Perceived Effectiveness of Workplace Violence Prevention Strategies Among Bulgarian Healthcare Professionals: A...

Background: Workplace violence (WPV) is a pervasive occupational hazard in healthcare that undermines staff safety and quality of care. In Bulgaria, WPV remains widespread and underreported, despite recent legislative initiatives. This study assessed healthcare professionals' perceptions of the effectiveness of WPV prevention strategies and examined how prior exposure shapes these perceptions. Methods: A nationwide cross-sectional online survey was conducted in December 2024 with 944 healthcare professionals from multiple sectors. Participants rated the perceived effectiveness of 11 prevention strategies, including environmental/security measures, organizational, and national-level interventions, on a three-point scale. Friedman ANOVA with Kendall's W assessed overall strategy rankings, while Mann-Whitney U tests with rank-biserial correlations compared specific effectiveness ratings between subgroups defined by WPV exposure (experienced or witnessed vs. not exposed in the previous 12 months). Results: In the previous 12 months, 34.7% of respondents reported direct WPV, and 43.4% had either experienced or witnessed incidents. Friedman ANOVA indicated significant differences in perceived effectiveness across strategies (Kendall's W = 0.13), with stronger differentiation among violence-exposed respondents (W = 0.37) than among non-exposed respondents (W = 0.09). National-level interventions and security/response measures were consistently ranked the highest. Mann-Whitney tests showed significantly higher endorsement of most strategies among violence-exposed professionals, with large effect sizes for security measures and enforcement of sanctions. Conclusions: Bulgarian healthcare professionals view WPV prevention as requiring a multicomponent approach that integrates robust national policy with organizational and environmental measures. Direct exposure to violence is associated with stronger support for security-focused and national interventions. These findings inform context-specific, evidence-based WPV prevention programs for Bulgarian healthcare facilities.