Accessing sexualized violence services and supports for women in rural Nova Scotia: A qualitative study
DOI:
https://doi.org/10.15273/hpj.v2i1.11082Abstract
Introduction: Both rural and urban women who experience sexualized violence can face significant barriers to accessing services and supports, including fear of victim blaming, stigma, and re-traumatization. To date, there is a paucity of research that specifically examines the experiences of women accessing sexualized violence services and supports in rural places and the unique or additional barriers they may face. Objectives: The purpose of this qualitative study was to understand the experiences of women living in rural Nova Scotia who accessed services or supports after experiencing sexualized violence. Methods: Participants were recruited through community organizations and social media. Interviews were conducted with nine women in Fall 2019. Data were analyzed using feminist-thematic analysis. Results: Findings indicate that the women shared experiences of navigating a fragmented system of services and supports, and many reported harmful experiences with the justice system and formal health care system. Some women also experienced positive experiences with community-based services. Enhancing community-based services is recommended as one key strategy for improving access to sexualized violence services and supports in rural communities.
References
Action Canada for Sexual Health and Rights. (2020, April 3). The state of sex-ed in Canada. https://www.actioncanadashr.org/sites/default/files/2020-04/8039_AC_
StateofSexEd-2ndEd_F-Web_0.pdf
Anderson, K. M., Renner, L. M., & Bloom, T. S. (2014). Rural women‘s strategic responses to intimate partner violence.”¯Health Care for Women International,”¯35(4), 423–441. https://doi.org/10.1080/07399332.2013.815757
Averill, J. B., Padilla, A. O., & Clements, P. T. (2007). Frightened in isolation: Unique considerations for research of sexual assault and interpersonal violence in rural areas.”¯Journal of Forensic Nursing,”¯3(1), 42–46. https://doi.org/10.1111/j.1939-3938.2007.tb00091.x
Bethune, A. (2019, April 18). Avalon Sexual Assault Centre‘s waitlist on hold. The Coast. https://www.thecoast.ca/halifax
/avalon-sexual-assault-centres-waitlist-on-hold/Content?oid=21459447
Bettinger-Lopez, C., & Bro, A. (2020, May 13). A double pandemic: Domestic violence in the age of COVID-19. Council on Foreign Relations. https://www.cfr.org/in-brief/double-pandemic-domestic-violence-age-covid-19
Boddy, C. R. (2016). Sample size for qualitative research. Qualitative Market Research, 19(4), 426–432. https://doi.org/10.1108/QMR-062016-0053
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
Braun, V., & Clarke, V. (2012). Thematic analysis. In H. Cooper, P. M. Camic, D. L. Long, A. T. Panter, D. Rindskopf, & K. J. Sher (Eds.), APA handbook of research methods in psychology: Vol. 2. Research designs: Quantitative, qualitative, neuropsychological, and biological (pp. 57–71).
American Psychological Association. https://doi.org/10.1037/13620-004
Break the Silence NS. (n.d.-a). Types of support. https://www.breakthesilencens.ca/types-of-support
Break the Silence NS. (n.d.-b).Where to get help. https://www.breakthesilencens.ca/where-to-get-help
Burgess-Proctor, A. (2015). Methodological and ethical issues in feminist research with abused women: Reflections on participants‘ vulnerability and empowerment. Women‘s Studies International Forum, 48, 124–134. https://doi.org/10.1016/j.wsif.2014.10.014
Campbell, R., Wasco, S. M., Ahrens, C. E., Sefl, T., & Barnes, H. E. (2001). Preventing the “second rape”: Rape survivors‘ experiences with community service providers. Journal of Interpersonal Violence, 16(12), 1239–1259. https://doi.org/10.1177/088626001016012002
Canada Without Poverty. (2015). Nova Scotia poverty progress profile. https://www.cwp-csp.ca/wp-content/uploads/2012/05/2015-Province-Poverty-Profiles_NS.pdf
Canadian Women‘s Foundation. (2020, April 9). Why is the COVID-19 pandemic linked to more gender-based violence? https://canadianwomen.org/blog/covid-19-pandemic-gender-based-violence/
Carter, N., Valaitis, R. K., Lam, A., Feather, J., Nicholl, J., & Cleghorn, L. (2018). Navigation delivery models and roles of navigators in primary care: A scoping literature review. BMC Health Services Research, 18, Article 96. https://doi.org/10.1186/s12913-018-2889-0
Carter-Snell, C., Jakubec, S., & Hagen, B. (2020). Collaboration with rural and remote communities to improve sexual assault services.”¯Journal of Community Health,”¯45(2), 377–387. https://doi.
