Adapting effective sexual assault prevention for online delivery

Can an in-person intervention that decreases young women’s risk of sexual assault maintain its effectiveness when adapted for online facilitation? Our recent research set out to answer this question

Many people have searched for ways to prevent sexual violence against women and girls, but few strategies have been found to be effective. ⁽¹⁾ Changing societal acceptance of gender-based violence takes time, and attitude change alone does not lead to decreases in rates of violence. Efforts to prevent sexual violence perpetration have had limited results, ⁽²⁾ though this work continues. Dr Charlene Senn and her team had a scientific breakthrough with CIHR funding, showing that empowering young women through resistance education can decrease their risk of sexual assault and intimate partner violence (IPV) by 50%. ^(3,4,5) The intervention was the Enhanced Assess, Acknowledge, Act (EAAA; also known as Flip the Script with EAAA®), a 12-hour program delivered in small groups by two expert near-peers on university campuses. Implementation is resource- intensive for universities (e.g., training and staffing costs) even though the program itself is available at cost (SARE Centre). It is the only intervention that has demonstrated large, long- lasting reductions in sexual and IPV victimization. It has been used on campuses in five countries; however, the reach is still limited.

Having a version of EAAA that could be delivered from a central location to women-identified students on various campuses would reduce the resources needed at individual universities and expand the program’s benefits to more students, enabling widespread scale-up.

Adaptation process

We employed a rigorous process to adapt the EAAA program for online delivery, known as Internet Delivered EAAA (IDEA3). We conducted consultations with experts in online education and feminist self-defense, as well as interviews and focus groups with facilitators and students who piloted the program. Additionally, we administered pre-and post-surveys to evaluate changes in outcomes that were found to be responsible for EAAA’s reduction in sexual victimization. ⁽⁶⁾

Changes to the content and process for the virtual environment fell into three general categories:

1. Delivery of IDEA3 and application activities with technology and software

Activities in EAAA utilize a variety of equipment, including laptops, projectors, flip charts, props, and laminated cards. Most were relatively easy to replace with videoconferencing tools that included screen sharing and annotation, breakout rooms, chats, sharing links to documents, a messaging app, and other free online apps. However, the speed of tech obsolescence and the complications it creates for the sustainability of online programming were made clear when several of the apps stopped being supported after a relatively short time, necessitating the identification of alternatives. IDEA3 is also delivered across four days instead of two, with additional breaks, to reduce screen fatigue.

2. Facilitating the engagement of participants

An empowering small group context. EAAA evaluations suggest that the small group environment was important to the way content was received and yielded unanticipated positive outcomes (e.g., friendships among first-year students). To replicate this camaraderie, we pair participants with another student, and they meet in person to join the virtual sessions together. Our research confirmed that this adaptation provided a meaningful connection to others in the group.

Ground rules. EAAA ground rules had to be expanded for the virtual environment, where behaviors like muting oneself and engaging in outside conversations during a Zoom call are more normative than in an in-person group. Facilitator training was enhanced with additional skills to deal with online group dynamics, as many of the strategies that manage disruptive behaviour in-person (e.g., standing near participants having a side conversation, indicating non-verbally that a phone should be put away) are impossible in a virtual context.

Mailed program kits. Buy-in for in-person prevention is enhanced through the positive mood created by refreshments, small gifts, and passing out interesting materials. Our adaptation included the delivery of a box of ‘goodies,’ including snacks, session envelopes to be opened when instructed, and small gifts (e.g., pens, stickers).

3. Addressing psychological and physical safety

EAAA in-person facilitators are carefully trained to maintain a safe psychological (trauma-informed, with confidentiality maintained) and physical environment, particularly during self-defense instruction. The virtual format raised questions about how to ensure privacy for participant discussions (e.g., people could be in the room but off camera, violating the privacy of group members), monitor individuals’ emotional state, and ensure safety in physical spaces not controlled by facilitators. New strategies and protocols were needed to address these issues.

1. Facilitators employ messaging software to communicate with all group members and check in with individual participants privately. We get cellphone numbers and addresses in case of emergency.
2. We added brief virtual space and privacy audits/interviews prior to attendance to ensure that participants have a private space large enough for self-defence practice.
3. We reduced the self-defence strategies taught to only those that could be supervised safely through Zoom. In EAAA, facilitators hold strike pads for participants to practice. In IDEA3, participants hold a yoga mat or pillow for their partner to practice strikes.

Feasibility and effectiveness of the adapted intervention

Our early consultations, qualitative research, and single-arm pilot trial demonstrated the feasibility of the IDEA3 program. Our pilot trial confirmed that indicators of potential efficacy were present: IDEA3 significantly increased students’ perceptions of the risk of acquaintance rape and their confidence that they could defend themselves, if necessary, while decreasing their acceptance of woman-blaming and other harmful beliefs about sexual assault. In the original randomized controlled trial (RCT), changes in these indicators were responsible for EAAA’s reductions in attempted and completed rape. (7)

In a CIHR-funded RCT (2022-2027; NCT04797741), we are now assessing whether IDEA3 leads to similar reductions in victimization for women who take it as found for the in-person EAAA program. If effective, IDEA3 will represent another leap forward in scalable, cost-effective, evidence-based sexual assault prevention for young women.

References

1. https://doi.org/10.1177/1524838018789153
2. https://journals.sagepub.com/doi/full/10.1177/1524838018801330
3. https://journals.sagepub.com/doi/10.1177/08862605241270057
4. http://www.nejm.org/doi/full/10.1056/NEJMsa1411131
5. https://journals.sagepub.com/doi/full/10.1177/0361684317690119
6. https://journals.sagepub.com/doi/full/10.1177/0361684320962561