Underserved survivors of sexual assault: a systematic scoping review

Figures & data

Figure 1. Flow chart

Table 1. Overview of studies included in the current review (N = 41)

Authors, yr. & origin	Aim	Population	Method	Findings relevant to review	Category
Abavi et al., 2020. Canada.	To explore barriers to accessing counselling for sexual assault (SA).	52 adult female survivors (age N/A) of SA	Qualitative (online forum)	Some survivors reported being unable to afford counselling.	3
Ackerman et al., 2006. USA.	To identify characteristics associated with return visits among women presenting for post-assault care.	812 female survivors of SA 15+	Quantitative (medical records)	Homelessness, psychiatric diagnosis & older age (50 y+) was associated with significantly less follow-up visits.	3, 5, 7
Akinsulure-Smith, 2014. USA.	To explore barriers faced by migrants seeking counselling for conflict related sexual violence (SV).	1 counsellor, displaced African female survivors of conflict-related SV (N = N/A, age N/A)	Qualitative (case studies, clinical experience)	Western models of intervention alone may not be appropriate or adequate to meet the needs of forced migrants.	1
Alvidrez et al., 2011. USA.	To examine ethnic differences in follow up among women presenting at a hospital for post-assault care.	104 female survivors of SA (18+)	Quantitative (clinical interview and clinic charts)	Despite higher treatment needs, Black women were significantly less likely than White women to engage in treatment.	1
Anderson & Overby, 2020. USA.	To explore barriers to formal support faced by service providers, who are also survivors of SV.	19 female and gender nonconforming (GNC) survivors of SV	Qualitative (interviews)	Participants identified the cost/perceived costs of services as a barrier to accessing support.	3
Bailey & Barr, 2000. UK.	To investigate the use of policies on conducting investigations of sex crimes against people with LD.	24 police forces	Quantitative (survey)	Policies for sexual crimes against people with disabilities were lacking (70% police forces did not have one (n = 17)).	2
Bows, 2018. UK.	To explore practitioner views on supporting older survivors of sexual abuse (60+).	23 practitioners working with older survivors of sexual abuse	Qualitative (interviews)	Age-related factors complicated service utilization and provision. Gaps in service provision were identified (e.g. a lack of collaboration across sectors).	7, 1
Brooker & Durmaz, 2015. UK.	To survey SARCs about their work in relation to mental health.	25 SARCs	Quantitative (survey)	40% of clients are already known to mental health services (N = 14). Almost two-thirds of SARCs report problems in referring on to mental health services (N = 24).	5
Burgess & Hanrahan, 2004. USA.	To investigate issues in the management of elder sexual abuse.	Experts (e.g. investigators) with experience with older SA survivors (N = N/A)	Qualitative (125 case studies of elder sexual abuse)	Participants believe older survivors of SV receive inadequate evidentiary exams, treatment and services.	7
DeLeon, 2017. USA.	To explore barriers to mental health service use experienced by black college-aged SA survivors.	20 campus- and community-based mental health providers working with SA	Qualitative (interviews)	Black college-aged SA survivors experience cultural barriers to treatment and reporting (e.g. lack of diverse staff).	1
Du Mont et al., 2011. Canada.	To investigate health care providers perceptions of challenges to maintaining an HIV post-exposure prophylaxis (PEP) programme for SA survivors.	132 providers working with survivors of SA	Mixed methods (survey and interviews)	A lack of accommodation to client needs was identified, including 1) administering PEP to aboriginal and remote clients 2) servicing clients who have low reading skills and non-English speakers.	1
Du Mont, Kosa, Abavi et al., 2019. Canada.	To evaluate SA centres responses to transgender survivors of SA.	27 SA programme leaders	Quantitative (questionnaire)	Barriers to providing trans-affirming care was identified and all 27 programme leaders felt that the staff would benefit from training in the care of transgender persons.	4
Du Mont, Kosa, Solomon et al., 2019. Canada.	To evaluate the level of competence among nurses engaged in the care of transgender persons in SA centres.	95 nurses in SA centres	Quantitative (questionnaire)	73.1% of nurses reported having little or no expertise in caring for transgender clients (N = 93, n = 68).	4
Frantz et al., 2006. USA.	To evaluate rape crisis, SA, and domestic violence services’ compliance with Americans with Disabilities Act.	Surveys of physical accessibility (N = 65) and programmatic accessibility (N = 54) at services	Quantitative (surveys)	Although great variability existed between services, all programmes fell short of full compliance.	2
Fraser-Barbour, 2018. Australia.	To identify ways to effectively support people with intellectual disabilities (ID) who are experiencing sexual and/or physical abuse.	7 professionals working across disability and violence sectors^1	Qualitative (interviews)	Barriers to utilization of mainstream violence services for people with ID included unavailable services and limited knowledge about ID among staff working within these organizations.	2
