Browsing by Author "Holton, Gail Allison"

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    Sexual assault survivors’ perspectives on enablers of and barriers to clinical follow-up at three facilities in the Eden District
    (Stellenbosch : Stellenbosch University, 2016-12) Holton, Gail Allison; Joyner, Kate; Mash, Robert; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science.
    ENGLISH SUMMARY ENGLISH SUMMARY : Background: Sexual assault affects the life of many South Africans and results in physical, emotional, psychological and spiritual health consequences. Effective follow-up care post-sexual assault is linked positively to recovery. However, follow-up rates are known to be low. The study aimed to explore enablers of and barriers to clinical follow-up of sexual assault survivors, thus informing evidenced-based recommendations for the improvement of access to and utilization of related services within the Eden District. Methods: Following an explorative, qualitative approach, ten participants were selected using purposive sampling. Accessing data from the Hospital Sexual Assault Register, case managers obtained consent for the researcher to contact potential participants. Digitally recorded in-depth interviews between the researcher and participants were transcribed and analyzed. Using an interactive process, complemented by the use of the software programme ATLAS.ti, emerging themes were identified, findings documented and discussed. Trustworthiness was ensured with attention to credibility, transferability, dependability and conformability. Ethical principles were applied throughout the study and in accordance with the ethical approval granted by the Health Research Ethics Committee of Stellenbosch University. The Research Division of Strategy and Health Support, Western Cape Department of Health granted access approval to the study sites. Results: All five of the ten participants who received scheduled follow-up appointments on official stationery accessed the follow-up service, whereas those who were not given appointments did not access it. Supportive responses to the survivor by the community, police and healthcare providers enabled utilization of follow-up services. Patient-centered care, in particular individualized care, further enabled access to and utilization of healthcare services. Survivors’ coping mechanisms and resilience influenced their ability to access healthcare services. Negative perceptions, based on hearsay or prior experience of police, judicial and healthcare systems, were barriers to care. Work and/or school commitments and finance for transport were identified as barriers. However, the participants who experienced these challenges overcame them and attended scheduled consultations. The failure of healthcare providers to integrate follow-up care for sexual assault survivors into established chronic care platforms was a missed opportunity and limitation in the implementation of a holistic patient-centered approach to care. Conclusion: This study highlights the need for patient-centered care for survivors of sexual assault, encompassing principles of good communication. The capacity to implement simple practical strategies to improve access to and utilization of follow-up services, such as the provision of a scheduled appointment on official documentation, is available at facility level and should be implemented as a priority intervention. Additional recommendations include: the need for accurate documentation of contact details in the Facility Sexual Assault Register to enable communication with survivors; the implementation of a standardized Sexual Assault Register or alternative data collection tool promoting accurate and meaningful collection of data used for programme evaluation; the provision of a standardized referral letter to every survivor, capacitating access to healthcare; the inclusion of the survivor in follow-up planning, encouraging a patient-centered approach, and the monitoring and implementation of patient-centered care.