Women Higher Education Students' Experiences of Sexual Violence: A Scoping Review and Thematic Synthesis of Qualitative Studies

Sexual violence (SV) against women is common in higher education settings, causing serious harm to the health, well-being, and academic outcomes of victim/survivors. There have been numerous systematic reviews of the quantitative evidence on this topic, highlighting the prevalence, health impacts, and barriers and facilitators to help-seeking after SV. To date, however, qualitative research exploring the lived experience of women higher education students has not been synthesized. This scoping review and thematic synthesis of qualitative studies aims to map the global evidence on women higher education students' experiences of SV and explore how they understand and make sense of their experiences. We searched five databases (CinAHL, Academic Search Complete, Medline, PsychInfo, and SocIndex) in January 2023 for relevant articles. Eligible articles needed to be published in English and describe qualitative or mixed-methods primary research on the lived experiences of women higher education students who were victim/survivors of SV. In all, 34 articles describing 32 studies met these inclusion criteria. Thematic analysis of data extracted from the included studies suggests that, for women higher education students, the experience of SV is characterized by profound shame, with often-irreversible impacts on hopes and plans for the future. Yet, at the same time, SV is normalized and expected as a part of the "student experience." Furthermore, an imagined "specter" of "real violence" is held up as a constant comparison that serves to minimize and trivialize their experiences. These findings have important implications for higher education providers seeking to improve programs to address SV.

Factors Associated with Growth in Sexual Violence Survivors: A Systematic Scoping Review

Sexual violence has been defined as any sexual act perpetrated against someone's will. Sexual violence has many negative consequences for the victims. The most prevalent mental health issue in victims is posttraumatic stress disorder. However, a new trend in positive psychology suggests that many survivors of traumatic events, in addition to negative repercussions, adapt and develop positive personal changes, i.e., Posttraumatic growth (PTG), to mitigate their impact. This review explores the literature on posttraumatic growth among survivors of sexual violence. The review follows 5 stages of Arksey and O'Malley's framework of scoping review. 6 databases were searched using indexed terms. Approximately 65 articles were initially identified and evaluated in the preliminary search using the specified keywords. Of those retrieved, 16 met the criteria and were included in this study. Posttraumatic stress, Control over Recovery, Social Support, and Spirituality/Religiosity were the significant factors for PTG. The results suggest that fostering social support, spirituality, and a sense of control over recovery can facilitate PTG, highlighting the importance of holistic approaches in promoting resilience after trauma. Implications for practice, policy, and future directions are discussed.

"I Could Never Tell My Parents": Barriers to Queer Women's College Sexual Assault Disclosure to Family Members

Queer women are at high risk of college sexual victimization, but they face barriers to formal support services. As a result, informal support is critical. This study uses data from 40 open-ended interviews to explore family members' reactions to queer women's disclosures and examine whether their family is a reliable source of informal support. Findings indicate that family reactions are often more harmful than helpful. In comparison to research focused on heterosexual survivors, we find family reactions to be more extreme and disparaging of queer survivors' sexual identities. In fact, family members' negative reactions may pose barriers to accessing formal services.

Alcohol Use Before Sexual Violence and Cognitive Appraisals: Differential Associations With Barriers to Help-Seeking

The current study examined two cognitive appraisals-labeling (identifying an unwanted sexual experience as sexual violence) and self-blame-as potential mechanisms between survivor alcohol use before sexual violence and three help-seeking barriers (minimization, negative treatment, and social-emotional barriers) among non-service-seeking sexual violence survivors. Participants were 141 undergraduate women who completed self-report measures. Three parallel mediation models were tested. Survivors who were drinking were more likely to label their victimization as sexual violence and, in turn, perceived fewer minimization and greater social-emotional barriers. Further, survivors who were drinking blamed themselves more and, in turn, perceived greater negative treatment and social-emotional barriers.

Female victims of acquaintance rape in college: Incidence and effects of encounters with perpetrators

Objectives: Acquaintance rape is the most common type of rape perpetrated against college women, but little information exists on later encounters with the perpetrator, lifestyle changes, and symptoms of posttraumatic stress disorder (PTSD). Participants: The sample consisted of 463 college-attending females, 16% of which indicated they were raped since attending college. Methods: The current study examines the incidence and effects of acquaintance rape perpetrated against female college students at a large, public university in the southeastern United States. Results: Eighty-four percent of the women who indicated they had experienced a rape since attending college knew their perpetrator, and 65.5% encountered their perpetrator after the attack. Participants who encountered their perpetrator after the attack reported more lifestyle changes and higher PTSD symptom severity on the PTSD Checklist for DSM-5 (PCL-5). Conclusions: The current research suggests that the effects of acquaintance rape in college is a complicated area needing further research. There is evidence to support negative effects on victims based on interactions with perpetrators.

