Table 2 Findings according to a social determinants of health framework

Macro

Gender: gender norms and dynamics

Culture: patriarchal society

Escalating abuse:

“So a lot of the women I worked with before [COVID] who I was talking to on a regular basis, like maybe once a week or once a month, they all of a sudden, the abuse changed, the abuse got worse because of the stress levels.” (Katherine)

Meso

Access to health and social services

Increased difficulty accessing services that have moved to online/phone due to technological barriers:

“[…] but again, because [this town] has so much poverty, few people have a cell phone. Very few people have access to Internet. There's no public phone [in this town] or a place where they can go to make calls or to receive calls” (Celeste)

Micro

Income

Increased financial precarity:

“People are struggling financially for food and just basics” (Arielle)

Social status

Increased vulnerability due to language barriers hindering the ability to access services:

“An immigrant woman who doesn’t speak a lot of English won’t be able to reach out to us without a community service to support them and they’re not there” (Genevieve)

Physical environment: built environment

The built environment of hotels limiting social support:

“In all honesty, there's been a little bit of a disconnect working at a hotel. Right. Because they were all in each other's space or in the same house [before]. Like, we all eat lunch at the same table. There's no staff room. We have a staff in an office, obviously, but we're all just in the same space everybody else. And being in a hotel, it's like, well, we're so separated from everyone.” (Holly)

Social networks

Increased isolation due to lockdown measures:

“[…] when you're in an abusive situation, you can at least go to work, spend time with your friends or your family are, you know, get out even go to Tim Hortons or whatever and you couldn't do that” (Holly)