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Kosa SD, Coelho M, Friedman-Burley J, Lebel N, Kelly CE, Macdonald S, Du Mont J. Bridging Gaps in Collaboration Between Community Organizations and Hospital-Based Violence Treatment Centers Serving Transgender Sexual Assault Survivors. J Interpers Violence 2024; 39:1811-1829. [PMID: 37970834 DOI: 10.1177/08862605231211922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Community and healthcare organizations have not historically collaborated effectively, leaving gaps in the continuum of care for survivors of sexual assault. These gaps are particularly acutely felt by transgender (trans) survivors, who experience additional barriers to care and face higher rates of sexual assault. To bridge these gaps and enhance the provision of comprehensive support for trans people, we developed an intersectoral network of trans-positive community and hospital-based organizations in Ontario, Canada. As part of a baseline evaluation of the network, we conducted a social network analysis to determine the extent and nature of collaboration between members within and across these two sectors. Using a validated social network analysis tool (PARTNER survey), data were collected from June 22 to July 22, 2021. The extent of collaboration was examined by relationship type: intrasectoral (same sector) and intersectoral (different sectors). The nature of collaboration was examined using relational scores (value: power, level of involvement, potential resource contribution; trust: reliability, mission congruence, openness to discussion). Fifty-four community organizations (65.9% of 82 invited) and 24 hospital-based violence treatment centers (64.9% of 37 invited) responded. The majority of collaborations were within, rather than across, the two sectors: of all 378 collaborations described, 70.9% (n = 268) were intrasectoral collaborations and 29.1% (n = 110) were intersectoral collaborations. Intersectoral relationships were characterized by lower scores for level of involvement, trust, reliability, and mission congruence than intrasectoral relationships, but higher scores for power. These findings were shared in a virtual consultation session of key stakeholders, in which some participants expressed "surprise" and concern for the lack of collaboration and character of relationships across sectors. Recommendations to increase intersectoral collaboration, which included intersectoral program planning and service design and supporting increased opportunities for intersectoral training and knowledge exchange, are presented.
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Affiliation(s)
- Sarah Daisy Kosa
- Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, ON, Canada
| | - Madelaine Coelho
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Joseph Friedman-Burley
- Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, ON, Canada
| | - Nicholas Lebel
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Carolyn Emma Kelly
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Sheila Macdonald
- Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, ON, Canada
| | - Janice Du Mont
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, ON, Canada
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Du Mont JA, Kelly CE, Seo H, Brouillard-Coyle S, Mason R, Macdonald S, Kosa SD. Enhancing care for transgender and gender diverse survivors of intimate partner violence: an Ontario-wide survey examining health and social service providers' learning needs. BMJ Open 2024; 14:e075180. [PMID: 38331863 PMCID: PMC10860041 DOI: 10.1136/bmjopen-2023-075180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 01/22/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES To better understand healthcare and social/community service providers' learning needs associated with supporting transgender and gender diverse (trans) persons who have experienced intimate partner violence (IPV). SETTING An online survey was distributed through the trans-LINK Network in Ontario, Canada. RESPONDENTS 163 of 225 healthcare and social/community service providers completed the survey (72.4% response rate) between November 2022 and February 2023. MAIN OUTCOME MEASURES Expertise, training, workplace practices and learning needs related to supporting trans survivors of IPV. METHOD Quantitative survey results were analysed descriptively and open-ended responses were organised thematically. In March 2022, survey results were shared with 33 stakeholders who helped define goals and objectives for an e-learning curriculum using Jamboard, data from which were collated and organised into themes. RESULTS Most (66.3%) survey respondents described having provided professional support to trans survivors of IPV, but only one-third (38.0%) reported having received relevant training, and many of the trainings cited were in fact focused on other forms of violence or trans health generally. The majority reported a mid (44.9%) or low-mid (28.5%) level of expertise and almost unanimously agreed that they would benefit from (further) training (99.4%). The most commonly recommended goal/objective for a curriculum emerging from the stakeholder consultation was to facilitate collaboration, knowledge sharing and (safe) referrals among organisations. CONCLUSIONS The results of this study highlight the critical need for an IPV curriculum specific to trans survivors and responsive to the needs of providers. As no one profession can address this complex issue in isolation, it is important that the curriculum aims to facilitate collaboration across sectors. In the absence of appropriate training and referrals, practitioners may perpetuate harm when caring for trans survivors of IPV.
