Public and healthcare professionals’ perspectives on preventing violence against healthcare workers: A social media crowdsourcing

ABSTRACT

Background:

Violence against healthcare professionals is the serious global issue. This study aimed to explore strategies to prevent such incidents using a qualitative crowdsourcing approach, gathering perspectives from both the public and healthcare professionals (HCPs).

Methods:

A Google Form with an open-ended question – ”How to prevent violence against healthcare workers” was distributed via social media platforms (Twitter [now X], LinkedIn, Facebook, and WhatsApp) from August 15 to December 14, 2024. Two independent authors analyzed responses thematically and a consensus was reached to finalize the themes.

Results:

A total of 224 responses were received (181 HCPs, 43 public). Thematic analysis identified several key strategies. The public emphasized security measures, strict legal frameworks (non-bailable offenses, fast-track courts), education and awareness campaigns, institutional responsibility, and de-escalation strategies. HCPs also emphasized enhanced security (police booths, strict visitor controls), institutional policies (zero-tolerance measures, structured reporting systems), better working conditions, communication strategies, public awareness campaigns, and technological solutions.

Conclusion:

Preventing violence against doctors requires a multifaceted approach, including legal reforms, security enhancements, institutional policies, public awareness, and technology-based safety measures. Collaborative efforts from governments, healthcare institutions, and society are essential to ensuring the safety and well-being of HCPs.

Introduction

Violence against healthcare professionals (HCPs) is a growing global concern, significantly impacting patient care and the well-being of medical professionals.[1] In India, the issue has reached alarming proportions. A study by Kaur et al.[2] found that 77.3% of Indian doctors faced verbal or physical abuse at some point in their careers. Incidents range from verbal threats and intimidation to severe physical assaults, often triggered by patient dissatisfaction, overcrowding, long waiting times, and communication gaps.[3] Emergency departments, intensive care units, and public hospitals are particularly vulnerable, with junior doctors and frontline staff facing the highest risks.[4]

Previous studies reported that a risk assessment tool for aggressive behavior may be introduced and a no tolerance policy may be implemented to prevent the violence.[5,6] In addition, de-escalation training and enhanced security measures may be used to deal with workplace violence.[7] The World Health Organization states that strategies to effectively handle aggressive patients and high-risk visitors are the main focus of interventions to avoid violence against HCPs in non-emergency situations. The physical security of healthcare institutions is the main goal of interventions for emergency situations.[8]

Addressing the issue requires a multifaceted approach, incorporating insights from both the general public and HCPs.[9] Crowdsourcing, a participatory method that leverages collective intelligence, has proven effective in identifying public concerns, generating innovative solutions, and shaping policy discussions.[10] Given the increasing public discourse on violence against doctors in India, social media provides a unique opportunity to explore community-driven ideas for prevention.[11]

With this background, this study employed a social media crowdsourcing approach to capture public and HCPs’ perspectives on preventing violence against HCPs. The findings may help inform evidence-based intervention ideas to stakeholders to form policies to prevent violence in healthcare settings. In addition, this study would be beneficial for practitioners by providing community-driven strategies to enhance their safety and professional well-being, while for patients, it would ensure continuity of care and foster a safer, more trusting healthcare environment.

Methods

Settings

The study was conducted in an entirely online setting, leveraging the accessibility of social media to reach participants from various geographic locations, professional backgrounds, and social strata. This approach allowed for broad participation without geographic or institutional restrictions, ensuring a diverse range of responses.

Tool of crowdsourcing

A Google Form served as the primary crowdsourcing tool for data collection.[12] The form was designed to be simple and user-friendly, containing only two items: an open-ended question – ”How to prevent violence against healthcare workers?” for respondents to provide text-based answers and a categorical question asking whether the respondent identified as a healthcare professional or a member of the public.

Data collection method

The survey link was distributed across multiple social media platforms, including Twitter (now X), LinkedIn, Facebook, and WhatsApp. The authors shared the message containing the survey link through their personal and professional networks, posting in relevant discussion groups, forums, and direct messaging channels to encourage participation. The use of multiple platforms helped maximize reach and engagement, capturing opinions from both laypersons and medical professionals. In addition to that the respondents were requested to share the link with other potential respondents. Hence, sampling method can be considered as a snowball type.