org/10.1007/s10900-019-00744-4
Cotter, A. (2021, April 26). Intimate partner violence in Canada, 2018: An overview. Statistics Canada. https://www150.statcan.gc.ca/n1/pub/85-002-x/2021001/article/00003-eng.htm
Cotter, A., & Savage, L. (2019, December 5). Gender-based violence and unwanted sexual behaviour in Canada, 2018: Initial findings from the Survey of Safety in Public and Private Spaces. Statistics Canada. https://www150.statcan.gc.ca/n1/pub/85-002-x/2019001/article/00017-eng.htm
Creating Communities of Care. (n.d.). Our background. https://creating
communities.ca/background/
Doctors Nova Scotia. (2018, July). Healing Nova Scotia part two: Supporting the academic physician mandate. https://doctorsns.com/sites/default/files/2018-07/nextsteps/HealingNS2-2018_0.pdf
Dohan, D., & Schrag, D. (2005). Using navigators to improve care of underserved patients: Current practices and approaches. Cancer, 104(4), 848–855.https://doi.org/10.1002/cncr.21214
Du Mont, J., Hemalal, S., Kosa, S. D., Cameron, L., & Macdonald, S. (2020). The promise of an intersectoral network in enhancing the response to transgender survivors of sexual assault. PLOS ONE, 15(11), Article e0241563. https://doi.org/10.1371/journal.pone.0241563
Edwards, K. M. (2015). Intimate partner violence and the rural-urban-suburban divide: Myth or reality? A critical review of the literature.”¯Trauma, Violence, & Abuse,”¯16(3), 359–373. https://doi.org/10.1177/1524838014557289
Ellsberg, M., & Heise, L. (2005). Researching violence against women: Practical guidelines for researchers and activists. World Health Organization. https://apps.who.int/iris/handle/10665/42966
Evans, M. L., Lindauer, M., & Farrell, M. E. (2020). A pandemic within a pandemic – Intimate partner violence during COVID-19. The New England Journal of Medicine, 383(24), 2302–2304. https://doi.org/10.1056/NEJMp2024046
Garasia, S., & Dobbs, G. (2019). Socioeconomic determinants of health and access to health care in rural Canada. University of Toronto Medical Journal, 96(2), 44–46. https://jps.library.utoronto.ca/index.php/utmj/issue/view/2375/454
Gatenby, B., & Humphries, M. (2000). Feminist participatory research: Methodological and ethical issues. Women‘s Studies International Forum, 23(1), 89–105. https://doi.org/10.1016/S0277-5395(99)00095-3
Gibson, R., Fitzgibbons, J., & Nunez, N. (2015). Nova Scotia. State of Rural Canada. https://sorc.crrf.ca/ns/
Gravelin, C. R., Biernat, M., & Bucher, C. E. (2019). Blaming the victim of acquaintance rape: Individual, situational, and sociocultural factors. Frontiers in Psychology, 9, Article 2422. https://doi.org/10.3389/fpsyg.2018.02422
Gregory, A., Johnson, E., Feder, G., Campbell, J., Konya, J., & Perôt, C. (2021). Perceptions of peer support for victim-survivors of sexual violence and abuse: An exploratory study with key stakeholders. Journal of Interpersonal Violence. Advance online publication. https://doi.org/10.
