Longitudinal effectiveness of a woman-led, nurse delivered health promotion intervention for women who have experienced intimate partner violence: iHEAL randomized controlled trial.

BACKGROUND: Intimate partner violence (IPV) threatens the safety, health and quality of life of women worldwide. Comprehensive IPV interventions that are tailored, take a long-term view of women's needs, including health concerns, and maximize choice and control, have the potential to effectively address heath and safety concerns. Few such interventions have been tested, including in the Canadian context. METHODS: A parallel randomized controlled trial of adult (age 19 + years), English-speaking, Canadian women with histories of IPV randomized either to iHEAL, a tailored health promotion intervention delivered by Registered Nurses over 6-7 months, or to community service information (usual care control). Primary (Quality of Life, PTSD symptoms) and secondary outcomes (Depression, Confidence in Managing Daily Life, Chronic Pain, IPV Severity) were measured at baseline and 6, 12 and 18 months post-intervention via an online survey. Generalized estimating equations were used to test for differences by study arm in intention-to-treat (full sample) and per protocol (1 + iHEAL visit) analyses focussing on short-term (immediately post-intervention) and longer-term (1 year post-intervention) effects. Selected process evaluation data were summarized using descriptive statistics. RESULTS: Of 331 women enrolled, 175 were randomized to iHEAL (135 who engaged in 1 + visits) and 156 to control. Women who received iHEAL showed significantly greater short-term improvement in Quality of Life compared to the control group, with these effects maintained 1 year later. Changes in PTSD Symptoms also differed significantly by group, with weaker initial effects that were stronger 1 year post-intervention. Significant moderate, short- and longer-term group effects were also observed for Depression and Confidence in Managing Daily Life. IPV Severity decreased for both groups, with significant immediate effects in favour of the intervention group that grew stronger 1 year post-intervention. There were no changes in Chronic Pain. CONCLUSION: iHEAL is an effective, acceptable and safe intervention for diverse groups of women with histories of IPV. Trial results provide a foundation for implementation and ongoing evaluation in health care settings and systems. Delayed effects noted for PTSD Symptoms and IPV Severity suggest that longer-term assessment of these outcomes may be needed in trials of IPV interventions. TRIAL REGISTRATION: Clinicaltrials.gov ID NCT03573778 (Registered on June 29, 2018).

"Our services are not the same": the impact of the COVID-19 pandemic on care interactions in women's shelters.

BACKGROUND: Guidelines and regulations in response to the COVID-19 pandemic have significantly impacted the health care sector. We explore these impacts in the gender-based violence (GBV) services sector and, more specifically, in the context of women's shelters. METHODS: Using an interpretive description and integrated knowledge mobilization approach, we interviewed 8 women's shelter clients, 26 staff, and conducted focus groups with 24 Executive Directors. RESULTS: We found that pandemic responses challenged longstanding values that guide work in women's shelters, specifically feminist and anti-oppressive practices. Physical distancing, masking, and closure of communal spaces intended to slow or stop the spread of the novel coronavirus created barriers to the provision of care, made it difficult to maintain or create positive connections with and among women and children, and re-traumatized some women and children. Despite these challenges, staff and leaders were creative in their attempts to provide quality care, though these efforts, including workarounds, were not without their own challenges. CONCLUSIONS: This research highlights the need to tailor crisis response to sector-specific realities that support service values and standards of care.

Vaccine Hesitancy Among Canadian Mothers: Differences in Attitudes Towards a Pediatric COVID-19 Vaccine Among Women Who Experience Intimate Partner Violence.