The data collection period spanned four months, from August 15, 2024, to December 14, 2024. During this time, participants could voluntarily submit their responses at their convenience. To maintain visibility and encourage broader participation, the survey message was periodically reshared and reposted. One such post in LinkedIn is shown in Figure 1. No incentives were offered, and participation was entirely voluntary. The survey was designed to maintain anonymity, with no personally identifiable information collected, ensuring that responses reflected candid opinions without concern for disclosure.

Figure 1.

A post in LinkedIn used for crowdsourcing ideas (screenshot captured from LinkedIn)

Data analysis

The responses were exported as a spreadsheet. The collected responses were thematically analyzed. Two authors reviewed the textual data systematically, identifying recurring patterns and key insights. The analysis followed the structured process, starting with familiarization through repeated reading, followed by initial coding of meaningful segments. These codes were then grouped into broader themes, which were reviewed, refined, and finalized through discussion. Any discrepancies in theme categorization were resolved through consensus to ensure rigor and reliability in the findings.

Ethics

The study was conducted using publicly accessible social media platforms and did not collect personally identifiable information. Participation was voluntary, and it was mentioned in the message shared along with the survey link. The study adhered to ethical guidelines for online research, ensuring confidentiality and respectful handling of all data. The study was approved by the Institutional Ethics Committee of Mata Gujri Memorial Medical College, Kishanganj, Bihar, India with approval number: MGM/IEC-03/2025.

Results

There was a total of 224 response received during the study period with 43 (19.2%) public and 181 (80.8%) HCPs.

The suggestions from public for preventing violence against HCPs fall into several key themes as shown in Table 1. Security was a dominant concern, with suggestions to enhance surveillance systems, increase the presence of security personnel, enforce access control, and implement emergency response systems such as pepper spray and shock devices in hospitals. Crowd management was also emphasized, with respondents advocating for strict regulations to prevent mob gatherings in healthcare settings.

Table 1.

Themes, sub-themes, and quotes generated from the text contributed by public (n=43)

Theme	Subtheme	Supporting quotes
Security	Enhanced security	“More security protection is required for doctors and nurses”
	Surveillance systems	“More Electronic devices and CCTV with cloud storages so none can delete the footages”
	Security personnel	“…both male and female security guards…”
	Access control	“Only one attendant per patient to be allowed inside hospital premises”
	Emergency response systems	“…hospital should also make sure to keep pepper spray and shock device in every part of the hospital for security”
	Crowd management	“Mob should not be allowed in hospitals…”
Legal framework	Punishment	“…give them (offender) a harsh punishment”
	Fast-track courts	“Fast-track court proceedings should be initiated for some cases to set examples for punishments…”
	Non-bailable offenses	“Non-bailable jail for violence against medics”
Education and awareness	Patient/family education	“Educating patients and their families about healthcare processes”
	Public awareness campaigns	“Advocate to the general public the importance of healthcare professionals in society/community”
	School education	“…importance of healthcare should be taught in schools to create more awareness in society.”
	Realistic expectations	“Doctors are humans, not gods (as is often claimed) and most certainly they do not perform miracles”
Communication Strategies	Transparent communication	“Communication should be straightforward regarding patient health to their relatives”
	Grievance redressal	“A public mediating team or customer relationship management should be developed and implemented in the hospital”
	Feedback systems	“…there should be a feedback system”
Oversight	Administrative accountability	“Safety at the workplace of employees is the responsibility of the employer”
	Government oversight	“There should be an authority to monitor the security from the government”
De-escalation Strategies	Conflict resolution	“Equipping healthcare workers with conflict management and communication skills can help”
	Self-defense training	“…it is better to learn self-defense techniques to defend oneself”
Systemic reforms	Healthcare reform	“Better communication between doctors and patients… and media can play an important role in dealing with this crisis…”
	Political will	“Political and administrative desire to stop any type of ill-treatment to health workers”

A strong legal framework was another critical theme, with respondents supporting harsh punishments, the establishment of fast-track courts, and classifying violence against healthcare workers as a non-bailable offense. Alongside legal measures, education and awareness were highlighted as essential preventive strategies. Respondents called for patient and family education on healthcare processes, public awareness campaigns to reinforce respect for medical professionals, and school-based education to instill these values from an early age. They also stressed the need to set realistic expectations, challenging the notion of doctors as miracle workers.

Communication strategies were seen as vital in reducing tensions, with suggestions for transparent communication between healthcare workers and patients’ families, grievance redressal mechanisms such as mediation teams, and structured feedback systems to address concerns proactively. Oversight was another key theme, with participants advocating for administrative accountability, where employers bear responsibility for workplace safety, and government oversight to ensure consistent enforcement of security measures.

