Where do those experiencing sexual violence seek help and is routine enquiry acceptable within a sexual healthcare setting? Findings from a population-based survey Original research

Sexual violence (SV) is increasingly acknowledged for its harmful effects on physical and mental health, incurring significant social and economic costs. Certain groups, such as women, racial/sexual minorities, and disabled individuals, face a higher risk of SV. Despite increased awareness (e.g., #MeToo movement), SV remains highly stigmatized, hindering help-seeking. Healthcare is crucial for addressing health risks associated with SV (pregnancy, STIs, injuries, psychological ill-health), and providing access to further support (counselling, legal aid). However, most SV remains undisclosed to healthcare professionals. A National Health Service England survey revealed that 72% of respondents were unaware of the national network of UK Sexual Assault Referral Centres (SARCs). While previous studies suggest disclosure in healthcare settings is acceptable, the optimal method for facilitating this (e.g., routine enquiry) remains uncertain. The type and source of support sought vary depending on individual needs and other factors. Specialist voluntary organizations offer advocacy, counselling, and emotional support, addressing a range of support needs over extended periods. Given the variation in SV experiences and support needs, a 'one-size-fits-all' approach is insufficient. This study used data from a national survey to examine healthcare choices, preferences, and experiences after SV in adults with and without a history of SV, addressing the limited knowledge on how different groups access care and what facilitates engagement.

The introduction section extensively reviews existing literature on the prevalence, consequences, and underreporting of sexual violence. It highlights the disparities in risk across various demographic groups, the role of social movements in raising awareness, and the persistent stigma surrounding SV that hinders help-seeking behaviors. Studies are cited regarding the health consequences of SV, the lack of awareness about support services like SARCs, and the need for healthcare settings to facilitate disclosure and access to appropriate care. The literature review also addresses the varied types of support available, including those offered by specialist voluntary organizations like Rape Crisis, and emphasizes the limitations of a 'one-size-fits-all' approach to support provision due to the diverse nature of SV experiences and individual needs.

This study employed an online, population-based survey in England. Data were collected from a panel of approximately 600,000 English residents, using a professional marketing and data company (Dynata). Quota sampling ensured representation across age (18-24 years minimum 5%, 55+ years maximum 10%), and ethnicity (maximum 85% white British, minimum 1% Black). The survey was open to those aged 18 and above. The survey, guided by the Consensus-Based Checklist for Reporting of Survey Studies (CROSS), comprised three sections: sociodemographic data, knowledge of existing services and support choices after SV, and history of SV and opinions on support in sexual health clinics, including acceptability of routine enquiry. A 7-day pilot study (300 participants) informed refinements to the survey. Data analysis involved χ² tests for nominal variables, Mann-Whitney U tests for ordinal variables, and Wilcoxon signed-rank tests for comparisons of disclosure experiences across healthcare settings. IBM SPSS Statistics V.28.0 was used for analysis. Respondents who didn't answer a question or selected 'not sure' were excluded from analysis of that specific question, unless otherwise stated. 'Not sure' responses for SV history were combined with 'yes' responses based on provided explanations. For multivariable analysis, logistic regression was used, adjusting for sociodemographic factors.

The survey received responses from 2007 individuals. 31.7% (621 of 1960) reported a history of SV. Younger, female, those from sexually minoritised communities, and disabled individuals were significantly more likely to report a history of SV. The police were the most frequent first choice for support (62.1%), but this was significantly less common among younger respondents and those with a history of SV (17.2% vs 29.9%). For those with a history of SV, Rape Crisis/similar organizations were the most common first choice (24%). SRHS were significantly more often chosen by younger respondents, males, and those of non-white ethnicity. Regarding SRHS experiences, most respondents felt believed and safe, but a considerable proportion felt blamed. The majority (84.4%) supported routine enquiry about SV in SRHS consultations, with higher support among younger respondents, those in intimate relationships, those with non-heterosexual orientations, and those with a history of SV. Support for routine enquiry was lower for telephone consultations (71.8%). Multivariable analysis showed younger age and a history of SV were independently associated with lower likelihood of choosing police as the first choice of support.

The study's high SV prevalence (27.1%) is consistent with previous research. Differences in help-seeking behavior, particularly the lower likelihood of choosing police among younger individuals and those with prior SV experience, highlight the need for tailored support services. The preference for Rape Crisis and primary care among those with a history of SV reflects potential mistrust in the police or changed preferences based on past experiences. The high rate of those feeling blamed in SRHS settings warrants investigation and service improvements. The strong support for routine enquiry in SRHS settings suggests a promising approach to increase SV disclosure, provided appropriate safeguards (safety, confidentiality, training, option to decline) are in place. The lower acceptance of routine enquiry during telephone consultations might be attributed to the different nature of the interaction.

The study supports the implementation of routine enquiry within SRHS settings, contingent on adequate training, referral pathways, and a safe disclosure environment. Findings highlight the need for tailored services addressing diverse help-seeking behaviours and improving trust, particularly among specific demographic groups. Future research could focus on developing and evaluating specific protocols for routine enquiry, exploring the reasons for the high rate of those feeling blamed, and further investigation into why older adults reported lower lifetime experience of SV.

The study's limitations include self-selection bias, requiring computer/smartphone access (potentially overrepresenting higher socioeconomic groups), and the handling of 'prefer not to say' and 'not sure' responses. While attempts were made to minimize bias by combining certain responses, potential selection bias remains. The use of self-reported data introduces recall bias and subjectivity.