Background: Globally, women 15-24 years are at heightened risk of sexual violence victimization, a risk factor for adverse mental, physical, and behavioral health outcomes. Sexual violence is common at universities and most often perpetrated by men, yet few evidence-based prevention strategies targeting men have been tested in low- and middle-income countries. GlobalConsent is a six-module, web-based educational program adapted from an efficacious U.S.-based program. Nine months post-treatment in a randomized trial in Vietnam, GlobalConsent reduced men's sexually violent behavior (odds ratio [OR] = 0.71, 95%CI 0.50-1.00) and increased prosocial intervening behavior (OR = 1.51, 1.00-2.28) relative to an attention-control. Evidence regarding optimal implementation strategies for scale up is needed.

Methods: We will randomize six medical universities in North, Central, and South Vietnam to deliver GlobalConsent using two different packages of implementation strategies that vary in intensity. Higher-intensity strategies will include greater (1) pre- and post-implementation engagement with university leaders and faculty and (2) greater pre-implementation outreach, follow-up, and incentives for students to promote engagement and completion of GlobalConsent. Higher intensity universities will receive additional training and support for their added activities. We will compare implementation drivers and outcomes, intervention effectiveness, and cost-effectiveness across the two implementation bundles. Our mixed-methods comparative interrupted time series design includes (1) qualitative interviews and quantitative surveys with university leaders and implementation teams to assess implementation barriers and facilitators; (2) repeated surveys with leaders and faculty, implementation teams, and male students to assess multilevel implementation drivers and outcomes; (3) repeated surveys with male students to assess behavioral outcomes (sexual violence and intervening behavior) and mediating variables (knowledge, attitudes, affect, and capacities); and (4) time diaries and cost tracking to assess cost-effectiveness of the two implementation-strategies bundles.

Discussion: This project is the first to assess packages of implementation strategies to deliver an efficacious web-based sexual violence prevention program for undergraduate men across all regions of Vietnam and synergizes with a violence-prevention training initiative (D43TW012188). This approach will produce rigorous evidence about how to disseminate GlobalConsent nationally, which holds promise to reduce gender-based health inequities linked to sexual violence as GlobalConsent is brought to scale.

Trial registration: NCT06443541. Retrospectively registered with ClinicalTrials.gov. Registered on June 05, 2024.

Keywords: Cost-effectiveness; Educational entertainment; GlobalConsent; Implementation trial; Low- and middle-income country; Primary prevention; Sexual violence; Vietnam.

© 2024. The Author(s).

背景： 全球范围内，15-24岁的女性遭受性暴力的风险较高，这是不良心理健康、身体和行为健康结果的一个风险因素。在大学里，性暴力很常见，并且大多数情况下是由男性实施的，然而，在低收入和中等收入国家中，针对男性的基于证据的预防策略很少被测试过。GlobalConsent 是一个六模块的网络教育项目，源自于美国的一项有效的预防计划。越南一项随机试验结果显示，九个月后，接受 GlobalConsent 的参与者比对照组减少了性暴力行为（优势比[OR] = 0.71, 95%CI 0.50-1.00）并增加了积极干预行为（OR = 1.51, 1.00-2.28）。需要关于如何有效扩大实施策略的证据。

方法： 我们将把六个位于越南北部、中部和南部的医学院校随机分配，使用两种不同的实施策略包来交付 GlobalConsent。较高强度的策略包括更多的（1）在实施前后与大学领导和教师的互动；以及（2）通过提供学生激励措施增加在实施前后的参与度并促进他们完成 GlobalConsent 的推广活动。高力度执行机构将为其额外活动获得附加培训和支持。我们将比较两种实施包之间的驱动因素和结果、干预效果及成本效益。我们的混合方法中断时间序列设计包括：（1）通过定性访谈和定量调查来评估大学领导以及实施团队的实施障碍和促进因素；（2）对领导者、教师、实施团队以及男生重复进行问卷调查，以评估多层次实施驱动因素和结果；（3）对男生重复进行行为结果（性暴力及干预行为）和中介变量（知识、态度、情绪和能力）的调查；（4）时间日志和成本跟踪来评估两种实施策略包的成本效益。

讨论： 本项目首次评估了在越南所有地区针对本科生男性交付一个有效网络性暴力预防项目的多种实施策略。此方法将产生有关如何在全国范围内传播 GlobalConsent 的严谨证据，这有望减少与性暴力相关的性别健康不平等，因为随着 GlobalConsent 被扩大规模。

试验注册： NCT06443541。2024年6月5日，该项目回顾性地在ClinicalTrials.gov上进行了注册。

关键词： 成本效益；教育娱乐；GlobalConsent；实施试验；低收入和中等收入国家；初级预防；性暴力；越南。