This paper is in the following e-collection/theme issue:
A Web-Based Sexual Violence Bystander Intervention for Male College Students: Randomized Controlled Trial
1Georgia State University, School of Public Health, Atlanta, GA, United States
2Centers for Disease Control and Prevention, Division of Violence Prevention, Atlanta, GA, United States
3University of South Carolina, Department of Epidemiology and Biostatistics, Columbia, SC, United States
4Independent Consultant, Mount Shasta, CA, United States
Laura F Salazar, PhD
Georgia State University
School of Public Health
P.O. Box 3984
Atlanta, GA, 30302-3984
Phone: 1 404 413 1396
Fax: 1 404 413 2544
Background: Bystander intervention approaches offer promise for reducing rates of sexual violence on college campuses. Most interventions are in-person small-group formats, which limit their reach and reduce their overall public health impact.
Objective: This study evaluated the efficacy of RealConsent, a Web-based bystander approach to sexual violence prevention, in enhancing prosocial intervening behaviors and preventing sexual violence perpetration.
Methods: A random probability sample of 743 male undergraduate students (aged 18 to 24 years) attending a large, urban university located in the southeastern United States was recruited online and randomized to either RealConsent (n=376) or a Web-based general health promotion program (n=367). Participants were surveyed online at baseline, postintervention, and 6-months postintervention. RealConsent was delivered via a password-protected Web portal that contained six 30-minute media-based and interactive modules covering knowledge of informed consent, communication skills regarding sex, the role of alcohol and male socialization in sexual violence, empathy for rape victims, and bystander education. Primary outcomes were self-reported prosocial intervening behaviors and sexual violence perpetration. Secondary outcomes were theoretical mediators (eg, knowledge, attitudes).
Results: At 6-month follow-up RealConsent participants intervened more often (P=.04) and engaged in less sexual violence perpetration (P=.04) compared to controls. In addition, RealConsent participants reported greater legal knowledge of sexual assault (P.001), greater knowledge of effective consent (P.001), less rape myths (P.001), greater empathy for rape victims (P.001), less negative date rape attitudes (P.001), less hostility toward women (P=.01), greater intentions to intervene (P=.04), less hyper-gender ideology (P.001), less positive outcome expectancies for nonconsensual sex (P=.03), more positive outcome expectancies for intervening (P.001), and less comfort with other men’s inappropriate behaviors (P.001).
Conclusions: Our results support the efficacy of RealConsent. Due to its Web-based format, RealConsent has potential for broad-based dissemination thereby increasing its overall public health impact on sexual violence.
Trial Registration: Clinicaltrials.gov: NCT01903876; http://clinicaltrials.gov/show/NCT01903876 (Archived by WebCite at http://www.webcitation.org/6S1PXxWKt).
(J Med Internet Res 2014;16(9):e203)
Internet; sex offenses; rape; universities; students; public health
Sexual violence is a major public health problem with long-term mental, physical, and social effects for victims [1-3]. Sexual violence encompasses a breadth of personal violations ranging from minor, nonconsensual noncontact acts, such as exhibitionism or verbal sexual harassment to sexual coercion, up to severe acts, such as attempted or completed nonconsensual oral, genital, or anal penetration [4,5]. The 2010 National Intimate Partner and Sexual Violence Survey found that 18.3% of women in the United States have been raped in their lifetime . Younger age has been shown to be a significant factor in sexual violence risk. Recent research has shown that 80% of female victims of sexual violence reported that their first rape occurred before the age of 25 years . According to results from the National College Women Sexual Victimization study, 2.8% of female college students surveyed reported either a completed rape or attempted rape in the previous 6 months, which equates with an incidence rate of 5.6% per year . Research has also shown that the majority of sexual victimizations occur by perpetrators the victim knows [6-8].
To combat the problem of sexual violence, most prevention and intervention programs have focused on college populations and have shifted efforts recently to target elements in the environment rather than solely targeting individual characteristics of perpetrators or victims. The bystander model is one such approach. It is a theoretical model of community-level change that targets community members to intervene actively in situations that may be harmful and engages them to be accountable and to take action [9-11]. In fact, bystander intervention programs applied to dating and/or sexual violence interventions have proliferated in the past 5 years [12-20]. Most of these have involved a small-group format (eg, workshops), whereas a few involved a localized social marketing campaign. Subsequent evaluations demonstrated that the bystander model, in some cases, is effective in promoting active bystander behaviors and in changing social norms .
As promising as these interventions are, because of their small-group in-person format, they are resource-intensive and limited in their reach and sustainability. Alternatively, the use of the Internet as an effective medium to deliver health-related interventions has emerged [21,22] and offers significant advantages over in-person interventions, such as lower cost of intervention delivery, greater reach, maintenance of fidelity, the possibility of delivery in a wide range of settings, and ability to tailor content to a variety of users [23-26]. There are Web-based treatment programs designed to ameliorate depression [27,28], obesity [29,30], eating disorders , alcohol abuse [32-36], smoking , sexual risk reduction , and posttraumatic stress disorder . In a study of college students, results showed that a Web-based format was preferable over a practitioner-delivered intervention for a hazardous drinking prevention program .