OBJECTIVES: Vaccine hesitancy (VH) in maternal decision-making is important to understand to achieve community immunity targets and optimize pediatric COVID-19 vaccine adoption. COVID-19 is exacerbating the risk of intimate partner violence (IPV) for women in abusive relationships, a known risk factor for maternal VH. This project aimed to: (1) determine if IPV impacts maternal VH in Canada; and (2) understand maternal attitudes towards routine childhood vaccines and a pediatric COVID-19 vaccine in Canada. METHODS: As part of a cross-sectional, quantitative study, 129 women completed an online survey. IPV was assessed using the Abuse Assessment Screen and the revised, short-form Composite Abuse Scale. The Parent Attitudes about Childhood Vaccines scale evaluated maternal attitudes towards routine vaccinations and a COVID-19 vaccine. Questions informed by the World Health Organization's Increasing Vaccination Model (IVM) evaluated perceived barriers and facilitators to COVID-19 vaccination. RESULTS: In total, 14.5% of mothers were hesitant towards routine childhood vaccines, while 97.0% were hesitant towards a COVID-19 vaccine. Experiencing IPV was significantly associated with maternal COVID-19 VH (W = 683, p < 0.05). Social processes were identified as instrumental barriers and facilitators to COVID-19 vaccination, meaning that social norms and information sharing among social networks are critical in maternal vaccination decision-making. CONCLUSIONS FOR PRACTICE: This study provides novel evidence of maternal IPV significantly impacting VH and the presence of strong maternal VH specific to a COVID-19 vaccine in the Canadian context. Further research is required to fully understand the factors that build confidence and mitigate hesitancy in mothers, especially mothers who have experienced IPV.

Navigating multiple pandemics: A critical analysis of the impact of COVID-19 policy responses on gender-based violence services.

COVID-19 illustrated what governments can do to mobilise against a global threat. Despite the strong governmental response to COVID-19 in Canada, another 'pandemic', gender-based violence (GBV), has been causing grave harm with generally insufficient policy responses. Using interpretive description methodology, 26 interviews were conducted with shelter staff and 5 focus groups with 24 executive directors (EDs) from GBV service organizations in Ontario, Canada. Five main themes were identified and explored, namely that: (1) there are in fact four pandemics at play; (2) the interplay of pandemics amplified existing systemic weaknesses; (3) the key role of informal partnerships and community support, (4) temporary changes in patterns of funding allocation; and (5) exhaustion as a consequence of addressing multiple and concurrent pandemics. Implications and recommendations for researchers, policy makers, and the GBV sector are discussed.

"We're so limited with what we actually can do if we follow all the rules": a qualitative study of the impact of COVID-19 public health protocols on violence against women services.

BACKGROUND: Violence against women (VAW) is a major public health problem that grew worse during the COVID-19 pandemic. While all services were impacted by changing pandemic guidance, VAW shelters, as congregate settings with multiple funders and regulators, faced unique challenges. METHODS: We conducted a qualitative analysis of interviews with 26 women's shelter staff and eight women accessing care, as well as 10 focus groups (five each at two time points approximately a year apart) involving 24 leaders from VAW and related services in Ontario, Canada. RESULTS: We identified eight overlapping themes specific to government and public health COVID-19 regulations and their application in women's shelters. Overall, inconsistency or lack of clarity in rules, and how they were communicated, caused significant stress for women using, and staff providing, services. Staff and leaders were very concerned about rules that isolated women or replicated other aspects of abusive relationships. Women wanted to understand what options were available and what was expected of them and their children in these spaces. Leaders sought clarity and consistency from their various government funders, and from public health authorities, in the face of ever-evolving directives. As in the broader public, there was often the perception that the rules did not apply equally to everyone, for example, for women of colour using VAW services, or those whose first language was not English. CONCLUSIONS: In the absence of consistent pandemic guidance and how to implement it, many VAW services devised tailored solutions to balance safety from COVID-19 with women's physical and emotional safety from abuse and its impacts. However, this was difficult and exhausting. A key policy implication is that women's shelters are a distinct form of congregate housing; they are very different in terms of services provided, size, type and age of facilities from other congregate settings and this must be reflected in public health directives. Better communication and synchronization of policies among government funders and public health authorities, in consultation with VAW sector leaders, would mean protocols tailored to minimize harm to women and children while protecting health and safety.

