“I Just Have to Go and Heal”: A Qualitative Study on the Acceptability of the Belgian Sexual Assault Care Centres for Victims of Recent Sexual Assault

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This study highlights the main aspects to concern when providing comprehensive multidisciplinary services for victims of recent sexual assault. The model developed in Belgium seems to be highly recommended and acceptable. In addition, it is very important to assess the effectiveness of the services. The Sechon’s Theoretical Framework of Acceptability is a reasonable framework for this assessment.

The manuscript is clear, relevant to the field, and presented in a well-structured manner. The cited references are mainly recently published and relevant. Manuscript does include some relevant self-citations, but not in an excessive number. Figures and tables are appropriate and properly present the data in an easily understandable manner. Ethics and data availability statements are adequate.

My main concern and critique for this manuscript concerns discussion of the bias. The main problem in surveys and interviews is that people who are very satisfied or highly unsatisfied with their services will answer. In this population, those who were very disappointed or did not even use the services after their first visit, partly because of the avoidance and other trauma reactions, never answer this kind of survey. This phenomenon leads to both selection and confirmation bias. These should be discussed more thoroughly in this manuscript.

Some detailed comments:

Lines 135-160: More detailed data on possible study participants and the selection of participants are needed for assessment of the bias. How many clients were treated during the study period? Were all clients informed about the study? During the study period three SACCs were open – do the participants represent all SACC clients geographically? How many clients were excluded because of language and other reasons? Study participants “were purposively selected by the researchers, applying principles of maximum variation and gradual selection” – how it succeeded, was the sample representative? Sentence “Forty-four of those contacted participated in an interview or focus group discussion” is somewhat confusing – were the interviews individual or group interviews?

Lines 164-169 and 718-720, Supplementary materials, Topic guide: How was a topic guide developed? Were the questions based on some validated questionnaire or developed by the researchers themselves? In discussion section could be few words of the questionnaire – Was the questionnaire appropriate to get all the information available, also the critical answers? You got, or at least reported, quite few critical comments from participants, and this is limitation and should be discussed.

Lines 673-681, Study limitations and strengths: Abovementioned sources of bias should be discussed in more detail in this section. Interviewing the support persons is a very good way to decrease the selection bias, but the risk for the bias is still very high. What would have been the answers of the clients who did not use the SACC services at all, or did not attend the follow-up? Did you had any critical comments or hints of obstacles from the interviews?

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors,

Thank you for sharing this important and timely qualitative evaluation of the Belgian Sexual Assault Care Centers (SACCs). It has been an honor to read the manuscript. The study is methodologically competent and clearly policy-relevant, and the use of Sekhon et al.’s Theoretical Framework of Acceptability (TFA) provides a strong foundation beyond satisfaction-oriented accounts.

My overall recommendation is Major Revision, primarily to strengthen the paper’s conceptual and interpretive architecture rather than to redesign the study. In my comments, I focus on three areas: (1) sharpening the theoretical contribution so TFA operates as an analytic lens (not only a coding structure), ideally by articulating a small number of conceptual insights that the trauma-informed, healthcare–justice interface reveals about acceptability; (2) expanding reflexivity/positionality to transparently address author proximity to SACC design/evaluation and the safeguards used to support trustworthiness; and (3) clarifying how support-person interviews were handled analytically and how proxy accounts are distinguished from first-person victim perspectives, including whether patterns converged or diverged across groups. I also recommend small language refinements to keep claims proportionate (acceptability vs effectiveness), and a brief acknowledgement of inclusivity limits (e.g., language and representation) alongside complete ethics reporting.

I appreciate the care evident in the study and believe these revisions will meaningfully strengthen clarity, credibility, and contribution. I look forward to reading the revised version.

Sincerely,

Comments for author File: Comments.pdf

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors,

Thank you for the careful revision of the manuscript. The paper has improved substantially, and it is clear that the reviewers’ comments have been thoughtfully and thoroughly addressed.

The revisions have strengthened the manuscript’s clarity, methodological transparency, and overall coherence. I have no further comments at this stage.

Overall, this is a much stronger version, and the manuscript appears ready for publication.

Kind regards,
Reviewer