Sexual violence is experienced by women of every age, country, social class, culture and religion. In a recent American survey for example, an estimated 18% of women reported having been raped and an additional 45% experienced other forms of sexual violence at some point during their lifetime.
While sexually assaulted women access the healthcare system, they do not necessarily disclose any information about the assault to their providers. In fact, a recent systematic review of disclosure of sexual assault to healthcare providers reported that across eight studies, just 6% to 27% of women ever disclosed to a health provider.
Disclosing sexual assault can be challenging due to a host of barriers including distrust of formal systems, concerns about confidentiality, and judgmental attitudes by healthcare providers which can exacerbate survivors’ feelings of embarrassment, self-blame, shame, and guilt.
Given the prevalence of sexual assault and the numerous associated negative health outcomes, it is clear that all health providers should have the requisite knowledge and skills to respond appropriately when a disclosure is made and to facilitate disclosure when indicators suggest the possibility of past sexual assault. Knowing how to do so is a matter of education and training and, in 2012, this was deemed a priority by the government of Ontario, Canada. In response, we undertook the development of an online curriculum suited to diverse health and allied healthcare providers. As the approach to health education is increasingly competency-based,developing core competencies to inform the curriculum was a necessary first step.
In developing the competencies for our curriculum, we followed a method we had employed in developing other curricula.
These findings were presented for discussion and review to members of an expert advisory committee formed to assist with the development of the curriculum. Members of the advisory committee had extensive expertise in the delivery of health care for victims of interpersonal violence and represented a range of disciplines and philosophical perspectives. After confirming the relevancy of our findings to clinical practice, the advisory committee provided further suggestions for providing competent care. For example, it was noted that “a stronger emphasis should be placed on providers examining their own values, beliefs, and experiences… as these often further victimize survivors”.
The agreed upon desirable behaviours, practices, and necessary knowledge were then rewritten in the form of competencies, sorted and aggregated following the updated version of Bloom’s taxonomy,
Working with the competencies a framework for the curriculum incorporating the key elements in the provision of care to women who have experienced past sexual assault - whether or not they choose to disclose - was developed. The framework acknowledges the need to address misconceptions or myths about sexual assault and its victims before introducing new practice behaviours and simultaneously recognizes that despite the development of knowledge and understanding, the introduction of new practices may face challenges from within the work environment (e.g. lack of funding to produce pamphlets or posters that support disclosure).
The next step was to prepare a series of scripts for interactive case scenarios and videos and submit these for review to subject matter experts in nursing, medicine, and occupational therapy. Working with a software development firm and a number of actors, the scripts were programmed, animated, uploaded, and piloted to determine whether they successfully engaged learners in achieving the competencies. Quizzes were incorporated into the online modules and a pre-test and post-test developed to track success in meeting the learning objectives and outcomes.
Our knowledge transfer strategy included bringing together the provincial leads of diverse health disciplines (e.g., medical technicians, midwives, physical therapists, occupational therapists, and nurses) to advise on how best to introduce the curriculum to their members. With their help, we developed postcards, advertisements, and presentations which were shared across the province.
The curriculum,
The authors declare that they have no conflict of interest.