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How, why, for whom and in what context, do sexual health clinics provide an environment for safe and supported disclosure of sexual violence: protocol for a realist review
  1. Rachel J Caswell1,
  2. Ian Maidment2,
  3. Jonathan D C Ross1,
  4. C Bradbury-Jones3
  1. 1Department of Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  2. 2School of Life and Health Sciences, Aston University, Birmingham, UK
  3. 3School of Nursing, University of Birmingham, Birmingham, UK
  1. Correspondence to Dr Rachel J Caswell; rachelcaswell{at}


Introduction Supporting people subjected to sexual violence includes provision of sexual and reproductive healthcare. There is a need to ensure an environment for safe and supported disclosure of sexual violence in these clinical settings. The purpose of this research is to gain a deeper understanding of how, why, for whom and in what circumstances safe and supported disclosure occurs in sexual health services.

Methods and analysis To understand how safe and supported disclosure of sexual violence works within sexual health services a realist review will be undertaken with the following steps: (1) Focussing of the review including a scoping literature search and guidance from an advisory group. (2) Developing the initial programme theories and a search strategy using context-mechanism-outcome (CMO) configurations. (3) Selection, data extraction and appraisal based on relevance and rigour. (4) Data analysis and synthesis to further develop and refine programme theory, CMO configurations with consideration of middle-range and substantive theories.

Data analysis A realist logic of analysis will be used to align data from each phase of the review, with CMO configurations being developed. Programme theories will be sought from the review that can be further tested in the field.

Ethics and dissemination This study has been approved by the ethics committee at University of Birmingham, and has Health Research Authority approval. Findings will be disseminated through knowledge exchange with stakeholders, publications in peer-reviewed journals, conference presentations and formal and informal reports. In addition, as part of a doctoral study, the findings will be tested in multisite case studies.

PROSPERO registration details CRD4201912998. Dates of the planned realist review, from protocol design to completion, January 2019 to July 2020.

  • quality in health care
  • genitourinary medicine
  • statistics & research methods

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  • Contributors All authors contributed to the conceptualisation of the review. RJC wrote the first draft. CB-J, JDCR and IM critically reviewed it and provided comments to improve the manuscript. All authors have read and approved the final manuscript.

  • Funding This work was supported by University Hospitals Birmingham Research and Development, as part of a doctoral study by RJC.

  • Competing interests JDCR reports personal fees from GSK Pharma, Hologic Diagnostics, Mycovia and Janssen Pharma as well as ownership of shares in GSK Pharma and AstraZeneca Pharma; and is author of the UK and European Guidelines on Pelvic Inflammatory Disease; is a Member of the European Sexually Transmitted Infections Guidelines Editorial Board; is a Member of the National Institute for Health Research Funding Committee (Health Technology Assessment programme). He is an NIHR Journals Editor and associate editor of Sexually Transmitted Infections journal. He is an officer of International Union against Sexually Transmitted Infections (treasurer), and a charity trustee of the Sexually Transmitted Infections Research Foundation.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.