Preventing Sexual Violence in College Men: Adaptation and Impact Evaluation of RealConsent for Use in Vietnam
Phase: NA
Conditions: Sexual Violence
Sponsor: Emory University

1 
 
EMORY UNIVERSITY 
Quantitative and Qualitative Study Protocols 
 
Title 
Preventing Sexual Violence in College Men: Adaptation and Impact Evaluation 
of RealConsent for Use in Vietnam 
Short Title 
RealConsent Vietnam 
Principal 
Investigator 
Kathryn M. Yount, PhD 
Asa Griggs Candler Chair of Global Health and Professor 
Hubert Department of Global Health 
Sponsor(s) 
Wellspring Advisors, LLC 
Protocol 
Version/Date 
Version 1.0, 11/16/2017 
NCT Number 
NCT04147455 
 
External Non-Emory Collaborators 
Tran Hung 
Minh, MD, MSc 
 
 
 
IRB 
Site Principal Investigator 
Director 
Center for Creative Initiatives in Health and Population (CCIHP) 
Số 48 Tổ 39 Ngõ 251/8 Nguyễn Khang, Cầu Giấy, Hà Nội, Vietnam 
 
This protocol and Dr. Tran’s engagement in human subjects research activities 
will be reviewed and approved by the institutional review committee at Hanoi 
University of Public Health (HUPH). 
 
Background and Significance 
Introduction 
Problem. Sexual violence is any sexual act committed against a person without 
freely given consent. Men and women may experience sexual violence, but 
most victims are women. Women’s first experiences of sexual violence often 
occur in adolescence. In Asia and the Pacific, about 14% of sexually 
experienced adolescent girls report forced sexual debut. Thus, early prevention 
with men is critical; yet, young men often are difficult to reach and may resist 
programs that target sexual violence, not seeing themselves as potential 
perpetrators. Prevention with men that integrates a bystander framework, which 
treats men as “allies” of women, is one way to target attitudes and behaviors 
while decreasing resistance to participation. Project Goals. In this project, we 
will adapt an existing program for use with men attending one of two universities 
in Hanoi, Vietnam. We will test the impact of the adapted program on 
knowledge/attitudinal/emotional mediators, and in turn, on sexual violence 
perpetration and prosocial bystander behavior in this target group. The program 
is a novel, six-session, web-based serial drama and educational program 
designed to prevent sexual violence perpetration and to enhance prosocial 
bystander behavior in young men. The program has reduced the incidence of 
sexual violence among men attending an urban, public university in the 
Southeastern United States. Methods and Activities. We will use a mixed-
methods design and the Center for Disease Control and Prevention’s Map of 
the Adaptation Process framework to adapt the program for college-going men 
in Vietnam, and then to test the impact of the adapted program in samples of 
men attending two universities in Hanoi. The qualitative research will have two 
steps. In step I, we will conduct semi-structured interviews with college men 

2 
 
(n=10) and women (n=10) to understand the social context of sexual violence in 
this setting, and focus group discussions (FGDs) with college men (n=12) and 
university stakeholders (n=12) to elicit feedback on the original program. From 
these data, we will create scripts in storyboard format of the adapted program. 
In step 2, we will conduct FGDs with college men (n=12) and university 
stakeholders (n=12) to elicit feedback on the storyboards and to refine the 
adapted Program to ensure acceptability. We will use grounded theory to 
analyze all transcripts inductively and deductively, identifying themes and 
patterns among themes and comparing the emergent theory with the underlying 
theory of change of the program. From the final storyboards, we will produce a 
web-based adaptation of the program in Vietnam. Finally, we will conduct a 
randomized controlled trial to test the impact of the adapted program (n=200), 
relative to a health-education control condition (n=200), on 
knowledge/attitudinal/emotional mediators, and in turn, on sexually violent 
behaviors, and prosocial bystander behavior in freshmen men attending two 
universities in Hanoi. Innovation and Long-term Impact. This project will be the 
first to adapt and to test the impact of a novel, theoretically grounded, web-
based intervention to prevent sexual violence perpetration and to promote 
prosocial bystander behavior among young men for use in a middle-income 
country. If our project shows that the adapted program is effective cross-
culturally, it will have exceptional potential for scale-up to prevent men’s 
perpetration of sexual violence against women globally. 
Background. 
Existing 
factors. 
Preliminary 
studies. 
Supporting 
literature. 
 
