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Abstract

Sexual violence (SV) is an insidious social phenomenon that results in physical, emotional, and psychological trauma. The aim of this article is to review the research pertaining to SV in regional, rural, and remote Australia. A systematic scoping review was undertaken using the Arksey and O’Malley five-step framework. A total of 25 articles were included in the review and appraised using the Mixed Methods Assessment Tool. Thematic analysis was undertaken to report the findings. This review highlight several key points: (a) similar findings resonated across all articles included in the review (published between 1996 and 2024), suggesting that despite public health and other campaigns highlighting gendered sexualized violence, little meaningful change has occurred, (b) the pervasive nature of SV in rural, remote, and regional Australia with some forms of SV being more prevalent than in metropolitan and urban areas, and (c) there are a multitude of noteworthy challenges of SV in rural and remote Australia, including barriers to disclosure and help-seeking. Problems with service delivery and responses to violence emerged as issues of concern. This scoping review highlights the unique issues and challenges that rural and remote communities face in relation to SV and that despite public health and other campaigns highlighting sexualized violence, little meaningful change has occurred. In addition, SV is a feature of life for many in rural, remote, and regional Australia.

Keywords

sexual health sexual violence sexual assault sexual harassment sexual abuse intimate partner sexual violence social media/technology-facilitated sexual violence

Introduction

Sexual violence (SV) is an insidious social phenomenon that can have profound consequences for individuals, families, and communities. The burden of SV is extensive for survivors, often resulting in physical and emotional trauma (Edmond et al., 2020), ongoing adverse health behavior, and financial stress (Townsend et al., 2022). The burden is also extensive for communities and services, with the predicted annual cost of SV estimated to be in the billions (Carter-Snell et al., 2020). Additionally, survivors of SV may experience longer term psychological conditions (such as depression, suicidal ideation, substance abuse, post-traumatic stress disorder [PTSD]), physical, emotional, sexual, and social impacts; Edmond et al., 2020; Jones et al., 2024; O’Dwyer et al., 2019; Sweeney & Taggart, 2018). SV impacts a survivor’s ability to function in society, their social connections, and impacts future relationships (Edmond et al., 2020). Despite what is known about the impacts of SV, the full burden of SV is likely to be hidden due to the shame, stigma, and fear associated with disclosure and reporting, disbelief and/or victim blaming at the time of disclosure, and perceived repercussions for disclosure (Jones et al., 2024). Re-traumatization also occurs through the justice seeking process with victims often having to recount their assault multiple times (Campbell & Fehler-Cabral, 2022; Papas et al., 2023). Furthermore, SV is often reported alongside sexual assault and other forms of violence (such as domestic violence, intimate partner violence, technology facilitated violence, and family violence; Jones et al., 2024).

The World Health Organization (WHO, 2024) defines SV as “any sexual act, attempt to obtain a sexual act, or other act directed against a person’s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting.” SV encompasses a range of behaviors, including sexual assault and aggravated sexual assault, rape, exposure to pornographic material, child sexual abuse, sexual harassment, recording private or sexual behavior without permission, sexual exploitation, sexual acts or touching without consent, and image-based sexual abuse, such as revenge porn and the sharing of unwanted sexual material (Australian Bureau of Statistics, 2018; Jones et al., 2024; NSW Government, 2022; Usher et al., 2023).

Prevalence rates of SV do not report the full picture as SV, as already stated above, is often reported alongside other forms of violence (e.g., sexual assault, domestic violence, intimate partner violence), and only a small number of incidents are disclosed to police. To fully understand the rates of SV we need to look at the prevalence of violence against women as well as SV rates, and these rates are concerning both globally and in Australia. In Australia, one in four or 2.3 million women reported experiencing intimate partner violence, 2.3 million women reported experience emotional abuse, 1.6 million women reported experiencing financial abuse (Australian Institute of Health and Welfare, 2024). One in four or 2.7 million women reported experiencing domestic violence and a further 2.2 million people reported witnessing domestic violence, 11% women reported experiencing child sexual abuse, one in five women reported experiencing stalking, and over 50% of the Australian population has experience technology assisted abuse (Australian Institute of Health and Welfare, 2024). Furthermore, statistics indicate that one in two women have experienced sexual harassment, and two in five young people (high school age) have experienced sexual harassment or sexual coercion (NSW Government, 2022). Globally one in three women will experience intimate partner violence, 38% of murders of women are related to intimate partner violence, while 6% of women reported experiencing sexual assault (WHO, 2024) and over 641 million women have been experienced domestic violence (World Health Organization [WHO], 2021).

Rates for SV are just as concerning. Global rates, reported by WHO, of physical and SV are estimated at 27% and 35%, respectively (Borumandnia et al., 2020; WHO, 2021), with over 645 million women experiencing physical or SV since the age of 15 (WHO, 2021). In Australia, it is estimated that over 2.8 million people have experienced a form of SV, 1.1 million women reported SV perpetrators was an intimate partner, 489,000 was a male friend/housemate (Australian Institute of Health and Welfare, 2024).

Reportedly, some rural and remote areas in Australia have significantly higher rates of SV than urban areas (Neame & Heenan, 2004). Despite this increased risk in rural and remote areas and the negative impact of SV on mental health, there is insufficient research that focuses on the unique issues and challenges faced by rural and remote communities. While men are victims of SV, SV victims are predominantly women, and this article will focus on SV against women in rural areas. Hence, this review aims to explore the empirical evidence on SV against women in regional, rural, and remote areas in Australia (determined by the Rural, Remote and Metropolitan Area—RRMA classifications Australian Bureau of Statistics; Commonwealth of Australia, 2021), evidence focusing on only metropolitan areas was excluded. Specifically, this review will:

examine the available empirical evidence on SV in regional, rural, and remote areas in Australia

explore the unique challenges and issues faced by rural and remote populations

explore the gaps in the evidence and areas for future research.

explore recommendations for policy change.

Methods

Design

A systematic scoping review was undertaken between November 2023 and May 2024. A literature review protocol was developed, based on the Joanna Briggs Institute (JBI) template (Joanna Briggs Institute [JBI], n.d.), following a systematic process using the Arksey and O’Malley (2005) five-step framework for scoping reviews updated by Peters et al. (2021). PRISMA-ScR was used as a checklist for reporting results (Tricco et al., 2018). A systematic scoping review was the best process to undertake for this review, as it allows for identification of empirical evidence to address broad research questions, to identify gaps in literature, and synthesis of the evidence to identify key areas for future research (Bradbury-Jones et al., 2022).

Search Strategy

The terms for this scoping review were developed using the population/participants, concept, context (PCC) framework (population- people living in regional, rural, and remote areas, concept- SV, context- Australia). This review used a comprehensive search strategy to identify the available empirical evidence pertaining to SV. A single reviewer performed the initial search to identify key literature relevant to the aims of this review and following the PCC framework. From the relevant literature key terms were identified and terms were expanded using medical subject headings (MeSH). A health librarian was then consulted to assist with the construction of the search string to be used to search the following databases for the full literature search of the following recommended databases: CINHAL complete, Scopus, ProQuest health and medicine, Medline/ of Science, Informit, and Google Scholar). A preliminary search was undertaken in CINHAL database by one reviewer to ensure the search strategy was able to identify relevant empirical evidence pertaining to the aims of this review. (The full search and search string for each database search is included in the Supplemental File.) Table 1 outlines the inclusion and exclusion criteria developed for this review (Table 1).

Table 1.

Inclusion/Exclusion Criteria.

Inclusion Criteria	Exclusion Criteria
• The literature is a form of published empirical evidence. • The literature focuses on any form of SV including aggravated sexual assault, sexual assault, sexual touching, sexual acts, sexual harassment, and social media/technology-facilitated SV OR the lived experience of survivors of SV. • The literature must report results specific to populations in regional, rural, and remote areas. • The literature is available in English.	• The literature does not present information related to regional, rural, or/and remote areas of Australia. • DV/IPV articles that do not present findings related to SV. • The literature was not available in English. • Not available in full-text. • Government policy, books, discursive (discussion papers), or editorials.

Inclusion Criteria

Exclusion Criteria

• The literature is a form of published empirical evidence.
• The literature focuses on any form of SV including aggravated sexual assault, sexual assault, sexual touching, sexual acts, sexual harassment, and social media/technology-facilitated SV OR the lived experience of survivors of SV.
• The literature must report results specific to populations in regional, rural, and remote areas.
• The literature is available in English.

• The literature does not present information related to regional, rural, or/and remote areas of Australia.
• DV/IPV articles that do not present findings related to SV.
• The literature was not available in English.
• Not available in full-text.
• Government policy, books, discursive (discussion papers), or editorials.