Fraser-Barbour et al., 2018. Australia.	To identify ways to effectively support people with ID who are experiencing sexual and/or physical abuse.	7 professionals working across disability and violence sectors^1	Qualitative (interviews)	Participants reported that professionals lack awareness of ways to effectively support people with ID. Participants also perceived people with ID to have little or limited autonomy after reporting the abuse.	2
Hawkins et al., 2009. Canada.	To explore formal help-seeking among Aboriginal women with HIV/AIDS and SV victimization histories.	20 aboriginal women (18+) with HIV/AIDS and experience of SV	Qualitative (interviews)	Participants reported experiences of stigma and discrimination in health care settings based on their cultural identity and HIV-status.	1, 3
Hendriks et al., 2018. Belgium.	To asses 15 hospital-based health services for survivors of SA.	60 professionals caring for SA survivors^2	Qualitative (interview/survey)	Only a minority of clinics (n = 3) tune their protocols based on the survivor’s gender identity and sexual orientation.	4
Holly & Horvath, 2012. UK.	To report the initial findings from a project seeking to increase support for survivors of domestic and SA with a dual-diagnosis.	Service leads were interviewed in 3 focus groups (N = N/A) and surveyed (N = N/A).	Mixed methods (surveys and interviews)	Mechanisms for sharing information between organizations (mental health, substance use and violence sector) and making appropriate referrals appears unnecessarily complicated and very restrictive.	5, 6
Goodfellow et al., 2003. Australia.	To explore access to justice among survivors of SA with cognitive impairment.	200 SA workers and people involved in the CJS including police	Qualitative (interviews)	Participants believe the CJS fails to meet the needs of survivors with cognitive impairments.	2
Jancey et al., 2011. Australia.	To explore professionals’ perceptions of SA management practices in a healthcare setting.	27 professionals	Mixed methods (questionnaires)	All participants agreed that there was a lack of appropriate services available to indigenous and culturally and linguistically diverse groups.	1
Jordan et al., 2019. USA.	To identify barriers to service use for transgender people accessing domestic violence/SV programmes.	10 transgender advocates in domestic violence/SV programmes	Qualitative (interviews)	Several barriers to service use for trans survivors were identified including ‘trans-exclusionary’ policies at services.	4
Kalmakis, 2011. USA	To report the experiences of women who were sexually assaulted and struggled with substance misuse.	8 female SA survivors (18+) with substance misuse issues	Qualitative (interviews)	Participants felt unable to access needed support.	6
Kattari, Walls, & Speer, 2017. USA.	To examine experiences of discrimination in accessing health services among transgender and GNC individuals.	2,424 adult (18+) transgender individuals at rape crisis centres (RCCs)^3	Quantitative (secondary analysis)	Disability and lower annual income were significantly associated with discrimination at RCC.	2, 3, 4
Kattari, Walls, Whitfield et al., 2017. USA.	To examine experiences of discrimination in accessing health services among transgender and GNC individuals.	2424 adult (18+) transgender individuals accessing RCCs^3	Quantitative (secondary analysis)	Significantly higher rates of discrimination were experienced by transgender People of Colour and Latino transgender individuals compared to their white counterparts.	1, 4
Keilty & Connelly, 2001. Australia.	To explore barriers to reporting sexual abuse to police among women with ID.	27 SA workers, 13 police officers	Qualitative (interviews)	Police require additional skills on how to effectively engage with survivors with ID. Police are not always compliant with guidelines on working with these survivors.	2
Lievore, 2005. Australia.	To explore help-seeking and survivor decision-making.	36 female survivors of SA (19+), 55 SA service providers, 65 representatives of services.	Qualitative (interviews and “consultations”)	Individuals with disabilities, non-English speakers and indigenous women face distinct barriers to formal support (e.g. due to lack of appropriately trained interpreters).	1, 2
Macy, Giattina, Montijo et al., 2010. USA.	To explore agency directors’ opinions about effective service delivery for survivors of SA or domestic violence.	14 domestic violence and SA agency directors^4	Qualitative (interviews)	There is a lack of bilingual staff/services and few affordable transportation options. Additional challenges were discussed (e.g. uncertainties about supporting survivors with co-occurring substance abuse and/or mental health issues).	1, 2, 3, 5, 6
Macy, Giattina, Parish et al., 2010. USA.	To investigate the challenges faced by domestic violence/SA agencies.	14 domestic violence and SA agency directors^4	Qualitative (interviews)	Challenges included providing welcoming services to survivors of diverse backgrounds and supporting survivors with co-occurring substance abuse and/or mental health issues.	1, 5, 6
Olsen & Carter, 2016. UK.	To explore how SA support services respond to women with learning disabilities (LD).	4 researchers and 8 adult women (age N/A) with LD and SV victimization	Qualitative (case study, action learning)	Survivors with LD experience barriers to obtaining support, including communication difficulties.	2