Sexual Violence is Global and Disproportionately Burdens Women 
Sexual violence is any sexual act committed against a person without freely 
given consent. Sexual violence ranges from unwanted sexual contact and non-
contact sexual experiences to completed or attempted forced penetration.1 
Globally, about 7.2% of women 15 years or older report some form of non-partner 
sexual violence, and estimates for Southeast Asia are similar, at 5.2%.2 Between 
16.4% and 19.7% of women and girls globally have reported sexual abuse in 
childhood (before age 18),3 and 14.9% of sexually experienced adolescent 
women 15–19 years have reported forced sexual debut.4 In Asia and the Pacific, 
forced sexual debut in sexually experienced adolescent women is an estimated 
13.8%.5 The physical, psychological, and economic aftermath of sexual assault 
often is severe for its victims,6,7 totaling $127 billion yearly in medical costs, lost 
earnings, pain, suffering, and lost quality of life in the US alone.8 Men can 
experience rape and sexual assault, but women comprise 91% of victims.9 
 
Masculinity Norms Influence Men’s Perpetration of Sexual Violence against 
Women in Vietnam 
Social cognitive theorists argue that behaviors are learned by observing 
others, and are reinforced by observing the associated rewards or 
consequences.10,11 In this way, boys who witness inter-parental violence or 
experience direct maltreatment may come to view violence in relationships as 
normal. In lower- and middle-income countries (LMICs),12,13 including sites in 
Vietnam14,15 and Bangladesh,16 witnessing male-on-mother violence or 
experiencing child maltreatment predicts men’s later perpetration of partner 
violence.  
Hearn 17 argues that ‘‘any learning (of violence or indeed anything else) 
is…gendered. Thus, boys may learn not only that violence is possible and is 
performed by older males, but also that it is done in the context of male 
domination more generally” (p. 27). In Vietnam, Rydstrøm18 has characterized 

3 
 
‘‘violent inter-generational practices’’ between grandfathers, fathers, and 
grandsons 
or 
sons 
as 
‘‘tangible 
manifestations 
of 
a 
masculine 
discourse...composed of a tradition of patrilineal ancestor worship [and] ideas 
about honor’’ (pp. 329-330). Confucianism stresses moral obligations in 
hierarchical relationships, such as father with child, older brother with younger 
brother, and husband with wife. Older persons are respected for their greater 
proximity to deceased ancestors, and the superior is expected to educate the 
inferior, who should return obedience, gratitude, and filial piety.19,20 Gendered 
privilege is embedded in this kinship system, as descent is traced through 
fathers.21,22 As such, senior men are viewed as superior to senior women,23 and 
a senior man symbolically and customarily heads the household.18,24,25 Thus, the 
head of household has the right to raise, educate, and discipline junior male and 
female kin,21,22,26 for example, by instilling fear or using physical punishment.27,28 
Such methods teach children ‘‘their subordinate role in the learning process’’ and 
the nature of social relations more generally.29 For instance, a mother or 
grandmother would rarely beat a son, because doing so would challenge the male 
household head’s authority to assess when corporal discipline is “needed.”18  
Violent intergenerational relations among male kin also reflect local ideas 
about ‘‘hot’’ superior masculinity and ‘‘cool’’ inferior femininity.18 When a father 
corporally punishes a son, the father elevates his own masculinity and demotes 
the boy to an inferior (feminine) position.18 Boys may even describe such violence 
as ‘‘justified’’ if they see themselves as at fault.18 In many male–male relational 
contexts in Vietnam, using violence to establish hierarchies among men and to 
reinforce violence is an accepted aspect of dominant masculinity.28 
In practice, new household arrangements are challenging these age-gender 
hierarchies.21,30-32 Since the 1990s, schooling attainments have reached gender 
parity33 and women34 increasingly migrate for work, spurring some husbands to 
assume unpaid family work.35 These deviations from customary age-gender 
hierarchies may threaten the ‘‘entitlements’’ of senior men, spurring violence as 
a means to reinstate male dominance.28 Thus, men’s dominance and use of 
violence not only is embedded in local patrilineal kinship systems, but also may 
increase in response to structural changes in gender relations. 
 