Promoting Attachment Through Healing (PATH): Results of a retrospective feasibility study providing trauma-and-violence-informed care to pregnant women.

AIM: To evaluate the impact of a trauma and violence-informed cognitive behavioural therapy (TVICBT) intervention, compared with standard care on mental health, coping, bonding and maternal-infant attachment among pregnant women with a history of intimate partner violence and who displayed symptomatology consistent with anxiety, depression or post-traumatic stress disorder (PTSD). DESIGN: A mixed-methods case study design was employed, where women either received standard perinatal care or were referred to a specialized TVICBT program. METHODS: Data were collected through a retrospective obstetric medical chart audit in 2017 at an Ontario hospital in a large urban centre. Multiple choice and 'yes/no' questions were analysed using measures of central tendency and dispersion, in addition to frequency counts. Qualitative data from clinical notes were subjected to an inductive content analysis approach to identify key concepts. RESULTS: In total, 69 women participated (intervention group = 37, standard care group = 32). Prevalence of mental illness between groups was consistent, apart from the TVICBT group having a significant increase in PTSD. In the TVICBT group, 83.8% of women (n = 31) expressed perinatal concerns, compared with only 37.5% (n = 12) of the standard care group. More women in the intervention group (94.6%, n = 35) coped successfully in the intrapartum period than the standard care group (78.1%, n = 25). However, more women in the standard care group (97.0%, n = 31) exhibited appropriate bonding behaviours than the TVICBT group (88.6%, n = 31). CONCLUSION: The TVICBT intervention was effective in assisting women to identify triggers during their pregnancy journey, develop appropriate coping strategies and advocate for their needs to best cope. IMPACT: TVICBT offers an effective, individualized, trauma and violence-informed approach to optimize the health outcomes of perinatal women and their infants by promoting positive coping and maternal-infant bonding, thus filling an existing practice gap of a lack of individualized, trauma-informed care.

Critical discourse analysis of policies impacting the intersection of health and experiences of intimate partner violence for rural women in Ontario, Canada.

INTRODUCTION: Intimate partner violence (IPV) impacts approximately one quarter of Canadian women, and services provided to support women are heavily influenced by policy. Policy sets the stage and tone for action in all sectors. To date, there have been no critical discourse analyses examining how provincial, hospital, and women's shelter policies intersect and impact women in rural communities. METHODS: A critical discourse analysis using a case study of one rural community in south-western Ontario was undertaken by a multisectoral team of researchers using a critical, feminist, intersectional lens. The selected policies were (1) Domestic Violence Action Plan for Ontario (ODVAP), (2) the rural women's shelter policy, and (3) the hospital policy. RESULTS: The internal analysis of the policies revealed that ODVAP focused on societal solutions to violence requiring cross-sectoral cooperation with a focus on marginalized populations, whereas the rural shelter policy focused on creating a philosophical orientation to underpin their work with clients. There was no formal hospital policy related to the provision of services for women who have experienced violence. The policies revealed a disconnect between the stated goals and the specifics concerning how the policies would come together to achieve these goals. Obstacles such as having no clear link for how ODVAP and the shelter policy would work together, idealization of training but a lack of specificity on what training would be useful, and the requirement of affirmative action on the part of women to engage with services functioned as a means to maintain the status quo, that is, working in a siloed approach to care. CONCLUSIONS: Integrative systems are important for women who have experienced IPV given the wide range of health, social, and economic consequences of violence. Policy alignment is important for women who have experienced or are experiencing IPV, particularly in rural contexts where services are fraught with additional barriers.

Coaching and/or education intervention for parents with overweight/obesity and their children: study protocol of a single-centre randomized controlled trial.

