Violence Against Health Care Workers in Fragile Settings
- Conditions
- Workplace Violence
- Interventions
- Behavioral: Training in de-escalating violenceBehavioral: Code of conduct delivered via a warning board
- Registration Number
- NCT05419687
- Lead Sponsor
- Swiss Tropical & Public Health Institute
- Brief Summary
The general objective of the project is to assess whether a violence de-escalating training for health professionals and of a publicly displayed Code of Conduct (a set of rules developed through a citizen science and co-design approach) for both health professionals and clients at the level of the health facility, can reduce the incidence and severity of episodes of violence, and to identify the most cost-effective way to implement these interventions in rural Democratic Republic of Congo (DRC) and in the mega city of Baghdad, Iraq.
- Detailed Description
The study will adopt a stepped-wedge cluster-randomized intervention trial (SW-CRT) design to assess the two intervention components, a violence de-escalating training and the implementation of the code of conduct co-developed during the formative qualitative phase. The study will adopt a closed cohort with repeated measurements on the same participants (nurses in DRC and junior doctors in Baghdad) and will involve the unidirectional transition of each enrolled cluster (health facilities in DRC and secondary hospitals in Baghdad) from the control (no intervention) to the intervention sequence in a randomized sequential manner according to a predefined roll out process.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 798
- HCWs from selected participating health facilities in DRC, junior doctors during their first year resident and permanent health care staff from participating secondary hospitals in Iraq
- HCWs and junior medical doctors and permanent health care staff must have been employed/ or worked as HCW/ medical doctors or as permanent health care staff for at least 6 months
- All above participants must have completed the written informed consent
- Age <18 years; cognitive impairment
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- CROSSOVER
- Arm && Interventions
Group Intervention Description Arm 1 De-escalating violence training Training in de-escalating violence The de-escalating violence training intervention will be introduced after a pre-interventional period of 3 months. A refreshment training will be introduced at month 11. Arm 5 De-escalating violence training + Code of conduct Training in de-escalating violence The de-escalating violence training intervention and the code of conduct via a warning board will be simultaneously introduced at month 11. A refreshment training will be introduced at month 18. Arm 6 Code of conduct + De-escalating violence training Code of conduct delivered via a warning board The code of conduct via a warning board will be introduced at month 11. The de-escalating violence training intervention will be introduced at month 18. Arm 7 De-escalating violence training + Code of conduct Training in de-escalating violence The de-escalating violence training intervention is introduced after a pre-interventional period of 3 months. The code of conduct via a warning board and a refreshment training will be simultaneously introduced at month 18. Arm 8 De-escalating violence training + Code of conduct Code of conduct delivered via a warning board The de-escalating violence training intervention will be introduced before the second observation period at month 11. The code of conduct via a warning board and a refreshment training will be simultaneously introduced at month 18. Arm 2 De-escalating violence training Training in de-escalating violence The de-escalating violence training intervention will be introduced before the second observation period at month 11. A refreshment training will be introduced at month 18. Arm 3 De-escalating violence training Training in de-escalating violence The de-escalating violence training intervention will be introduced before the third observation period at month 18. Arm 4 De-escalating violence training + Code of conduct Code of conduct delivered via a warning board The de-escalating violence training intervention will be introduced after a pre-interventional period of 3 months. The code of conduct via a warning board will be introduced at month 11. A refreshment training will be introduced at month 18. Arm 9 De-escalating violence training + Code of conduct Training in de-escalating violence The code of conduct via a warning board and the violence de-escalating training will be simultaneously introduced at month 18. Arm 9 De-escalating violence training + Code of conduct Code of conduct delivered via a warning board The code of conduct via a warning board and the violence de-escalating training will be simultaneously introduced at month 18. Arm 5 De-escalating violence training + Code of conduct Code of conduct delivered via a warning board The de-escalating violence training intervention and the code of conduct via a warning board will be simultaneously introduced at month 11. A refreshment training will be introduced at month 18. Arm 8 De-escalating violence training + Code of conduct Training in de-escalating violence The de-escalating violence training intervention will be introduced before the second observation period at month 11. The code of conduct via a warning board and a refreshment training will be simultaneously introduced at month 18. Arm 4 De-escalating violence training + Code of conduct Training in de-escalating violence The de-escalating violence training intervention will be introduced after a pre-interventional period of 3 months. The code of conduct via a warning board will be introduced at month 11. A refreshment training will be introduced at month 18. Arm 6 Code of conduct + De-escalating violence training Training in de-escalating violence The code of conduct via a warning board will be introduced at month 11. The de-escalating violence training intervention will be introduced at month 18. Arm 7 De-escalating violence training + Code of conduct Code of conduct delivered via a warning board The de-escalating violence training intervention is introduced after a pre-interventional period of 3 months. The code of conduct via a warning board and a refreshment training will be simultaneously introduced at month 18. Arm 10 Code of conduct Code of conduct delivered via a warning board The code of conduct via a warning board will be introduced at month 11. Arm 11 Code of conduct Code of conduct delivered via a warning board The code of conduct via a warning board will be introduced at month 18.
