Trauma-informed healthcare from the perspectives of women who have experienced sexual violence in adulthood: a systematic review and meta-ethnography.

BACKGROUND: Sexual violence is a global public health problem with wide-ranging and long-term health impacts. Survivors may experience further harm when healthcare settings replicate dynamics of sexual violence (re-traumatisation), underscoring the need to understand survivor perspectives on how healthcare settings can prevent harm and promote healing (trauma-informed approaches). We synthesised qualitative research exploring healthcare experiences and expectations among female survivors of sexual violence in adulthood. METHODS: Systematic review and meta-ethnography. We searched 14 electronic databases (upper date limit 13th February 2024), supplemented by citation tracking, to identify qualitative studies exploring healthcare experiences and expectations among female survivors of adulthood sexual violence. First- and second-order constructs (participant quotes and author interpretations) were extracted and synthesised using meta-ethnography, including reciprocal and refutational translations and a line of argument synthesis. Quality appraisal was conducted using the CASP and COREQ tools, alongside additional criteria to document trauma-sensitive research considerations. Confidence in review findings was assessed using CERQual. RESULTS: Fifty studies were synthesised, generating a conceptual model and line-of-argument synthesis positioning demonstrating trustworthiness as central to trauma-informed healthcare. Trust was built by countering key harms of sexual violence, illustrated in three themes. The first theme, name the violence, described how survivors needed time, safety, and reassurance to recognise and make sense of experiences of sexual violence, which was often hidden or minimised, to reduce self-blame and shame and begin to heal. The second theme, make sexual violence visible, explored how providers and services could challenge silencing by asking, believing, responding, and framing sexual violence as a human rights violation. The third theme, bear witness, emphasised the importance of affirming survivors' dignity, agency, and autonomy to counter the dehumanising effects of sexual violence. CONCLUSIONS: Healthcare can replicate the harms of sexual violence, but also holds unique potential to support healing when survivors are met with validation, affirmation, dignity, and respect. Demonstrating trustworthiness is central to this process and depends not only on individual provider actions but also on system-level conditions that shape safety, visibility, and equity. System-wide trauma-informed approaches are needed to build trust and address systemic conditions and practices that perpetuate harm and undermine healing.