BACKGROUND: In Canada, a majority of children and adults are insufficiently active for health gains, and about one in seven children and over 20% of adults are overweight or obese. Overweight and obesity are risk factors for many chronic diseases in both adults and children and can result in lower quality and quantity of life. Children whose parents are overweight or obese are more likely to become overweight themselves. Thus, parent/child interventions are important for reducing obesity and promoting long-term healthy weights among members of the family unit. Programs using Co-Active coaching have resulted in positive behaviour changes among adults with overweight/obesity; however, little research has explored the effects of Co-Active coaching on parents, and the consequent impact on the family unit (i.e. all parents and children in the same household). This protocol paper provides a detailed methodological account of a coaching-based program targeting parent and child dyads, in hopes of enhancing health behaviours within the family unit. METHODS: Using a randomized controlled trial design, the researchers aim to identify the impact of coaching plus education (intervention) compared to education only (control) on parents with overweight/obesity and their children (ages 2.5-10, of any weight). A total of 50 dyads are being recruited and randomly assigned using a 1:1 ratio into the control or intervention group. The control group receive 6 webinar-based education sessions focused on physical activity and nutrition. The intervention group receive the same education sessions and nine, 20-min telephone-based sessions with a certified coach. Coaching and health education sessions are conducted with the parent/guardian of the dyad. This paper provides a detailed methodological account of this program. DISCUSSION: The expected findings from this research will advance coaching literature, research, and practice on this topic by determining whether coaching and education are more effective than education alone at producing behaviour changes among a family unit. If proven effective, this approach may be applied more broadly through public health interventionists to parent and child populations in hopes of affecting change with both individuals and their families. TRIAL REGISTRATION: ISRCTN ISRCTN69091372 . Retrospectively registered 24 September 2018.

A rural shelter in Ontario adapting to address the changing needs of women who have experienced intimate partner violence: a qualitative case study.

INTRODUCTION: Intimate partner violence is a significant public health problem, with shelters offering the predominant community-based solution. Shelters in Canada are mandated to provide a safe place, protection planning, advocacy and counseling among other services. Recently it has been noted the role of the shelter was shifting from an inpatient to outpatient model with a focus on increased integration of health and social services. This changing role of the shelter is amplified within the rural context where resources and cultural norms may be limited or incompatible with help-seeking behaviors. Women's shelters located in rural settings provide services within a specific cultural context that can be at odds with the needs of women who have experienced abuse, because cultural values such as rural pride, lack of anonymity, and lack of services may inhibit access to health and social services. METHODS: The purpose of this in-depth qualitative case study was to examine and explore how one rural Canadian women's shelter role was changing and how the shelter was adapting to achieve the changing role. The theoretical framework utilized was a feminist intersectional lens. Qualitative interviews (averaging 60 minutes) were conducted with shelter service providers (n=6) and women staying in the shelter or utilizing shelter services (n=4). Throughout semi-structured interviews, data-trustworthy steps were taken including member-checking and paraphrasing to ensure data were an accurate representation of participants' experiences. Inductive content analysis of all interviews and field notes was conducted independently by two researchers. RESULTS: Analysis revealed the shelter's role was changing to include filling gaps, case management, and system navigation. To achieve the changing role, relationship building, community mobilization (both education and empowerment), and redesigning delivery were implemented as adaptation strategies. Together both the changing role of the shelter and the adaptation strategies being implemented were found to be working toward a larger goal of transformation of cultural and structural norms related to violence against women. CONCLUSIONS: This study uniquely identified the specific changes to the role of one rural Canadian shelter and the adaptations strategies utilized to adapt to the changing needs of women. The changing role of the shelter and the adaptation strategies being utilized have significant implications for the health of women given the increased use of healthcare services for women who have experienced violence. Specifically, the changing role of the shelter has the potential to decrease healthcare service use while increasing the potential fit of services. Further research is required to assess the impact of the changing role of the shelter on the healthcare needs and outcomes for women who have experienced intimate partner violence.