The Legal Framework in Vietnam Favors Sexual Violence Prevention 
In the context of social norms and kinship practices favoring male 
dominance, the State has pursued legal reforms to promote gender equality, 
penalties for gender-based violence, and violence prevention. The Law on 
Marriage and Family in 1986 gave men and women equal rights in marriage, and 
the Law on Gender Equality in 2006 sought to eliminate gender discrimination 
and to curb differential rights based on gender.36-38 The Penal Code of 1989 
defined penalties for acts of sexual violence.39,40 Rape was deﬁned legally as an 
act committed by someone who, through violence or its threat, or by using the 
victim’s helplessness or other means, forces the victim to have sexual intercourse 
against her will. Rape carries a punishment of imprisonment for two to seven 
years. Convicted offenders are barred from certain jobs or positions of 
responsibility for one to ﬁve years. Terms of up to 20 years or even life 
imprisonment could be imposed when victims suffer grievous bodily harm, 
perpetrators are known HIV carriers, or victims die or commit suicide because of 
the rape.41 A 2007 law codified definitions of physical, psychological, sexual, and 
economic violence as a step to prevent these forms of violence.42,43  
 

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Preventing Sexual Violence Must Engage Men 
Despite legal reform, sexual and other forms of violence against women 
persist in Vietnam.37,43 In our research outside of Hanoi, men have discounted, 
excused, or denied many acts of violence.44 As a result, men’s reported rates of 
sexual violence perpetration (0.2%) are lower than women’s reported rates of 
victimization (12.0%).15 Thus, prevention work with men is critical to create an 
environment where women’s bodily integrity and freedom from violence are 
possible.45 Yet, young men often are difficult to reach46,47 and resist programs that 
target sexual violence, not seeing themselves as potential perpetrators.48 Limited 
data also suggest that the behavior of bystanders, or witnesses of sexual 
violence, is gender-specific.49 Although evidence from rigorous evaluations is 
limited,50 prevention with men that integrates a bystander framework is a way to 
target attitudes and behaviors while decreasing resistance to participation51-53 
because men are treated as the “allies” of women.54  
Innovation. 
Generalizability. 
Intended 
purpose and 
audience for 
results. 
     The proposed project will disrupt several programmatic paradigms related to 
the prevention of sexual violence. First, interventions to prevent sexual violence 
by young men are rare in low- and middle-income countries.55 This project will 
be the first to adapt and to test the impact of the program on sexual violence 
prevention and prosocial bystander behavior in college-going men in a middle-
income country. Second, even in high-income countries, most programs entail 
in-person, small-group formats, which limit their reach and public-health 
impact.56,57 The program is a novel, theory-driven, evidence-based serial drama 
and educational program tailored to young men and delivered in six episodes 
via the web. Each of these novel features of the program warrant comment: 
 
1) 
Gender-specific programming. First, gender-specific content is shown to 
be more effective than gender-generic content in behavioral interventions to 
reduce drinking58 and to prevent rape.59 As such, programs to prevent sexual 
violence perpetration should be gender-specific.60,61 The program is the only 
gender-specific program commercially available for cross-cultural adaptation.  
2) 
Evidence-based approach. Second, the program integrates well-known 
behavioral change techniques, which we will retain in the adapted program for 
Vietnam. These techniques include 1) providing information and instruction on 
obtaining effective consent for sex and intervening safely, 2) modeling 
communication and intervening behaviors; 3) showing positive outcomes for 
getting consent and intervening plus negative outcomes for perpetrating and not 
intervening; and 4) reinforcing with support and positive feedback.62  
3) 
Interactive, problem-based learning via educational entertainment. Third, 
the program uses several best practices, such as didactic presentation of 
material via video and infographics, problem-based learning with interactivity, 
and short videos or animations to model behavior. Problem-based learning 
activities with real-time feedback are core elements. These activities require the 
user to make a decision (e.g., “do something” or “stay out of it”) after viewing a 
brief filmed scenario. Based on his decision, the user is guided through a 
sequence of outcomes so each consequence of a poor choice is shown. This 
feature is based on theories of social learning by reinforced practice,63 and the 
program enhances this formula by adding educational entertainment, starting 
and ending each module with a 3-minute episode of a professionally written, 

