Sexual assault medical and forensic examiners in regional and rural New South Wales, Australia: a qualitative study of experiences impacting workforce participation

Introduction: People who have experienced sexual assault have many acute needs requiring timely attention.In New South Wales (NSW), Australia, reported sexual assault rates have been increasing over the past decade, with reported rates increasing at a higher rate outside metropolitan areas.These regional and rural areas experience chronic shortages of medical and forensic examiners able to deliver timely care.The aim of this study was to identify the motivations, barriers and facilitators affecting the recruitment and retention of examiners in regional and rural NSW, Australia.Methods: Doctors and sexual assault nurse examiners who have worked as examiners for NSW sexual assault services in a nonmetropolitan area were recruited to participate in semi-structured interviews.Written informed consent was obtained, and interviews were recorded and transcribed.Data were coded using a combination of deductive and inductive approaches.Themes were developed according to Braun and Clarke's thematic analysis approach.Results: A total of 13 participants were interviewed, of whom 11 were female and 2 were male; 9 were doctors and 4 were nurses.Five key themes were identified: structural challenges of rural service delivery, near invisibility in the health system, isolation and missed connections with colleagues, inability to thrive, and sense of duty to patients, colleagues and community.While motivated by obligation to colleagues and community, barriers of travel time over large geographic areas and insufficient examinations to maintain skills were present.Potential facilitators such as peer support, contributing to policy and funded training opportunities were considered to be lacking. Conclusion:To ensure the sustainability of rural sexual assault medical workforces, change addressing isolation and invisibility is needed.Future changes to services should be considered from a rural lens, as rural examiners face unique barriers to workforce participation and are essential to service delivery.