/08862605211007931
Guest, G., Bunce, A., & Johnson, L. (2006). How many interviews are enough?: An experiment with data saturation and variability. Field Methods, 18(1), 59–82. https://doi.org/10.1177/1525822X05279903
Gurr, J., Pajot, M., Nobbs, D., Mailloux, L., & Archambault, D. (2008). Breaking the links between poverty and violence against women. National Clearinghouse on Family Violence, Public Health Agency of Canada. https://publications.gc.ca/collections/collection_2012/aspc-phac/HP20-14-2008-eng.pdf
Heath, N. M., Lynch, S. M., Fritch, A. M., & Wong, M. M. (2013). Rape myth acceptance impacts the reporting of rape to the police: A study of incarcerated women. Violence Against Women, 19(9), 1065–1078. https://doi.org/10.1177/1077801213501841
Jaffray, B. (2020, September 9). Experiences of violent victimization and unwanted sexual behaviours among gay, lesbian, bisexual and other sexual minority people, and the transgender population, in Canada, 2018. Statistics Canada. https://www150.statcan.gc.ca/n1/pub/85-002 x/2020001/article/00009-eng.htm
Jaffray, B. (2021, April 26). Intimate partner violence: Experiences of sexual minority women in Canada, 2018. Statistics Canada. https://www150.statcan.gc.ca/n1/pub/85-002-x/2021001/article/00005-eng.htm
Jeffrey, N., Johnson, A., Richardson, C., Dawson, M., Campbell, M., Bader, D., Fairbairn, J., Straatman, A. L., Poon, J., & Jaffe, P. (2019). Domestic violence and homicide in rural, remote, and northern communities: Understanding risk and keeping women safe (Domestic Homicide Issue Brief No. 7). Canadian Domestic Homicide Prevention Initiative. http://cdhpi.ca/sites/cdhpi.ca/files/Brief_7.pdf
Jenkinson, B., Kruske, S., & Kildea, S. (2017). The experiences of women, midwives and obstetricians when women decline recommended maternity care: A feminist thematic analysis. Midwifery, 52, 1–10. https://doi.org/10.1016/j.midw.2017.05.006
Jewkes, R., Sen, P., & Garcia-Moreno, C. (2002). Sexual violence. In E. G. Krug, L. L. Dahlberg, J. A. Mercy, A. B. Zwi & R. Lozano (Eds.), World report on violence and health (pp. 147–182). World Health Organization. https://www.who.int/violence_injury_prevention/violence/global_campaign/en/chap6.pdf
John, N., Casey, S. E., Carino, G., & McGovern, T. (2020). Lessons never learned: Crisis and gender-based violence.”¯Developing World Bioethics,”¯20(2), 65–68. https://doi.org/10.1111/dewb.12261
Logan, T. K., Evans, L., Stevenson, E., & Jordan, C. E. (2005). Barriers to services for rural and urban survivors of rape. Journal of Interpersonal Violence, 20(5), 591–616. https://doi.org/10.1177/0886260504272899
Logan, T. K., Stevenson, E., Evans, L., & Leukefeld, C. (2004). Rural and urban women‘s perceptions of barriers to health, mental health, and criminal justice services: Implications for victim services. Violence and Victims, 19(1), 37–62. https://doi.org/10.1891/
vivi.19.1.37.33234
Logan, T. K., Walker, R., Cole, J., Ratliff, S., & Leukefeld, C. (2003). Qualitative differences among rural and urban intimate violence victimization experiences and consequences: A pilot study. Journal of Family Violence, 18(2), 83–92. https://doi.org/10.1023/A:1022837114205
Lutfiyya, M. N., McCullough, J. E., Haller, I. V., Waring, S. C., Bianco, J. A., & Lipsky, M. S. (2012). Rurality as a root or fundamental social determinant of health. Disease-a-Month, 58(11), 620–628. https://doi.org/10.1016/j.disamonth.2012.08.005
