Therapists perspectives on the Early Intervention after Rape study : a qualitative process evaluation of a randomized controlled trial

Background: Early interventions using trauma-focused cognitive behavioural therapy have the potential to alleviate post-traumatic stress symptoms in individuals who have experienced recent sexual assault. Specialized Sexual Assault Centers (SACs) in Norway offers psychosocial support, however, this support varies across SACs and its efficacy has not been researched. The Early Intervention after Rape (EIR) study is a multisite randomized controlled trial designed to assess the efficacy and effectiveness of training SAC nurses and social workers to deliver a modified version of prolonged exposure therapy shortly after rape.

Objective: This article aims to present a qualitative process evaluation of the implementation of the EIR study across three SACs in Norway, from the perspective of nurses and social workers.

Method: We conducted semi-structured interviews with fifteen nurses and social workers, ten of whom received training in prolonged exposure therapy (mPE). We used Thematic Analysis to identify themes and subthemes.

Results: Thematic analysis yielded four significant themes for process evaluation: (1) The quality of the new intervention modified prolonged exposure was considered satisfactory through training and supervision and delivered with good adherence to the manual, although some therapists perceived the manual as too rigid; (2) Adoption dynamics within the SACs are complex and include both enthusiasm for clinical research as well as resistance to change; (3) Narrow inclusion criteria and burden with participation for patients may limit reach and representativeness of the RCT; (4) Unintended consequences were identified, such as delayed start, conflicting advices and cross-contamination, underscoring the ongoing necessity for process evaluation alongside RCTs.

Conclusion: This qualitative process evaluation offers insight into real-world clinical challenges with implementing a new intervention and conducting a multisite RCT within SACs in Norway. This study may inform opportunities to advance evidence-based practices for rape survivors seeking help.

Trial registration: ClinicalTrials.gov identifier: NCT05489133.

HIGHLIGHTS

• Process evaluations provide insight into the challenges and opportunities of conducting randomized controlled trials, and should be integrated in RCTs.
• Training and supervision are essential for ensuring high-quality implementation.
• Providing SAC therapists with effective treatment tools could improve services for rape survivors.