Providing a supportive environment for disclosure of sexual violence and abuse in a sexual and reproductive healthcare setting: a realist review

Background: Sexual and reproductive healthcare services [SRHS] are an environment where medical care relevant to sexual violence and abuse [SV] is available. However, barriers to disclosure need to be overcome to allow timely access to this care. There is limited research identifying and explaining how interventions remove barriers and create a safe and supportive environment for disclosure. The purpose of this review was to develop and refine theories that explain how, for whom and in what context SRHS facilitate disclosure.

Methods: Following published realist standards we undertook a realist review. After focusing the review question and identifying key contextual barriers, articles pertaining to these were identified using a traditional systematic database search. This strategy was supplemented with iterative searches.

Results: Searches yielded 3172 citations and 28 articles with sufficient information were included to develop the emerging theories. Four evidence-informed theories were developed proposing ways in which a safe and supportive environment for the disclosure of SV is enabled in SRHS. The theories consider how interventions may overcome barriers surrounding SV disclosure, at levels of individual, service-delivery and society.

Conclusions: Benefits of SRHS engagement with health promotion and health activism activities to address societal level barriers like lack of service awareness and stereotypic views on SV are presented. Although trauma informed practice and person-centered care were central in creating a safe and supportive environment for disclosure the review found them to be poorly understood and implemented.