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Affiliation(s)
- Janice A Du Mont
- Women's College Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - C Emma Kelly
- Women's College Hospital, Toronto, Ontario, Canada
| | - Hannah Seo
- Women's College Hospital, Toronto, Ontario, Canada
| | | | - Robin Mason
- Women's College Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Sheila Macdonald
- Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, Ontario, Canada
| | - Sarah Daisy Kosa
- Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, Ontario, Canada
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Mitric C, Kosa SD, Kim SR, Nelson G, Laframboise S, Bouchard-Fortier G. Cost impact analysis of enhanced recovery after minimally invasive gynecologic oncology surgery. Int J Gynecol Cancer 2023; 33:1786-1793. [PMID: 37524497 DOI: 10.1136/ijgc-2023-004528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE The implementation of a peri-operative care program based on enhanced recovery after surgery principles for minimally invasive gynecologic oncology surgery led to an improvement in same day discharge from 29% to 75% at our center. This study aimed to determine the program's economic impact. METHODS Our initial enhanced recovery quality improvement program enrolled consecutive patients undergoing minimally invasive hysterectomy at a single center during a 12-month period and compared them to a pre-intervention cohort. The primary outcome was overall costs. The secondary outcomes were surgical and post-operative visit costs. The surgical visit costs included pre-operative and operating room, post-operative stay, pharmacy, and interventions costs. The 30-day post-operative visit costs included clinic and emergency room, and readmission costs. The costs for every visit were collected from the case-cost department and expressed in 2020 Canadian dollars (CAD). RESULTS A total of 96 and 101 patients were included in the pre- and post-intervention groups, respectively. The median total cost per patient for post-intervention was $7252 compared with $8381 pre-intervention (p=0.02), resulting in a $1129 cost reduction per patient. The total cost for the program implementation was $134 per patient for a total cost of $13 106. The median post-operative stay cost was $816 post-intervention compared with $1278 pre-intervention (p<0.05). Statistically significant savings for the post-intervention group were also found for operative visit, operating room costs, and pharmacy (p<0.05). On multivariate analysis, surgical approach was the only factor associated with operating room costs, whereas both surgical approach and group (pre- vs post-intervention) impacted the total and post-operative stay costs (p<0.05). CONCLUSION In addition to increasing the same day discharge rate after minimally invasive gynecologic oncology surgery, an enhanced recovery-based peri-operative care program led to significant reductions in cost.
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Affiliation(s)
- Cristina Mitric
- Division of Gynecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health System, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, Division of Gynecology Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Daisy Kosa
- Department of Health Research Methods, Evidence, and Impacts, McMaster University, Hamilton, Ontario, Canada
| | - Soyoun Rachel Kim
- Division of Gynecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health System, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, Division of Gynecology Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Gregg Nelson
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stephane Laframboise
- Division of Gynecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health System, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, Division of Gynecology Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Geneviève Bouchard-Fortier
- Division of Gynecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health System, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, Division of Gynecology Oncology, University of Toronto, Toronto, Ontario, Canada
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Du Mont J, Coelho M, Lebel N, Friedman Burley J, Kosa SD, Macdonald S. Recommendations to Improve the Nature and Extent of Relationships Among Organizations Within a Network to Enhance Supports for Transgender Survivors of Sexual Assault. J Public Health Manag Pract 2023; 29:507-515. [PMID: 36867516 DOI: 10.1097/phh.0000000000001699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
CONTEXT To enhance the provision of comprehensive supports to transgender (trans) survivors of sexual assault, a structurally marginalized group with complex care needs, we developed an intersectoral network of trans-positive health care and community organizations in Ontario, Canada. OBJECTIVE As a baseline evaluation of the network, we conducted a social network analysis to determine the extent and nature of collaboration, communication, and connection among members. DESIGN Relational data (eg, activities of collaboration) were collected from June to July 2021, and analyzed using a validated survey tool, Program to Analyze, Record, and Track Networks to Enhance Relationships (PARTNER). We shared findings in a virtual consultation session with key stakeholders and facilitated discussion to generate action items. Consultation data were synthesized into 12 themes through conventional content analysis. SETTING An intersectoral network in Ontario, Canada. PARTICIPANTS Of the 119 representatives of trans-positive health care and community organizations invited to participate in this study, 78 (65.5%) completed the survey. MAIN OUTCOME MEASURES Proportion/count of organizations collaborating with other organizations. Network scores for value and trust. RESULTS Almost all (97.5%) invited organizations were listed as collaborators, representing 378 unique relationships. The network achieved a value score of 70.4% and trust score of 83.4%. The most prominent themes were "Communication and knowledge exchange channels," "Clearer roles and contributions," "Indicators of success," and "Client voices at the centre." CONCLUSION As key antecedents of network success, high value and trust indicate that network member organizations are well positioned to further foster knowledge sharing, define their roles and contributions, prioritize the integration of trans voices in all activities, and, ultimately, achieve common goals with clearly defined outcomes. There is great potential to optimize network functioning and advance the network's mission to improve services for trans survivors by mobilizing these findings into recommendations.