"If you don't stop the cycle somewhere, it just keeps going": Resilience in the context of structural violence and gender-based violence in rural Ontario.

Bolstering women's resilience in the context of gender-based violence (GBV) requires attention to structural conditions needed to support women to thrive, particularly in rural communities. This cross-sectional study explored how resilience was influenced by structural violence in rural Ontario among women experiencing GBV (n = 14) and service providers in the GBV sector (n = 12). Interviews were conducted and revealed forms of structural violence that undermine resilience for women experiencing GBV in rural communities, including 1) housing- gentrification, short-term rentals of residential properties, and long waitlists, 2) income- fighting for enough money to survive, 3) safety- abusers gaming the system, and 4) access- successes and new barriers. Structural conditions must be attended to as they are prerequisites required to build resilience.

Toxic Relationships Described by People With Breast Cancer on Reddit: Topic Modeling Study.

BACKGROUND: Social support is essential to promoting optimal health outcomes for women with breast cancer. However, an estimated 12% of women with breast cancer simultaneously experience intimate partner violence (IPV; physical, psychological, or sexual abuse by an intimate partner). Women who experience IPV during breast cancer may lack traditional social support, and thus seek out alternative sources of support. Online community forums, such as Reddit, can provide accessible social connections within breast cancer-specific communities. However, it is largely unknown how women with breast cancer use Reddit to describe and seek support for experiences of IPV. OBJECTIVE: This study aims to explore how patients with breast cancer describe toxic relationships with their partners and immediate family members on Reddit. METHODS: This exploratory, cross-sectional, topic-modeling study analyzed textual data from 96 users in the r/breastcancer subreddit in February 2023. The meaning extraction method, inclusive of principal component analysis, was used to identify underlying components. Components were subjected to sentiment analysis and summative content analysis with emergent categorical development to articulate themes. RESULTS: Seven themes emerged related to toxic relationships: (1) contextualizing storytelling with lymph nodes, (2) toxic behavior and venting emotions, (3) abandonment and abuse following diagnosis, (4) toxic relationships and social-related fears, (5) inner strength and navigating breast cancer over time, (6) assessing social relationships and interactions, and (7) community advice and support. Toxic relationships were commonly characterized by isolation, abandonment, and emotional abuse, which had profound emotional consequences for patients. Reddit facilitated anonymous venting about toxic relationships that helped patients cope with intense feelings and stress. Exchanging advice and support about navigating toxic relationships during breast cancer were core functions of the r/breastcancer community. CONCLUSIONS: Findings emphasized the value of Reddit as a source of social support for patients with breast cancer experiencing toxic relationships. Clinicians who understand that many patients with breast cancer experience toxic relationships and considerable psychological sequelae are better prepared to support their patients' holistic well-being. Further investigation of Reddit as a possible resource for advice, information, and support has the potential to help inform clinical practice and subsequently, patient health outcomes.

"Breaking through the Brokenness": An Arts-Based Qualitative Exploration of Pregnant Women's Experience of Intimate Partner Violence while Receiving Trauma- and Violence-Informed Antenatal Care.

Intimate partner violence (IPV) is a pervasive, worldwide public health concern. Risk of IPV may elevate during the perinatal period, increasing maternal and fetal health risks. Trauma- and violence-informed care shows promise among interventions addressing associated mental health sequelae. As a secondary analysis, the purpose of this study was to employ a qualitative arts-based exploration to better understand pregnant women's experiences of trauma and violence-informed perinatal care in the context of IPV. Using an arts-based qualitative methodology, different art forms were used to analyze, interpret, and report data, resulting in a layered exploration to represent phenomena. From this, four themes were reflected in four poetic pieces: Black Deep Corners, Triggering my Thoughts, Breaking through the Brokenness, and Now Perfectly Imperfect. Nine pieces of visual art were created reflecting these themes, creating a layered, embodied, artistic way to empathically explore and translate phenomena.