Note. SV = sexual violence; OR = error; DV = domestic violence; IPV = intimate partner violence.

Search and Screening Process

Two reviewers (RJ & CT) undertook the search independently across all databases using the search strategy. The reviewers met after conducting the search to compare results. The reference, title, abstract, and keywords of each result were exported to Covidence, and duplicates were removed. Two reviewers (RJ & CT) independently screened the title and abstracts in Covidence against the inclusion and exclusion criteria (Table 1), any conflicts were discussed between the two reviewers, and conflicts were resolved. The same process was applied to full-text screening. The results of the screening are reported in Figure 1.

Figure 1.

PRISMA screening results.

The search identified 510 articles. These were uploaded into Covidence for screening and 90 duplicates were removed resulting in 420 titles and abstracts that were screened. A further 279 articles were excluded at the title and abstract screening stage, with 141 identified for full-text screening. Among these 141 articles, 8 reports could not be retrieved, 44 were excluded due to not reporting empirical evidence, 34 were excluded as they did not focus on a regional, rural, or remote Australian population, and 28 were excluded as they did not fit with the aims of the review (see Figure 1). A total of 25 articles were included in this scoping review.

Appraisal and Data Synthesis

The two reviewers independently reviewed the included articles using Mixed Methods Assessment Tool (MMAT; (Hong et al., 2018; see Supplemental File), the results were compared before finalizing their assessment. MMAT consists of five questions requiring a yes or no response, each article received an asterisk for every yes response with papers that were allocated five asterisks (100% quality) deemed high quality, articles allocated three to four asterisks (60%–80% quality) deemed moderate quality and articles allocated two or less asterisks (0%–40% quality) deemed low quality.

The data extraction tool was adapted from the JBI template (JBI, n.d.) and included citation, aims and objectives, study design, methods, setting and population, state, and key findings. The data extraction tool was trialed by one reviewer (RJ & CT) before two reviewers (RJ & CT) independently extracted data and met to resolve any conflicts. A thematic analysis, as outlined by Arksey and O’Malley (2005), was employed to describe the key findings from the literature under common themes that were developed deductively from the aims of the review and the key findings (Table 2).

Table 2.

Study Characteristics and Key Findings.