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Affiliation(s)
- Janice Du Mont
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada (Drs Du Mont and Kosa, Ms Coelho, and Messrs Lebel and Friedman Burley); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (Dr Du Mont); and Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, Ontario, Canada (Mr Friedman Burley, Dr Kosa, and Ms Macdonald)
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Du Mont J, Kosa SD, Friedman Burley J, Macdonald S. Development of a WebPortal to Advance and Mobilize Knowledge Relevant to Trans-Affirming Care for Sexual Assault Survivors in Ontario, Canada. Transgend Health 2022; 7:375-380. [PMID: 36016867 PMCID: PMC9398482 DOI: 10.1089/trgh.2020.0184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Transgender persons experience high rates of sexual assault and often encounter providers who lack the knowledge to deliver appropriate postassault care and supports. To build capacity within health care and social service organizations supporting trans survivors of sexual assault across Ontario, Canada, we undertook a study to inform the development of a WebPortal intended to provide freely accessible resources relevant to the provision of trans-affirming care. In this survey, 70 representatives from community and health care organizations indicated their overall dissatisfaction with the information currently available on the care and support of trans survivors and identified a need for improved access to a range of resources.
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Affiliation(s)
- Janice Du Mont
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sarah Daisy Kosa
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, Canada
| | - Joseph Friedman Burley
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, Canada
| | - Sheila Macdonald
- Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, Canada
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Abstract
Trans survivors of sexual assault have called for the development and implementation of training for care providers. To answer this call, we developed and evaluated an innovative e-learning curriculum for forensic nurses working across Ontario, Canada, on the provision of trans-affirming care. The e-learning curriculum, developed in Storyline 360 by Articulate, was launched in August 2019. The competence of nurses (N=65) completing the curriculum improved significantly from pre- to post-training across all content domains (Initial assessment, Medical care, Forensic examination, and Discharge and referral). This e-learning curriculum could be of utility in training forensic nurses worldwide.
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Affiliation(s)
- Janice Du Mont
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Daisy Kosa
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Ontario Network of Sexual Assault/Domestic Violence Treatments Centres, Toronto, Ontario, Canada
| | - Sheila Macdonald
- Ontario Network of Sexual Assault/Domestic Violence Treatments Centres, Toronto, Ontario, Canada
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Du Mont J, Hemalal S, Kosa SD, Cameron L, Macdonald S. The promise of an intersectoral network in enhancing the response to transgender survivors of sexual assault. PLoS One 2020; 15:e0241563. [PMID: 33206636 PMCID: PMC7673577 DOI: 10.1371/journal.pone.0241563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 10/18/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This study explores the promise of an intersectoral network in enhancing the response to transgender (trans) survivors of sexual assault. METHODS One hundred and three representatives of healthcare and community organizations across Ontario, Canada were invited to participate in a survey. Respondents were asked to: 1) identify systemic challenges to supporting trans survivors, 2) determine barriers to collaborating across sectors, and 3) indicate how an intersectoral network might address these challenges and barriers. Descriptive statistics were used to summarize quantitative data and qualitative data were collated thematically. RESULTS Sixty-seven representatives responded to the survey, for a response rate of 65%. Several themes capturing the challenges organizations face in supporting trans survivors were identified: Lack of knowledge and training among providers, Inadequate resources across organizations and institutions, and Limited access to and availability of appropriate services. Barriers to collaborating across sectors considered important by the overwhelming majority of respondents were: Lack of trans-positive service professionals (e.g., a paucity of sensitivity training), lack of resources (e.g., staff, staff time and workload, spaces to meet), and Institutional structures (e.g., oppressive policies, funding mandates). Four ways in which a network could address these challenges and barriers emerged from the data: Center the voices of trans communities in advocacy; Support competence of professionals to provide trans-affirming care; Provide the platform, strategies, and tools to aid in organizational change; and Create space for organizations to share ideas, goals, and resources. CONCLUSION Our findings deepen our understanding of important impediments to enhancing the response to trans survivors of sexual assault and the role networks of healthcare and community organizations can play in comprehensively responding to complex health and social problems.