Milesi, P., Süssenbach, P., Bohner, G., & Megàas, J. L. (2020). The interplay of modern myths about sexual aggression and moral foundations in the blaming of rape victims. European Journal of Social Psychology, 50(1), 111–123. https://doi.org/10.1002/ejsp.2622
Misra, V., Sedig, K., Dixon, D. R., & Sibbald, S. L. (2020). Prioritizing coordination of primary health care. Canadian Family Physician, 66(6), 399–403. https://www.cfp.ca/content/66/6/399
Moffitt, P., Aujla, W., Giesbrecht, C. J., Grant, I., & Straatman, A.-L. (2020). Intimate partner violence and COVID-19 in rural, remote, and northern Canada: Relationship, vulnerability and risk. Journal of Family Violence. https://doi.org/10.1007/s10896-020-00212-x
O‘Dwyer, C., Tarzia, L., Fernbacher, S., & Hegarty, K. (2019). Health professionals‘ experiences of providing care for women survivors of sexual violence in psychiatric inpatient units.”¯BMC Health Services Research, 19, Article 839. https://doi.org/
1186/s12913-019-4683-z
O‘Neil, A., Sojo, V., Fileborn, B., Scovelle, A. J., & Milner, A. (2018). The #MeToo movement: An opportunity in public health? The Lancet, 391(10140), 2587–2589. https://doi.org/10.1016/S0140-6736(18)30991-7
Peek-Asa, C., Wallis, A., Harland, K., Beyer, K., Dickey, P., & Saftlas, A. (2011). Rural disparity in domestic violence prevalence and access to resources.”¯Journal of Women‘s Health, 20(11), 1743–1749. https://doi.org/10.1089/jwh.2011.2891
Penney, D. (2018). Defining “peer support”: Implications for policy, practice, and research. Advocates for Human Potential. https://www.ahpnet.com/AHPNet/media/AHPNetMediaLibrary/White%20Papers/DPenney_Defining_peer_support_2018_Final.pdf
Philip, G., & Bell, L. (2017). Thinking critically about rapport and collusion in feminist research: Relationships, contexts and ethical practice. Women‘s Studies International Forum, 61, 71–74. https://doi.org/10.1016/j.wsif.2017.
002
Province of Nova Scotia. (2019). Annual accountability report on emergency departments. https://novascotia.ca/dhw/publications/Emergency_Departments_Report_2019.pdf
Ravenscroft, E. F. (2005). Access within a fragmented healthcare system: A nurse‘s perspective on Romanow. Canadian Journal of Nursing Leadership, 18(2). https://doi.org/
12927/cjnl.2005.19031
Rhode, D. L. (1990). Feminist critical theories. Stanford Law Review, 42(3), 617–638. https://doi.org/10.2307/1228887
Rotenberg, C., & Cotter, A. (2018, November 8). Police-reported sexual assaults in Canada before and after #MeToo, 2016 and 2017. Statistics Canada. https://www150.statcan.gc.ca/n1/en/pub/85-002-x/2018001/article/54979-eng.pdf?st=uZLK5Jew
Rubin, P. (2008, October). Suffering in silence: An assessment of the need for a comprehensive response to sexual assault in Nova Scotia. Nova
Scotia Sexual Assault Services Planning Group. https://novascotia.ca/coms/svs
/docs/SufferinginSilence_2008.pdf
Shah, T. I., Clark, A. F., Seabrook, J. A., Sibbald, S., & Gilliland, J. A. (2020). Geographic accessibility to primary care providers: Comparing rural and urban areas in Southwestern Ontario. The Canadian Geographer, 64(1), 65–78. https://doi.org/10.1111/cag.12557
Sharma, A., & Borah, S. B. (2020). Covid-19 and domestic violence: An indirect path to social and economic crisis. Journal of Family Violence. Advance online publication. https://doi.org/10.