5 
 
produced, and edited serial drama based on formative research. In the US, 
most male participants rated the episodes as an effective or highly effective way 
to learn about consent and prosocial intervening behaviors.64 
4) 
Web-based and mobile website platforms. Initially, behavioral change 
techniques were developed for delivery to small groups in person. Today, 
researchers are applying best practices for behavioral change techniques to 
web and mobile applications. Online behavioral-change programs tend to have 
larger effects when they include more behavioral change techniques,65 deliver 
content that resonates with the user,66 and integrate audio, graphics, and 
interactivity.67 For example, a gender- or race-specific vignette may resonate 
(via vicarious learning) with a like user and, thus, have stronger effects on 
knowledge and motivation, because personal relevance enhances learning and 
increases motivation to complete the program. These techniques are part of the 
web-based platform of the program, and will be retained in the adaptation for 
Vietnam.  
 
The high video-production quality of the program, with rigorous scientific content 
based on principles of behavioral change tailored to young men, will appeal to 
educational leaders who seek to reduce sexual violence in their schools. the 
program has reduced the incidence of sexual violence perpetration in men 
attending an urban, public university in the Southeastern US.68 Once developed, 
web-based programs like the program are less resource-intensive to adapt.68-70 If 
shown to be adaptable and effective in Vietnam, the program has exceptional 
promise as a cost-effective, scalable means to reduce the incidence of sexual 
violence against women globally.   
 
Goals/Aims 
The results from the qualitative research arm of this study conducted in AIM1 will inform quantitative 
research in AIM2. Specifically: 
Qualitative Arm 
 
AIM1 
We will conduct formative qualitative research to identify and to adapt non-core 
elements of the program to be acceptable to the local context and target 
population. The goals of the program are 1) to increase prosocial intervening 
behaviors, such as trying to stop a peer who is being coercive, which reduce the 
risk for sexual violence perpetration, and 2) to prevent sexually violent behaviors 
toward women.  
Quantitative Arm 
AIM2 
From the qualitative arm, we plan to adapt the program for use with college men 
in Vietnam and to test whether it:  
H1 improves their knowledge, attitudes, and emotional valence regarding sexual 
violence against women 
H2 increases their tendency to intervene to prevent such violence; and  
H3 reduces their propensity to perpetrate sexual violence against women. 
 
Qualitative Study Design 
Organizational 
structure of the 
team 
Translation, 
Recruitment, 
Training, 
and 
Ethics/Research 
Committee 
Approval. Contributions to Data Collection, Analyses, Interpretation, Writing, 
and Dissemination Activities. 

6 
 
CCIHP 
Site Principal Investigator: Tran Hung Minh, MD, MSc 
Research Assistants (Total = 2) for Pilot, SSIs, FGDs 
     Interviewers: (4, ≥ Master’s level)  
     Supervisor: (1, ≥ Master’s level) 
 
Emory University IRB Approval, Contributions to Data Collection, Analyses, 
Interpretation, Writing, and Dissemination Activities. 
Emory University 
Principal Investigator: Kathryn M. Yount, PhD 
Co-Investigator: Jessica Sales, PhD 
Consultant: Laura Salazar, PhD 
Setting and 
location 
Setting. The undergraduate system in Vietnam is a suitable context for adapting 
the program, given its similarities with the US context where the program originated. 
Undergraduate study is 4–6 years, with two foundational years and 2–4 years for 
specialization. Except for political education and national defense, universities 
design their own curricular and extra-curricular activities and maintain networks 
through the Ministry of Education and Training (MoET), professional associations, 
and Youth Union, all potential pathways to bring the program to scale in the future.  
Study site. The sites for this project are Hanoi Medical University (HMU) and 
Thang Long University (TLU), both in Hanoi. HMU is a 100-year-old state school 
with dental, medical, nursing, nutrition, public health, and paramedical/ 
ophthalmology technical programs. Its 1000 enrolled students are 40% men. TLU 
is a 24-year-old private university with 15 departments (e.g., math, business 
administration, social sciences). Its 7000 enrolled students are 45%-50% men. Both 
schools have provided letters of support for adaptation of the program with their 
students.  
Study 
Population 
In step 1 of the qualitative work, we will conduct semi-structured interviews 
(SSIs) with undergraduate men and women and meetings with university 
stakeholders. In step 2, we will conduct FGDs with college men.. 
Recruitment 
Qualitative samples.  Qualitative research participants will be men and women 
undergraduates and university stakeholders (administrators and faculty) at HMU 
and TLU. To recruit students, CCIHP personnel will contact department chairs to 
discuss the study with them. With their agreement, CCIHP will talk with faculty about 
the study and ask them to announce it in their classes using a flyer with a brief, 
standard project description. Students will contact the research team to take part. 
The team has used this strategy successfully to recruit undergraduates. CCIHP key 
personnel will hold separate meetings with university stakeholders to invite their 
participation. CCIHP will work with the chairs of departments to announce the study 
in their regular meetings and invite the staff to participate (who are interested in the 
topic of sexual violence/and or working in this field, want to learn about the program, 
have good understanding and information about male students’ relationships with 
female students or with other girls so that they can contribute effectively to give 
comments and adapt the program). Male focus group discussion participants will be 
recruited purposively to represent a range of ages, years of study, sexual 
experience, and other relevant demographic characteristics. 