Citation	State	Aims/Objectives	Study Design	Methods/Analysis	Sample	Key Findings
Amos et al. (2023)	Australia	To identify factors associated with reported experiences of abuse based on sexual orientation or gender identity.	Quantitative	Cross-sectional survey Descriptive and logistic regression analysis Convenience sampling	n = 2,629	• Participants with severe disability and trans women or non-binary persons were significantly more likely to have experienced verbal abuse. • Participants 18–24 years, and participants who lived in a remote/rural area were significantly more likely to report having experienced sexual assault. • Trans women or non-binary persons, people with severe disability, and people who lived in an outer-suburban area were more likely to have experienced social exclusion.
Bismark et al. (2020)	Australia	To examine sexual misconduct notifications for a national cohort of all registered health practitioners.	Quantitative	Database (de-identified data) Descriptive statistics Multivariate analysis	n = 1,507	• 24.8% of healthcare practitioners reported sexual misconduct (sexual relationships, sexual harassment, and sexual assault) was working in regional/rural locations. • Rates of sexual harassment or assault for practitioners in regional or rural localities and metropolitan areas were similar.
Brown et al. (2021)	Central Australia, Remote WA, Regional NSW	To explore Aboriginal and Torres Strait Islander women’s perspectives of technology-facilitated abuse in regional and remote settings.	Qualitative	Yarning interviews and Interviews Thematic analysis	n = 27	• Aboriginal and Torres Strait Islander women in rural and remote areas experience multiple forms of technology-facilitated violence, including intimate partner violence, family violence, impersonation and image-based abuse, and racist violence. • Women’s response to technology-facilitated violence is primarily through disengagement or removal of exposure and collecting evidence to protect themselves. • Non-contact orders were the primary support provided by police or legal services, but these were often not enough to stop abuse. • Facilitated abuse behaviors reported by women included harassment, threats, monitoring and impersonation by male partners, and ex-partners to assert control over them. This form of abuse tended to occur gradually, becoming more intense and consuming over time, before escalating into physical violence.
Carrington et al. (2013)	NSW, QLD, WA	To explore why (non-Indigenous) men living in regional and remote areas of Australia experience higher mortality and morbidity rates related to violence than men living in the nation’s major cities.	Mixed methods	Secondary data analysis, survey, and semi-structured interviews Thematic analysis Descriptive statistics	n = 142	• The unreported, hidden nature of domestic and sexual violence was a prominent thread recurring in our interviews with the service providers and professionals who dealt firsthand with the victims of domestic and sexual violence • Women living on farms were less likely than town residents to seek support or even to appreciate that verbal and psychological abuse and harassment constituted domestic violence. • Social attributes associated with masculinity in agricultural and mining communities shape disparate patterns of violence. • Support workers stated that isolated victims were sometimes denied telephones or transport when partners were absent, and access to money when visiting town was strictly controlled. • Shame and a culture of keeping “difficulties” secret were deterrents for seeking help. Underreporting was also linked to lack of appropriate services in rural towns to effectively deal with situations. • On the one hand, lack of anonymity in rural areas added to social self-censorship. On the other hand, police officers and social service workers linked the likelihood of incident reporting to the establishment of trustworthy relationships.
Corbett et al. (2023)	VIC	The aim of this study was to enhance understanding of sexual revictimization within regional and rural areas. The driving research question was “What are the intersecting material-discursive forces that enable sexual revictimization to occur in regional and rural areas within Victoria, Australia?”	Qualitative (CBPR)	Semi-structured interviews (2 time points) Thematic analysis	n = 12	• There is a lack of appropriate responses and support provided by the family, community, and legal and social services. Women are often disbelieved or blamed when they disclose. • Family, community, and services’ inappropriate responses are linked to rural infrastructure, isolated geography, fear of social isolation, idealization of men in the community, and limited relationship and sexuality education. • Women reported that both nonresponse and inappropriate responses to signs and disclosures of abuse contributed to a normalization of violence within their lives.
Easteal and Saunders (2011)	Australia	To examine what elements, contribute to a successful outcome for a sexual harassment complainant.	Case studies	AustLII online legal database—Document analysis	2005–2012 All legal sexual harassment cases across Australia	• There was a relatively higher proportion of rural complainants employed in the hospitality sphere: three worked in hotels and one in a club. • Almost half of the cases rural employers (45%) were deemed liable for the actions of their employees in contrast to only one-third of employers in the urban cases (32%). • Eight of the rural matters (73%) involved more than one type of sexual harassment as compared to 34 of the urban cases (60%). Most of the rural multiple manifestations did include a sexually permeated environment. A sexually permeated workplace might be one in which pornographic material was obviously displayed or in which rude jokes were told frequently. • In almost all rural cases (90%, 10/11), the alleged offender was in a senior position to the complainant as compared to 44 of the 57 (77%) of the alleged urban offenders. In seven of the eight matters in which the claim of sexual harassment was upheld, the respondent was in a position of seniority.
Fisher et al. (1996)	Australia	Aims to validate anecdotal evidence that suggest violence directed toward RANs is becoming a major problem in remote communities.	Mixed methods	Survey, Interviews Descriptive statistics No info on qualitative data analysis	n = 237 Surveys n = 4 Interviews	• A significant number of nurses had experienced violence of all types within the 12 months prior to the study. • Verbal aggression and obscene behavior, property damage, and physical violence were most commonly experienced. Other types of violence include throwing things; physical attacks; and property damage. spitting, attempting to strangle, sexual harassment, and gunshots. • 31.8% Respondents experienced sexual harassment, 10.6% had experienced sexual abuse, and 8.3% had experienced stalking in the past 12 months. • Although violence occurred in communities of all sizes, more violence occurred in smaller communities, particularly verbal abuse and obscene behavior and both on duty and on call. • All participants in the interview identified alcohol as a contributing factor towards violence.
Ghafournia and Healey (2022)	NSW	To map the main characteristics of and differences between domestic violence and sexual assault cases presenting to a hospital ED in Australia.	Quantitative	Cross-sectional Survey Descriptive statistics And logistic regression analysis	n = 258	• SA findings: 16/105 (15%) cases were identified as Australian First Nations peoples. The average case age was 28 years (SD 14.4). 69/105 (66%) cases were between the ages of 18–65 years, while 34/105 (32%) cases were under the age of 18. • The mean age of SA cases was much lower than that of DV cases. • 54/105 (51%) cases had recurrent presentations, defined as any presentation at the ED including those related to DV or SA. 42/105 (40%) cases had an associated mental health diagnosis. • 92/105 (88%) SA cases were referred to related support services, mostly to the local health district SA team and/or the Child Wellbeing Unit.
Harris and Woodlock (2022a)	NSW, VIC, QLD	To examine the impact of technology-facilitated violence on victim–survivors of intimate partner violence in regional, rural, or remote areas of Australia (New South Wales, Victoria, and Queensland) who are socially or geographically isolated.	Qualitative—Descriptive	Semi-structured interviews Focus groups Thematic analysis	n = 13	• Participants indicated that perpetrators used technology as part of their control and intimidation tactics. Digital violence continued (and often escalated) post-separation. • All victim–survivors had experienced multiple forms of offline abuse (such as psychological, financial, sexual and physical abuse, and in-person stalking) alongside online abuse. • The spacelessness of technological abuse meant the women worried that they could encounter harm anytime and anywhere they used technologies and made perpetrators seem omnipresent and omnipotent. • Victim-survivors in non-urban areas experienced geographical and social isolation as major barriers to existing abusive relationships and seeking help. • Many participants were concerned that the perpetrator was using surveillance and tracking strategies and channels that were undetected. • Criminal justice system sometimes dismisses, minimizes, or overlooks technological abuse.
Harris and Woodlock (2022b)	NSW, VIC, QLD	This article investigated women’s experiences of technology-facilitated domestic violence in regional, rural, and remote areas.	Qualitative—Descriptive	Semi-structured interviews Focus groups Thematic analysis	n = 13	• While digital coercive control is a form of spaceless violence, the socio-spatial aspects of women victim-survivors’ non-urban location affects their experiences of such violence. • Women’s space for action was constrained by place—geographic isolation—the sheer distance between their residences and informal and formal supports as well as medical assistance. • In smaller communities, women were more visible than they would have been in urban locations. Consequently, women had little anonymity or privacy when help-seeking, and it was easy for abusers and abuser allies to find and monitor women. • Dismissed when disclosing violence, which could deter women from engaging police initially or in future. • Traditional gender roles and structures were also oppressive in legitimizing, excusing, or even assisting abusers, with allies recruited offline and online.
Mitra-Kahn et al. (2016)	Australia	The consultations focused on reviewing what is known about the experiences of domestic and family violence and sexual assault against diverse groups of women, and what data are currently collected in relation to this.	Mixed methods	Survey Semi-structured interviews and round tables Content analysis	n = 158 Interviews n = 26 Surveys	Key gaps in information are: • Limitations in quantitative evidence on prevalence and perpetration of violence. • Complexity and specificity of violence. • Multiple and interrelated barriers to reporting violence and accessing services. • Intersections of identity and disadvantage.
Nasir et al. (2021)	QLD and NSW	The aim was to determine the prevalence, types, and age of occurrence of traumatic events among community-living Indigenous Australians and associations with PTSD.	Quantitative	Survey Descriptive statistics	n = 544	• Indigenous Australians are at greater risk of experiencing potentially harmful traumas and developing PTSD than non-Indigenous Australians. • Rural residence is an independent predictor of PTSD among Indigenous Australians. • 40.5% Females and 17.2% males reported experiencing sexual violence. • The combination of both sexual and physical violence was associated with the highest risk of developing PTSD.
Nicholson (1998)	VIC	The initial aim of investigating whether women (experiencing violence) in rural communities were disadvantaged by the lack of female police members in rural stations.	Qualitative	Questionnaire interviews	n = 18	• Women experiencing violence in rural communities were disadvantaged by the lack of female police members in rural stations. • The disadvantage stemmed primarily from the masculinized and hierarchical nature of the police culture, and a lack of awareness and sensitivity about violence against women. • Male police are more comfortable if they don’t have to deal with sexual assault. Police endeavor to meet the needs of the victim but prefer to hand it over to a female colleague in instances of sexual assault and family violence. • Male police tended to focus primarily on investigative aspects of the crime, whereas female police were initially concerned with establishing rapport with and facilitating the comfort and security of the victim. • Police men and women appear to apportion a degree of blame to the victim—as if she was complicit in or contributed to the violence perpetrated against her. • Demonstrating a degree of “victim-blaming” but it can be reasonably assumed that the response may also reflect victim-blaming by the community—highlighting the reality of what there is to fear from the perpetrator (retribution), community attitudes to violence against women (what people might say), and a sense of self-responsibility (embarrassed they allowed the violence to happen).
Opie et al. (2010)	Australia	To assess the incidence of workplace violence in the remote area nursing workforce and to compare present data to data collected 13 years previously.	Quantitative	Cross-sectional Survey Descriptive statistics and bivariant correlations	n = 349	• Increases were found in all incidents of reported violence at the workplace between 1995 and 2008. • Verbal aggression, property damage, and physical violence were the most common forms of workplace violence experienced by RANs. • Correlation between sexual harassment, sexual abuse/assault, and PTSD symptoms. • 32.1% Nurses reported witnessing sexual harassment and 10.9% reported witnessing sexual abuse/assault, in the workplace.
Prentice et al. (2017)	QLD	To identify the barriers preventing Aboriginal and Torres Strait Islander clients from accessing local services when they have been affected by sexual and family violence.	Qualitative-(CBPR)	Survey-open-ended questions Yarning interviews Thematic analysis	n = 5 Interviews n = 62 Surveys	• Most of the respondents discussed the effect that social taboo and shame have on a person’s capacity to access interventions or seek support for issues relating to sexual and family violence. • Lack of culturally appropriate services is a major barrier to service access. • Services must commit to improving consultation with the Indigenous communities and seek to develop meaningful long-term relationships to address sexual and family violence. A number of community members and workers touched upon negative experiences of service provision and were critical of the prevailing Western-centric model. • There was widespread concern from community members and workers that the normalization of sexual and family violence acted as a deterrent to service access and program interventions. There was a lack of knowledge about what constitutes sexual and family violence, but also limited awareness as to what services are available when support is required. • Justice system deterrents were highlighted as a barrier for the nonreporting of sexual and family violence, and the subsequent reluctance to access support. Many respondents attributed this to a lack of confidence or trust in the system, and a strongly held belief that reporting would not lead to a desired outcome.
Radcliffe (2003)	VIC	The central purpose of this study was to explore the attitudes and beliefs about sexual assault of health and welfare professionals in a rural area.	Qualitative	Interviews Narrative analysis	n = 14	• Attitudes and beliefs of rural health and welfare workers often include theoretical frameworks that ignore the role of power and gender and include myths about behaviors of victim-survivors and perpetrators. • Lack of service provision in rural communities for victim-survivors of sexual assault is a challenge. • Most health and welfare workers indicate a lack of confidence in their knowledge about sexual assault, and their ability to work with victim-survivors. • Participants referred to victim-blaming attitudes of the community, which lead to difficulties for victims/survivors in reporting or disclosing sexual assault based on issues of shame, guilt, and blame. • The consequences of sexual assault are far reaching and may affect all aspects of emotional, physical, and psychological wellbeing. Responses by participants listed a number of physical, emotional, and psychological effects to sexual assault including: low self-esteem (7); psychiatric disorders including depression (5); alcohol and drug issues (5); relationship issues (5); sense of self/identity (4); self-blame/guilt/responsibility (4); and lack of trust (3).
Ragusa (2017)	Australia	To explore the women’s lived experiences of the complexities disadvantaged individuals face negotiating with rural communities as part of their IPV recovery process.	Qualitative	In-depth interviews Thematic analysis	n = 36	• Specific intimate partner violence experiences of physical abuse included pushed, grabbed, or shoved (95%); slapped (81%); thrown (78%); bit, kicked, or punched (70%); shook (56%); raped (39%); used a knife, gun, or weapon (39%). • Rural women-specific intimate partner violence survivors believe that rurality affected their intimate partner violence experiences. • Rural Australia’s systemic challenges (economic disadvantage, unemployment, lack of informal support, limited availability and access to support services, quality alternative housing, and timely/appropriate crisis counseling) exacerbated women’s personal capacity to end intimate partner violence. • Despite believing, or even knowing, one should leave, the structural realities of rural living combined with emotional distress to make intimate partner violence escape very challenging. • Rural Australia’s inability to provide suitable medical and health care services was a crucial issue confounding intimate partner violence escape as women not only had to want to escape intimate partner violence, but they also had to orchestrate a plan enabling them to be confident in their capacity as “sole provider” financially and emotionally for their children.
Rawsthorne (2003)	NSW	To explore the experiences and understandings of sexual violence among young rural people, how these experiences and understandings are shaped and the barriers to effective prevention of sexual violence in rural settings.	Qualitative	Observation Interviews Workshops Media coverage Content analysis	n = 71	• There were gender differences in understanding violence (rape, assault, and force), 74% of young women were able to recognize the violence compared to 40% of young men, older women were likely to name the violence compared to young women, young men (years 9 and 10) were more likely to name the violence compared to older men (years 11 and 12). Young people drew strongly on common rape myths when making sense of sexual violence. • Participants reported perpetrators as responsible for the violence, with a minority blaming both the perpetrator and the victim. Two-third young men and one-fourth of young women felt men couldn’t stop making sexual violence inevitable. • Consent was seen as a complex issue by women and many participants found it difficult to exercise control over their sexual behavior. Many young people were unable to negotiate sexual consent safely. • Rural young people were affected by the same social discourses about sexuality and sexual violence as their urban counterparts. However, the physical and cultural features of rural settings also influenced rural young people’s understandings, for example, living in smaller communities with poor or no public transport, and lack of anonymity when accessing social services. These factors made naming and responding to sexual violence very difficult for young people and service providers.
Saunders and Easteal (2012)	Australia	To examine the perception of workers in bush workplaces about barriers, which might affect their inclination to internally (informally or formally) report sexual harassment incidents.	Qualitative	Interviews based survey (phone)	n = 107	• Only one-third of participants reported they would disclose sexual harassment, three-fourth participants stated they had experienced sexual harassment. Sixty-nine percent of the 62 who had been the target of harassment would not make a disclosure and 59% of the 22 who had not experienced harassment indicated that they would not generally be inclined to report sexual harassment. • Quite a few people were concerned about possible negative consequences of reporting. Several participants referred to fear of their employer or senior manager “joining in” with the harassing behavior if it were drawn to their attention by way of a formal report. Barriers to reporting may be linked to 69% of (52) employees and 61% of (18) employers believe that sexual harassment is just about “boys being boys.” • Lack of sexual harassment policies with a clear complaints path. Half of the workplaces evidently do not have these policies or, if they do, the respondents are not aware of their existence. • Only 17% of the rural workplaces in our sample offered training about sexual harassment. Almost two-thirds (64%) of those without training would not report as compared to 54% whose workplaces do have training.
Saunders and Easteal (2013)	Australia	To explore sexual harassment in rural areas and to see if masculine workplaces have higher levels of sexual harassment.	Qualitative	Interviews	n = 107	• Almost three-quarters of the 101 workplace respondents (73%) reported that they had experienced sexual harassment by a colleague whilst 70% of participants had witnessed it. • Those working in agricultural/horticultural occupations were significantly more likely to have been the target of sexual harassment than those employed within the professional occupations. • Most respondents had experienced or witnessed both one-on-one and group-on-one sexual harassment. • Male-dominated rural workplace environments are more likely to be permeated with sexual harassment. • The mining industry was also likely to foster sexually permeated environments. Respondents from mining workplaces were also significantly more likely to have experienced group-type sexual harassment (91%) than those from professional occupations and retail, hospitality and fast-food occupations (22%). • Those employed in agriculture/horticulture were significantly more likely (86%) to have experienced group harassment than those in professional occupations. • The most common type of sexual harassment was verbal (73%), followed by obscene gestures (53%), bullying (47%), pornography (37%), and physical (29%).
Sloan (1998)	SA	To improve the co-ordination of existing police, counseling, and medical services for people aged 16 years and over who have experienced recent rape or sexual assault.	Qualitative	Surveys Consultation	n = 778 Surveys n = 86 Consultation	• Access to services is made difficult because of a lack of co-ordination between services, access to services is made difficult because of distance, and the majority of services cannot subsidize travel. • Most services do not have policies and procedures regarding rape and sexual assault, there is inconsistency amongst professional groups as to the availability of forensic medical examinations in their local area, aboriginal people and people from a linguistically and culturally diverse background are less likely to access counseling, medical and legal services. • Confidentiality is a major issue in relation to accessing services. • Most rapes and sexual assaults in country areas are not reported to police.
Taylor (2004)	VIC	To explore difficulties experienced by victim-survivors of sexual abuse in rural communities.	Qualitative case study and vignette analysis	Four case studies and vignettes	n = 4	• Victim-survivors explore multiple difficulties when trying to disclose or seek help. These problems may be exacerbated for rural victim-survivors. • Victim-survivors often seek help through services outside their community because of concerns regarding lack of confidentiality.
Wall and Stathopoulos (2013)	Australia	This Wrap aims to provide a snapshot of the impact of context on six sexual assault services from regional, remote, and rural areas in Australia: how context has provided the impetus for flexibility in the pursuit of better and more effective practice in staffing, removing barriers for victim/survivors to access sexual assault services, and collaboration.	Qualitative	Consultation	n = 6	• Issues arising in sexual assault service provision in regional, rural, and remote areas are often context-specific, that is they relate to the economic features and population diversity of a community, geographic distances, and staffing needs. • Collaboration with other services as well as with the community is essential for sexual assault service provision in regional, remote, and rural areas.
Wendt et al. (2017) (Final report and key findings)	WA and SA	To explore how geographical and social isolation impact on women’s ability to cope and seek assistance with experiences of domestic and family violence.	Qualitative	Qualitative Case study Interviews Focus groups Thematic analysis	n = 40 Interviews n = 37 Focus groups	• Women experienced a range of behaviors and tactics by men to exercise power and control, including physical, sexual, psychological, financial, social, and spiritual violence. • Women experiencing violence largely tried to seek assistance from informal social networks when they felt that they could not cope with the violence alone. • Women experienced feelings of shame and embarrassment while facing domestic and family violence. • Despite women’s efforts to cope alone or through help from informal networks, all participants experienced intervention by police and support from specialist domestic and family violence services. • Women reported largely positive experiences with police and specialist domestic and family violence services. • Access to secure emergency specialist accommodation was crucial for women. • Most women were not negatively affected by geographical isolation. Geographic isolation was only a factor for women who lived on isolated properties outside the regional center. • Geographic isolation was a key concern for service providers, and it significantly shaped agency responses and work contexts. • There is little to no support for men who use violence in regional, rural, and remote areas, outside a criminal justice system response.
Wilson and McCormack (2010)	VIC	This article is a brief analysis exploring the effectiveness of visiting sexual assault services in regional area.	Mixed methods	Survey Interviews	n = 20	• The costs of visiting services and the demands placed on staff by being a sole worker, coping with isolation, and the pressure of offering a service to a wide range, the venue as an appropriate place for counseling, staff support, and safety is of great importance. • Deterrents to offering a visiting service include costs of visiting services, demands placed on staff on account of being a sole worker, coping with isolation, and the pressure of offering a service to a wide range of clients. • Lack of anonymity and privacy when accessing services was a concern for some service users.

