Article Text

Download PDFPDF
Making sexual and reproductive healthcare environments safe and supportive for disclosure of sexual violence: interview findings from patients and healthcare professionals using a realist approach
  1. Rachel J Caswell1,
  2. Jonathan DC Ross1,
  3. Caroline Bradbury-Jones2
  1. 1Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  2. 2School of Nursing and Midwifery, University of Birmingham, Birmingham, UK
  1. Correspondence to Dr Rachel J Caswell, Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; rachelcaswell{at}


Objectives Most people who have experienced sexual violence (SV) will disclose the event(s) to someone. Key recipients of disclosure are those working in healthcare. Telling someone in healthcare about experiences of SV can be an important step in accessing necessary medical care and being signposted to other services. While recognising healthcare settings are a key place for people to seek support, evidence is lacking about how best to create a safe environment for disclosure to take place, how services can make changes to better facilitate this experience and what changes matter most.

Design This study used a realist approach to identify mechanisms that facilitate safe and supported disclosure. Data were generated through three focus groups with Sexual and Reproductive Health Services healthcare professionals in the UK, and one-to-one interviews with survivors of SV who attended healthcare settings (n=18).

Results The analysis found that service users needed to feel empowered and recognised as appropriate candidates for care in the material used to promote sexual healthcare services after SV. This promotional material needs to address rape myths, stereotypes and silence surrounding SV, to ensure that all individuals and especially those from diverse groups are empowered to access care. Three fundamental mechanisms for safe and supported disclosure were identified: being listened to, being validated and having choice. Trauma-informed care was identified as being essential for implementing these mechanisms. Healthcare professionals who were confident and competent regarding enquiry about SV and response to disclosures of SV were key.

Conclusions The development of services that are conducive to the disclosure of SV is needed to provide better support for those who have experienced SV and are ready to seek support. Use of appropriate promotional material, specific staff training and a trauma-informed approach are key elements to improve services.

  • Delivery of Health Care

Data availability statement

No data are available.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

No data are available.

View Full Text


  • Handling editor Adam Williams

  • Contributors RJC, CB-J and JDR planned the study. RJC conducted the interviews, and RJC and CB-J were involved in data analysis. RJC wrote the first draft of the paper. All authors made significant contributions to subsequent drafting and revising of the article. RJC is guarantor for this study.

  • Funding Doctoral funding from Umbrella, University Hospitals Birmingham.

  • Competing interests JDR reports personal fees from GSK Pharma, Hologic Diagnostics, Mycovia and Janssen Pharma, as well as ownership of shares in GSK Pharma and AstraZeneca Pharma; is author of the UK and European Guidelines on Pelvic Inflammatory Disease; is a member of the European Sexually Transmitted Infections Guidelines Editorial Board; and is a member of the National Institute for Health Research (NIHR) Funding Committee (Health Technology Assessment Programme). He is an NIHR journals editor and associate editor of Sexually Transmitted Infections journal. He is an officer of the International Union against Sexually Transmitted Infections (treasurer) and a charity trustee of the Sexually Transmitted Infections Research Foundation.

  • Provenance and peer review Not commissioned; externally peer reviewed.