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Affiliation(s)
- Janice Du Mont
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Shilini Hemalal
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
| | - Sarah Daisy Kosa
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
- Ontario Network of Sexual Assault/Domestic Violence Treatments Centres, Toronto, ON, Canada
| | | | - Sheila Macdonald
- Ontario Network of Sexual Assault/Domestic Violence Treatments Centres, Toronto, ON, Canada
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Kosa SD, Du Mont J, Macdonald S. Development and Evaluation of an Elder Abuse Forensic Nurse Examiner e-Learning Curriculum. Gerontol Geriatr Med 2020; 6:2333721420965819. [PMID: 33173804 PMCID: PMC7588757 DOI: 10.1177/2333721420965819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 12/04/2022] Open
Abstract
In Ontario, Canada, there is a need for an easily accessible training for forensic nurse examiners on the provision of care for abused older adults. In this study, our objective was to develop and evaluate a novel elder abuse nurse examiner e-learning curriculum focused on improving the care provided to older adults. The curriculum was launched on an online learning management system to forensic nurses working across Ontario’s hospital-based violence treatment centers in June 2019 and evaluated using pre- and post-training questionnaires that measured self-assessed changes in knowledge and skills-based competence related to providing elder abuse care. There were significant improvements pre- to post-training in self-reported knowledge and competence across all core content domains: Older Adults and Abuse; Documentation, Legal, and Legislative Issues; Interview with Older Adult, Caregiver, and Other Relevant Contacts; Initial Assessment; Medical and Forensic Examination; and Case Summary, Discharge Plan, and Follow-Up Care. As the curriculum enhanced the knowledge and skills associated with caring for abused older adults, it may have implications for training forensic nurse examiners and associated staff working in more than 25 countries internationally.
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Affiliation(s)
- Sarah Daisy Kosa
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Ontario Network of Sexual Assault/Domestic Violence Treatments Centres, Toronto, ON, Canada
| | - Janice Du Mont
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sheila Macdonald
- Ontario Network of Sexual Assault/Domestic Violence Treatments Centres, Toronto, ON, Canada
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Baldeh T, MacDonald T, Kosa SD, Lawson DO, Stalteri R, Olaiya OR, Alotaibi A, Thabane L, Mbuagbaw L. More pilot trials could plan to use qualitative data: a meta-epidemiological study. Pilot Feasibility Stud 2020; 6:164. [PMID: 33292715 PMCID: PMC7597013 DOI: 10.1186/s40814-020-00712-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 10/18/2020] [Indexed: 12/11/2022] Open
Abstract
Background Pilot trials often use quantitative data such as recruitment rate and retention rate to inform the design and feasibility of a larger trial. However, qualitative data such as patient, healthcare provider, and research staff perceptions of an intervention may also provide insights for a larger trial. Methods As part of a larger study investigating the reporting of progression criteria in pilot studies, we sought to determine how often pilot studies planned to use qualitative data to inform the design and feasibility of a larger trial and the factors associated with plans to use qualitative data. We searched for protocols of pilot studies of randomized trials in PubMed between 2013 and 2017. Results We included 227 articles. Only 92 (40.5%; 95% confidence interval [CI] 34.1–47.2) reported plans to collect qualitative data. The factors associated with collecting qualitative data were large studies (defined as sample size ≥ 60; adjusted odds ratio [aOR] 2.77; 95% CI 1.47–5.23; p = 0.002) and studies from Europe (aOR 3.86; 95% CI 1.68–8.88; p = 0.001) compared to North America and the rest of the world. Pilot trials with pharmacological interventions were less likely to plan to collect qualitative data (aOR 0.20; 95% CI 0.07–0.58; p = 0.003). Conclusions Qualitative data is not used enough in pilot trials. Large pilot trials, pilot trials from Europe, and pilot trials of non-pharmacological interventions are more likely to plan for qualitative data.
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Affiliation(s)
- Tejan Baldeh
- Department of Health Research Methods, Evidence and Impact, McMaster University Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada.
