Caswell Rachel J, Ross Jonathan D C, Maidment Ian, Bradbury-Jones Caroline
Department of Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
School of Life and Health Sciences, Aston University, Birmingham, UK.
Trauma Violence Abuse. 2023 Oct;24(4):2661-2679. doi: 10.1177/15248380221111466. Epub 2022 Jun 28.
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. Following published realist standards we undertook a realist review. After focussing 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. 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 individual, service-delivery and societal levels. 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-centred care were central in creating a safe and supportive environment for disclosure the review found them to be poorly defined in this setting.
性与生殖健康服务（SRHS）是一个可获得与性暴力和虐待（SV）相关医疗护理的环境。然而，需要克服披露方面的障碍，以便及时获得这种护理。关于确定和解释干预措施如何消除障碍并为披露创造安全和支持性环境的研究有限。本综述的目的是发展和完善理论，以解释SRHS如何、为谁以及在何种背景下促进披露。按照已发表的现实主义标准，我们进行了一项现实主义综述。在聚焦综述问题并确定关键背景障碍后，使用传统的系统数据库搜索来识别与之相关的文章。该策略辅以迭代搜索。搜索产生了3172条引用，28篇有足够信息的文章被纳入以发展新兴理论。提出了四种基于证据的理论，阐述了如何在SRHS中营造一个安全且支持性的环境以促使披露性暴力情况。这些理论考虑了干预措施如何在个人、服务提供和社会层面克服围绕性暴力披露的障碍。介绍了SRHS参与健康促进和健康维权活动以解决社会层面障碍（如缺乏服务意识和对性暴力的刻板观念）的益处。尽管创伤知情实践和以患者为中心的护理在营造安全且支持性的披露环境中至关重要，但综述发现它们在这种情况下的定义并不明确。
