Toward a comprehensive, survivor-centered measure of barriers and facilitators to sexual assault services: findings from cognitive interviews

BMC Health Serv Res. 2026 Jul 17. doi: 10.1186/s12913-026-15131-8. Online ahead of print.

ABSTRACT

BACKGROUND: Although medical, mental health, advocacy, and legal services exist for people who have experienced sexual assault, usage rates remain low, particularly among survivors from historically marginalized backgrounds. A review of existing measures assessing barriers and facilitators to post-assault services found that existing measures had limited inclusion of facilitators and community-level and identity-specific barriers, and were rarely developed with input from people who have experienced sexual assault. To address these gaps, we used cognitive interviews to develop and refine a preliminary measure assessing barriers and facilitators to post-sexual assault service-seeking across the social-ecological model.

METHOD: We conducted five iterative rounds of cognitive interviews (N = 27) via videoconference between May 2024 and March 2025 with a diverse sample of people who had experienced sexual assault. Using verbal probing techniques, we assessed participants’ comprehension, interpretation, and responses to survey items and gathered feedback on item clarity, relevance, and coverage. Interview data were analyzed using directed content analysis within a social-ecological model that combined deductive main categories with inductively identified categories and subcategories. Items were revised iteratively across survey versions based on participant feedback.

RESULTS: Participants identified barriers that existing measures had not adequately assessed, including lack of identity and culturally affirming services, language and geographic access barriers, social stigma, mistrust of systems, fear of repercussions, and a range of mental, emotional, and physical challenges. New facilitators included integrative and wraparound service models and trust in services. Participants also identified clarity concerns related to terminology that assumed familiarity with formal service systems and item structures that combined conceptually distinct experiences. Participant feedback informed iterative revisions to improve item clarity, reduce redundancy, and expand coverage of underrepresented barriers and facilitators.

CONCLUSIONS: Cognitive interviews with people who have experienced sexual assault revealed critical gaps in how existing measures assess barriers and facilitators to post-sexual assault service-seeking. Findings also highlighted how terminology and item structure can undermine response accuracy for survivors from diverse survivor backgrounds. Psychometric validation of the revised measure is underway to support its use in research and practice aimed at improving service access for underserved survivors. Finally, these findings reflect the U.S. service, legal, and sociopolitical context in which we developed the measure and may not transfer to other settings.

PMID:42469782 | DOI:10.1186/s12913-026-15131-8