Note. ED = emergency department; NSW = New South Wales; PTSD = post-traumatic stress disorder; QLD = Queensland; RANs = remote area nurses; SA = South Australia; VIC = Victoria; CBPR = community-based participatory research.

Results

The research methods used in the included articles were qualitative (n = 16), quantitative (n = 5), and mixed methods (n = 4). Of the 25 articles included, 16 were conducted across Australia (or across multiple states), 5 in Victoria (VIC), 2 in New South Wales (NSW), 1 in Queensland (QLD), and 1 in South Australia (SA). Most of the articles used interviews (semi-structured, in-depth or yarning, n = 16) or surveys/questionnaires (n = 11) for data collection, with round tables and consultation (n = 3), focus groups (n = 3), data bases (n = 2), case studies (n = 2), and media coverage (n = 1), also used.

Quality assessment (using MMAT) was undertaken with all 25 included articles; 10 articles were deemed high quality, 8 articles were deemed moderate quality, 10 articles were deemed low quality (including 2 articles who received a no response for all 5 criteria; see Supplemental File). For qualitative and quantitative descriptive papers, a large number were considered high quality (qualitative high n = 6, moderate n = 4, low n = 4; quantitative descriptive high n = 3, moderate n = 1, low n = 2), and for mixed methods most of the articles were considered low quality (high n = 1, moderate n = 1, low n = 3).

Four themes were identified. Figure 2 depicts a summary of the overarching theme of Rural Context, the subthemes identified, and the threads/codes identified under each subtheme. The following results report findings for the four themes. The four themes were (a) frequency and impact, (b) drivers and facilitators, (c) barriers to disclosure, help-seeking, and service delivery, and (d) unique challenges for communities. Table 3 presents the themes reported by the included articles and the decade in which they were published.

Figure 2.

Overarching theme, subthemes, and codes/threads.

Table 3.

Themes Reported by Included Studies and the Decade Published.

