Title: Gynecological health and uptake of gynecological care after domestic or sexual violence:
a qualitative study in an emergency shelter
Version: 1 Date: 20 Dec 2023
Reviewer:  Elodie Million
Reviewer's report:
Very interesting article on a topical subject with a particular focus on the experience of women
in socially vulnerable situations. It would have been interesting to adopt a phenomenological
analysis rather than a thematic one to gain a better understanding of these women's experiences.
However, the thematisation was very thorough and the authors were able to convey the meaning
of the women's discourse using rich verbatims.
The introduction is well written and clear. The method section needs to be reviewed and clarified
and justified. Some of the results should be moved to the "results" section. A thematic tree is
missing for a clear presentation of the results.
The discussion should be more detailed, with a precise organisation: 1-answer to the research
question, 2- comparison with the literature, highlighting what the study has to offer on the
subject, 3- description of strengths and weaknesses.
The conclusion should provide a clearer outlook for healthcare professionals.
Here are my questions and recommendations line by line:
Introduction: No comments
Method :
Line 108: "Between April 2022 and January 2023, 25 semi-structured interviews were conducted
with women aged 19 to 52," These are results to be moved to the results section.
Line 111: "None of the interviews were conducted with women who presented signs of
psychotrauma, or who had therapeutic expectations from the research interview" How did
you define this absence of psychotrauma? Was it a criterion that had already been identified
quantitatively? "None" is a result unless it was an exclusion criterion: please specify the method.
Line 112: "Five women who had consented to participate in the study were lost to follow-up"
is a result.
Line 116: "lasted on average 90 minutes" This is a result. It should be moved to the "results"
section. It is also important to have the range: minimum and maximum duration, as well as the
duration of each interview in a table (this could be the table for the participants' characteristics).
Line 117: "Between one and three pre-interviews were necessary to establish a trusting
relationship between the researcher and the participant" If this is a method criterion, OK,
otherwise it is a result and should therefore be moved.
Line 123 : "Some examples of interview questions" The interview guide should be provided.
Line 126: "After verifying the accuracy of the transcription", i.e. how did you check it?
Line 128: "until data saturation" Did you confirm saturation and, if so, how?
Line 135: "figure1" You are in the method section. The figure should only clarify your analysis
method with an example of verbatim, coding, sub-themes and themes, and not provide all the
results.
Line 140: "Close interaction with the interviewees ensured the consistency of the data, while
taking care not to confront them with a verbatim that was difficult to listen to or read." I don't
understand your sentence, please reword it
Line 142: "The professional backgrounds of the four authors, who combine experience in
sexual and reproductive health (EI, JPM, IB) and forensic medicine (PC), have enriched data
collection and analysis." It is customary, on the contrary, to distance oneself from one's own
experience as a researcher in order to allow the data to emerge from the verbatims without
losing the sense of what the participants wanted to say. Please explain how the experience of
the researchers enriched the collection and analysis of the data without losing the meaning of
what the participants said.
Results
Line 146: "The majority of participants were in a vulnerable social situation...". This is
quantitative data. There was no mention of this in the method: please correct. In addition, the
"results" section should start with the number of interviews and, if you add the pre-interviews,
this should be specified in detail somewhere. The length of the interviews is missing from the
summary. In the method, you need to specify what you consider to be a recent social migration
situation.
Line 148: "For some, speaking in French or English was difficult when it was not their mother-
tongue. How did you manage this difficulty?
Line 152 : A thematic tree would be recommended as part of a thematic analysis to present a
summary of the results.
Line 342: "In addition to lack of knowledge and vision of the care pathway in France, which led
them not to seek gynecological care, any such care was associated with pelvic examination and
coercive control by the perpetrator" Sentence too long to cut out to make it easier to understand.
Line 360: "In addition to social vulnerability leading to limited financial resources for specialised
care, the choice not to care was also due to low self-esteem and lack of capacity to deal with the
consequences of a diagnosis of gynecological illness, in a context where they did not wish to
add negative events to an already chaotic and complex life." Idem: sentence to be shortened
Discussion
Line 411: "discussion". Please restructure this paragraph as recommended in my previous
comment: 1-answer to the research question, 2- comparison with the literature, highlighting what
the study brings to the subject, 3- description of strengths and weaknesses.
Line 445: "In France, the National Health Authority recommends screening for domestic
violence [37], as have international learned societies [38,39]. However, there is no French
medical recommendation on screening for a history of sexual violence in adult women,
as opposed to other countries like the US [40,41]. This study also led to question the
appropriateness of practices around gynecological examination. In the US, the UK and Australia,
the indications of pelvic examinations are well defined [42-44]. Any gynecological examination
should be carried out within the framework of an equal relationship between caregiver and
patient, for the general population and for women with a history of violence. paragraph to be
switched to discussion instead