| | - Tonya MacDonald
- Department of Health Research Methods, Evidence and Impact, McMaster University Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada.,School of Midwifery, Laurentian University, Sudbury, ON, Canada
| | - Sarah Daisy Kosa
- Department of Health Research Methods, Evidence and Impact, McMaster University Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada.,Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Daeria O Lawson
- Department of Health Research Methods, Evidence and Impact, McMaster University Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada
| | - Rosa Stalteri
- Department of Health Research Methods, Evidence and Impact, McMaster University Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada
| | - Oluwatobi R Olaiya
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Ahlam Alotaibi
- Department of Pediatrics, Princess Noura University, Riyadh, Saudi Arabia
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada.,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Departments of Paediatrics and Anaesthesia, McMaster University, Hamilton, ON, Canada.,Centre for Evaluation of Medicine, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada.,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Centre for the Development of Best Practices in Health, Yaounde, Cameroon
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Du Mont J, Saad M, Kosa SD, Kia H, Macdonald S. Providing trans-affirming care for sexual assault survivors: An evaluation of a novel curriculum for forensic nurses. Nurse Educ Today 2020; 93:104541. [PMID: 32781351 DOI: 10.1016/j.nedt.2020.104541] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/15/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Transgender (trans) persons experience high rates of sexual victimization, often face discrimination by healthcare providers, and may have unique and diverse needs post-victimization. However, there remains a lack of comprehensive trans-specific training among healthcare professionals, including nurses. OBJECTIVES Our primary objective was to develop and evaluate a novel curriculum for its efficacy in improving the competence of forensic nurses in providing sensitive, informed, and appropriate healthcare services for trans survivors of sexual assault. METHODS The curriculum was evaluated among forensic nurses working in sexual assault treatment centres across Ontario, Canada. Forty-seven nurses participated in this study, all of whom were selected by their respective programs to receive in-depth formal Sexual Assault Nurse Examiner training. Changes in participants' perceived expertise and competence in providing trans-affirming care were assessed on a 5-point Likert scale (5 being the highest level) using pre- and post-training questionnaires. Participants were asked to indicate their level of agreement with 31 competency-based statements, which were organized thematically into four domains: Initial Assessment, Medical Care, Forensic Examination, and Discharge and Referral. A clinical vignette assessed participants' demonstrated competence in providing care across four questions. RESULTS Participants level of expertise improved significantly from pre- to post-training (Mean [M] = 1.89, Standard Deviation [SD] = 0.84 vs. M = 3.47, SD = 0.62, p< 001), as well as their competence across all content domains: initial assessment (M = 3.79, SD = 0.63 vs. M = 4.70, SD = 0.31, p < .001), medical care (M = 3.33, SD = 0.73 vs. M = 4.69, SD = 0.33, p < .001), forensic examination (M = 3.40, SD = 0.75 vs. M = 4.72, SD = 0.35, p < .001), and discharge and referral (M = 3.62, SD = 0.80 vs. M = 4.59, SD = 0.40, p < .001). There were also significant improvements in competence associated with the clinical vignette pre- to post- training (M score = 2.13, SD = 1.06 vs. M score = 3.23, SD = 0.87, p < .001). CONCLUSIONS The success of this curriculum may have relevance to the more than 5000 members of the International Association of Forensic Nurses who practice and support forensic nursing across the globe, as well as to other healthcare professionals.
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Affiliation(s)
- Janice Du Mont
- Women's College Research Institute, Women's College Hospital, 76 Grenville St, Toronto, ON M5S 1B2, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada.
| | - Megan Saad
- Women's College Research Institute, Women's College Hospital, 76 Grenville St, Toronto, ON M5S 1B2, Canada; Ontario Network of Sexual Assault/Domestic Violence Treatments Centres, 76 Grenville Street, Toronto, ON M5S 1B2, Canada.
| | - Sarah Daisy Kosa
- Women's College Research Institute, Women's College Hospital, 76 Grenville St, Toronto, ON M5S 1B2, Canada; Ontario Network of Sexual Assault/Domestic Violence Treatments Centres, 76 Grenville Street, Toronto, ON M5S 1B2, Canada.
| | - Hannah Kia
- School of Social Work, University of British Columbia, 2080 West Mall, Vancouver, BC V6T 1Z2, Canada.
| | - Sheila Macdonald
- Ontario Network of Sexual Assault/Domestic Violence Treatments Centres, 76 Grenville Street, Toronto, ON M5S 1B2, Canada.
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Mont JD, Kosa SD, Hemalal S, Cameron L, Macdonald S. Formation of an intersectoral network to support trans survivors of sexual assault: A survey of health and community organizations. Int J Transgend Health 2020; 22:243-252. [PMID: 34240068 PMCID: PMC8118235 DOI: 10.1080/26895269.2020.1787911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND To address the growing international recognition of the inequities faced by transgender (trans) persons and the lack of services that attend to the specific concerns of trans sexual assault survivors, we undertook the development of an intersectoral network of hospital-based violence treatment centers and trans-positive community organizations to enhance available supports. AIMS To examine anticipated involvement of organizations in the network and determine network activities, deliverables, and values. METHODS We developed a survey with guidance from an advisory group of trans community members and their allies. Items on the survey related to network activities, deliverables, and values, which were also informed by key insights from earlier network planning meetings, were rated on a 5-point Likert scale for their importance (1 = not important at all, 5 = very important). RESULTS Sixty-four out of 93 organizations invited responded to the survey, giving a response rate of 69%. The highest prioritized network activities were: improve access to support services for trans survivors, educate trans survivors on their rights/what to expect when seeking supports and information on organizations, provide ongoing education/training for service providers on trans-affirming care, and inform guidelines on appropriate and sensitive standards of care/better practices for trans survivors (means = 4.6). The highest prioritized deliverables were: provision of standardized sensitivity training on violence against trans persons for professionals and development of an online directory/resource list of trans-affirming service providers and organizations that is continuously updated (means = 4.5). Trauma- and violence-informed and trans-guided were the most highly rated values (means = 4.8). CONCLUSION These findings have implications for healthcare and community leaders seeking to collaborate across sectors to address the inequities faced by trans persons experiencing sexual assault.