		1990–1999			2000–2009			2010–2019											2020–2024
Citations		Fisher et al. (1996)	Nicholson (1998)	Sloan (1998)	Rawsthorne (2003)	Radcliffe (2003)	Taylor (2004)	Opie et al. (2010)	Wilson and McCormack (2010)	Easteal and Saunders (2011)	Saunders and Easteal (2012)	Wall and Stathopoulos (2013)	Carrington et al. (2013)	Saunders and Easteal (2013)	Mitra-Kahn et al. (2016)	Prentice et al. (2017)	Ragusa (2017)	Wendt et al. (2017)	Bismark et al. (2020)	Brown et al. (2021)	Nasir et al. (2021)	Ghafournia and Healey (2022)	Harris and Woodlock (2022a)	Harris and Woodlock (2022b)	Amos et al. (2023)	Corbett et al. (2023)
Themes
Frequency and Impacts	Impacts					X		X													X	X
	Frequency	X						X		X	X			X			X		X	X	X	X	X
	At risk groups																			X					X
	Amplified behaviors	X				X		X		X	X			X			X	X	X	X	X	X	X	X
Drivers and facilitators	Misconceptions				X	X					X					X
	Alcohol use	X
	Policy			X						X				X
	Training										X
	Gender norms												X	X										X		X
	Workplace culture									X				X
	Technology assisted
Barriers to disclosure, help-seeking and service delivery	Perceived consequences										X
	Normalizing violence				X	X	X						X			X							X	X		X
	Shame and guilt		X		X	X	X						X			X		X						X		X
	Victim blaming		X			X							X			X		X
	Inappropriate response					X																	X	X		X
	Availability of services and support		X		X											X		X
	Geographical isolation			X			X						X			X								X		X
Unique challenges for rural/remote communities	Rural culture					X							X
	Geographical isolation				X	X			X			X						X
	Privacy confidentiality								X				X											X
	Rural infrastructure		X	X	X	X			X			X	X					X
	Lack of resources	X	X	X			X						X											X
	Oppressing victim voices					X							X	X										X		X
	Service delivery frameworks			X		X
	Protecting and hiding perpetrators			X									X	X			X							X		X
	Response and management					X																				X

Frequency and Impacts

Types of behavior experienced were reported in 14 of the 25 articles. Behavior reported included SV, domestic violence, intimate partner violence, family violence, rape, sexual harassment and sexual misconduct, technology-facilitated abuse and image-based abuse, exposure to pornography, obscene gestures and behavior, spiritual violence, financial abuse, physical abuse/violence and strangulation, digital coercion, psychosocial abuse, racist violence, and stalking and monitoring (Bismark et al., 2020; Brown et al., 2021; Easteal & Saunders, 2011; Fisher et al., 1996; Ghafournia & Healey, 2022; Harris & Woodlock, 2022a, 2022b; Nasir et al., 2021; Opie et al., 2010; Radcliffe et al., 2004; Ragusa, 2017; Saunders & Easteal, 2012, 2013; Wendt et al., 2017).

The incident rates of SV were reported by 7 of the 25 articles. The reported participant prevalence rates were sexual harassment between 25% and 73% (Bismark et al., 2020; Fisher et al., 1996; Opie et al., 2010; Saunders & Easteal, 2012, 2013), SV (reported as sexual assault) rates between 11% and 25% (Bismark et al., 2020; Opie et al., 2010), stalking at 8% (Fisher et al., 1996), SV at 41% for females and 17% for males (Nasir et al., 2021), and rape at 39% (Ragusa, 2017). In one study, 73% of participants reported experiencing more than one form of sexual harassment, and a higher percentage of employers were deemed accountable for the incidents in rural areas compared to cases in urban areas (Easteal & Saunders, 2011). Ghafournia and Healey’s (2022) study reported that participants’ mean age for experiencing SV (reported as sexual assault) was lower compared to those experiencing domestic violence, and 51% of cases attending a hospital emergency department (ED) had presented on more than one occasion (reoccurring presentations). The study by Harris and Woodlock (2022a) reported that participants had experienced multiple incidents of technology-facilitated abuse. In addition, Brown et al.’s (2021) study reported that technology-facilitated violence increased over time and escalated to a form of physical violence.

Of the 25 articles, 2 reported on at-risk groups and 4 reported on the impacts of experiencing SV. At-risk groups included women with a disability, trans women and non-binary persons, rural and remote women between 18 and 24 years (Amos et al., 2023), and Indigenous women (Brown et al., 2021). Impacts were reported as emotional, physical, and psychological, and included low self-esteem, substance use, relationship and trust issues, guilt, and self-blame (Radcliffe et al., 2004), and depression and PTSD (Ghafournia & Healey, 2022; Nasir et al., 2021; Opie et al., 2010; Radcliffe et al., 2004). One study reported that 40% of participants who presented to an ED for SV (reported as sexual assault) and domestic violence had an associated mental illness (Ghafournia & Healey, 2022), and two studies reported a correlation between PTSD and SV, sexual harassment and physical violence (Nasir et al., 2021; Opie et al., 2010).

Drivers and Facilitators

Drivers and facilitators were reported in 9 of the 25 articles. Drivers of SV included a lack of understanding of consent and of what constituted SV, a lack of training on SV, sexual harassment in workplaces, traditional gender roles, and masculine or sexually permeated work environments. In addition, alcohol use, technology use, and blaming victims were seen as facilitators of SV.

There was a clear discrepancy identified in understanding consent and violence, including rape, assault, and force, with a lack of understanding of what constituted violence reported by one study (Prentice et al., 2017). In another study, 36% of female participants and 40% of male participants were not able to accurately identify violence (in case scenarios; Rawsthorne, 2003). This study also reported that younger men and women were less likely to identify violence, believed they had a lack control over sexual behavior, were more likely to believe in common rape myths, and had difficulty negotiating sexual consent (Rawsthorne, 2003).

In some workplaces, there was a lack of awareness or implemented policies relating to SV and sexual harassment, unclear pathways for reporting incidences, and only 17% of organizations offered training (Saunders & Easteal, 2012). There was a potential link between training and increased reporting of incidents of sexual harassment in the workplace (Saunders & Easteal, 2012). Sexually permeated work environments (where one sex is made to feel uncomfortable through the sharing of sexualized content or comments such sharing pornographic material and rude jokes) and masculine work environments (such as mining and agriculture industries) were seen as high-risk places for sexual harassment, in particular, group sexual harassment (Easteal & Saunders, 2011; Saunders & Easteal, 2013). In addition, strong gender norms in rural areas were seen to legitimize, excuse, and assist perpetration (Harris & Woodlock, 2022b), with alcohol use also contributing to violence against women (SV, domestic violence, and intimate partner violence; Fisher et al., 1996).

Apportioning the blame to the victim and justice systems either dismissing or minimizing incidents was seen to increase incidents of violence or foster the notion that SV and sexual harassment are acceptable behaviors (Harris & Woodlock, 2022a; Nicholson, 1998; Rawsthorne, 2003). Technology was increasingly used as a facilitator of SV with surveillance, stalking behaviors, coercive control, and intimidation tactics reported (Harris & Woodlock, 2022a). Additionally, technology-facilitated abuse was less visible to the police resulting in the justice system often overlooking this form of abuse (Harris & Woodlock, 2022a).

Barriers to Disclosure, Help-Seeking, and Service Delivery

Of the 25 articles, 12 reported findings for the disclosure, help-seeking, and service delivery theme. Victim blaming, survivors’ feelings of guilt and shame, and their lack of trust in the justice system to prosecute and convict were seen as a deterrent to reporting incidents (Carrington et al., 2013; Nicholson, 1998; Prentice et al., 2017; Radcliffe et al., 2004; Wendt et al., 2017). For work-related incidents, there was increased complexity with perceived negative consequences for reporting (such as management or supervisors contributing to the harassment) and the common belief that harassment in the workplace was just “boys being boys” (Saunders & Easteal, 2012). There were several deterrents to disclosing SV and help-seeking. These included normalization of violent behavior, shame, and secret keeping as part of rural culture, insufficient social, informal or formal support, lack of confidentiality, and isolation (Carrington et al., 2013; Corbett et al., 2023; Harris & Woodlock, 2022b; Prentice et al., 2017; J. Sloan, 1998; Taylor, 2004). Additionally, previous negative experience with disclosure not only contributed to normalization of violent behavior but also acted as a deterrent for future reporting and help-seeking (Corbett et al., 2023; Harris & Woodlock, 2022a, 2022b; Radcliffe et al., 2004).

A lack of culturally appropriate services impacted help-seeking and service delivery, and often resulted in negative experiences when seeking help, especially in among culturally and linguistically diverse communities (Prentice et al., 2017; J. J. Sloan et al., 2004). One study identified the need to improve consultation to embed services and improve relationships with communities and services (Prentice et al., 2017). Other identified issues with service delivery included a lack of policy and procedures for responding to SV and undertaking forensic exams (J. J. Sloan et al., 2004), a lack of available services (such as crisis accommodation), and women relying more on informal social supports (Wendt et al., 2017). Additionally, male police officers felt ill-equipped to respond to SV preferring to focus on the investigation rather than supporting the victim/survivor (Nicholson, 1998).