"Do it for Your Kid": Resilience and Mothering in the Context of Intimate Partner Violence in Rural Ontario.

Intimate partner violence (IPV) includes multiple forms of harm inflicted on an intimate partner. Experiences of IPV impact mental and physical health, social relationships, and parenting and resilience may play an important role in how women overcome these detrimental effects. There is little research on how resilience relates to mothers' experience of IPV. We explored the role of resilience in the context of mothers who have experienced IPV in rural settings via semi-structured interviews with six women and 12 service providers. The relationship between resilience and motherhood was a common theme across all narratives. From this theme emerged three subthemes: 1) breaking the cycle of abuse; 2) giving children the "best life"; and 3) to stay or to leave: deciding "for the kids". Findings underscore the importance of supporting rural women who experience violence in cultivating their resilience and consideration of policy changes which support trauma- and violence-informed care.

Resilience Across the Life Course for Women Experiencing Intimate Partner Violence.

This study employed a life course perspective to explore the resilience of Canadian women of various ages who had experienced intimate partner violence (IPV). Interpretive description was used to analyze 22 in-depth, semi-structured interview transcripts with women who ranged in age from >19 to 60+ years. Results revealed that developmental age affected service accessibility and effectiveness, historical age shaped abuse normalization, and social age presented barriers and facilitators to women's resilience. This study highlighted the central role of resilience for women of all ages who have experienced IPV and emphasized the need for accessible, effective, and supportive services.

The Resilience of Caregivers and Children in the Context of COVID-19: A Systematic Review.

The COVID-19 pandemic has necessitated caregivers and school-aged children to adapt to ongoing changes and uncertainty. Understanding why some caregivers and school-aged children area able to adapt and others are not could be attributed to resilience. The relationships between caregiver or child resilience and socioeconomic status (SES) in the context of COVID-19 remain largely un-explored. Therefore, the purpose of this qualitative systematic review was to explore (1) what is currently known about the relationship between caregiver and child resilience in the context of COVID-19; and (2) the role of SES on caregiver or child resilience throughout the COVID-19 pandemic. Four databases (i.e., MEDLINE, Scopus, PsycINFO, and CINAHL) were systematically searched, title/abstract and full-text screening were conducted, and 17 articles met the inclusion criteria (i.e., discussed resilience of caregivers/children during COVID-19, mean age of children between 7-10, primary research/grey literature, English), including 15 peer-reviewed and two grey literature sources. Thematic analysis revealed five themes: (1) the mitigating effects of child resilience; (2) overcoming the psychological toll of the pandemic; (3) the unknown relationship: caregiver and child resilience; (4) family functioning during COVID-19; and (5) the perfect storm for socioeconomic impacts. Results from this review provide the first synthesis of the impact of the COVID-19 pandemic on the resilience of caregivers and school-aged children. Future research should conduct longitudinal data collection to understand the possible long-term impacts of the pandemic on these populations' resilience. Understanding these impacts will be integral to assisting families in bouncing back from the long-lasting adverse circumstances caused by the COVID-19 pandemic.

Exploring Coping Strategies Among Older Women Who Have Experienced Intimate Partner Violence During COVID-19.

This interpretive description study explored coping among older women in Ontario experiencing intimate partner violence (IPV) during COVID-19. Twelve in-depth interviews with older women found age-related normative beliefs played a role in how older women viewed their lives and how they looked beyond their experiences of IPV. Their roles as caretakers and homemakers influenced their response to IPV, and COVID-19 exacerbated feelings of lost time and loneliness. Coping strategies consisted of social support, including telephone formal services and physical activities. Women expressed a lack of appropriate services and financial limitations as barriers. They identified the need for age-appropriate services that acknowledge their unique experiences.

The Impact of the COVID-19 Pandemic on Staff in Violence Against Women Services.

