Title: Barriers and Facilitators to Accessing Post Sexual-Based Violence Health Services among
Young Women Attending Higher Education Institutions in Nigeria
Version: 4 Date: 02 Oct 2024
Reviewer's report:
Thank you for the opportunity to review this paper. The study focused on knowledge of GBV
and post-sexual-based violence health services among students of higher institutions. It also
explored the students’ perception about post-SBV service awareness, availability, accessibility,
and competency. This is a timely study given the increasing cases of sexual violence, with
women disproportionately affected.
Below are my comments:
Major comments:
Line 112: The paper should show how the sample size for the study was determined or calculated.
This is important even for a purposive sampling technique. The pre-determined sample size will
provide information on the response rate. For instance, the study could have a sample size of
150, with 114 as the number of returned questionnaires/responses, giving a response rate of 76%
Lines 120-121: I am wondering how the study ensured that only students of higher institutions
completed the questionnaire since general social media platforms were used to disseminate the
tool. Can this be included in the paper?
Lines 134-137: It is unclear if the study excluded students who have never experienced any
form of violence as noted in this sentence. The questionnaire does not show this, neither did the
information sheet (who can take part)
Lines 208-211: Presenting this on a Table would aid in the correct interpretation of the results.
Currently, one is unsure of the exact number and proportion of participants who selected each
form of violence studied. For instance, the paper stated that 89 of the respondents identified
physical and sexual violence and put the proportion at 89%, whereas 89 respondents out of 114
would give 78.1%. The paper needs to also clarify why the responses for physical and sexual
violence were combined.
Lines 235-236: The n for those who are aware of contraceptives in the paper is lower than the
total number of those who responded (Yes/No/Not sure is 105/3/2, making a total of 110). This
needs to be clarified.
I am wondering why the sample size (denominator) for the questions on the utilization of
contraceptives, PEP, EC, and condom is not limited to those who responded “yes” to the question
on awareness of these service provision? For example, if I am not aware of contraceptives,
should I be able to answer the question on the usage? Additionally, using the size of those who
are aware as the denominator will provide a better picture of how awareness relates to utilization.
For instance, 70 respondents were aware of EC. Of this, 23 (32.9%) had used it. In the paper,
only condoms took this into account: 107 respondents were aware of condom and only the same
number responded to the question on utilization.
“Indicate if you have ever been concerned or worried about your health and well-being while
or after having sex with a partner (n=109)”.
“Indicate if you spoke to anyone about it (n=95)”
“Indicate if you got support from a SBV-health service facility (n=77)”
It is unclear how the sample size for the above three questions was determined. Were they asked
of all the respondents or limited to only those who earlier responded to having had intercourse,
those who were concerned or worried, and those who spoke to someone about it, respectively?
The paper needs to be clear on this. The questionnaire also shows that these questions had a skip
pattern but I have not been able to observe that this was done in the reporting.
Lines 276-281: There is a discrepancy between the way the barriers were measured in the
paper and the questionnaire used for the study. The latter describes a scale of 1-7 while the
earlier reports 1-5. The description and reporting of the rating in lines 279-281 is also not clear.
Additionally, the scale not at all through to being very much as stated in the paper sounds more
appropriate for the study which did not focus on only those who have experienced any form of
violence compared to most experienced and least experienced used in the questionnaire. This
needs clarity.
Lines 410-413: My opinion is that the Tanzania Study does not sufficiently compare well with
your findings. There are many studies that looked at GBV knowledge among undergraduate
students/young adults that can be used to support your findings or otherwise. Read through the
following and compare with your findings:
https://www.researchgate.net/publication/361954642_Knowledge_and_Incidence_of_Gender-
Based_Violence_among_Young_Adults_in_the_South-
South_Region_of_Nigeria_A_Comparative_Study
https://www.calebuniversity.edu.ng/oer/storage/2022/07/no10-c19de0eb.pdf
https://www.ajhssr.com/wp-content/uploads/2019/08/R1938135145.pdf
https://doi.org/ 10.3126/njmr.v5i1.44615
https://www.researchgate.net/
publication/382915442_Campus_Voices_University_Students'_Awareness_of_Gender-
based_Violence_Against_Women_Girls_and_Children
Conclusions: I think  the conclusions have been generalized beyond the direct findings of the
study.
References: Some of the references are incomplete and cannot be ascertained. For example,
references 2-4 are incomplete (no title, URL, place of publication).
Minor comments:
Lines 84-88: The sentences appear to be making a case for training health service providers/
workers on documenting SBV services, which is not the focus of the study to investigate the
factors associated with the underutilization of SBV services.
Lines 89-90: The sentence does not connect well with the previous paragraph (lines 84-88).