De-escalation strategies focused on conflict resolution training and self-defense training for HCPs to help them manage volatile situations. Hence, these findings highlight the need for a multi-faceted approach, integrating legal, administrative, technological, and educational measures to create a safer healthcare environment and improve public health service delivery.

The insights provided by HCPs are shown in Table 2. A strong legal framework was one of the most frequently mentioned solutions, with calls for strict laws and enforcement, and the classification of violence against healthcare workers as a non-bailable offense. Many professionals emphasized the need for fast-track courts and heavy penalties to deter aggression against medical staff, drawing parallels with the protections afforded to law enforcement officers.

Table 2.

Themes, sub-themes, and quotes generated from the text contributed by public (n=181)

Theme	Subtheme	Supporting quotes
Legal framework	Strict laws and enforcement	“This simply needs to stop through strong legal actions”, “We need strict laws and zero tolerance policy”
	Non-bailable offenses	“Just like nobody will mess with a police officer on duty. The same rules for all frontline workers who are always taking risk for the public”
	Fast-track courts	“Demand for fast-track courts for dealing cases of attacks”
	Heavy penalties	“Heavy penalties against violence”
Security Measures	Enhanced security personnel	“We can have special security appointed at hospitals,” “By appointing armed guards in the hospital campus 24×7 and strict rules against those who use violence against healthcare workers”
	Security staffing	“Sufficient number of security personnel deployment in the hospital campus”
	CCTV surveillance	“Well equipped and vigilant workplaces which includes CCTV cameras (well functional), guards at almost every isolated area”
	Access control	“Only one attendant per patient to be allowed inside hospital premises”
	Visitor management	“Limit the visitors entry and allowed them strictly during visiting hours only and whosoever enters will keep their Icard/ration card/Adhaar card or any card at the reception”
	Police presence	“Every government hospital must have their own police booth”
Institutional policies	Reporting Systems	“Establish a reporting structure. Make it easy for employees to report violent incidents to law enforcement”
	Zero-tolerance policy	“Establish clear policies against violence, including reporting mechanisms from institution”
	Training	“Institutional to conduct workshops on handling patients and relatives”
	Emergency response teams	“A rapid action team should be available in every hospital”
Communication strategies	Transparent communication	“The key to preventing violence is effective communication between doctors and patients/relatives”
	Breaking bad news	“Death of a patient should be revealed in a private room, with no other people listening. A psychologist may accompany the doctor and give the support till the bystander leaves the hospital”
	Empathetic approach	“Health care professionals should communicate health condition of patient to individual and relatives empathetically”
	Managing expectations	“The general public must be educated about the role of modern medicine including its benefits and disadvantages”
	Conflict resolution	“Communication with patient/relatives especially in vulnerable situations like emergency, high risk consent”
Public awareness	Media campaigns	“Using digital platform and visual media to create awareness about doctors’ safety”
	Educational programs	“Creating a monthly awareness program among the general public along with the police personnel and lawyers”
	Realistic expectations	“All emergency service provider areas must have a clear statement (that doctors treat only)”
	Healthcare worker value	“By making the public feel the need of a healthcare worker in the society, why a healthcare person is important… if we know the importance of something then we always try to protect it”
Improved working conditions	Reduced workload	“Rostering on a rotational basis to ensure no HCW is sleep deprived”
	Duty hour limitations	“Duty hours should not be more than 12 hrs. Instead, more doctors should be recruited if need be”
	Staff facilities	“There should be proper facilities for healthcare workers/ residents to rest /sit /eat while at work. Till date residents sleep at any vacant space available in hospital”
	Work-life balance	“Senior doctors should be considerate to enquire about the physical/ mental well-being of their residents and not just bothered about the rounds”
	Adequate Staffing	“By adding more manpower in the health sector so each doctor gets a smaller number of patients, so they can take good care of them”
Technology solutions	SOS devices	“Clinics and hospital should have alarm system and emergency team”
	Biometric systems	“Mandatory biometric attendance of security personnel also”
	RFID access control	“Restricted access inside premises with RFID etc.”
	Safety apps	“If the healthcare worker feels something suspicious…press the emergency button in the app”
	AI-enabled systems	“Two-tier security of the hospital along with AI-enabled CCTVs”
Healthcare system reforms	Consumer protection act reform	“Take out the doctors out of the ambit of consumer protection laws”
	Administrative reforms	“The healthcare in govt should be administrated by separate medical cadre administrative services and not IAS or IPS”
	Infrastructure development	“Healthcare infrastructure also needs an improvement for the safety of healthcare professionals during night duties”
	Salary improvements	“The payment structure in government hospitals should be at par with private hospitals so that more medical manpower stays in the govt hospitals”
Self-help	Defense techniques	“Should be ready to save us in any situation”
	Stress management	“Stress management courses after regular intervals for health care professionals”