The COVID-19 pandemic has been harmful to survivors of abuse. Less understood is the impact on staff in the violence against women (VAW) service sector. Using interpretive description methodology, we examined staff experiences during the pandemic in Ontario, Canada, and found four core themes: (1) the emotional toll of the work; (2) remote (doesn't) work; (3) work restructuring; (4) efforts to stay well and subthemes nuancing staff experiences in a sector vulnerable to vicarious trauma. This research underscores the need to mitigate experiences of stress, heavy workloads, and guilt for staff in VAW services during crises and provides action-oriented recommendations.

Motivational interviewing and smoking behaviors: a critical appraisal and literature review of selected cessation initiatives.

The present paper systematically reviewed and critically appraised three different dimensions of motivational interviewing currently utilized in smoking cessation initiatives: social support, motivation, and tailored interventions. A review of four databases generated 57 primary articles, 17 of which met the inclusion criteria of an intervention study utilizing at least one dimension of motivational interviewing, adults between 18 and 64 years, no comorbidities, and a follow-up period of at least 6 weeks. More than 11,600 participants are represented in this review. The implementation of social support, motivation, and tailored interventions yielded mixed results. Furthermore, threats to validity emerged, including self-report, follow-up period, sample sizes, a priori differences in groups, and web-based and text-based interventions. Further research must ascertain the efficacy of the three dimensions of motivational interviewing indicated by the mixed results reported in terms of statistical significance of cessation rates. More empirically rigorous designs with evaluations based on stringent replicable criteria are needed.

Trauma- and Violence-Informed Care: Orienting Intimate Partner Violence Interventions to Equity.

Purposeof Review: Intimate partner violence (IPV) is a complex traumatic experience that often co-occurs, or is causally linked, with other forms of structural violence and oppression. However, few IPV interventions integrate this social-ecological perspective. We examine trauma- and violence-informed care (TVIC) in the context of existing IPV interventions as an explicitly equity-oriented approach to IPV prevention and response. Recent Findings: Systematic reviews of IPV interventions along the public health prevention spectrum show mixed findings, with those with a theoretically grounded, structural approach that integrates a trauma lens more likely to show benefit. Summary: TVIC, embedded in survivor-centered protocols with an explicit theory of change, is emerging as an equity-promoting approach underpinning IPV intervention. Explicit attention to structural violence and the complexity of IPV, systems and sites of intervention, and survivors' diverse and intersectional lived experiences has significant potential to transform policy and practice.

Resilience is more than Nature: An Exploration of the Conditions that Nurture Resilience Among Rural Women who have Experienced IPV.

Purpose: Intimate partner violence (IPV) is a significant public health concern exacerbated by the pandemic. Experiences of violence vary based on geographic location and living in rural communities has been found, in some contexts, to amplify consequences of IPV. Resilience, the ability to survive and thrive despite facing adversity, has long been a dominant narrative within IPV literature, yet little is known about how resilience is cultivated among rural women experiencing violence. The purpose of this study was to explore how rural women experiencing IPV cultivate resilience. Methods: Using Interpretive Description, in-depth qualitative interviews were conducted with 14 women who experienced IPV and 12 staff from women's shelters across rural communities in Ontario, Canada to elicit perspectives about women's resilience and environmental conditions that may shape resilience in the context of IPV. Results: Women's resilience was cultivated by personal changes aimed at surviving or thriving, and aspects of their environment that enabled or created barriers for resilience. Women adopted a positive, hopeful mindset and bolstered their inner strength through living from a place of integrity, being resolute in decisions, and using mental resistance when faced with doubt. Women faced barriers to resilience in the form of unhelpful help and COVID-19 public health guidelines. Paradoxically, living in a rural community both cultivated and undermined resilience. Conclusions: Supporting women to cultivate resilience through modifying environmental factors to enable personal strengths to flourish is paramount in supporting women who have experienced IPV, particularly in rural contexts.