7 
 
Field Methods 
 
     
 
Data 
collection overview.  In step 1 of the qualitative work, we will conduct semi-
structured interviews (SSIs) with undergraduate men and meetings with university 
stakeholders. In step 2, we will conduct FGDs with college men.. Semi-structured 
lists of open-ended questions or viewing guides will guide each SSI and FGD, 
respectively, with options to probe unexpected responses. Interviewers will keep 
field diaries to record their observations and interactions during data collection. 
Table 1 shows the data collection plan for each MAP step. Participants will be 
reimbursed ($5 per student $15 per university stakeholder) for their time and will 
receive refreshments. 
Semi-structured interviews. SSIs will allow us to explore the context of sexual 
relations and sexual violence among young people in Vietnam. Trained interviewers 
will elicit narratives about dating, sexual violence events, views about these events, 
and sexual violence generally. Narratives enable analyses of how a person’s 
memories of the past and expectations of the future shape their understanding of 
personal experience.83 Through narratives, we will explore how participants 
perceive acts of sexual and other forms of dating violence and understand 
“consent,” “rape,” local laws on sexual and other forms of dating violence, and forms 
of recourse for survivors. We will ask participants about their personal attitudes and 
about family and community norms. These data will clarify the context in which the 
program will be adapted. 
Meetings with university staff. University staff (n=10-12) across the two 
participating universities will be granted access to program materials to view 
individually and provide written feedback. Research staff will meet directly with 
university staff to discuss their impressions of acceptability and relevance of 
program modules. Feedback from university staff will inform the direction of FGDs 
with university men. 
Focus group discussions. Interactions among participants in FGDs can elicit 
diverse views on a topic, discussion and debate, explanations of issues, and 
“normative” data that would not emerge from SSIs.84 We will conduct 12 FGDs with 
5-10 university men each,, distributed evenly across universities. (Table 1). Groups 
will meet in an accessible location (e.g., school building) to view together 2 modules 
from the original program with subtitles in Vietnamese and provide feedback. As 
part of the FGD, they will be asked to complete viewing guides to assist in collecting 
their impressions of the program. These data will inform decisions about 
adaptations of the program. We will use their feedback to assess the acceptability 
and relevance of adaptations, ensure that the core elements of the program remain, 
and finalize changes to ensure acceptability and relevance. 
Fieldwork and data management. Interviewers will be Vietnamese men and 
women (4:2) experienced in qualitative research on gender-based violence. 
Fieldwork at HMU and TLU will occur concurrently so learning from one site informs 
data collection at the other. CCIHP personnel will visit both sites regularly to 
supervise the work. Interviews will be in Vietnamese and will be transcribed and 
MAP
Total
Step
Data Collection Method
Men
Wome
Staff
Men
Wome
Staff
Assess
Meetings with university staff
0
0
6 (5-6)
0
0
6 (5-6)
12
Semi-structured interviews
5
5
0
5
5
0
20
Prepare
Focus group discussions (size)
6 (5-10)
0
0
6 (5-10)
0
0
12
A,P
Field diaries 
8
4
Thang Long University
Hanoi Medical University
4
Table 1. Qualitative Data Collection Methods
Notes. A=assess step; P=prepare step

8 
 
translated into English at CCIHP. Collected data will include audio recordings, 
textual transcripts from the SSIs and FGDs and text from interviewer field diaries 
and viewing guides (Table 1). 
Quality control. We will listen to a random sample of 20% of the audio-files to 
confirm that transcripts are complete and accurate. One additional FGD each with 
young men and university staff will be conducted near the end of the analysis to 
share the findings and to ensure their credibility.85 
 