To date, there have been no Web-based sexual violence prevention programs that target male college students and incorporate the bystander approach, which have also been tested using a true experimental design and with sexual violence as an outcome. In response, RealConsent, a Web-based sexual violence prevention program incorporating a bystander approach, was developed and tested for its efficacy. This paper reports primary and secondary outcomes from a randomized controlled trial (RCT) of RealConsent. It was hypothesized that participants randomized to receive the RealConsent program would report greater increases in self-reported prosocial intervening behaviors and fewer incidents of sexual violence perpetration in comparison to participants randomized to receive an attention-placebo comparison program.
Recruitment and Study Design
An RCT was implemented at a Georgia State University, a large, urban university located in Atlanta, GA. Study procedures were approved by the participating sites’ Institutional Review Boards. Participants provided informed consent; however, documentation was waived because of online recruitment.
Eligible participants were male undergraduates aged 18 to 24 years, single, who self-reported being either heterosexual or bisexual; exclusion criteria were graduate student status and homosexual sexual orientation. Active recruitment began February 2010 and ended in April 2010, and was accomplished through email messages from the principal investigator’s university email address sent to randomly selected students. The sampling frame to generate the random sample was a list of student names obtained from the university’s Office of Legal Affairs. The list included only first and last names, email addresses, and year of birth for all undergraduate students enrolled during 2009-2010 school year (N=21,280). To pare down the sampling frame, the list was sorted by birth year and all students born on or before January 1, 1984 were deleted from the list. Next, the list was sorted alphabetically by first name and an online resource (Baby Name Guesser) was used to determine likelihood of a name belonging to a male. This process resulted in a final sampling frame of 8458 male students. A random sample function from SPSS version 18.0 was used to select groups for invitation to participate in the RCT. Over the course of 10 weeks, 5 groups of randomly selected email addresses ranging in size from 300-3000 were emailed an invitation to participate.
Email invitations included a link to a website that included a short description of the study that blinded participants to the research questions and a short screener to determine eligibility. Eligible students were directed to a webpage that contained the informed consent form. Students were told that the purpose of the study was to “test multimedia, Web-based interactive programs designed for male college students.” They were also told that the study would be anonymous (ie, email addresses could not be linked to their user ID or to their responses on the survey). Participants who provided consent were then directed to the RealConsent Web portal to register and obtain a username and set their password. After registering, simple randomization was implemented using a customized algorithm that assigned participants to either the experimental condition (RealConsent) or to an attention-placebo comparison condition. Participants were then directed to complete the baseline online survey. Following completion of the survey, they were directed to either the RealConsent program or to the comparison program where they could begin the modules immediately or at a later time. Participants were asked to complete a survey postintervention and at 6-month follow-up. Weekly email reminders were sent to participants reminding them to complete each survey. The Web portal also allowed participants to send emails to a project coordinator and post messages if they needed assistance or had questions. Participants were paid US $25 via PayPal for completing each online survey.
The content for RealConsent was based on several complementary theoretical frameworks (social cognitive theory , social norms theory , and the bystander educational model ) as well as extensive formative research with the targeted population. RealConsent had two primary goals: (1) to increase prosocial intervening behaviors that reduce risk for sexual violence perpetration (eg, expressing disapproval when a peer is verbally disparaging toward women, attempting to stop a peer who tries to be coercive/violent) and (2) to prevent sexually violent behaviors toward women. These goals were to be achieved by affecting theoretically and empirically derived mediators, such as increasing knowledge of and skills for safely intervening, correcting misperceptions in normative beliefs, affecting negative attitudes toward date rape, increasing knowledge of the elements constituting effective consent for sex, affecting masculine gender roles, enhancing communication skills, and increasing empathy for victims of sexual assault.
RealConsent was delivered via a password-protected Web portal (see Figure 1 for screenshot) and consisted of six 30-minute modules with each module ranging in number of segments (1-14) and types of activities with diverse actors and appropriate language. Each of the modules involved interactivity, didactic activities, and episodes of a serial drama, which allowed us to model positive behaviors and illustrate both positive and negative outcome expectations for intervening and for perpetrating violence against women. Behaviors modeled in the serial drama included intervening, communicating with female sex partners, and obtaining effective consent for sex.
RealConsent was also programmed so that participants could not skip or click-through segments within each module. Participants were allowed to complete the modules at their own pace, but were encouraged via email to complete all modules within 3 weeks. Following the completion of each module, participants were immediately assessed and compensated US $10 for providing their acceptability and feedback on the module. These procedures ensured that each participant at follow-up had completed each module in its entirety.