Abstract
BackgroundSexual assault is a threat to public health in refugee and conflict affected settings, placing survivors at risk for unintended pregnancy, unsafe abortion, STIs, HIV, psychological trauma, and social stigma. In response, the International Rescue Committee developed a multimedia training tool to encourage competent, compassionate, and confidential clinical care for sexual assault survivors in low-resource settings. This study evaluated the effect of the training on healthcare providers’ attitudes, knowledge, confidence, and practices in four countries.MethodsUsing a mixed-methods approach, we surveyed a purposive sample of 106 healthcare providers before and 3 months after training to measure attitudes, knowledge, and confidence. In-depth interviews with 40 providers elaborated on survey findings. Medical record audits were conducted in 35 health facilities before and 3 months after the intervention to measure healthcare providers’ practice. Quantitative and qualitative data underwent statistical and thematic analysis.ResultsWhile negative attitudes, including blaming and disbelieving women who report sexual assault, did not significantly decrease among healthcare providers after training, respect for patient rights to self-determination and non-discrimination increased from 76% to 91% (p < .01) and 74% to 81% (p < .05) respectively. Healthcare providers’ knowledge and confidence in clinical care for sexual assault survivors increased from 49% to 62% (p < .001) and 58% to 73% (p < .001) respectively following training. Provider practice improved following training as demonstrated by a documented increase in eligible survivors receiving emergency contraception from 50% to 82% (p < .01), HIV post-exposure prophylaxis from 42% to 92% (p < .001), and STI prophylaxis and treatment from 45% to 96% (p < .01).ConclusionsAlthough beliefs about sexual assault are hard to change, training can improve healthcare providers’ respect for patient rights and knowledge and confidence in direct patient care, resulting in more competent and compassionate clinical care for sexual assault survivors.
Highlights
Sexual assault is a threat to public health in refugee and conflict affected settings, placing survivors at risk for unintended pregnancy, unsafe abortion, sexually transmitted infections (STIs), HIV, psychological trauma, and social stigma
This paper describes the effect of the International Rescue Committee (IRC) Clinical Care for Sexual Assault Survivors (CCSAS) multimedia training on the attitudes, knowledge, confidence, and practices of healthcare providers (HCPs) providing clinical care to sexual assault survivors in refugee camps in Ethiopia and Kenya, a post-conflict setting in the Democratic Republic of Congo (DRC), and an urban refugee setting in Jordan
Demographics A total of 106 HCPs from DRC, Ethiopia, Kenya, and Jordan participated in the CCSAS training and completed the clinician questionnaire (Table 1)
Summary
Sexual assault is a threat to public health in refugee and conflict affected settings, placing survivors at risk for unintended pregnancy, unsafe abortion, STIs, HIV, psychological trauma, and social stigma. The International Rescue Committee developed a multimedia training tool to encourage competent, compassionate, and confidential clinical care for sexual assault survivors in low-resource settings. The consequences of sexual assault on a survivor’s physical and mental health are well documented and may include physical injury, sexually transmitted infections (STIs) including HIV, unwanted pregnancy, unsafe abortion, anxiety, shame, posttraumatic stress, and depression [3]. Access to clinical care, delivered by competent and compassionate healthcare providers (HCPs), is essential to prevent adverse consequences and begin a survivor’s physical and emotional healing
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