Sexual assault survivors’ perspectives on enablers of and barriers to clinical follow-up at three facilities in the Eden District

Holton, Gail Allison (2016-12)

Thesis (MCur)--Stellenbosch University, 2016.

Thesis

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.

AFRIKAANSE OPSOMMING : Agtergrond: Seksuele aanranding beïnvloed die lewens van talle Suid Afrikaners en het fisiese, emosionele, psigologiese en geestelikegesondheidsprobleme tot gevolg. Doeltreffende opvolgsorg na seksuele aanranding hou positief verband met herstel, maar opvolgkoerse is baie laag. Die doel van die studie was om instaatstellers van en hindernisse tot kliniese opvolging ná seksuele aanranding te ondersoek en sodoende bewysgebaseerde aanbevelings te maak vir beter toegang tot en gebruik van verwante dienste in die Eden-distrik. Metode: ’n Verkennende, kwalitatiewe benadering is gevolg en tien deelnemers is deur doelgerigte steekproefneming gekies. Data is van die hospitaalregister van seksuele aanranding verkry, en gevallebestuurders het instemming vir die navorser verkry om potensiele deelnemers te kontak. Digitale opnames van diepte-onderhoude tussen die navorser en die deelnemers is getranskribeer en ontleed. Deur ’n interaktiewe proses aangevul met die gebruik van die sagtewareprogram ATLAS.ti is ontluikende temas geïdentifiseer en bevindings is opgeteken en bespreek. Betroubaarheid is verseker met oorweging van geloofwaardigheid, oordraagbaarheid, afhanklikheid en bevestigbaarheid. Etiese beginsels is regdeur die studie toegepas in ooreenstemming met die etiese goedkeuring verleen deur die Gesondheidsnavorsingsetiekkomitee van die Universiteit Stellenbosch. Goedkeuring vir toegang tot die studieterreine is verleen deur die navorsingsafdeling van Strategie- en Gesondheidsondersteuning, Wes-Kaapse Departement van Gesondheid. Resultate: Al vyf van die tien deelnemers wat geskeduleerde opvolgafsprake op amptelike dokumentasie ontvang het, het toegang tot die diens verkry, maar nie diegene wat nie ʼn afspraak gehad het nie. Ondersteunende reaksie teenoor die oorlewende deur die gemeenskap, polisie en gesondheidsorgverskaffers het die gebruik van opvolgdienste in die hand gewerk. Pasientgesentreerde, geindividualiseerde sorg het verder toegang tot en die gebruik van gesondheidsorgdienste in die hand gewerk. Oorlewendes se hanteringsmeganismes en veerkragtigheid het hul vermoe om toegang tot gesondheidsorgdienste te verkry, beinvloed. Negatiewe persepsies, gegrond op hoorsê of vorige ondervinding van polisie-, regterlike en gesondheidsorgstelsels was hindernisse tot sorg. Werks- en/of skoolverpligtinge en finansies vir vervoer is as hindernisse geïdentifiseer. Die deelnemers wat hierdie uitdagings ondervind het, het dit egter oorkom en die geskeduleerde konsultasies bygewoon. Die versuim van gesondheidsorgverskaffers om opvolgsorg vir oorlewendes van seksuele aanranding met bestaande kroniesesorg-platforms te integreer, is ʼn verbeurde geleentheid en beperking tot die implementering van ʼn holistiese pasientgesentreerde benadering tot sorg. Gevolgtrekking: Die studie beklemtoon die behoefte aan pasientgesentreerde sorg vir oorlewendes van seksuele aanranding wat beginsels vir goeie kommunikasie insluit. Die kapasiteit om eenvoudige praktiese strategiee te implementeer om toegang tot en gebruik van opvolgdienste te verbeter, soos die voorsiening van ʼn geskeduleerde afspraak op amptelike dokumentasie, is beskikbaar op fasiliteitsvlak en moet as prioriteitintervensie geïmplementeer word. Bykomende aanbevelings sluit in: akkurate optekening van oorlewendes se kontakbesonderhede in die fasiliteitsregister van seksuele aanranding om kommunikasie met oorlewendes moontlik te maak; die implementering van ʼn gestandaardiseerde register van seksuele aanranding om akkurate en betekenisvolle insameling van data vir programevaluering te bevorder; die voorsiening van ʼn gestandaardiseerde verwysingsbrief aan elke oorlewende om toegang tot gesondheidsorg te verkry; die insluiting van die oorlewende by opvolgbeplanning, waardeur ʼn pasientgesentreerde benadering aangemoedig word; en die monitering en implementering van pasientgesentreerde sorg.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/100218
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