Unique Challenges for Rural/Remote Communities

Of the 25 articles, 18 reported on the theme of unique challenges and issues for rural and remote communities. This theme is related to findings on SV that are not found in other metropolitan focused findings for SV. There were many challenges and issues highlighted by the included articles that were unique to rural communities, and these were summarized under privacy/confidentiality, the culture of rural communities, geographical isolation, and rural infrastructure including economic sustainability, service provision, transportation, and crisis housing. Within smaller communities, there is limited privacy making it more difficult for incidents/reported incidents of SV and other violence to remain confidential. This impacted disclosure and help-seeking (Wilson & McCormack, 2010), and increased the sense of shame (Carrington et al., 2013). Lack of privacy and anonymity in rural communities made it easier for perpetrators and their allies to monitor victims/survivors. This made victims’ attempts to escape the violence and access services more difficult and often necessitated going outside their communities for help (Carrington et al., 2013; Harris & Woodlock, 2022b).

There is a uniqueness to the characteristics of rural communities that impacts SV, domestic violence, and intimate partner violence, with several studies reporting that increased masculinity, idealization of masculine gender roles, and adherence to traditional gender roles increased perpetration of violence, and contributed to oppressing victims’ voices (making it difficult to disclosure or seek-help) and legitimized/excused perpetrators’ behavior (victim-blaming, abuser allies; Carrington et al., 2013; Corbett et al., 2023; Harris & Woodlock, 2022b; Saunders & Easteal, 2013). The culture of secret-keeping in rural communities also worked to silence women’s voices and associate shame, guilt, and blame with those who were identified as victims (Carrington et al., 2013; Radcliffe et al., 2004). In addition, the culture of some work environments and communities made it difficult to identify and respond to SV which fostered and supported perpetration (Saunders & Easteal, 2013), with one study indicating most SV in rural communities is not reported (J. Sloan, 1998).

Due to geographical isolation and rural infrastructure, there were issues with service delivery, including a lack of appropriate services, service coordination, and access to services arising from staff shortages and the cost of delivery (Harris & Woodlock, 2022b; Radcliffe et al., 2004; Rawsthorne, 2003; J. J. Sloan et al., 2004; Wall & Stathopoulos, 2013; Wendt et al., 2017; Wilson & McCormack, 2010). The service delivery challenges impacted management and responses, including inappropriate responses, to SV within rural communities (Corbett et al., 2023; Radcliffe et al., 2004). The lack of services often required victims to travel great distances or leave their communities to seek help (Harris & Woodlock, 2022b; J. Sloan, 1998; Taylor, 2004) and contributed to reduced reporting (Carrington et al., 2013) and further silencing of victim voices. The absence of appropriate services and the manner in which victims have to seek help is especially concerning as one study reported smaller communities had higher rates of violence (Fisher et al., 1996). Reportedly support services in rural areas utilized a theoretical and practice framework that supported rape myths and ignored power and gender when supporting victims of SV and supported rape myths (Radcliffe et al., 2004) which in turn impacted disclosure and help-seeking. This study found that healthcare workers lacked confidence to manage/respond to SV (Radcliffe et al., 2004), and reports that some services lacked clear policies and procedures for managing SV (J. Sloan, 1998) which in turn impacted help-seeking and disclosure of incidents.

Geographical isolation and fear of social isolation made it easier for perpetrators and perpetrator allies to control and monitor victims, limited their access to help (Corbett et al., 2023; Harris & Woodlock, 2022b), and were reported as barriers to victims leaving unsafe environments (Harris & Woodlock, 2022a; Ragusa, 2017). One study reported that rural women were disadvantaged by the lack of female police to respond to and manage disclosures of violence (Nicholson, 1998). In addition, rural communities often faced economic disadvantages, unemployment, lack of informal and formal support, alternative crisis housing, and crisis counseling, which was seen to exacerbate the disadvantage and the impact on victims/survivors and prevented them from seeking help or leaving unsafe situations (Ragusa, 2017). However, one study did report that the closeness of rural communities allowed for trusting relationships between communities and services such as police which was seen to improve reporting/disclosure (Carrington et al., 2013).

Discussion

Summary of critical findings

This scoping review included evidence from 1996 to 2024, with findings reported in recent research resonating with findings reported by earlier research, suggesting that despite public health and other campaigns highlighting gendered sexualized violence, little meaningful change has occurred. SV and other forms of violence (domestic violence, intimate partner violence, and family violence) continue to be a feature of life for many in non-urban areas. This review has highlighted the pervasive nature of SV in rural, remote, and regional Australia with some forms of SV being more prevalent than in metropolitan and urban areas. This higher prevalence is likely to be perpetuated due to the unique challenges and various risk factors existing in rural and remote areas that increase perpetration or rates of SV, domestic violence, and intimate partner violence. In small communities, size decreases confidentiality and anonymity when reporting or disclosing, increases the risk of encounters with perpetrators and their allies in social situations and in daily life, and financial dependence on perpetrators (Edmond et al., 2020; Jones et al., 2024; Ragusa, 2017). Other factors include drinking cultures, particularly in mining and agricultural communities (Carrington et al., 2013), shame as an informal form of social control, social expectations, patriarchal gender norms (A. Flynn et al., 2023; Jones et al., 2024; Owen & Carrington, 2015), and gaps in service provision (Carter-Snell et al., 2020; A. Flynn et al., 2023; O’Callaghan et al., 2022). Critical findings of this review are summarized in Table 4.

Table 4.

Summary of Critical Findings.

Despite public health and other campaigns highlighting sexualized violence, little meaningful change has occurred over the past several decades.

Higher prevalence in regional, rural, and remote Australia with some forms of SV being more prevalent than in metropolitan and urban areas. The higher prevalence is likely to be perpetuated due to the unique challenges and various risk factors existing in rural and remote areas that increase perpetration or rates of SV, domestic violence, and intimate partner violence.

Barriers that impacted disclosure and help-seeking included victim blaming, geographical and social isolation, shame, experiencing inappropriate responses when disclosing, lack of knowledge on available services, normalization of violence in rural areas, and the justice system.

Challenges in responding to and preventing SV in rural and remote areas included a lack of health care services, decreased availability of emergency responses and crisis interventions, decreased availability of legal services, and social isolation.

Note. SV = sexual violence.

Challenges of SV in rural and remote areas

The results highlight a multitude of noteworthy challenges of SV in rural and remote Australia. Barriers to disclosure and help-seeking, and issues with service delivery and responses to violence emerged as issues of concern. Barriers that impacted disclosure and help-seeking included victim blaming, geographical and social isolation, shame, experiencing inappropriate responses when disclosing, lack of knowledge on available services, normalization of violence in rural areas, and the justice system. Specific rural challenges in responding to and preventing SV include lack of health care services (such as mental health support, sexual assault counseling, sexual assault forensics/rape kits), decreased emergency response (such as increased response times, reduced resources) and crisis intervention (such as financial support, crisis housing), availability of legal services, and issues with social support and social isolation (Carrington et al., 2013; Carter-Snell et al., 2020; Edmond et al., 2020; C. Flynn et al., 2022; O’Callaghan et al., 2022).

To reduce SV in rural, remote, and regional Australia, there is a need for a comprehensive, multi-faceted approach involving several key strategies to improve access to services and address the unique challenges of help-seeking in small rural communities. These could include prevention strategies to enhance awareness of issues around SV, including improving knowledge of essential factors such as consent and respectful relationships that could be offered through school- and community-based programs. The formation of local groups for peer support, led by local people, could aid in enhancing understanding of the elements of consent and healthy relationships, and provide a potential means for survivors to share experiences and gain support. Adapting a codesign approach to these services could be valuable for gaining local community engagement and support.