Responding to Disclosure of Sexual Assault: The Potential Impact of Victimization History and Rape Myth Acceptance

Victims of sexual assault often disclose their victimization experiences to friends and family members in the hope of gaining support. However, a number of factors may influence the manner in which these confidants respond to the disclosure (e.g., severity of the victim's assault). The purpose of this study was to examine the role of two unique factors-the disclosure recipient's sexual victimization history and endorsement of rape myths-in predicting responses to disclosure. Participants were 114 undergraduate students who indicated that a close friend or family member had previously disclosed a sexual victimization experience to them. The participants' responses to that disclosure, personal sexual victimization history, and rape myth attitudes were assessed via a self-report. Results indicated that a history of victimization predicted increased emotionally supportive responses to disclosure. Lower rape myth acceptance predicted increased supportive responses (i.e., emotionally supporting the victim and aiding the victim) and decreased unsupportive responses (i.e., treating the victim differently after the abuse, distracting the victim from the abuse, and blaming the victim). These results have implications for prevention efforts and those working with sexual assault survivors.

"You Should Have Known Better": The Social Ramifications of Victimization-Focused Sexual Assault Prevention Tips

Common sexual assault prevention strategies emphasize individuals' responsibility to protect themselves from victimization. Using a feminist theoretical approach, the present study was the first to assess the unintended, negative consequences that result when taking a victimization-focused approach to sexual assault prevention. Participants (N = 321) were primarily heterosexual, Caucasian undergraduate students from a Western postsecondary institution. A between-participants experimental design was employed, whereby participants were randomly assigned to one of three conditions: (a) victimization-focused prevention tips (n = 114; e.g., "Be alert and aware of your surroundings"); (b) perpetration-focused prevention tips (n = 103; e.g., "Don't slip any unwanted substances into drinks at bars or parties"); or (c) study tips for control purposes (n = 104; e.g., "Take a ten-minute break every hour"). Following prevention tip exposure, participants read a sexual assault vignette and completed measures of victim culpability and several related constructs (i.e., ambivalent sexism, belief in a just world, and rape myth acceptance). Results indicated that participants who received victimization-focused prevention tips attributed significantly more blame to the victimized woman in the vignette than participants in both the control condition and perpetration-focused condition. Based on these results, it is recommended that social institutions further evaluate the efficacy and unintended consequences of prevalent victimization-focused sexual assault prevention strategies. Specifically, institutions should consider the implications of endorsing strategies that are evidenced to enhance victim blame, thereby perpetuating rape culture. Prevention strategies that engage bystanders and seek to prevent perpetration should be considered as an alternative approach.

I'm Just a Person: Self-Labeling Following Sexual Assault

OBJECTIVE

The purpose of this study was to examine college women's self-labeling as a victim or a survivor following a sexual assault and describe the relationship of self-labeling with mental health, self-blame, control over recovery, and help-seeking.

METHODS

This cross-sectional study collected data in an online anonymous survey in November and December of 2018. Participants (N = 375) were recruited from two public universities, were 18- to 24-year-old undergraduate students, identified as female, and had experienced a sexual assault since entering college.

RESULTS

Most respondents (46.4%, 174/375) chose labels other than victim or survivor. Statistically significant differences were found between choice of label (survivor, victim, or other) and depression, well-being, characterological self-blame, and perceived control over recovery. Short-answer responses revealed three major themes for alternative labels: choosing no label, normalizing, and seeking congruence.

CONCLUSION

As when caring for a patient with any diagnosis, nurses and other healthcare providers should see a person-not a patient, a survivor, or a victim.

"I've Never Told Anyone": A Qualitative Analysis of Interviews With College Women Who Experienced Sexual Assault and Remained Silent

The purpose of this study was to gain an understanding of the decision made by some college women who are raped to tell no one. In-depth interviews were conducted with 15 college women between the ages of 19-24 who had never shared their sexual assault with anyone prior to speaking to the researchers. This study provides a systematic investigation of the factors underlying women's decisions to remain silent. The knowledge and understanding gained from these in-depth interviews offer insight for individuals and institutions to support these students and for the development of future efforts encouraging women survivors to tell someone.

Resource Use After Unwanted Sexual Experiences in Undergraduates: A Comprehensive Evaluation of Factors Related to the Decision to Seek Help

The risk for sexual victimization in college is high, and although there can be significant mental and physical consequences for the survivor, resource utilization for this issue is extremely low. The current study used the frameworks of both the ecological model and the theory of planned behavior to examine factors related to resource use in undergraduate survivors of unwanted sexual experiences. The sample consisted of 217 undergraduates who reported at least one unwanted sexual experience while in college (89% female, 76.5% Caucasian, M age 19.6). Data were collected in an online survey from a private liberal arts college, and were analyzed using decision tree modeling. Results suggested that resource use was less related to demographic or event characteristics, but rather related to victim response to the event as well as perceptions about control over potential resource use. In addition to key assault prevention efforts, it is thus important to also support survivor mental health and self-efficacy postassault.

