Testing the effectiveness of a sexual assault resistance programme in 'real-world' implementation.

Background: In a multi-site randomized controlled trial (RCT), the EAAA programme designed for first year university women (17-24 years old) was shown to reduce the likelihood of any (attempted and completed) rape in the next year by 50% (Senn, C. Y., Eliasziw, M., Barata, P. C., Thurston, W. E., Newby-Clark, I. R., Radtke, H. L., & Hobden, K. L. (2015). Efficacy of a sexual assault resistance program for university women. New England Journal of Medicine, 372(24), 2326-2335). Through a non-profit organization, EAAA has been available to universities globally since 2016 using a Train-the-Trainer model. Observations of the 'real world' implementation suggested that universities often altered eligibility criteria (especially year of study and age) in their recruitment.Objective: The current study (2017-2021) evaluated whether EAAA was effective when implemented by universities in Canada outside of the constraints of an RCT.Method: Five universities participated. Women students who signed up to take the EAAA programme on their campuses were recruited for the research. Participants completed surveys at 1-week pre-program and 1-week and 6-months post-programme. Compared to the RCT, participant eligibility was broader, the sample was more diverse in terms of race and sexual identity and had a higher proportion of survivors. Programme fidelity was adequate.Results: Comparisons in this quasi-experimental design, between students who took the programme and students in the control group (i.e. those who signed up but did not attend the programme), confirmed the effectiveness of the EAAA programme. Reduction of any rape exceeded the a priori benchmark of 37.5%. Completed rape was significantly reduced by 57.3% at 6-months. Reduction in attempted rape of 32.9% was lower than in the RCT likely due to the somewhat older (average age 22 vs 18) sample. Positive changes to previously established mediators of the programme effects were all replicated.Conclusions: These findings suggest that the EAAA is highly effective when implemented by universities even when eligibility for students in terms of year of study and age is broadened.

This study evaluates whether the EAAA programme is effective when implemented by university staff at five Canadian universities outside of the constraints of an RCT.Women-identified students who attended the EAAA programme experienced a 57.3% reduction in completed rape and other benefits including increased confidence and reductions in rape myth beliefs when compared to a comparable group of students who signed up but didn't attend the programme.These reductions in sexual victimization in the 'real-world' implementation of the EAAA programme in a sample of diverse undergraduate and graduate students enhances our confidence in its ability to reduce the pervasive public health issue of sexual violence experienced by women in university.

An Evaluation of Strategies Used to Maximize Intervention Fidelity in a Randomized Controlled Trial of a Sexual Assault Resistance Program for University Women.

In this paper, we describe and evaluate the strategies used to maximize intervention fidelity in a randomized controlled trial to examine the efficacy of a sexual assault resistance intervention. The EAAA program was based on the best available theory and evidence on how women can successfully resist sexual coercion from male acquaintances. Extensive protocols for hiring, training, and supervising facilitators were established a priori. Detailed intervention manuals were developed that clearly described program goals, learning objectives, core elements, troubleshooting tips, sections that must be delivered verbatim, adaptations that could be made if necessary, and the ideal and minimum dose. Program sessions were audio-recorded, and a subsample of recordings were scored for adherence to the manuals using detailed Intervention Fidelity Checklists (IFC) developed specifically for this research. The Gearing et al. (2011) Comprehensive Intervention Fidelity Guide (CFIG) was employed retrospectively to provide objectivity to our analysis and help identify what we did well and what we could have done better. The SARE (Sexual Assault Resistance Education) Trial received high scores (38 out of 44 (86%) from each of the first two authors on the CFIG, suggesting a high level of intervention fidelity. Although a potential for bias on the part of the two raters was an obvious limitation, as was our neglection to include measures of implementation receipt, which Gearing et al. (2011) recommended, our analysis underscores the utility in employing methods recommended to enhance intervention fidelity when developing and evaluating evidence-based interventions.

Integrating weight bias awareness and mental health promotion into obesity prevention delivery: a public health pilot study.

INTRODUCTION: Promoting healthy weight is a top priority in Canada. Recent federal guidelines call for sustained, multisectoral partnerships that address childhood obesity on multiple levels. Current healthy weight messaging does not fully acknowledge the influence of social determinants of health on weight. METHODS: An interactive workshop was developed and implemented by a team of academic researchers and health promoters from the psychology and public health disciplines to raise awareness about 1) weight bias and its negative effect on health, 2) ways to balance healthy weight messaging to prevent the triggering of weight and shape preoccupation, and 3) the incorporation of mental health promotion into healthy weight messaging. We conducted a full-day workshop with 342 Ontario public health promoters and administered a survey at preintervention, postintervention, and follow-up. RESULTS: Participation in the full-day workshop led to significant decreases in antifat attitudes and the internalization of media stereotypes and to significant increases in self-efficacy to address weight bias. Participants reported that the training heightened their awareness of their own personal weight biases and the need to broaden their scope of healthy weight promotion to include mental health promotion. There was consensus that additional sessions are warranted to help translate knowledge into action. Buy-in and resource support at the organizational level was also seen as pivotal. CONCLUSION: Professional development training in the area of weight bias awareness is associated with decreases in antifat attitudes and the internalization of media stereotypes around thinness. Health promoters' healthy weight messaging was improved by learning to avoid messages that trigger weight and shape preoccupation or unhealthful eating practices among children and youth. Participants also learned ways to integrate mental health promotion and resiliency-building into daily practice.