/s10896-020-00188-8
Smith, K. B., Humphreys, J. S., & Wilson, M. G. A. (2008). Addressing the health disadvantage of rural populations: How does epidemiological evidence inform rural health policies and research? The Australian Journal of Rural Health, 16(2), 56–66. https://doi.org/10.1111/j.1440-1584.2008.00953.x
Statistics Canada. (2015). Rural area (RA). In 2011 census dictionary. https://www12.statcan.gc.ca/census-recensement/2011/ref/dict/geo042-eng.cfm
Statistics Canada. (2017). Income highlight tables, 2016 census [Data set]. https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/hlt-fst/inc-rev/Table.cfm?Lang=Eng&T=301&S=99&O=A
Statistics Canada. (2018). Population and dwelling count highlight tables, 2016 census [Data set]. https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/hlt-fst/pd-pl/Table.cfm?Lang=Eng&T=703&S=87&O=A
Statistics Canada. (2019). Focus on geography series, 2016 census [Data set]. https://www12.statcan.gc.ca/census-recensement/2016/as-sa/fogs-spg/Facts-pr-eng.cfm?Lang=Eng&GK=PR&GC=12&TOPIC=1
Statistics Canada. (2020). Atlantic region – Percentage of the population below the after-tax low-income measure in 2015, by 2016 census subdivision (CSD) [Data set]. https://www12.statcan.gc.ca/census-recensement/2016/geo/map-carte/ref/thematic-thematiques/inc-rev/map-eng.cfm?TYPE=3&UID=100
Sualp, K., Forgetta, S., Anderson, K., Revell, J., & Godbee, B. (2021). “Let‘s not talk about it:” Multiple perspectives on service barriers and recommendations for Black sexual assault survivors: A mixed-methods study. Journal of Social Service Research, 47(1), 118–130. https://doi.org/10.1080/01488376.2020.1725218
Tracy, K., & Wallace, S. P. (2016). Benefits of peer support groups in the treatment of addiction. Substance Abuse and Rehabilitation, 7, 143–154. https://doi.org/10.2147/SAR.S81535
Ullman, S. E. (2010). Talking about sexual assault: Society‘s response to survivors. American Psychological Association. https://psycnet.apa.org/doi/10.1037/12083-000
UN Women. (2020). COVID-19 and ending violence against women and girls [Issue brief]. https://www.unwomen.org/sites/default/files/Headquarters/Attachments/Sections/Library/Publications/2020/Issue-brief-COVID-19-and-ending-violence-against-women-and-girls-en.pdf
University of Kentucky Centre for Research on Violence Against Women (2011, December). Top ten things advocates need to know: what services do survivors of rape find most helpful, and what help do they say they need?
Whatley, M. A. (1996). Victim characteristics influencing attributions of responsibility to rape victims: A meta-analysis. Aggression and Violent Behavior, 1(2), 81–95. https://doi.org/10.1016/1359-1789(95)00011-9
Wilson, C. R., Rourke, J., Oandasan, I. F., & Bosco, C. (2020). Progress made on access to rural healthcare in Canada.”¯Canadian Journal of Rural Medicine, 25(1), 14–19. https://doi.org/10.4103/CJRM.CJRM_84_19
Women‘s Action Coalition of Nova Scotia. (n.d.). Brief From the Women‘s Action Coalition of Nova Scotia (WACNS) [Issue brief]. House of Commons Canada. https://www.ourcommons.ca/Content/Committee/411/FINA/WebDoc/WD5138047/411_FINA_PBC2011_Briefs/Womens%20Action%20Coalition%20of%20Nova%20Scotia%20E.html
Women‘s Centres Connect. (n.d.). About Women‘s Centres Connect. https://womenconnect.ca/about-wcc/
Wuerch, M. A., Zorn, K. G., Juschka, D., & Hampton, M. R. (2019). Responding to intimate partner violence: Challenges faced among service providers in northern communities.”¯Journal of Interpersonal Violence, 34(4), 691–711. https://doi.org/10.1177/08862605