Furthermore, the recognized barriers to help-seeking and underreporting of SV incidence in rural and remote communities, and the concerns about a lack of privacy and anonymity, need to be addressed through the creation of respectful, confidential, and safe disclosure, treatment and reporting services. Access to psychological assessment and treatment is essential for survivors, to identify and treat trauma and other psychological sequelae. Considering the issues relating to distance, isolation, and anonymity, strategies such as telehealth may provide one accessible component of confidential counseling and support services. In addition, mobile units may be another useful strategy to provide access to appropriate and timely forensic examinations and collections, to improve access to services and help enhance equity for people outside urban areas. It is important to note that these services must be trained in the complexities of rural communities and the rural SV context, to ensure that services are effective, utilized, and culturally appropriate. In addition to training staff to understand rural communities and provide culturally appropriate services, additional training and education appears needed for health staff more broadly on responding and managing SV. The findings of this review suggest a lack of confidence in healthcare workers in managing and responding to SV, which highlights a pressing professional development need. All healthcare staff, in urban and rural areas, who may be in contact with survivors of SV need to be alert to the need to screen for possible SV, need to be able to respond appropriately, and ensure that appropriate support is activated. In addition, robust and accurate data collection is essential, especially because the areas of SV are known areas of underreporting. Thus, it is important that consideration be given to the development and implementation of appropriate reporting systems which could help facilitate reporting if there is a fear of stigma or other barriers to reporting. Table 5 summarizes the implications for practice and research.

Table 5.

Implications for Practice, Policy, and Research.

To reduce SV in regional, rural, and remote Australia, there is a need for a comprehensive, multi-faceted approach involving several key strategies to improve access to services and address the unique challenges of help-seeking in small rural communities.

The formation of local groups for peer support, led by local people, could aid in enhancing understanding of the elements of consent and healthy relationships, and provide a potential means for survivors to share experiences and gain support.

Services need to consider the complexities of rural communities and the rural SV context, to ensure that services are effective, utilized, and culturally appropriate.

There is a pressing need to ensure healthcare professionals are trained in managing and responding to SV in regional, rural, and remote areas in Australia.

Research needs to consider using methodologies that are robust, ensure accurate data collection, and consider ways to counteract the underreporting issues, stigma, and shame associated with SV/sexual assault reporting. The focus of research needs to include barriers and facilitators of reporting, the unique nuances of rural life and its impact on SV perpetration, and service delivery including digital health interventions that can bridge the gap in service provision often found in rural communities.

Note. SV = sexual violence.

Limitations and Strengths

This study undertook a rigorous scoping review to synthesize the results of original research. The outcome clearly demonstrates the growing research in this area and the need for further research in the future. Limitations of this scoping review include the exclusion of articles not available in English, conducting of the search from November 2023 to May 2024 limited inclusion of articles published after May 2024, and the exclusion of gray literature (which may have resulted in publication bias but prevented the inclusion of articles with unknown methodology and unreliable reporting; Hopewell et al., 2005).

Conclusion

A scoping review of SV in regional, rural, and remote Australia revealed that despite public health and other campaigns highlighting gendered sexualized violence, little meaningful change has occurred, and that SV is a feature of life for many in rural, remote, and regional Australia. Unique to rural communities were the issues of privacy/confidentiality, culture of rural communities, geographical isolation, and rural infrastructure including economic sustainability, service provision, transportation, and crisis housing. In smaller communities, limited privacy makes it harder to keep incidents or reports of SV and other violence confidential. This affects disclosure and heightens feelings of shame.

Supplemental Material

sj-docx-1-tva-10.1177_15248380251320988 – Supplemental material for Sexual Violence and Assault in Rural Australia: A Scoping Review of Regional, Rural, and Remote Contexts

Supplemental material, sj-docx-1-tva-10.1177_15248380251320988 for Sexual Violence and Assault in Rural Australia: A Scoping Review of Regional, Rural, and Remote Contexts by Rikki Jones, Debra Jackson, Kylie Rice, Kim Usher, Ryan Davies, Chye Toole-Anstey, Jasleen Chhabra, Jennifer Smith, Louise Morley, Erica Russ, Dixie Statham and Alankaar Sharma in Trauma, Violence, & Abuse

Footnotes

Acknowledgements

None.

Author Contributions

Literature review protocol: R.J., K.U., and K.R.; literature search and screening: R.J., C.T.-A., and J.C.; data extraction: R.J. and A.S.; data appraisal: R.J. and R.D.; data synthesis: R.J., A.S., D.J., K.R., and K.U.; manuscript preparation; R.J., D.J., K.U., K.R., R.D., C.T.-A., J.C., L.M., J.S., E.R., D.S., and A.S.

Authorship Statement

We acknowledge that all authors listed meet the authorship criteria according to the latest guidelines of the International Committee of Medical Journal Editors, and that all authors are in agreement with the manuscript.

Prisma/Prospero

The authors confirm the PRISMA-ScR guidelines were followed for this scoping review. A protocol was developed to guide the scoping review but was not registered with PROSPERO as it is a scoping review, not a systematic review.

Data Availability

Not applicable (A Supplemental File is included to outline the search results and MMAT findings—no other data was collected through this project).

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethical Approval

Not applicable.

ORCID iDs

Rikki Jones

Chye Toole-Anstey

Supplemental Material

Supplemental material for this article is available online.

Author Biographies

Rikki Jones, BN, RN, PhD, is a professor in nursing and an ECR with an emerging research profile. Her research activities focus on Rural and Remote, Mental Health, and Violence (Occupational, Sexual and Drug-related). Jones completed her PhD in 2021 and has since been working under the mentorship of a world-renowned researcher, Professor Kim Usher. Recent projects include working as a chief investigator on a collaborative government tender, and as a principal chief investigator on multiple research projects focusing on rural first responders’ mental health, childhood sexual assault and sexual violence, nursing students’ experience of learning and clinical placement, and drug and alcohol violence. Jones has over 17 years of clinical experience working as a registered nurse in rural and regional areas. Her experience is in both acute and community health with main areas focusing on Emergency care, theaters, and rural care in MPS (multipurpose service). Jones has an established and sustained research contribution in the field of nursing in relation to outcomes in the areas of drug and alcohol, violence, mental health, rural and remote health care, and public health. Jones’ PhD project was the first in Australia to explore the experience of paramedic and police first responders in relation to managing methamphetamine intoxication in the pre-hospital environment. As a result, it was pivotal in building new knowledge in this area. Jones was recently awarded a Medical Research Futures Fund (MRFF) grant as CIA focusing especially on rural Australia’s first responders’ mental health (2024–2026).

Debra Jackson, AO, PhD, is a distinguished nurse scientist and scholar, and her career has spanned clinical practice, academic work, research, and scholarship. She is a Fellow of the Australian College of Nursing, and a Senior Fellow of the Higher Education Academy (UK).In 2015, she won a Principal Fellowship of the NIHR-funded Oxford Biomedical Research Centre, awarded in recognition of her sustained contribution to generating knowledge to enhance the care of NHS patients. In 2019, her work was honored through her being awarded Officer of the Order of Australia (AO) for distinguished service to medical education in the field of nursing practice and research as an academic and author. In 2020, she was appointed Fellowship Ad Eundem, Royal College of Surgeons, Ireland. Professor Jackson has been named as Australia’s leading nurse researcher by the Australian newspaper in their list of Australia’s Top 250 Research Field Leaders in 2020, 2021, and 2023. In 2021, she was also named global leader in nursing research. This is based on the highest number of citations from articles published in the past 5 years in the 20 top journals in the field. She has also been named as the top-rated global expert in nursing 2013 to 2023 (Nursing: Worldwide—Expertscape.com). Professor Jackson’s current bibliometric statistics are h-index 93, i10 index 471, and there are more than 35,000 citations to her work (Google Scholar October 9, 2023). Her work has been translated into Swedish, Danish, French, German, and Spanish, and her average FWCI is 3.357. Twenty-eight percent of her publications are in the top 10% most cited worldwide and more than 38% of her publications are in the top 25% most cited documents worldwide (SciVal November 1, 2023). Professor Jackson is Editor-in-Chief of the Journal of Advanced Nursing (JAN) and serves on the Editorial Boards of Nursing Inquiry, International Journal of Mental Health Nursing, and Journal of Child Health Care. She holds visiting professorial appointments at several international institutions, including Florence Nightingale Faculty, Kings College, London (UK), Oxford Health NHS Foundation Trust (UK), Bournemouth School of Nursing (UK), Auckland University of Technology (NZ), and the Ngangk Yira Research Centre for Aboriginal Health and Social Equity at Murdoch University (Australia), and has completed advanced leadership training at the Said Business School, University of Oxford (UK).

Kylie Rice, PhD, is a clinical psychologist with experience working in various settings including Health, Education, and Private Practice. Current position: Rice has recently joined academia and is a Senior Lecturer in Clinical Psychology. Qualifications: Rice holds a Bachelor of Psychology with Honours, a Masters of Lifelong Learning and Career Development, and Doctorate in Clinical Psychology. Rice has established numerous quantitative research programs of national significance, including the creation of the first measure of registered psychologist competencies in Australia and leading a national data collection of psychologist competencies. In an associated research program, Rice is working with Usher and an Aboriginal PhD student, Peter Smith, on cultural responsiveness. This research aims to improve the cultural responsiveness of mental health practitioners working with Aboriginal and Torres Strait Islander people and has involved community engagement, the formation of cultural mentoring and an Aboriginal Advisory Group, and both qualitative and quantitative data collection with Aboriginal communities. Rice is also the lead researcher on a multi-site data collection of psycho-oncology services across three Area Health Services of NSW Health and a longitudinal large-scale national survey. This research aims to promote the well-being of cancer patients and their carers, as well as equity of access to psychosocial support services for those affected by cancer in regional Australia. This project is a partnership with NSW Health, with in-kind support from the Cancer Council NSW, and a grant from Tour de Cure, and Rice is the primary supervisor for three PhD students on this project.

