Hooper Laura, Meyrick Jane
College of Health, Science and Society, University of the West of England, Bristol, UK
College of Health, Science and Society, University of the West of England, Bristol, UK.
BMJ Open. 2025 May 21;15(5):e102181. doi: 10.1136/bmjopen-2025-102181.
To explore barriers to healthcare among survivors of sexual violence (SV) and the behavioural pathways behind avoidance, focusing on survivor-led solutions.
A mixed methods study collated qualitative interviews/surveys to explore the lived experiences of survivors of SV. Data were analysed using both quantitative descriptors and qualitative thematic analysis to expand the mechanisms/solutions to reported rates.
Higher education setting in the UK.
Forty-two survivors of SV between the ages of 18 and 29 self-identified as female (36), male (4), genderfluid (1) and non-binary transmasculine (1), with 10 describing themselves as being from racially minoritised communities and 32 as White survivors.
Analysis found 86% of survivors completely or significantly avoided healthcare, particularly sexual and reproductive services. Three themes were identified: (1) wider societal blame/marginalisation of survivors hindered their ability to access care in what felt like 'a system of oppression'; (2) once past these barriers, direct experiences with professionals replicated trauma, exacerbating avoidance and health disparities through 'healthcare-induced re-traumatisation'; (3) survivors identified what they needed to re-engage in healthcare including trauma-informed professionals and compassionate services with 'survivor-centred care'.
SV may deepen health inequalities as survivors avoid healthcare. Survivor-led reforms called for survivor-centred practices and encouraged systemic reflection on how healthcare systems may contribute to the broader marginalisation of survivors. Findings echo policy recommendations for co-produced services led by minoritised/marginalised patients and operationalise trauma-informed training for healthcare professionals. Additionally, access-focused psychological support could reduce the impact of sexual trauma on morbidity and mortality.
探讨性暴力幸存者获得医疗保健的障碍以及回避背后的行为路径，重点关注以幸存者为主导的解决方案。
一项混合方法研究，整理了定性访谈/调查，以探究性暴力幸存者的生活经历。使用定量描述符和定性主题分析对数据进行分析，以扩展针对报告发生率的机制/解决方案。
英国的高等教育机构。
42名年龄在18至29岁之间的性暴力幸存者，自我认定为女性（36名）、男性（4名）、性别流动者（1名）和非二元跨男性（1名），其中10人将自己描述为来自少数族裔社区，32人为白人幸存者。
分析发现，86%的幸存者完全或显著回避医疗保健，尤其是性健康和生殖健康服务。确定了三个主题：（1）更广泛的社会对幸存者的指责/边缘化阻碍了他们在感觉像是“压迫系统”中获得护理的能力；（2）一旦克服这些障碍，与专业人员的直接接触会重现创伤，通过“医疗保健导致的再次创伤”加剧回避行为和健康差距；（3）幸存者确定了他们重新参与医疗保健所需的条件，包括了解创伤情况的专业人员和提供“以幸存者为中心的护理”的富有同情心的服务。
由于幸存者回避医疗保健，性暴力可能会加剧健康不平等。以幸存者为主导的改革呼吁采用以幸存者为中心的做法，并鼓励对医疗保健系统如何可能导致幸存者更广泛的边缘化进行系统性反思。研究结果呼应了由少数族裔/边缘化患者主导的联合生产服务的政策建议，并为医疗保健专业人员实施了解创伤情况的培训。此外，以获得服务为重点的心理支持可以减少性创伤对发病率和死亡率的影响。