Informed 
Consent 
Assurances, IRB approvals, and oversight:  Our ethics protocol will follow 
WHO guidelines for research on violence against women.131 Ethical approval will be 
sought from CCIHP, Emory University, and Georgia State University. Team 
members have completed certification training in research ethics. 
Consent process. Informed consent will be sought when eligible participants 
are first asked to take part. Informed consent requires a clear understanding of the 
study’s purpose; voluntariness, nature, extent and duration of participation; extent 
of confidentiality; right to anonymity; and right to withdraw any time. Participants will 
be informed that, with permission, SSIs and FGDs will be audiotaped, and 
researchers will take notes. Because CCIHP does not feel written consent is 
suitable, we will audiotape verbal consent with a witness before starting interviews. 
Qualitative interviews will be conducted in private settings at the study sites, where 
the interviewer will provide more detail about the exact nature of the study, 
procedures, and any expected risks and benefits to eligible participants. 
Participants will be informed that audio-recordings will be kept in a locked cabinet 
or secure computer with limited access for a specified duration before being 
destroyed. All participants will be compensated appropriately for their time (without 
overcompensation) and qualitative research participants will be offered 
refreshments. Online consent will be obtained before participants will be allowed to 
view and participate in the online survey for the impact evaluation portion of this 
study. 
Potential Risks 
/ Discomforts. 
Protections. 
College men and stakeholders taking part in step 1 FGDs may experience 
embarrassment or stress when giving opinions on the content of the program. 
College men and women taking part in SSIs and may feel stress or adverse 
psychological reactions to questions about personal experiences of sexual violence 
or may reveal related prior experiences, such as child maltreatment, dating 
violence, or witnessing parental violence. We do not foresee any risks for 
participating in round 2 FGDs, to elicit feedback on adapted scripts and segment 
materials, although some may experience some stress and embarrassment from 
reviewing these materials. College men may experience stress or adverse 
psychological reactions to survey questions about sexual violence perpetration or 
prior experiences of violence exposure. 
Protection against Potential Risks.  Procedures to protect participants against 
risk include: 
1. CCIHP will identify and retrain field staff with prior experience conducting 
qualitative research on gender-based violence. Local staff will be prepared to 
handle potential risks.  
2. Every effort will be made to enhance disclosure and to ensure the accuracy 
of collected data.131 for example, we will avoid questions with abstract or value‐
laden terms (e.g., “abuse”) and use questions that guide SSI participants through 
specific instances of sexual violence. Also, we will match female participants with 
mature, female interviewers who are similar in age and experienced at discussing 

9 
 
sensitive issues. Similarly, male interviewers will interview male study participants, 
or will be interviewed in private via the online survey platform. 
3. Before starting a SSI or quantitative online survey, participants will be told 
their responses are confidential and they can, at any time, stop the interview and 
request assistance using the contact information provided on the consent forms. 
4. Before starting a FGD, participants will be told the guidelines for 
participation, such as “please do not discuss what was said during the group with 
others outside this group,” “be respectful of each other’s comments and do not talk 
over each other,” “if you do not want to answer a question, you do not have to,” and 
“if you need to leave, please let us know by raising your hand and we can help you 
leave the group.”  
5. We will state that participants have the right to withdraw any time during their 
SSI, FGD, survey, or viewing of the program. 
6. SSIs and FGDs will be audiotaped. The digital file will be transcribed 
verbatim; participants will be identified numerically. Transcribed files will be stored 
on a password-protected computer in a locked office at CCIHP, accessible only to 
study staff. After data analysis, digital files will be destroyed to protect 
confidentiality. 
7. Counseling services will be offered to participants experiencing adverse 
psychological reactions associated with participating in SSIs, FGDs, or review of 
the program materials. Services will be provided by the Center for Studies and 
Applied Sciences in Gender – Family – Women and Adolescent (CSAGA) a non-
governmental, non-profit organization that promotes the rights of women and 
children vulnerable to violence and discrimination. CSAGA operates 6 counseling 
hotlines and a counseling hotline by the Ministry of Labour and Social affairs (for 
children). CCIHP also operates a website and free online counseling for youth on 
gender, sexuality, and sexual violence. A resource list with numbers and websites 
for counseling services will be provided for all participants. 
8. Procedures to minimize loss of confidentiality include encryption to maintain 
the confidentiality of participants’ identity and their data. Collected data will be 
identified only by identification numbers with no personal identifiers. Personal 
identifiers will be redacted from transcripts, and pseudonyms will replace names. 
Confidential data will be kept in a locked office file cabinet with restricted access. 
Names will be stored in a separate locked cabinet and will not be linked to study 
data. 
9. We will work with our respective IRBs to obtain a Certificate of 
Confidentiality. 
Benefits 
Study participants will receive no direct benefit from their involvement in this 
research. The insights gained from this study, however, should improve college 
men’s engagement in prevention of sexual violence against women. Considering 
the extensive protections to be undertaken to minimize potential risks to participants 
in this research, and the substantial anticipated benefits for future research and 
policy development, no problems are anticipated that outweigh the advantages of 
the proposed research. 
Compensation 
Participants will be reimbursed ($5 per student $15 per university stakeholder) 
for their time and will receive refreshments. 
Data 
Management 
and monitoring 
The qualitative data will consist of verbatim, textual responses to open-ended 
questions administered in face-to-face interviews and group discussions with men 
and women. University staff and FGD participants will also provide written data in 
viewing guides to be completed while viewing program content either individually or 

