Violence prevention in primary care: a qualitative study of barriers and facilitators in general practice

Healthcare staff in primary care settings are increasingly exposed to verbal and physical aggression. Although violence prevention measures are available, implementation remains inconsistent. This study aimed to explore facilitators and barriers to the use of violence prevention strategies, with a particular focus on the roles of staff and leadership in general practice. We conducted a qualitative study involving semi-structured interviews with thirty physicians and medical assistants working in German general practices. The interview guide addressed perceptions of individual roles, leadership support, organisational structures, and existing preventive measures. We analysed the data using qualitative content analysis following Mayring. We found that the use of violence prevention strategies is influenced by interrelated individual, organisational, and leadership factors. Key facilitators included strong leadership engagement, clear communication of expectations, structured staff training, and individual competencies such as resilience and prior experience. Major barriers included high workload, staff shortages, limited financial and time resources, and a lack of formalised procedures. Leadership emerged as a central determinant: visible commitment, active involvement, and resource provision by practice leaders enhanced staff adherence and confidence. In contrast, insufficient leadership prioritisation hindered the systematic use of preventive measures. Effective violence prevention in general practice requires a multi-level approach integrating individual, organisational, and leadership dimensions. Strengthening leadership engagement, improving resource allocation, developing practical guidelines, and embedding training into routine workflows are important for overcoming existing barriers. Future efforts should prioritise the development of a proactive prevention culture, with leadership playing a pivotal role in enabling and supporting staff in managing patient aggression. Not applicable.