- Primary Outcome Measures
Name Time Method Incidence and severity of self-reported non-physical aggression 6 months Number of self-reported non-physical aggression (verbal abuse, threats, ironic language, provocative or aggressive body language etc.) during the fulfillment of a professional activity in the last 6 months
Incidence and severity of self-reported physical aggression 6 months Number of self-reported physical aggression during the fulfillment of a professional activity in the last 6 months
- Secondary Outcome Measures
Name Time Method Level of confidence in coping with patient aggression 0, 6, 12, 18 months Instrument "Clinicians confidence in coping with patient aggression (CCPAI) (Thackreys, 1987)"
Level of post-traumatic stress disorders (PTSD) among HCWs 0, 6, 12, 18 months Instrument "Post-traumatic stress disorder PTSD Checklist for DSM-5 (PCL-5)) (Weathers, F.W. et al. 2013)"
Level of burnout among HCWs 0, 6, 12, 18 months Instrument "Level of burnout" (Malach 2005), burnout measure short version (BMS). The ten-item version of the BMS are evaluated on 7-point frequency scales, with a score of 4 or above indicating burnout.
Psychological empathy among HCWs 0, 6, 12, 18 months Instrument "Jefferson scale of physician empathy (Hojat M et al. 2007)"
Absenteeism 0, 6, 12, 18 months Number of sick leave spells taken by the HCWs during the study period
Intent to leave among HCWs 0, 6, 12, 18 months The shortened, six-item version of the turnover intention scale (TIS-6) (Bothma \& Roodt 2013), will be used to assess turnover intentions and as well as to predict actual turnover among HCWs. The TIS-6 scale is scored on a five-point Likert-type scale with scores ranging from 1 (never) to 5 ( always). A high score indicates stronger turnover intention.
Economic cost of the intervention 18 months Two types of costs will be considered: 1) direct costs of the intervention (e.g training costs, space or rent costs, costs to develop the code of conduct) and 2) direct costs due to health system disruption (e.g. health care services foregone or postponed, material etc.), cost incurred by the HCWs as a consequence of violent episodes including direct medical costs (e.g. hospital stay cost, consultation costs, laboratory costs), non-medical costs (e.g. transportation, meals etc.), and indirect costs (e.g. absenteeism, presenteeism).
Productivity loss (presenteeism) 18 months Work Limitation questionnaire (WLQ) (Lerner D. et al. 2002). The WLQ consists of eight items investigating four domains (time management, physical tasks, mental-interpersonal tasks, and output tasks), which are calculated into scores ranging from 0 (no limitations) to 100 (highest limitations).
Health care workers health-related quality of life 0, 6, 12, 18 months European Quality of Life-5 Dimensions (EuroQol EQ-5D-5L) (Devlin NJ et al. 2017). The EQ-5D-5L questionnaire is self-assessed and it measures health outcomes on five dimensions (mobility, self-care, daily activities, pain/discomfort, and depression/anxiety) with five levels ranging from none to major complaints. Scores range from 0 (death) to 1 (full health).
Trial Locations
- Locations (2)
Catholic University of Bukavu, School of Public Health
🇨🇩Bukavu, Congo, The Democratic Republic of the
Al-Mustansiriya University
🇮🇶Baghdad, Iraq