Rhetoric or reality: an exploration of healthcare needs and access following the experience of rape and/or sexual assault in Scotland.

The PhD project aims to improve the academic, professional and public understanding of healthcare needs and access to support and care through the voices of survivors of sexual violence.

Sexual violence, and in particular rape and sexual assault, are serious public health issues that can affect the health and wellbeing of a survivor. As such, healthcare has a vital role to play in the support and care of a survivor. However, evidence consistently shows that many survivors rarely disclose, or take years to do so.

A large-scale population-based study in Britain (Natsal-3) reveals how many women disclose at some point in their lives (42%) but not the experience(s) of disclosing. The impacts of sexual violence occur across the system - from the individual and community level to the organisational and broader macro levels. The landscape of supports for sexual violence in Scotland has recently shifted, moving sexual assault referral centres (SARCs) out of police and into health contexts, placing one aspect of health at the frontline of support whilst mental health services see increasing waiting lists.

This PhD is, therefore, timely in exploring survivors' disclosure (if at all) and their healthcare needs and experiences.

This research seeks to give voice to the perspectives of marginalised women who have experienced sexual violence, to better understand their help-seeking needs and experiences and the responses to disclosures. The specific research questions are: - When and who do survivors disclose their experience of rape and/or sexual assault to?

- What was the nature of the response they received?

- What barriers do survivors anticipate (or have they experienced) when accessing healthcare following an experience of rape and/or sexual assault?

- What supports do survivors anticipate (or have they experienced) when accessing healthcare following an experience of rape and/or sexual assault?

- How do survivors envision future healthcare better meeting the needs of those who have experienced rape and/or sexual assault?

Qualitative in nature, the PhD research specifically seeks marginalised voices (e.g., class and race/ethnicity) - women who are under-represented in the evidence-base - as not every woman may experience a willingness to disclose or a response to a disclosure in the same way. As such, an intersectional approach will be used to expand the space of understanding on how different social forces inter-relate.

By moving beyond gender as an analytical focus, the PhD will enable greater mobilisation of efforts to support a diverse group of women in their healthcare needs and supports.

The study is phenomenon-driven: uncovering as much as possible about a complex, layered and continually situated reality. Qualitative episodic interviews will be used to elicit participant memories pertaining to experiences. The study will focus on women over the age of 18 who have experienced sexual violence between 2-15-years previously, with the minimum time of 2-years to allow for disclosure to have occurred (friend, family member or professional), and for time to have elapsed for women to identify their experience as sexual assault or rape. Focussed on Scotland only, the aim is to recruit a minimum of 24 women.

A dissemination plan has been created to ensure a wide audience is made aware of the findings of this research. Effort will be made, through the existing and developing networks created through the study, to ensure dissemination to leaders in Public Health and Scottish Government who have the ability and influence to change policy. A media and engagement plan will also be created to ensure an awareness with the public on this issue.

A short infographic report (for non-academic audiences) and a webinar that taps into the network created will also be used to help disseminate findings.