.","journal-title":"J Clin Nurs"},{"issue":"4","key":"10243_CR27","first-page":"533","volume":"29","author":"SA Khan","year":"2017","unstructured":"Khan SA. Pakistan\u2019s march towards universal health coverage. J Ayub Med Coll Abbottabad. 2017;29(4):533\u20134.","journal-title":"J Ayub Med Coll Abbottabad"},{"key":"10243_CR28","unstructured":"Sehat Sahulat Program. [cited 2020 Jan 4]. Available from: https:\/\/www.pmhealthprogram.gov.pk\/about-us\/"},{"issue":"2","key":"10243_CR29","first-page":"12","volume":"45","author":"L O\u2019Brien-Pallas","year":"2009","unstructured":"O\u2019Brien-Pallas L, Hayes L, Wang S, Laporte D. Creating work environments that are violence free. World Hosp Health Serv. 2009;45(2):12\u20138.","journal-title":"World Hosp Health Serv"},{"issue":"3","key":"10243_CR30","doi-asserted-by":"publisher","first-page":"198","DOI":"10.26719\/2012.18.3.198","volume":"18","author":"N Samir","year":"2012","unstructured":"Samir N, Mohamed R, Moustafa E, Abou SH. Nurses\u2019 attitudes and reactions to workplace violence in obstetrics and gynaecology departments in Cairo hospitals. EMHJ-Eastern Mediterranean Health J. 2012;18(3):198\u2013204.","journal-title":"EMHJ-Eastern Mediterranean Health J"},{"issue":"1","key":"10243_CR31","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1111\/j.1466-7657.2010.00834.x","volume":"58","author":"M Esmaeilpour","year":"2011","unstructured":"Esmaeilpour M, Salsali M, Ahmadi F. Workplace violence against Iranian nurses working in emergency departments. Int Nurs Rev. 2011;58(1):130\u20137.","journal-title":"Int Nurs Rev"},{"issue":"8","key":"10243_CR32","first-page":"1157","volume":"68","author":"LA Baig","year":"2018","unstructured":"Baig LA, Ali SK, Shaikh S, Polkowski MM. Multiple dimensions of violence against healthcare providers in Karachi: results from a multicenter study from Karachi. J Pak Med Assoc. 2018;68(8):1157\u201365.","journal-title":"J Pak Med Assoc"},{"issue":"4","key":"10243_CR33","doi-asserted-by":"publisher","first-page":"e002112","DOI":"10.1136\/bmjgh-2019-002112","volume":"5","author":"S Shaikh","year":"2020","unstructured":"Shaikh S, Baig LA, Hashmi I, Khan M, Jamali S, Khan MN, et al. The magnitude and determinants of violence against healthcare workers in Pakistan. BMJ Glob Health. 2020;5(4):e002112.","journal-title":"BMJ Glob Health"},{"issue":"5","key":"10243_CR34","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1016\/j.avb.2014.07.010","volume":"19","author":"N Lanct\u00f4t","year":"2014","unstructured":"Lanct\u00f4t N, Guay S. The aftermath of workplace violence among healthcare workers: a systematic literature review of the consequences. Aggress Violent Behav. 2014;19(5):492\u2013501.","journal-title":"Aggress Violent Behav"},{"issue":"2","key":"10243_CR35","first-page":"294","volume":"34","author":"L Baig","year":"2018","unstructured":"Baig L, Tanzil S, Shaikh S, Hashmi I, Khan MA, Polkowski M. Effectiveness of training on de-escalation of violence and management of aggressive behavior faced by health care providers in a public sector hospital of Karachi. Pakistan J Med Sci. 2018;34(2):294.","journal-title":"Pakistan J Med Sci"},{"issue":"3","key":"10243_CR36","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1080\/10410236.2012.743869","volume":"29","author":"M Dean","year":"2014","unstructured":"Dean M, Oetzel JG. Physicians\u2019 perspectives of managing tensions around dimensions of effective communication in the emergency department. Health Commun. 2014;29(3):257\u201366.","journal-title":"Health Commun"},{"issue":"4","key":"10243_CR37","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1177\/1048291117732301","volume":"27","author":"JT Brophy","year":"2018","unstructured":"Brophy JT, Keith MM, Hurley M. Assaulted and unheard: violence against healthcare staff. New Solut J Environ Occup Health Policy. 2018;27(4):581\u2013606.","journal-title":"New Solut J Environ Occup Health Policy"}],"container-title":["BMC Public Health"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-021-10243-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12889-021-10243-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-021-10243-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,23]],"date-time":"2024-08-23T20:39:28Z","timestamp":1724445568000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpublichealth.biomedcentral.com\/articles\/10.1186\/s12889-021-10243-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,10]]},"references-count":37,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["10243"],"URL":"https:\/\/doi.org\/10.1186\/s12889-021-10243-8","relation":{},"ISSN":["1471-2458"],"issn-type":[{"value":"1471-2458","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,10]]},"assertion":[{"value":"13 May 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 January 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 February 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study was approved by the Ethics Board of Khyber Medical University, Peshawar. Informed written consent obtained from study participants following explanation of the study aims and objectives. All procedures were performed with strict ethical standards.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The author(s) declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"330"}}