Another major concern was security measures within hospital premises. HCPs advocated for enhanced security personnel, strict access control, visitor management, and the presence of police booths in government hospitals. They also suggested increased surveillance through CCTV cameras and AI-enabled monitoring systems to ensure safety in high-risk areas. Additionally, the deployment of emergency response teams and better security staffing were proposed to mitigate violent incidents before they escalate.

Institutional policies were another key area of concern, with professionals highlighting the need for transparent incident reporting systems, zero-tolerance policies, and conflict resolution training for hospital staff. Establishing structured workshops on patient and relative interactions was seen as a crucial step toward improving doctor-patient relations and minimizing misunderstandings that could lead to violence.

Communication strategies emerged as an essential factor in preventing conflict. Many responses pointed to the importance of transparent communication with patients and families, particularly in breaking bad news in private settings with the support of mental health professionals. They emphasized an empathetic approach when discussing patient conditions and the need for public education on medical limitations to manage unrealistic expectations.

HCPs also stressed the importance of public awareness campaigns to foster respect for medical workers. Suggestions included media campaigns, monthly educational programs for the public, and efforts to reinforce the societal value of healthcare workers. By increasing public knowledge about doctors’ roles and the limitations of modern medicine, professionals believed that hostility toward them could be significantly reduced.

Improved working conditions were frequently mentioned as a critical aspect of reducing tensions in healthcare settings. Many professionals expressed concerns over excessive workloads, long duty hours, inadequate staff facilities, and poor work-life balance, all of which contribute to burnout and increase the risk of conflict. Calls for better staffing, improved infrastructure, and fair salary structures were seen as essential reforms to ensure that healthcare workers remain focused on providing quality care.

Technology-driven solutions were also proposed, including save our souls (SOS) devices, biometric security systems, radio frequency identification (RFID)-based access control, and AI-enabled surveillance to enhance hospital security. HCPs also suggested safety apps that allow workers to trigger an emergency response in cases of threat or violence.

Healthcare workers also commented on the need for self-help strategies such as defense training and stress management courses to help them navigate high-risk situations. They also called for reforms in the healthcare system, including removing doctors from the Consumer Protection Act, establishing a specialized medical administration cadre, and improving salary structures to retain talent in government hospitals.

Hence, the responses from HCPs indicate a multi-layered approach to preventing violence, encompassing legal, security, communication, institutional, and systemic reforms. Implementing these strategies would create a safer, more supportive healthcare environment, ultimately improve patient care and strengthening public trust in the healthcare system.

Discussion

The findings from the study highlight the shared concerns and distinct priorities of both the public and HCPs in preventing violence against medical workers. Security emerged as a key theme in both groups, with strong support for enhanced CCTV surveillance, access control, police presence, and emergency response systems to deter violent incidents in hospitals. A robust legal framework was another major focus, with respondents advocating for fast-track courts, non-bailable offenses, and strict penalties to discourage attacks on healthcare workers. The study finding is in line with the action and suggestions by the Union Ministry of Health and Family Welfare, India, formulated in 2022, while COVID-19 pandemic was there. The measures to protect HCPs is shown in Table 3.[13]

Table 3.

Mechanism to prevent violence against doctors

Security of sensitive hospitals to be managed by a designated and trained force.

Installation of CCTV cameras and round the clock Quick Reaction Teams with effective communication / security gadgets particularly at Casualty, Emergency and areas having high footfalls.

Well-equipped centralized control room for monitoring and quick response.

Entry restriction for undesirable persons.

Institutional First Information Report (FIR) against assaulters.

Display of legislation protecting doctors in every hospital and police station.

Appointment of Nodal Officer to monitor medical negligence.

Expeditious filling up of vacant posts of doctors and para-medical staff in hospitals / Primary Health Centers (PHCs) to avoid excessive burden / pressure on doctors and to maintain global doctor-patient ratio.

Better infrastructural facilities and medical equipment and provision of extra monetary incentive for the doctors and para medical staff serving in hard/remote areas as compared to major and metro cities with better career prospects, etc.