Peters, 2019. USA.	To explore the impact of medical neoliberalism in RCCs.	6 RCC clinicians (24+)	Qualitative (interview)	All participants wanted RCCs to be more accessible for marginalized and underserved survivors (e.g. LGBTQs), and identified barriers to achieving this goal (e.g. a lack of diverse staff).	1, 4
Scannell, 2018. USA.	To investigate factors associated with completion of PEP.	246 female survivors (18+)	Quantitative (medical records)	Lack of insurance was associated with significantly lower completion rates.	3
Seelman, 2015. USA.	To study discrimination against transgender and GNC individuals in health settings.	Transgender and GNC people (18+) in RCCs (N = 2424)^3	Quantitative (secondary analysis)	4,9% of transgender/GNC individuals experience unequal treatment at RCCs (n = 104). Those who are low-income, not U.S. citizens or have sex work histories are significantly more likely to experience unequal treatment.	1, 3, 4
Sit & Stermac, 2017. Canada.	To explore how help seeking can be improved for SV survivors living in poverty.	15 female survivors of SA (18+) living in poverty	Qualitative (interviews)	Barriers to service use included costs and prejudicial attitudes towards people living in poverty among providers.	3
Smele et al., 2019. Canada.	To examine how police respond to survivors of SA with developmental disabilities (LD).	7 police officers/SA investigators, 8 workers at victim crisis services	Qualitative (Interviews)	Policies are not always followed and police officers lack training on SA cases involving survivors with LD.	2
Ullman & Townsend, 2007. USA.	To explore barriers to service provisions experienced by workers at RCCs.	25 rape victim advocates working in RCCs	Qualitative (interviews)	Stereotypical views about people with disabilities, the elderly, sexual minority individuals, mental illness, and sex workers and racism against people of colour is a barrier affecting advocates’ work. There is a lack of bilingual services and services disabled survivors. Cost-barriers affect some survivors.	1, 2, 3, 4, 5, 7
Vandenberghe et al., 2018. Belgium.	To evaluate the care provided to survivors of SA in 15 hospitals.	60 health professionals caring for SA survivors^2	Qualitative (survey/interview)	Professionals had limited knowledge about care for “vulnerable groups” (defined as LGBTs, migrants and disabled people).	1, 2, 4
Vik et al., 2020. Norway.	To investigate differences in police investigations between cases of SA against women with and without vulnerability factors.	223 female survivors (16+)	Quantitative (merged police files and medical records)	“Vulnerable victims” (mental health issues, disability or substance abuse) received borderline significant lower quality investigation compared to survivors without vulnerability.	2, 5, 6
White et al., 2019. USA.	To discuss future directions in formal responses to survivors of SA and domestic violence.	72 leaders in the domestic violence and SA field	Qualitative (“discussions”)	There is a lack of adequate services for underserved, marginalized, and culturally specific survivors (e.g. people with disabilities, LGBTQs and members of various racial and ethnic groups). Micro-loans and substance abuse services are needed.	1, 3, 4, 6
Zweig et al., 2002. USA.	To evaluate if domestic violence and SA services focus on women facing multiple barriers.	Staff from 20 programmes focused on multibarriered women (N = N/A)	Qualitative (interviews)	Few programmes focus on survivors facing multiple barriers. The system blames multibarriered women more and takes them less seriously.	2, 5, 6
Zweig et al., 2014. USA.	To examine barriers to the medical forensic examination for survivors of SA.	47 representatives from SA coalitions, 409 providers, American Indian survivors (N = N/A, age = N/A)	Mixed methods (surveys, interviews and “meetings”)	78% of coalitions (N= 47) and 57% providers (N = 409) considered non-English-speaking survivors to have a somewhat or harder time obtaining exams than English-speaking survivors).	1

Superscript is used to indicate studies that appear to use the same sample.

Abavi, R., Branston, A., Mason, R., & Du Mont, J. (2020). An exploration of sexual assault survivors’ discourse online on help-seeking. Violence and Victims, 35(1), 126–15. doi:10.1891/0886-6708.VV-D-18-00148

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Akinsulure-Smith, A. M. (2014). Displaced African female survivors of conflict-related sexual violence. Violence Against Women, 20(6), 677–694. doi:10.1177/1077801214540537

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Alvidrez, J., Shumway, M., Morazes, J., & Boccellari, A. (2011). Ethnic disparities in mental health treatment engagement among female sexual assault victims. Journal of Aggression, Maltreatment & Trauma, 20(4), 415–425. doi:10.1080/10926771.2011.568997

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Bows, H. (2018). Practitioner views on the impacts, challenges, and barriers in supporting older survivors of sexual violence. Violence Against Women, 24(9), 1070–1090. doi:10.1177/1077801217732348

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Data availability

Data sharing is not applicable to this article as no new data were created or analyzed in this study.