Undergraduates' Disclosures of Unwanted Sexual Experiences: Who, Why, and When?

This study evaluated patterns of sexual assault disclosures as well as the response and impact of that response on assault survivors. The sample consisted of 217 undergraduates with a history of sexual assault (89.5% female, 76.5% Caucasian). Participants reported the order in which they disclosed and the nature and impact of the response they received. Results indicated that the majority of participants told close peers first and perceived the first response to be supportive. These findings are encouraging but also demonstrate the need for improving the response that an assault survivor receives.

Sexual Violence Victimization Among College Females: A Systematic Review of Rates, Barriers, and Facilitators of Health Service Utilization on Campus

To date, little work specifically addresses empirical studies concerning barriers and facilitators to health service use among college female sexual violence victims. The following objectives were addressed: (1) analyze studies of college-aged women who have been victims of sexual violence to examine the frequency and moderating characteristics of utilization of university-based resources available, (2) identify inconsistencies and gaps in the literature concerning sexual victimization and service utilization, and (3) provide next steps for researchers and clinical care coordinators. Six electronic databases were searched from 1990 to May 2016. Inclusion criteria for the review were (1) university or college setting or sample, (2) empirical design, and (3) inclusion of some discussion or measurement of health service use. Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) procedures, 22 articles were identified for the review. Although prevalence rates of sexual victimization were high (4.7-58%), rates of service utilization were lower (0-42%). There were significant discrepancies between hypothetical use of services and actual rates of service use. Identified barriers included feelings of shame, guilt and embarrassment, not wanting friends and family to find out, and thinking the victimization was not serious enough to report. Identified facilitators included acknowledging the sexual violence victimization as a crime, receiving encouragement from friends and family to utilize health services, and receiving a positive response during the initial informal disclosure. Finally, measurement of victimization was inconsistent across studies. Recommendations are offered for college campus prevention programming and future research.

Occupational Well-Being in Sexual Assault Victims and Survivors

Purpose: While researchers have established that sexual assault may adversely affect successful employment and academic achievement, little is known about the barriers and facilitators of occupational well-being from the perspective of sexual assault survivors. This study assessed the barriers and facilitators of occupational well-being. Design: Constructivist grounded theory. Method: Digitally recorded, semistructured interviews were used to collect data. Data were collected from 22 adult female sexual assault survivors. Analysis consisted of coding, creation of data matrices, and within and across case analysis. Findings: Theoretical saturation was achieved after interviews with 22 participants. Barriers to occupational well-being were mental health symptoms and diagnoses, substance abuse, inflexible attendance policies, and workplace bullying. Facilitators to occupational well-being were personal coping strategies, and organizational and social support. Conclusions: Sexual assault has significant effects on the occupational well-being of women. The work or academic environment can exacerbate the harms of sexual assault or facilitate healing in sexual assault survivors. To facilitate the occupational well-being of sexual assault survivors, workplaces and academic institutions can adopt a trauma-informed approach, create policies that allow for time off to deal with sequela of sexual assault, implement anti-bullying programs, and make resources for gendered violence available.

Service seeking experiences of college-aged sexual and intimate partner violence victims with a mental health and/or behavioral disability

OBJECTIVE

To examine mental health service experiences following sexual violence (SV) and intimate partner violence (IPV) victimization among college women with a disability.

PARTICIPANTS

College women (n = 27, ages 19 to 24) with a disability who experienced at least one SV/IPV occurrence; interviewed July/August 2016.

METHODS

Qualitative study using in-depth interviews, with thematic analysis.

RESULTS

Women tended to wait several months (or did not seek care at all) following SV/IPV, because they downplayed their experience (e.g., not wanting to label an experience as "rape"). Those seeking services primarily did so because of escalating mental health concerns. Among service seekers, women were satisfied when professionals validated their experiences/concerns; and were dissatisfied when faced with extended wait time for care and/or professionals unskilled with SV/IPV and mental health. However, women still sought care following negative experiences.

CONCLUSIONS

Improved access to integrated care for SV/IPV and mental health, along with skilled professionals, is essential.

An Ecological Model of Well-being After Sexual Assault: The Voices of Victims and Survivors

In this article, the authors describe factors that enhance or detract from well-being after adult sexual assault from the perspective of sexual assault victims and survivors. The authors present a holistic view of the complex ways in which women respond to and cope with the impact of adult sexual assault while trying to create a sense of well-being. The forces that facilitate or detract from well-being are organized into an ecological model. The data originate from a grounded theory study in 2015, with 22 adult female adult sexual assault victims/survivors.