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Affiliation(s)
- Janice Du Mont
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sarah Daisy Kosa
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- Ontario Network of Sexual Assault/Domestic Violence Treatments Centres, Toronto, Canada
| | - Shilini Hemalal
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | | | - Sheila Macdonald
- Ontario Network of Sexual Assault/Domestic Violence Treatments Centres, Toronto, Canada
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Mbuagbaw L, Kosa SD, Lawson DO, Stalteri R, Olaiya OR, Alotaibi A, Thabane L. The reporting of progression criteria in protocols of pilot trials designed to assess the feasibility of main trials is insufficient: a meta-epidemiological study. Pilot Feasibility Stud 2019; 5:120. [PMID: 31700654 PMCID: PMC6827233 DOI: 10.1186/s40814-019-0500-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 09/16/2019] [Indexed: 11/10/2022] Open
Abstract
Introduction Pilot and feasibility trials are conducted to determine feasibility or to collect information that would inform the design of a larger definitive trial. Clear progression criteria are required to determine if a definitive or main trial is feasible and how it should be designed. We sought to determine how often progression criteria are reported and the associated factors. Methods We conducted a methodological review of protocols for pilot randomised trials published in three journals that publish research protocols (BMJ Open, Trials, Pilot and Feasibility Studies), using a PubMed search (2013–2017). We extracted bibliometric information including the country in which the study was conducted, source of funding, type of intervention, use of a primary feasibility outcome, sample size reporting, and justification. We used generalised linear models to determine the factors associated with reporting progression criteria. Results Our search retrieved 276 articles, of which 49 were not eligible. We included 227 articles. Overall, 45/227 (19.8%; 95% confidence interval [CI] 14.8–25.6) reported progression criteria. Protocols published in more recent years were significantly associated with higher odds of reporting progression criteria (adjusted odds ratio [aOR] 1.40; 95% CI 1.03–1.92; p = 0.034). Pilot trials from Europe (aOR 0.19; 95% CI 0.08–0.48; p < 0.001) and the rest of the world (aOR 0.05; 95% CI 0.01–0.18; p < 0.003) compared to North America were significantly associated with lower odds of reporting progression criteria. Journal, source of funding, sample size, intervention type, and having a primary outcome related to feasibility were not significantly associated with reporting progression criteria. Conclusion Progression criteria are not often explicitly stated in protocols of pilot trials leaving room for varied interpretation of findings. The development of formal guidance for progression criteria in protocols of pilot trials is warranted.
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Affiliation(s)
- Lawrence Mbuagbaw
- 1Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada.,2Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare-Hamilton, 50 Charlton Avenue East, 3rd Floor Martha Wing, Room H321, Hamilton, ON L8N 4A6 Canada.,Centre for the Development of Best Practices in Health, Yaoundé, Cameroon
| | - Sarah Daisy Kosa
- 1Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada.,4Toronto General Hospital, University Health Network, Toronto, ON Canada
| | - Daeria O Lawson
- 1Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada
| | - Rosa Stalteri
- 1Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada
| | - Oluwatobi R Olaiya
- 5Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON Canada
| | - Ahlam Alotaibi
- 6Department of Pediatrics, McMaster University, Hamilton, ON Canada
| | - Lehana Thabane
- 1Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada.,2Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare-Hamilton, 50 Charlton Avenue East, 3rd Floor Martha Wing, Room H321, Hamilton, ON L8N 4A6 Canada.,7Departments of Paediatrics and Anaesthesia, McMaster University, Hamilton, ON Canada.,8Centre for Evaluation of Medicine, St Joseph's Healthcare-Hamilton, Hamilton, ON Canada.,9Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON Canada
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Du Mont J, Kosa SD, Solomon S, Macdonald S. Assessment of nurses' competence to care for sexually assaulted trans persons: a survey of Ontario's Sexual Assault/Domestic Violence Treatment Centres. BMJ Open 2019; 9:e023880. [PMID: 31133574 PMCID: PMC6538203 DOI: 10.1136/bmjopen-2018-023880] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Our primary objective was to examine the perceived level of competence and need for additional training among nurses engaged in the care of sexually assaulted trans persons. Among these nurses, a secondary objective was to examine the impact of prior trans-specific training on their perceived level of competence. SETTING An online survey was distributed to nurses working within 35 hospital-based violence treatment centres in Ontario, Canada. RESPONDENTS 95 nurses completed the survey. PRIMARY AND SECONDARY OUTCOME MEASURES The perceived level of competence and need for additional training overall and on 31 specific items associated with initial assessment, medical care, forensic examination and discharge and referral, as well as sociodemographic, work experience and prior training information, was collected and summarised using descriptive and inferential statistics. RESULTS Almost three-quarters (73.1%) of nurses indicated that they had little or no expertise in caring for trans clients who have been sexually assaulted and 95.7% strongly agreed/agreed that they would benefit from (additional) training. The mean level of competence was 4.00 or greater (strongly agreed/agreed with the statement) for just 9 out of the 31 competencies related to caring for trans clients. Having undergone prior trans-specific training (61.3%) was associated with greater perceived competence in initial assessment (p=0.004) and medical care (p<0.001). CONCLUSION It is of key importance that nurses demonstrate knowledge of and respond competently to the complex and diverse needs of trans survivors of sexual assault. The nurses surveyed overwhelmingly identified a need for additional training to care for sexually assaulted trans clients. It appears that additional training would be beneficial, as prior trans-specific training was associated with higher perceived competence in delivering certain aspects of care.
