Establishing Sexual Assault Care Centres in Belgium: health professionals’ role in the patient-centred care for victims of sexual violence

Vandenberghe et al. BMC Health Services Research https://doi.org/10.1186/s12913-018-3608-6 (2018) 18:807 RESEARCH ARTICLE Open Access Establishing Sexual Assault Care Centres in Belgium: health professionals’ role in the patient-centred care for victims of sexual violence Anke Vandenberghe1* , Bavo Hendriks1, Laura Peeters1, Kristien Roelens2 and Ines Keygnaert1 Abstract Background: Having ratified the Convention of Istanbul, the Belgian federal government commits itself to the foundation of Sexual Assault Care Centres (SACC). In the light of researching the feasibility of these centres, this study aimed to evaluate the care for victims of sexual violence (SV) in Belgian hospitals anno 2016 as well as to formulate recommendations for the intended model. Methods: Between April and October 2016, a questionnaire was distributed to 159 key health professionals active in 17 different hospitals attached to an AIDS Referral Centre. The survey covered four parts, i.e. the health professionals’ profile, their knowledge, attitude and practices, an assessment of the hospital’s policy and the caregivers’ opinion on the care for victims of SV and on the intended SACCs. Subsequently, a descriptive analysis using ‘IBM SPSS Statistics 23’ was performed. Results: A total of 60 key health professionals representing 15 different hospitals completed the questionnaire resulting in a response rate of 38%. The results showed a lack of knowledge and practical experience of caregivers’ regarding the care for SV victims. Approximately 30% of responders face personal or professional difficulties upon provision of care to victims of SV. Participants evaluate the current care as good, despite the limited psychosocial support, follow-up, insight for the needs of vulnerable groups and support for family, relatives and health professionals. Yet, the majority of health professionals appraise the SACCs as the best approach for both victims and caregivers. Conclusions: By introducing a SACC, the Belgian federal government aims to provide holistic and patient-centred care for victims of SV. Essential in patient-centred health care is an extensive and continuous education, training and supervision of health professionals concerning the care for victims, support for family, relatives and caregivers. At the end and as a result of a participatory process with many professional experts as well as victims, a specific Belgian model, adjusted to the health care system anno 2016 was developed for piloting. The main challenges in establishing SACCs are situated at the institutional and policy level. Collaborating with other institutions and further research are herewith required. Keywords: Sexual assault, Sexual violence, Sexual assault care Centre, Patient-centred care, Holistic care, Primary health care * Correspondence: 1 International Centre for Reproductive Health (ICRH), Department of Uro-Gynaecology, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, UZP114, 9000 Ghent, Belgium Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Vandenberghe et al. BMC Health Services Research (2018) 18:807 Background The World Health Organisation’s (WHO) definition of sexual violence (SV) in 2015 is: “any sexual act that is perpetrated against someone’s will” committed “by any person regardless of their relationship to the victim, in any setting”. It includes, but is not limited to, rape, attempted rape and sexual slavery, as well as unwanted touching, threatened SV and verbal sexual harassment [1]. SV is a major public health problem [2], with a lifetime prevalence in European women of 5,2% committed by a non-partner and 25,4% by the victims (ex-)partner [3]. The Sexpert study in Flanders found a prevalence of 22,3% and 10,7% in case of respectively girls and boys. For adult women and men the percentages of lifetime victimization were respectively 13,8% and 2,4% [4]. A multi-level analysis in 10 European countries showed lifetime sexual victimisation rates of 20,4% and 10,1% for respectively Belgian young women and men aged 16 to 27 years [5]. The prevalence of SV in case of Lesbian, Gay, Bisexual and Transgender people (LGBT’s) is 31,7% to 41,1% and in case of migrants 56,6%, making them groups at risk [6–9]. However it remains impossible to exactly compare prevalence studies, due to differences in study designs, selection and response bias. Nevertheless since only 1 out of 10 victims report SV, the prevalence is strongly underestimated [10–12]. SV has important physical, reproductive and psychological implications for victims [13]. Many patients develop symptoms of functional somatic syndromes, posttraumatic stress disorder (PTSD), depression, substance abuse and despair [13, 14], in the context of facing stigmatization, rape myths and stereotypes [15]. In order to provide the needed support, international guidelines state that caregivers should recognise these symptoms and explore the patient’s history of SV [16, 17]. Figure 1 illustrates the WHO’s recommended initial care after acute sexual assault [17]. Early presentation is crucial for the forensic examination, tests, proper treatment and referral within 72 h after the incident [11, 15]. Guidelines advice to conduct the forensic examination simultaneously with the physical examination, according to the anamnestic findings, at the victim’s pace and after receiving informed consent [15, 18, 19]. The required safety and privacy should be guaranteed [16, 20]. Depending on the victim’s wishes, a family member, relative or attendant should be able to offer support during the examination. The patient should never be fully undressed, while examinations and interviews should be reduced to a minimum where possible. Caregivers should give patients the opportunity to make an informed autonomous treatment choice and respect the choice made [15, 16]. Every victim also needs appropriate support from family, relatives and health professionals with regular follow-up during the first 1–3 months [17]. At follow-up Page 2 of 11 Fig. 1 WHO’s recommended pathway for initial care after acute sexual violence [17]. Abbreviations: WHO World Health Organisation, HIV Human immunodeficiency virus, PEP Post-exposure prophylaxis, STI Sexually transmitted infection consultations patients should be asked about treatment difficulties, th (...truncated)