Promoting positive body image among university students: A collaborative pilot study.

The purpose of the present study was to pilot a prevention program designed to promote positive body image among university students. Thirty-seven undergraduate students from three Canadian universities were recruited to participate in the study. They were selected from a pool of students enrolled in a peer health education program facilitated by the university-based health promotion staff. Borrowing from the tenets of the non-specific vulnerability stressor model and the disease-specific social cognitive theory, the intervention focused on media literacy, self-esteem enhancement strategies, stress management skills and ways to recognize healthy versus unhealthy relationships. Separate ANOVAs revealed that participants reported significant improvements in body satisfaction and reductions in the internalization of media stereotypes between the baseline and post-program period. The program received a favorable response from the participating students, who appreciated the face-to-face format of the intervention, and from the university staff who expressed interest in embedding the strategies into their routine peer mentoring training activities. Limitations of the study and suggestions for future research are discussed.

A community-based training program for eating disorders and its contribution to a provincial network of specialized services.

The Ontario Community Outreach Program for Eating Disorders is a pilot training project within the eating disorder programs at the University Health Network--Toronto General Hospital (TGH) and the Hospital for Sick Children. This system provides ongoing training, consultation, and research evaluation in areas ranging from prevention through to tertiary care, in the hopes of increasing the capacity of practitioners to respond to the healthcare pressures of those experiencing eating disorders. A total of 3,315 health care practitioners and educators in Ontario participated in community-based training workshops. A pre-post analysis of participants' self-report evaluations was conducted using chi-square analyses. The findings revealed that there was a statistically significant increase in participants' (a) knowledge of eating disorders and of body image issues and (b) level of comfort to either treat clients with eating disorders or teach a curriculum on body image. The contribution of the training program to the development of a provincial network of specialized eating disorder services, designed to promote the public's access to timely and appropriate care for the full spectrum of eating disorders, are discussed.

Evaluation of a school-based program designed to improve body image satisfaction, global self-esteem, and eating attitudes and behaviors: a replication study.

OBJECTIVE: The purpose of the current study was to evaluate the effectiveness of a life-skills promotion program designed to improve body image satisfaction and global self-esteem, while reducing negative eating attitudes and behaviors and feelings of perfectionism, all of which have been identified as predisposing factors to disordered eating. METHOD: A total of 258 girls with a mean age of 11.8 years (intervention group = 182 and control group = 76) completed questionnaires before, and 1 week after, the six-session school-based program, and again 6 and 12 months later. RESULTS: The intervention was successful in improving body image satisfaction and global self-esteem and in reducing dieting attitude scores at post intervention only. The gains were not maintained at the 12-month follow-up. DISCUSSION: The need to assess the influence of health promotion programs on predisposing risk factors, compared with problem-based outcome measures, is discussed.

School-based peer support groups: a new approach to the prevention of disordered eating.

The goal of the present study was to evaluate the effectiveness of a school-based peer support group designed to improve body esteem and global self-esteem and to reduce negative eating attitudes and behaviors. A total of 214 girls in grades 7 and 8, 115 of whom were in the control group, completed self-report questionnaires immediately before and following the intervention, and three months later. The findings revealed that participation in the 10-session group, facilitated by public health nurses, led to increases in weight-related esteem and decreases in dieting. The role of peer support groups in the prevention of disordered eating is discussed.

Replication of a peer support program designed to prevent disordered eating: is a life skills approach sufficient for all middle school students?

The evaluation of a school-based peer support group previously shown to improve body esteem and global self-esteem and reduce dieting in young adolescent girls was replicated in the present study. A total of 282 girls in grades 7 and 8, 196 of whom were in the control group, completed self-report questionnaires immediately before and after the life skills intervention, and 3 months later. Contrary to the findings reported in the original study, participation in the 10-session peer support group did not lead to improvements in body esteem or eating attitudes and behaviors beyond what was experienced by the control group. Interestingly, participants of the current intervention group exhibited higher disordered eating scores at baseline than those participants in the original study. Implications for matching prevention curriculum with the developmental and symptom levels of students are discussed.