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Affiliation(s)
- Janice Du Mont
- Women’s College Research Institute, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sarah Daisy Kosa
- Women’s College Research Institute, Toronto, Ontario, Canada
- Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, Canada
| | - Shirley Solomon
- Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, Canada
| | - Sheila Macdonald
- Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, Canada
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Kosa SD, Monize J, Leenus A, Leenus S, Samra S, Szwiega S, Shi D, Valvasori S, Gafni A, Lok CE, Thabane L. Reporting quality of pilot clinical trials in chronic kidney disease patients on hemodialysis: a methodological survey. Pilot Feasibility Stud 2019; 5:53. [PMID: 30997141 PMCID: PMC6451784 DOI: 10.1186/s40814-019-0436-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 03/22/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The conduct of high-quality pilot studies can help inform the success of larger clinical trials. Guidelines have been recently developed for the reporting of pilot trials. OBJECTIVE This methodological survey evaluates the completeness of reporting in pilot randomized controlled trials in chronic kidney disease patients on hemodialysis (HD patients) and explores factors associated with better completion of reporting. METHODS The authors searched Pubmed on July 1, 2018, for all pilot trials conducted in HD patients. Reporting quality was assessed against the 40-item Consolidated Standards of Reporting Trials (CONSORT) Extension for Pilot Trials. Study factors including year and country of publication, intervention, number of centers, type of funding, and journal endorsement of CONSORT were also examined. RESULTS The mean number of items reported from the CONSORT extension for pilot trials across all included articles was 18.4 (standard deviation [SD] = 4.4). In the adjusted analysis, studies reported in later years (IRR = 1.026, 95% CI [1.018, 1.034], p < 0.001) and an increase of 20 persons in sample size (adjusted IRR = 1.021, 95% CI [1.010, 1.031], p < 0.001) were associated with a significantly higher number of CONSORT pilot items reported. CONCLUSIONS Current reporting completeness of pilot trials in HD patients is suboptimal. Endorsing the CONSORT extension specific to pilot and feasibility studies and ensuring that pilot trials focus on the feasibility objectives may improve reporting completeness of these trials.
