Sample characteristics
Table 1 summarizes the characteristics of the study sample. Overall and across institutional settings, the majority of interview participants were female (77.8%, 73.3%-86.7% across settings), as were the sub-sample of focus group participants (77.3%, 57.1%-88.9%). Among CSO members, the gender distribution of focus group participants was more gender equitable (57.1% female; 42.9% male). Overall, a majority of study participants also were from North Vietnam (53.3% of interview participants, 54.5% of focus group participants). Among university lecturers, a majority of interview participants were from the South (53.3%), and among CSO staff, three each (42.9%) were from the North and Central regions of Vietnam.
Overview of emergent themes and their contextualized relationships
Figure 1 summarizes the contextualized relationships between salient CFIR domains, as articulated by key informants, influencing the implementation of sexual violence prevention programs in high schools, universities, and CSOs in Vietnam. Salient influences emerged in the outer setting, the inner settings of all three organizational environments, the characteristics of individuals within and outside these organizational environments, and the characteristics of sexual violence prevention interventions and their delivery process. Some influences were common to all three organization environments, and some were unique to specific organizational environments. These similarities and distinctions are clarified, below.
Adapted Consolidated Framework for Implementation Research on Sexual Violence Prevention Interventions in Youth-Focused Organizations in Vietnam
Outer setting influences
Changing sexual norms amidst resistant gender norms
Key informants from all organizational settings characterized gender and sexual norms in Vietnam as in a state of transition. While premarital sex among young people was becoming more common and accepted, other entrenched gender norms persisted (Table 2, Quote 2.1). This shift in sexual norms was described as having progressed further in younger than older generations and in more urban than rural areas. Several key informants from the CSO and high school settings, for example, noted parents’ reluctance to talk about sexual matters as a barrier to education and programming (Table 2, Quote 2.2). According to key informants in the CSO setting, parents still monitored and controlled the relationships and sexual activities of daughters more than of sons (Table 2. Quote 2.3). Others, however, felt that even older generations of parents had begun to be more open to discussions of sex and sexuality, particularly as these discussions related to their children’s health.
Persistent gender norms that bolstered myths about sexual violence, including victim blaming and male sexual privilege within heterosexual relationships, were described as root causes of sexual violence and barriers to addressing it. Several key informants across all organizational settings discussed or gave examples of relationships in which women and girls either did not recognize sexual violence or felt pressured to tolerate sexual violence within the relationship (Table 2, Quote 2.4).
Ambiguity of national laws on sexual violence and poor implementation
Closely linked to the influences of gender and sexual norms on sexual violence in adolescent dating relationships, key informants across organizational settings cited the ambiguity of contents and implementation of laws in Vietnam as a challenge to addressing sexual violence. Although the age of consent (16 years) was considered common knowledge, and potential prosecution based on violation of the age of consent was cited frequently (Table 2, Quote 2.5), knowledge was limited about the acts that constituted sexual violence under the law, particularly for those over age 16. Key informants also expressed a lack of clarity about formal avenues of legal recourse, which was perceived to contribute to these challenges. Moreover, some key informants perceived that laws were poorly enforced, further discouraging victims from reporting their experiences to formal authorities (Table 2, Quotes 2.6–2.7).
Influences of external organizations
Governmental and non-governmental organizations were highly networked with high schools and universities in the provision and monitoring of education about sexual and reproductive health and sexual violence. The Ministry of Education and Training was viewed as a potential ally in requiring the creation of sexual violence prevention programming, but also was viewed as a source of red tape in the implementation of such programming in public high schools and universities (Table 2, Quote 2.8). When discussed, universities and high schools were partnered with CSOs, medical staff, and the police to provide subject-matter expertise on sexual violence that might be lacking among internal staff at those institutions. Some outside organizations were perceived to be less accessible to adolescents than others due to logistical barriers (Table 2, Quote 2.9).
Influences of the media
Finally, traditional and social media arose frequently in discussions of factors influencing the prevalence of and responses to sexual violence. Social media and the internet were viewed as preferred sources of information among adolescents about health and relationships, filling the information gap left by schools, parents, and official government media (Table 2, Quote 2.10). However, technology-facilitated sexual violence was identified almost universally as a growing problem and driver of sexual violence among high school and university students (Table 2, Quote 2.11). Moreover, traditional and social media were believed, on the one hand, to perpetuate harmful norms and rape myths based on the ways in which high-profile cases of sexual violence were covered, but on the other hand, to be potentially important avenues for norms change (Table 2, Quote 2.12–2.13).
Inner setting influences
Participants shared various thoughts on the implementation inner setting, identified as the internal school or university environment in which GlobalConsent would be administered. Several similarities and differences emerged with respect to the inner settings of high schools and universities.
Institutional culture
According to several key informants, the ability of influential actors to advocate for sexual violence prevention depended on the institutional culture around sexual violence and gender. First, several key informants perceived varying institutional openness to address sexual violence among students, staff, and leadership at their institutions. On the one hand, in university settings, concerns about sensitivity and institutional reputation, as well as a belief that sexual violence was uncommon, often were cited as barriers to address the problem (Table 3, Quotes 3.1–3.2). On the other hand, universities in urban settings having social sciences and humanities departments, younger staff, and more international students were characterized as more open to discussions of sexual matters.
Several key informants also identified gender norms as an influential element of the institutional culture, reflecting broader normative changes in Vietnam. According to some key informants, male and female students still endorsed more rigid gender norms, characterized by a belief in male privilege and a tendency toward victim blaming (including self-blame) (Table 3, Quote 3.3). By contrast, other informants described gender expectations among students as more equitable, supportive of LGBTQ classmates, and receptive to efforts against gender-based violence.
