What is the aim of this review?
The aim of this review was to explore the experiences of survivors of sexual abuse and violence who received interventions to support them and improve their health and well-being, as well as experiences of their family members and the professionals who delivered such interventions. To do this, we analysed 37 studies that described views and experiences of an intervention.
- Survivors, their family members and professionals highlighted that the organisational settings (e.g. their locations and the approach of all staff in the organisation) within which interventions were delivered were very important for their experience of the interventions and the benefits they drew from them.
- Participants talked about positive outcomes from therapies and interventions, such as improved physical and mental health, mood, interpersonal relationships, understanding of trauma, and their abilities to re-engage in a wide range of areas of their lives.
- Participants explained that features of interventions and their settings that best enabled them to benefit from interventions were often features that could be a barrier. For example, the relationship with the therapist when open and warm was a benefit, but if such a relationship could not be achieved, it was a barrier.
- Aspects of interventions relevant to subgroups of survivors (e.g. for faith-based interventions) and the extent to which they made all survivors (e.g. survivors who were men, had a disability or were from other minority communities) feel a sense of inclusion were also important to enable each survivor to gain the most benefit from them.
What was studied in this review?
We looked for studies that explored the experiences of survivors and professionals who took part in interventions that supported survivors of sexual abuse and violence, or family members who supported survivors who completed these interventions.
We included studies that:
- treated survivors who were sexually abused when they were children or adults, or both;
- involved participants of any age, gender, sexuality, ethnicity, or [dis]ability.
We included studies from any country and setting.
What are the main findings of this review?
We analysed 37 of the 97 studies that were relevant to our review. Most of the 37 studies were from high-income countries and included survivors. There was a wide range of interventions that supported and responded to those who had experienced sexual abuse and violence included in these studies, with only one type of intervention examined in more than one study.
Our review highlighted that people did not discuss the features of the different types of interventions (e.g. aspects related to mindfulness therapy, or rape counselling) but rather, referred to a wide range of features associated with the interventions they considered important. For example,
- they emphasised that a good relationship with the therapist was vital,
- that other members of the group (where interventions were delivered in groups) could make them feel more or less included.
They also stressed that features of the wider setting of the intervention, such as the location and friendliness of a receptionist and other staff, had an important impact on them being able to benefit from interventions.
The review showed that survivors benefitted from the interventions in a wide range of ways, most of which have not been examined in more quantitative research studies that look at how effective these interventions are. Such studies tend to examine mental health, but our review found that survivors thought interventions had also benefitted their:
- physical health,
- relationships with others,
- and ability to set boundaries and be assertive.
How up to date is this review?
This review includes studies published up to May 2021.
We had high or moderate confidence in all but one of our review findings. Further research in low- and middle-income settings, with male survivors of sexual abuse and violence and those from minority groups could strengthen the evidence for low and moderate confidence findings. We found that few interventions had published quantitative and qualitative evaluations. Since this QES has highlighted important aspects that could enable interventions to be more suitable for survivors, using a range of methodologies would provide valuable information that could enhance intervention uptake, completion and effectiveness. This study has shown that although survivors often found interventions difficult, they also appreciated that they needed to work through trauma, which they said resulted in a wide range of benefits. Therefore, listening to survivors and providing appropriate interventions, at the right time for them, can make a significant difference to their health and well-being.
It is well-established that experiencing sexual abuse and violence can have a range of detrimental impacts; a wide variety of interventions exist to support survivors in the aftermath. Understanding the experiences and perspectives of survivors receiving such interventions, along with those of their family members, and the professionals who deliver them is important for informing decision making as to what to offer survivors, for developing new interventions, and enhancing their acceptability.
This review sought to:
1. identify, appraise and synthesise qualitative studies exploring the experiences of child and adult survivors of sexual abuse and violence, and their caregivers, regarding psychosocial interventions aimed at supporting survivors and preventing negative health outcomes in terms of benefits, risks/harms and barriers;
2. identify, appraise and synthesise qualitative studies exploring the experiences of professionals who deliver psychosocial interventions for sexual abuse and violence in terms of perceived benefits, risks/harms and barriers for survivors and their families/caregivers;
3. develop a conceptual understanding of how different factors influence uptake, dropout or completion, and outcomes from psychosocial interventions for sexual abuse and violence;
4. develop a conceptual understanding of how features and types of interventions responded to the needs of different user/survivor groups (e.g. age groups; types of abuse exposure; migrant populations) and contexts (healthcare/therapeutic settings; low- and middle-income countries (LMICs));
5. explore how the findings of this review can enhance our understanding of the findings from the linked and related reviews assessing the effectiveness of interventions aimed at supporting survivors and preventing negative health outcomes.
In August 2021 we searched MEDLINE, Embase, PsycINFO and nine other databases. We also searched for unpublished reports and qualitative reports of quantitative studies in a linked systematic review, together with reference checking, citation searches and contacting authors and other researchers to identify relevant studies.
We included qualitative and mixed-methods studies (with an identifiable qualitative component) that were linked to a psychosocial intervention aimed at supporting survivors of sexual abuse and violence. Eligible studies focused on at least one of three participant groups: survivors of any age, gender, sexuality, ethnicity or [dis]ability who had received a psychosocial intervention; their carers, family members or partners; and professionals delivering such interventions. We placed no restrictions in respect of settings, locations, intervention delivery formats or durations.
Six review authors independently assessed the titles, abstracts and full texts identified. We extracted data using a form designed for this synthesis, then used this information and an appraisal of data richness and quality in order to stratify the studies using a maximum variation approach. We assessed the methodological limitations using the Critical Skills Appraisal Programme (CASP) tool. We coded directly onto the sampled papers using NVivo and synthesised data using a thematic synthesis methodology and used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. We used a narrative synthesis and matrix model to integrate our qualitative evidence synthesis (QES) findings with those of intervention review findings.
We identified 97 eligible studies and sampled 37 of them for our analysis. Most sampled studies were from high-income countries, with four from middle-income and two from low-income countries. In 27 sampled studies, the participants were survivors, in three they were intervention facilitators. Two included all three of our stakeholder groups, and five included two of our groups. The studies explored a wide range of psychosocial interventions, with only one type of intervention explored in more than one study.
The review indicates that features associated with the context in which interventions were delivered had an impact on how individuals accessed and experienced interventions. This included organisational features, such as staff turnover, that could influence survivors' engagement with interventions; the setting or location in which interventions were delivered; and the characteristics associated with who delivered the interventions.
Studies that assess the effectiveness of interventions typically assess their impact on mental health; however, as well as finding benefits to mental health, our QES found that study participants felt interventions also had positive impacts on their physical health, mood, understanding of trauma, interpersonal relationships and enabled them to re-engage with a wide range of areas in their lives.
Participants explained that features of interventions and their contexts that best enabled them to benefit from interventions were also often things that could be a barrier to benefiting from interventions. For example, the relationship with the therapist, when open and warm was a benefit, but if such a relationship could not be achieved, it was a barrier. Survivors' levels of readiness and preparedness to both start and end interventions could have positive (if they were ready) or negative (if they were not) impacts. Study participants identified the potential risks and harms associated with completing interventions but felt that it was important to face and process trauma.
Some elements of interventions were specific to the intervention type (e.g. faith-based interventions), or related to an experience of an intervention that held particular relevance to subgroups of survivors (e.g. minority groups); these issues could impact how individuals experienced delivering or receiving interventions.