Kim Usher, AM, RN, PhD, FACMHN, FACN, is a professor of nursing in the School of Health, Research Fellow, Ngangk Yira Research Institute for Aboriginal Health & Social Equity, and Adjunct Professor Murdoch and University of Technology Sydney, Australia. She is the Editor-in-Chief of the International Journal of Mental Health Nursing. Professor Usher was awarded the Member of the Order of Australia in 2017 in recognition of sustained contribution to nursing and midwifery education and research. She was recognized for teaching by the award of Australian Learning and Teaching Council Citation for Outstanding Contribution to Student Learning (2008) and a James Cook University Vice Chancellor’s Award for Higher Degree Research Supervision in 2009. In 2018, Professor Usher was named in the top 10 nursing academics in Australia and New Zealand. Professor Usher’s research output includes more than 300 publications in high-quality peer-reviewed journals and numerous book chapters. Her current bibliometric statistics include: H-index—58 (Google Scholar), 41 (Scopus), and 20 (Web of Science), and she has a FWCI of 2.65 for 2018 to 2023 with 33.30% of articles in the top 10% of publications (as at February 14, 2024). She has served on Editorial Boards of key journals in her field, such as the International Journal of Mental Health Nursing, and has served on the National Health and Medical Research Committee (NHMRC) Centre of Research Excellence panel, and regularly reviews for the Australian Research Council (ARC) and NHMRC project grants. She was appointed to the ARC College of Experts in 2022. Professor Usher has successfully supervised over 40 PhD students to completion and continues to supervise many higher degree research students. Her students have received numerous awards and mostly publish numerous outcomes from the research during their period of candidature.

Ryan Davies is a PhD candidate and a lecturer at the University of New England (Australia) UNE, Department of Psychology.

Chye Toole-Anstey, PhD, is a lecturer in social work at the University of Wollongong. Threading Chye’s academic and practice work is a strong value of social justice and working with people. Chye completed a PhD exploring child-to-parent violence, including mothers’ stories of and practitioners’ responses to the violence. Chye draws on 15 years of practice experience in working within the community sector in her research. Chye views social work teaching and research as a way to work with people to enact social work. Chye has worked in a range of fields including refugees, community development, young people experiencing the impacts of cancer, and advocacy/policy. With collaborative and storied methodologies, Chye continues to research child-to-parent violence, as well as family violence, pedagogy, and young people.

Jasleen Chhabra, PhD, is a lecturer in psychology at the Institute of Health and Wellbeing in Berwick, Melbourne, Victoria. She is a post-doctoral fellow with the Manna Institute, a Commonwealth-funded, Regional University Network (RUN) virtual research and training institute focused on mental health and wellbeing in regional communities. Dr Chhabra’s research interests are within the area of paternal perinatal mental health. This is a critical area of research because untreated depressed fathers have a high chance of negatively influencing the mental health of their partners and children. As well as benefiting individuals, Dr Chhabra endeavors to influence clinicians and policy-makers on the importance of early diagnosis and treatment. Additional areas of interest include masculinity; psychological disorders; the identity of young men; adolescent and childhood psychology; maternal perinatal mental health; gender; and intercultural psychology.

Jennifer Smith, PhD, is currently employed as an Associate Professor at the Queensland Centre for Domestic and Family Violence Research. She has been a practitioner/academic social worker for 40 years. Her experience includes 17 years of university teaching (at QUT, UQ, ACU, and UNE) and 23 years as a practitioner in the government (Child Health and Child Safety) and community sectors (Lifeline and UnitingCare Community). Jennifer’s teaching and publications have been in the areas of domestic and family violence, child protection, social work, child and family practice, counseling, and group work. Her social work master’s and doctorial research focused on the impact of domestic violence on children and their mother’s parenting, as well as children’s perceptions of domestic violence, and was the earliest Australian research in this field. Jennifer is passionate about child advocacy, early intervention, family support, and public health approaches to family violence as well as trauma-informed and narrative approaches to practice. My interests also include professional supervision and the “use of self” and the “wounded healer” in professional practice. In 2002, while employed as the Director of the Child Advocacy service at the Royal Children’s Hospital, Jennifer was a successful recipient of a Creswick Fellowship in Family Relations and Child Development which enabled me to undertake further studies at the Kempe Centre, Denver Children’s Hospital and Primary Children’s Hospital, Salt Lake City.

Louise Morley, PhD, is a senior lecturer in social work at the University of New England in Armidale, Australia. She has extensive practice experience in government and non-government organizations working with individuals, groups, and communities in Australia and overseas. Her practice areas include health (oncology), disability, rural practice, and child protection (specifically child sexual assault). Throughout her career, she has focused on the systematic impacts of inequality on rural and remote communities. In 2015, she completed her doctoral research, where she examined the deeply personal issues for workers in a highly contested political and policy environment. Her thesis was concerned with social workers’ private experience of professional practice when working with vulnerable children and their families.

Erica Russ, PhD, has extensive social work industry experience with a focus on children and families developed a strong commitment to children’s rights and voice. Having also held management and senior executive positions, and led large strategic projects, I developed an interest in workforce issues and social work education. Her primary research focus is on the social work career path from social work education to workforce issues including readiness, well-being, and resilience. Research has included social work field education, child welfare, rural and eco-social work, and research that reflects children’s voices. Erica’s research interests focus on collaborative research using qualitative methodology with an applied focus. Erica is a team member for multiple contracted research projects including a joint project with Their Futures Matter initiatives and Family and Community Services NSW; Community Sector projects on staff well-being and disaster management; enhancing participation of children and young people; and service evaluation. Currently a co-supervisor for a PhD student, previously served as the principal supervisor for a PhD student and a completed MPhil student. Available for supervision in social work areas relevant to the research focus.

Dixie Statham, PhD, is a professor of clinical psychology at the Institute of Health and Wellbeing in Ballarat, Victoria. She is a chief investigator with the Manna Institute, a Commonwealth funded, Regional University Network virtual research and training institute focused on mental health and well-being in regional communities. Professor Statham joined Federation University Australia in 2018, moving from the University of the Sunshine Coast where she taught and supervised the clinical and professional Masters’ programs, and held the role of Director of the University Psychology Clinic. Professor Statham is currently a member of both the Victorian and the National Committees of the Australian Psychological Society’s (APS) College of Clinical Psychologists; she is a Fellow of the Australian Clinical Psychological Association (ACPA), and an International Affiliate of the American Psychology Association (APA).

Alankaar Sharma, PhD, is an academic with over 20 years of experience as a researcher, educator, and practitioner working internationally including in Australia, India, and the United States. His primary academic areas of interest are critical studies of men and masculinities; sexual violence and child sexual abuse; and sexuality and sexual rights. He earned his PhD from the University of Minnesota, USA, and a master’s degree in social work from Tata Institute of Social Sciences, India. His research is inspired by social justice and (pro)feminism and has been published in leading international peer-reviewed academic journals and books. His most recent publication is a co-authored book on social research methods, titled “Using social research for social justice: An introduction for social work and human services,” published in 2024 by Routledge.

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Supplementary Material

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Sexual Violence and Assault in Rural Australia: A Scoping Review of Regional,Rural,and Remote Contexts

Abstract

Keywords

Introduction

Methods

Design

Search Strategy

Search and Screening Process

Appraisal and Data Synthesis

Results

Frequency and Impacts

Drivers and Facilitators

Barriers to Disclosure, Help-Seeking, and Service Delivery

Unique Challenges for Rural/Remote Communities

Discussion

Summary of critical findings

Challenges of SV in rural and remote areas

Limitations and Strengths

Conclusion

Supplemental Material

sj-docx-1-tva-10.1177_15248380251320988 – Supplemental material for Sexual Violence and Assault in Rural Australia: A Scoping Review of Regional, Rural, and Remote Contexts

Footnotes

Acknowledgements

Author Contributions

Authorship Statement

Prisma/Prospero

Data Availability

Declaration of Conflicting Interests

Funding

Ethical Approval

ORCID iDs

Supplemental Material

Author Biographies

References

Supplementary Material