Organizational infrastructure and resources
Key informants identified several influential features of the organizational infrastructure for the implementation of sexual violence prevention programming. A few informants described departments within universities and high schools as siloed, such that limited coordination was a barrier to program implementation (Table 3, Quote 3.4), as was a lack of experience implementing large-scale programming (Table 3, Quote 3.5). Resources also were identified as a salient barrier to sexual violence prevention programming. Key informants noted limited funding and red tape as barriers to implementation, especially in public institutions, and some university lecturers cited technological difficulties, such as inconsistent access to the internet and information/communication technologies, as barriers to students’ participation in online programming (Table 3, Quote 3.5). Informants from high school and university environments discussed limited time and competing priorities among students and teachers as barriers to implementation (Table 3, Quote 3.6–3.7).
Influential Actors
In the context of institutional norms and structures, several types of actors were considered important for engaging students in sexual violence prevention and response, and championing program implementation. At universities and high schools, leadership who demonstrated strong buy-in were notable at campuses where successful sexual violence prevention programs were in place (Table 3, Quote 3.8). Within universities, human-resource staff, the Youth Union, school boards or management committees, and student affairs/administrative staff also were identified as facilitating or impeding the institutional response to sexual violence and the implementation of prevention programming. In high schools and universities, several informants cited teachers and other student-facing staff as vital to the implementation process, and a pathway intervention integration and student engagement (Table 3 Quotes 3.9–3.10). These actors operated within the inner setting, autonomously or alongside inner setting leadership, to influence activities and norms, including by championing counter-cultural or deprioritized programs.
Influential characteristics of individuals
Individuals who interact with the intervention during implementation may exist in the inner and outer settings, and characteristics of those individuals can influence the intervention’s effectiveness (ex., receptivity to change, willingness to engage) and requirements for successful implementation (ex., level of knowledge provided, familiarity with topics). Teachers and lecturers, who are potential facilitators, have varying levels of subject-matter expertise on sexual violence (Table 4, Quote 4.1). Teachers or lecturers with science or social science backgrounds were seen as better prepared to tackle content related to sexual and reproductive health and sexual violence. Also, younger lecturers were considered more open to discussion and perhaps better able to engage with and relate to students’ experiences. Likewise, university students’ area of study was linked with their awareness of sexual violence, willingness to engage in discussions about sexual matters, and involvement with extracurricular activities related to social justice (Table 4, Quote 4.2), as was the urbanicity or rurality of their university. High school and CSO informants often described parents’ more customary attitudes towards sex among young people as a potential barrier to program acceptability (Table 4, Quote 4.3). However, a few CSO informants suggested that parents with more contemporary attitudes could be a potential avenue toward community-level norms change, serving as a bridge to the outer setting (Table 4, Quote 4.4).
Influential characteristics of prevention interventions and implementation processes
Interview and focus group participants, respectively, provided feedback on violence prevention programming generally and GlobalConsent specifically in organizational settings. Participants offered several insights into intervention program structure, often overlapping with views on the process of implementation. Participants’ comments fell into three categories: the intervention medium, intervention delivery, and intervention content. Responses were similar across high schools and university, underlining the needs of students.
Intervention medium
Many key informants suggested the medium of the web-based program—online versus in-person—would be effective to raise awareness of sexual violence in universities and high schools, especially through familiar apps and websites (Table 5, Quote 5.1). Key informants noted that virtual programming could fit more easily into students’ schedules and provide greater confidentiality. However, others discussed challenges with virtual programming, including the need for more intentional engagement with students, the difficulty of eliciting feedback from intervention participants, and the time burden outside of school hours (Table 5, Quote 5.2). Responsive to this, some suggested that the program should be implemented in-person, and a few informants felt that one-way delivery of information would be suboptimal, instead suggesting a discussion- or activity-based program. Informants were divided on how to execute sexual violence prevention programming generally, with some suggesting integration into classes, some suggesting a 30-min remote session, and many suggesting more intensive, sustained intervention, including hybrid interventions with in-person and online activities (Table 5, Quotes 5.3–5.5).
Intervention delivery
Delivery of the intervention—the means through which information is delivered, such as the facilitator, didactic versus interactive, and means to engage students—was underscored as requiring trusted sources (Table 5, Quote 5.6). Intervention facilitators were cited as needing training on how to communicate concepts related to violence (Table 5, Quote 5.7). Given the digital format, several participants noted the potential to deliver intervention materials through numerous mechanisms and the overall flexibility of a web-based platform, and conveyed that integrating other types of activities, such as games and talk-show-style content, may be beneficial (Table 5, Quote 5.8–5.9). These approaches were recommended to offset the abundant information presented throughout the program (Table 5, Quote 5.10). To facilitate students’ engagement in the content, participants underscored the importance of peer education (Table 5, Quote 5.11). Participants also expected difficulty engaging students without incentives or integration into school activities (Table 5, Quote 5.12).
Intervention content
Participants generally liked the content of the GlobalConsent program (Table 5, Quote 5.13). Participants underscored the need to provide information on ancillary support to students who engage in the intervention, such as sexual violence support services (Table 5, Quote 5.14). Other recommended new content on relationships that are not only student–student, but involve teachers (Table 5, Quote 5.15). Some content was noted as too advanced for high school students, and required adaptation to that audience (Table 5, Quote 5.16). Several participants also encouraged adding content for women in the intervention (Table 5, Quote 5.17).
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