These lines should be moved to after line 84. Also, it does not depict that the study has been
conducted (currently in future tense) Consider: This study explored the barriers and facilitators
in accessing…
Results (lines 240-257): The paper needs improvement for conciseness, flow, clarity, line
spacing, and punctuation. For example, see an excerpt from the paper (below) and a suggested
rephrase (in inverted commas)
About a half (50.9%) and (20.5%) of respondents, respectively, strongly agreed and agreed that
a Post-SBV health service should be the first place to go following rape.  When asked whether
healthcare workers (HCWs) can prevent SBV from re-occurring, (23.2%) respondents strongly
agreed.  (33.9%) and 35 (31.3%) respondents respectively agreed and were neutral about the
statement, Also, less than half of the respondents (39.6%) strongly agreed, and (38.7%) agreed,
that HCWs are available to offer PEP to prevent HIV following rape.
"About one-fifth (20.5%) and half (50.9%) of the respondents agreed and strongly agreed that
a post-SBV health service should be the first place to visit following rape, respectively. A total
of 23.2% strongly agreed and 31.3% agreed that healthcare workers can prevent SBV from
re-occurring. One-third (33.9%) of them were however neutral about this statement. Majority
(78.3%) of the respondents either strongly agreed (39.6%) or agreed (38.7%) that HCWs are
available to offer PEP for the prevention of HIV following rape".
Lines 130-143: This dwells a lot on the studies from which the questionnaire was adapted. I
think this should be summarized so that it does not take focus away from your own study. Lines
128-130 may be sufficient to describe this. If specifics are essential, they can be summarized.
For example: The questionnaires from the Tanzania studies were adapted to develop the
knowledge, opinion about GBV health services, and the barriers and facilitators constructs while
the study from Kenya was used to develop questions on factors that could improve access to
GBV health services.
Lines 162-164: I think these should be reviewed for clarity. Consider:
The questionnaire was piloted among 5 undergraduate students and the findings were used to
review the tool and produce a final version that was administered to the participants.
Line 165: It might be better to streamline the data analysis to the statistical tool used and the
tests conducted with the tool. Information such as the Likert scale and the response options for
knowledge questions can be reported under measures.
Lines 197-198: What informed the age categorization of below 16, 16-20, and
21-24 year? Since the age of sexual consent in Nigeria is 18 years, according
to the Child Rights Act (chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://
www.nigeriarights.gov.ng/files/childrightact.pdf), it might be nice to have a below 18 category
to show if there are reported sexual activities with minors and look at their perception of whether
the act was consensual or not.
Line 202:  Age categorization on Table 1 should include those below 16 years. There is a
discrepancy between the proportion of those who had no sexual intercourse within the listed age
category that was reported on the Table (65.1%) and on line 198 (65.8%). Furthermore, the not
applicable (on the table)/did not have their first intercourse within any of the highlighted age
categories (line 198) does not provide enough information/clarity on whether they had never
had sexual intercourse (which would justify the not applicable), had sexual intercourse but not
within the highlighted age categories (which would be unlikely since the age category matches
the age at sexual debut), and/or did not answer the question. However, since the upper limit of
the studied age category is 24 years, it is probable that some of them did not respond to this
question, or they have never had sex. This should be clarified in the paper.
Lines 210-211: Can the authors clarify the need for this statement? If this was presented on a
Table, then I agree to its importance. Without that, I suppose a full description of the responses
in prose should be sufficient. The paragraph can start with: Respondents were asked to identify
violence that can be experienced in an intimate partner relationship. Majority….stated that….,
78.0% identified…
Lines 258-270: Depicting the results on either a Table or in a figure should be sufficient, rather
than the two. I think the authors should choose one.
Line 240: Please check the discrepancy between the proportion of respondents who agreed to
the statement in line 240 and Table 3.
Lines 308-350: I believe these lines should come before figure 2, which is supposed to support
the prose presentation of the result. In addition, I think this can be made more concise yet
informative in order to have a snapshot of the proportion of respondents’ perception of each
barrier. This applies also to the facilitators. The authors may consider this review. For example
(in italics):
Over half of the respondents viewed that stigma and shame (58.1%), lack of support systems to
facilitate visits to post-SBV health services (54.1%), and lack of awareness of existing post-SBV
health services (53.3%) were very important barriers to accessing post-SBV health services.
Forty-one percent, 40.9%, and 37.8% mentioned financial barrier, fear of reporting offender, and
negative and unfriendly attitude, including distrust of health care providers as very important
barriers, respectively. About one-third of the respondents also stated that fear of HIV testing
(33.3%) and distance to SBV health service facility (32.7%) were the very important barriers.
Only one-fourth (25.2%) rated belief that violence was normal as a very important barrier.
Lines 276-281: There is a discrepancy between the way the barriers were measured in the
paper and the questionnaire used for the study. The latter describes a scale of 1-7 while the
earlier reports 1-5. The description and reporting of the rating in lines 279-281 is also not clear.
Additionally, the scale not at all through to being very much as stated in the paper sounds more
appropriate for the study which did not focus on only those who have experienced any form of
violence compared to most experienced and least experienced used in the questionnaire. This
needs clarity.