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Affiliation(s)
- Sarah Daisy Kosa
- Kidney CARE Network International, Toronto, Ontario Canada
- Division of Nephrology, Toronto General Hospital, University Health Network, 200 Elizabeth Street 8N844, Toronto, Ontario M5G 2C4 Canada
- Department of Health Research, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Jillian Monize
- Kidney CARE Network International, Toronto, Ontario Canada
| | - Alvin Leenus
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario Canada
| | - Selvin Leenus
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario Canada
| | | | - Sylwia Szwiega
- Kidney CARE Network International, Toronto, Ontario Canada
| | - Daniel Shi
- Faculty of Health Sciences, Queen’s University, Kingston, Ontario Canada
| | - Sara Valvasori
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario Canada
| | - Amiram Gafni
- Department of Health Research, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Charmaine E. Lok
- Kidney CARE Network International, Toronto, Ontario Canada
- Division of Nephrology, Toronto General Hospital, University Health Network, 200 Elizabeth Street 8N844, Toronto, Ontario M5G 2C4 Canada
- Department of Health Research, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Lehana Thabane
- Department of Health Research, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
- Biostatistics Unit, St Joseph’s Healthcare, Hamilton, Ontario Canada
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Kosa SD, Monize J, D'Souza M, Joshi A, Philip K, Reza S, Samra S, Serrago B, Thabane L, Gafni A, Lok CE. Nutritional Mobile Applications for CKD Patients: Systematic Review. Kidney Int Rep 2018; 4:399-407. [PMID: 30899867 PMCID: PMC6409338 DOI: 10.1016/j.ekir.2018.11.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/14/2018] [Accepted: 11/26/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction Mobile health applications offer the potential to help people living with chronic kidney disease (CKD) manage diet-related challenges. This systematic review examined CKD dietary mobile app interventions; specifically, app characteristics, feasibility, and effectiveness in changing user behavior, as well as user satisfaction. Methods This review was reported in accordance with PRISMA guidelines. We searched scholarly databases, as well as the gray literature, for all randomized controlled trials, observational studies, needs assessments, and pilot testing/studies/trials focused on the development or evaluation of CKD dietary mobile app interventions. The characteristics, user satisfaction with, usability/feasibility, and effectiveness in changing dietary behavior of the mobile application were summarized using descriptive statistics and in a narrative manner. Results Thirteen full-text studies were included, of which 11 were single center, with a mean sample size of 23. Of the 7 studies that measured usability/feasibility, all found at least some aspects of the application feasible/useful. Of the 5 studies that reported an evaluation of changes in behavior/diet related to self-management, all reported some positive change. Conclusion According to current studies, nutritional apps show promise in CKD self-management.
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Affiliation(s)
- Sarah Daisy Kosa
- Research, Kidney CARE Network International, Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, Toronto, Ontario, Canada.,Department of Health Research, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jillian Monize
- Research, Kidney CARE Network International, Toronto, Ontario, Canada
| | - Mitchell D'Souza
- Research, Kidney CARE Network International, Toronto, Ontario, Canada
| | - Arundhati Joshi
- Research, Kidney CARE Network International, Toronto, Ontario, Canada
| | - Kaylyssa Philip
- Research, Kidney CARE Network International, Toronto, Ontario, Canada
| | - Samiha Reza
- Research, Kidney CARE Network International, Toronto, Ontario, Canada
| | - Simranjit Samra
- Research, Kidney CARE Network International, Toronto, Ontario, Canada.,School of Nutrition, Faculty of Community Services, Ryerson University, Toronto, Ontario, Canada
| | - Bridgette Serrago
- Research, Kidney CARE Network International, Toronto, Ontario, Canada.,School of Food & Nutritional Sciences, Brescia University College, London, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Biostatistics Unit, Research Administration, St Joseph's Healthcare-Hamilton, Hamilton, Ontario, Canada
| | - Amiram Gafni
- Department of Health Research, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Charmaine E Lok
- Research, Kidney CARE Network International, Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, Toronto, Ontario, Canada.,Department of Health Research, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Du Mont J, Solomon S, Kosa SD, Macdonald S. Development and evaluation of sexual assault training for emergency department staff in Ontario, Canada. Nurse Educ Today 2018; 70:124-129. [PMID: 30193237 DOI: 10.1016/j.nedt.2018.08.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 07/25/2018] [Accepted: 08/17/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The purpose of this evaluation was to assess the efficacy of a training in improving competence to address sexual assault among Emergency Department (ED) staff, as well as to compare in-person and online training modalities. METHODS A total of 1564 staff from 76 EDs in acute care hospitals across Ontario participated in either on-site (n = 828 staff) or online (n = 736 staff) training sessions, of whom 1366 (87%) completed both a pre- and post-training questionnaire. Mean pre- and post-training scores measuring perceived competence in responding to victims/survivors of sexual assault were compared using paired t-tests. The mean gain score for in-person and online training was then compared using the Mann-Whitney U test. Finally, in-person and online participants' ratings of the training content and delivery were compared using the Mann-Whitney U test. RESULTS There were significant improvements for all 16 self-reported measures of competence following training. The mean gain in knowledge and skills was higher for in-person training participants. Participants in the in-person modality more strongly agreed that the information they learned would help in providing care for sexual assault victims/survivors, and were more satisfied with the training overall. However, these participants less strongly agreed that there was an appropriate amount of time allotted for the scope of material presented. CONCLUSIONS Overall, the training led to immediate improvements in ED staff perceived understanding and ability to address the needs of victims/survivors of sexual assault, with particular advantages to the in-person training.
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Affiliation(s)
- Janice Du Mont
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Shirley Solomon
- Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, Ontario, Canada
| | - Sarah Daisy Kosa
- Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, Ontario, Canada
| | - Sheila Macdonald
- Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, Ontario, Canada
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