Multi-disciplinary Evaluation of Sexual Assault Referral Centres (SARCs) for better Health (MESARCH): protocol for a 1-year cohort study examining health, well-being and cost outcomes in adult survivors of sexual assault attending SARCs in England

Lorna O'Doherty, Grace Carter, Eleanor Lutman-White, Rachel Caswell, Louise Jackson, Gene S. Feder, Jon Heron, Richard W. Morris, Katherine Brown

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    Introduction Sexual violence is commonplace and has serious adverse consequences for physical and mental health. Sexual Assault Referral Centres (SARCs) are viewed as a best practice response. Little is known about their effectiveness and cost-effectiveness. Long-term data on the health and well-being of those who have experienced rape and sexual assault are also lacking. Methods and analysis This is a mixed-methods protocol for a 1-year cohort study aiming to examine the health and well-being in survivors of sexual violence after attending a SARC in England. Quantitative measures are being taken at baseline, 6 and 12 months. Post-traumatic stress (PTS) is the primary outcome (target N=270 at 12-month follow-up). Secondary measures include anxiety, depression, substance use and sexual health and well-being. Using mixed-effects regression, our main analysis will examine whether variation in SARC service delivery and subsequent mental healthcare is associated with improvement in trauma symptoms after 12 months. An economic analysis will compare costs and outcomes associated with different organisational aspects of SARC service delivery and levels of satisfaction with care. A nested qualitative study will employ narrative analysis of transcribed interviews with 30 cohort participants and 20 survivors who have not experienced SARC services. Ethics and dissemination The research is supported by an independent study steering committee, data monitoring and ethics committee and patient and public involvement (PPI) group. A central guiding principle of the research is that being involved should feel diametrically opposed to being a victim of sexual violence, and be experienced as empowering and supportive. Our PPI representatives are instrumental in this, and our wider stakeholders encourage us to consider the health and well-being of all involved. We will disseminate widely through peer-reviewed articles and non-academic channels to maximise the impact of findings on commissioning of services and support for survivors. Trial registration number ISRCTN30846825.

    Original languageEnglish
    Article numbere057449
    Number of pages11
    JournalBMJ Open
    Issue number5
    Early online date24 May 2022
    Publication statusPublished - 24 May 2022

    Bibliographical note

    This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made.

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    © 2022 BMJ Publishing Group. All rights reserved.


     Contributors LOD conceived the study design with support and input from GF, RM, RC, LJJ and KB. RM paid particular attention to designing the analysis plan and LJJ to designing the health economics plan. LOD led the successful application for funding with contributions from GF, RM, RC, LJJ and KB. GC supported by ELW oversees recruitment and data collection and LOD oversees the preparation of data in readiness for analysis. RM drafted the original cohort study analysis plan which was updated by JH. GC leads the children and young people’s study. KB leads the nested qualitative study. KB drafted the manuscript based on the approved study protocol V3.3 and all co-authors read, contributed to re-drafting and approved the submitted manuscript. All authors have agreed to be accountable for all aspects of the work. Funding This work is supported by the National Institute for Health Research (Health Services & Delivery Research programme) grant number 16/117/04. Disclaimer The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Competing interests None declared. Patient and public involvement Patients and/or the public are involved in the design, conduct, reporting, and dissemination plans of this research. Refer to the Methods section for further details


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