10 
 
as part of a FGD. Information linking the names of specific individuals will be kept 
in a locked filing cabinet and a security-protected computer. Given the sensitivity of 
the topic under study, it is especially important that the instruments to be used in 
these interviews are well designed, and that the interviewers are well trained in the 
conduct of research on sexual violence. To these ends, we will employ interviewers 
who have worked with us previously on studies related to gender and violence. 
These interviewers also will receive refresher training on the issue of sexual 
violence, ways of asking questions about sensitive topics, the management of 
difficult situations that may arise from the discussion of these issues, the importance 
of and methods for ensuring confidentiality, and the safety and protection of 
participants in the study. Every effort will be made to enhance disclosure and to 
ensure the accuracy of the data that are collected. We will avoid general questions 
that use abstract or judgmental terms (e.g., “abuse”), and use questions that guide 
the study participants through a range of specific acts, settings, and circumstances 
of violence. We will be mindful of study participants’ interpretations of the questions 
and terminology, and the effects of question ordering on responses. Our experience 
suggests that interviewers who are similar in age and matched on gender to the 
participants and who are skilled at discussing sensitive issues can enhance trust. 
Plans for 
analysis 
Qualitative data analysis entails a “search for patterns in data and for ideas 
that help explain why those patterns are [present].”86 We will use a grounded-theory 
approach, or techniques to identify categories and concepts that emerge from text 
and to link them into substantive and formal theories.86 This approach combines 
deductive and inductive techniques to discern general themes while allowing new 
understandings and sub-themes to emerge. We also will use narrative analysis, 
which preserves the particularities of a narrative while framing individual narratives 
within larger socio-cultural patterns.87 The use of multiple sources of data, or 
triangulation, enhances the validity of data obtained from a single source.84 Thus, 
notes from field diaries and verbatim transcripts of the FGDs and SSIs will be coded 
similarly and analyzed through constant comparative analysis.88 Two study team 
members will code all notes and transcripts separately using the MaxQDA 
qualitative software program; one in English, and one in Vietnamese. Emory and 
CCIHP key personnel will supervise the coding to verify that findings are grounded 
in the data. The team will discuss cases when the RAs disagree, and themes on 
which two or more team members agree will be included in the final analysis. These 
steps adhere to qualitative data analytic strategies in the social and behavioral 
sciences. 
Confidentiality 
All key personnel have completed the Human Participant Protections Education 
for Research Teams online course, sponsored by NIH or the Social/Behavioral 
Research course through CITI.  
As previously detailed in the protections of risk section, above, we are careful 
to ensure confidentiality. Several strategies will be used to ensure the confidentiality 
of participants in the research.  
(1) Interviewers will receive strict instructions about the importance of maintaining 
confidentiality.  
(2) Interviewers will not conduct research within their own communities of residence.  
(3) The names of study participants will not be written on questionnaires or interview 
guides. Instead, unique numeric codes will be used to distinguish the 
questionnaires and textual transcripts of study participants.  
(4) If identifiers are needed to link a questionnaire with a household location or a 
particular study participant, these identifiers will be kept separate from the 
questionnaires in a locked cabinet or separate, secure computer with access 