Sexual violence screening practices of student health centers located on universities in Florida

OBJECTIVE

The purpose of this study is to describe current sexual violence screening practices of student health centers located on universities in Florida.

PARTICIPANTS

Institutional level data was collected from 33 student health centers from November 2015 through January 2016. The student health centers were located on public or private universities.

METHODS

A cross-sectional descriptive study design was used. Data was collected from student health center representatives through use of a telephone administered survey.

RESULTS

Findings reveal that the majority of student health centers screen for sexual violence. However, not all use effective screening strategies. Further, the majority of screening questions used are not specific to sexual violence.

CONCLUSIONS

Findings can be used to assist universities with responding to campus sexual violence among the college population. Recommendations for strengthening sexual violence screening practices and future research are provided.

"It Happens to Girls All the Time": Examining Sexual Assault Survivors' Reasons for Not Using Campus Supports

Sexual assault is a prevalent problem in higher education, and despite the increasing availability of formal supports on college campuses, few sexual assault survivors use them. Experiencing sexual assault can have devastating consequences on survivors' psychological and educational wellbeing, which may intensify if survivors do not receive adequate care. Drawing from existing theoretical frameworks and empirical research, this study used a mixed methodological approach to examine why survivors did not use three key campus supports-the Title IX Office, the sexual assault center, and housing staff-and if these reasons differed across the three supports. Using data from 284 women who experienced sexual assault in college, our qualitative findings identified four overarching themes, including logistical issues (e.g., lacking time and knowledge), feelings, beliefs, and responses that made it seem unacceptable to use campus supports, judgments about the appropriateness of the support, and alternative methods of coping. Quantitative findings revealed that survivors' reasons for not seeking help differed across supports. Collectively, our findings suggest that community norms and institutional policies can make it challenging for survivors to use campus supports. We propose several suggestions for institutional change (e.g., taking a stronger stance against "less serious" forms of sexual assault, reducing a quasi-criminal justice approach to investigation and adjudication, limiting mandated reporting).

Posttraumatic Growth and Sexual Violence: A Literature Review

Posttraumatic growth (PTG) is the positive psychological growth that a person might experience after enduring a traumatic event. PTG is a relatively new area of research identified by researchers because it represents a shift in thinking. Rather than focusing on the negative consequences of trauma, it explores the potential for positive outcomes associated with trauma. Although PTG is well documented across different types of traumas, it is unclear how this kind of growth stems from sexual violence, specifically. This review provides an overview of the literature concerning PTG that is associated with sexual violence. Results across the literature indicate that sexual violence is consistently associated with PTG. However, given the inconsistency in research designs, assessment, and operational definitions used to study PTG, many researchers suggest that it might be difficult to determine how and when PTG occurs. This study provides a literature review of the research on PTG in the aftermath of sexual violence. Important implications for future directions and trauma-based therapy are discussed and include the identification of relevant predictors, the importance of context, and how service providers might benefit from a better understanding of PTG.

A Review of Sexual Assault Information on College Web Sites

This article presents a comprehensive review of information available on campus Web sites at all four-year colleges and universities in New Jersey. This study used a descriptive, content analysis methodology with a sample that consisted of 28 college and university Web pages. To evaluate the Web sites, ecological approaches were rated with a checklist created to document the presence and extent of information about sexual assault, including five key areas: (1) general information about sexual assault, (2) the availability of services for students, (3) information about how to report an incident of sexual assault, (4) whether there was a department exclusively dedicated to the school's response to sexual assault, and (5) information about the existence of a policy prohibiting sexual assault on campus. Almost all of the schools provided policies and information about services for students. However, the comprehensiveness of the information and the ease of finding it varied greatly by campus. The article concludes with a discussion of the implications for social workers and those responding to survivors of sexual assault on a college campus.

Campus and College Victim Responses to Sexual Assault and Dating Violence: Disclosure, Service Utilization, and Service Provision

After sexual assault or dating violence occurs, a college victim may disclose the event to formal and informal sources as well as seek services. The current review explores empirical research on formal disclosure, informal disclosure, service utilization, and service provision among college students. Forty-five empirical articles and reports that met certain criteria were reviewed. Overall, rates of informal disclosure were considerably higher than rates of formal disclosure. Characteristics of the incident, victim, and offender were associated with disclosure. Rates of service utilization were varied but appear to be low among those victimized in the past year. When services were used, physical and mental health services were most often utilized. Available services, policies for dating violence and sexual assault, and judicial processes varied according to the type of institution, and indicate several areas for improvement. A number of research, practice, and policy implications emerge from this critical review of the literature.