Source: https://pib.gov.in/PressReleaseIframePage.aspx?PRID=1806206

Both groups recognized the importance of public education and awareness campaigns to manage patient expectations and reinforce respect for medical professionals. While training may help build confidence among HCPs, it may not reduce violence.[6] Hence, public awareness program may be an unexplored area. Communication strategies, particularly transparent doctor-patient interactions and grievance redressal mechanisms, were also identified as essential in reducing tensions and preventing conflicts before they escalate. Effective doctor-patient communication is key to building a strong therapeutic relationship with patients and poor communication often leads to patient dissatisfaction and complaints.[14]

While the public largely focused on external measures, such as increased law enforcement and stricter hospital security policies, HCPs emphasized systemic and institutional reforms. Their responses revealed concerns about workplace conditions, long duty hours, inadequate staffing, and administrative accountability, suggesting that addressing internal inefficiencies in healthcare settings is equally critical in reducing violence. Professionals also highlighted self-defense training and stress management courses, recognizing the need for both preventive and coping strategies. Moreover, technological solutions like biometric access control, AI-enabled surveillance, and save our souls (SOS) alert systems were proposed as practical tools to enhance workplace safety.[15] These insights underscore the multi-faceted nature of violence prevention, requiring a combination of legal, administrative, technological, and educational interventions to create a safer and more effective healthcare system.[16]

These insights, although was primarily for institutional healthcare workers, it can be informative to the private practitioners and primary care physicians, who often work in small clinics or solo practices with limited security compared to large hospitals. Enhanced security measures, including CCTV surveillance, restricted patient entry, and save our souls (SOS) alert systems, can be implemented in private clinics to deter potential threats. Additionally, improving communication strategies, such as transparent discussions about treatment limitations and clear grievance redressal mechanisms, can help prevent misunderstandings that often escalate into aggression.[17] Public education and awareness programs about the role of primary care physicians and the challenges they face can also foster greater respect and cooperation from patients.

In any violent situations, HCPs should act carefully and responsibly. In case of violence, remain calm and avoid reacting with anger. Assign someone to document the incident through photos, videos, and audio recordings. Ensure patient records are photocopied to prevent loss. Inform a lawyer and immediately contact the police, keeping a record of the call. Identify key troublemakers and gather written statements from witnesses. File an FIR, ensuring it is under the relevant act for medical personnel protection.[18] The steps are summarized in Figure 2 and it was made from the article contributed by Nagpal.[18]

Figure 2.

How to deal with violence in healthcare setting

Despite providing valuable insights into preventing violence against healthcare workers, this study has several limitations. The data collection relied on social media crowdsourcing, which may introduce selection bias,[19] as participants were self-selected and likely more engaged with the issue than the general population. This limits the generalizability of findings to broader, less vocal groups. In addition, the study primarily gathered qualitative responses, which, while rich in detail, lack quantifiable measures to assess the prevalence or statistical significance of proposed solutions. Furthermore, the perspectives captured may be influenced by emotional responses, particularly from individuals with direct experiences of violence. The lack of demographic details in responses also prevents an analysis of how views differ across various regions, professions, or healthcare settings. The survey was primarily distributed by HCPs and their known groups only and it is true about social media followers too.[20] Hence, there might be high chance that the survey did not capture from a diverse population. While the study identifies key areas for intervention, it does not evaluate the feasibility or effectiveness of these recommendations in real-world healthcare environments, requiring further empirical research to validate their impact.

Future studies should use more diverse and representative samples, combining qualitative and quantitative approaches with demographic details to enhance generalizability. Pilot testing of proposed interventions with evaluation of feasibility, cost-effectiveness, and impact will provide stronger evidence to guide policymakers in preventing violence against HCPs.

Conclusion

This study highlights the urgent need for comprehensive strategies to prevent violence against healthcare workers, incorporating legal, security, communication, and systemic reforms. Both the public and HCPs emphasized the importance of strict laws, fast-track courts, enhanced security measures, public awareness campaigns, and improved communication to reduce conflicts in healthcare settings. While the public largely focused on external measures such as law enforcement and security infrastructure, HCPs underscored workplace reforms, stress management, and institutional accountability as critical components of violence prevention. The findings would help stakeholders to make policy regarding the steps for reducing violence in healthcare settings.

Conflicts of interest

Raman Kumar is the editor-in-chief of the journal. To ensure impartial review, an independent editor handled the editorial and peer-review process.

Funding Statement

Nil.