11 
 
 
Quantitative Study Design 
Organizational 
structure of the 
team 
Translation, Recruitment, Training, and Ethics/Research Committee 
Approval. Contributions to Data Collection, Analyses, Interpretation, 
Writing, and Dissemination Activities. 
CCIHP 
Site Principal Investigator: Tran Hung Minh, MD, MSc 
Research Assistants (Total = 1) 
      
Emory University IRB Approval, Contributions to Data Collection, 
Analyses, Interpretation, Writing, and Dissemination Activities. 
Emory University 
Principal Investigator: Kathryn M. Yount, PhD 
Co-Investigator: Jessica Sales, PhD 
Consultant: Laura Salazar, PhD 
Setting and 
location 
Setting. The undergraduate system in Vietnam is a suitable context for 
adapting the program, given its similarities with the US context where the 
program originated. Undergraduate study is 4–6 years, with two foundational 
years and 2–4 years for specialization. Except for political education and 
national defense, universities design their own curricular and extra-curricular 
activities and maintain networks through the Ministry of Education and Training 
(MoET), professional associations, and Youth Union, all potential pathways to 
bring the program to scale in the future.   
Study site. The sites for this project are Hanoi Medical University (HMU) 
and Thang Long University (TLU), both in Hanoi. HMU is a 100-year-old state 
school with dental, medical, nursing, nutrition, public health, and paramedical/ 
ophthalmology technical programs. Its 1000 enrolled students are 40% men. 
TLU is a 24-year-old private university with 15 departments (e.g., math, 
business administration, social sciences). Its 7000 enrolled students are 45%-
50% men. Both schools have provided letters of support for adaptation of the 
program with their students. 
Quantitative 
Study Population 
 Men 18–24 years and identifying as heterosexual or bisexual and 
enrolled at HMU and TLU as freshmen on 9/1/2019 are eligible. 
restricted to only the immediate research team.  
(5) Digital recordings that are made during the qualitative interviews will be kept on 
a password protected computer with limited access only for the transcribers and 
researchers on the project. Recordings will be destroyed upon completion of the 
study (we will keep them available during the data analysis in case questions 
arise that require a review of the recording.)  
(6) The research team will take particular care during the presentation of the findings 
to ensure that no one community or study participant can be identified in the 
transcripts. To ensure the anonymity of communities and study participants 
involved in the research, all identifying names of study participants and locations 
that are recorded in the transcripts will be changed to pseudonyms. 
(7) Identifiable data will be stored securely in REDCap or an equivalent HIPPA 
compliant data system. User defined access will be provided to members of the 
study team. Only de-identified data will be downloaded to password protected 
computers for further analysis. 

12 
 
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3 weeks 
RealConsent 
or 
Active Attention-Control 
Male, enrolled freshman, 18-
24 y, identify as heterosexual 
or bisexual, have not been at 
risk of sexual violence 
Knowledge, attitudinal, 
emotional mediators; prosocial 
bystander behavior; control 
variables 
Knowledge, attitudinal, emotional 
mediators; prosocial bystander 
behavior; SV behavior; control 
variables 
Figure 1. Impact of RealConsent to Prevent Sexual Violence and to Enhance Prosocial Bystander Behavior: 
Randomized Controlled Study Design 
Real 
Consent 
Real 
Consent 
post-txt      6mo 

13 
 
control program, using block randomization with random block sizes. 
Participants and analysts will be blinded to assignments.   
Outcomes will be assessed at baseline, posttest (just after finishing the last 
module), and six months (Table 2). We will consider confounders and modifiers, 
like social desirability, emotional adjustment, sensation seeking, sexual 
behavior, aggressive peers, peer and social network diversity, peer social 
support, witnessing family violence, family cohesion, and social support (Table 
2). Questions will model others in the field.68 
 
Informed 
Consent 
Assurances, IRB approvals, and oversight:  Our ethics protocol will follow 
WHO guidelines for research on violence against women.131 Ethical approval 
will be sought from CCIHP, Emory University, and Georgia State University. 
Team members have completed certification training in research ethics. 
Consent process. Informed consent will be sought when eligible 
participants are first asked to take part. Informed consent requires a clear 
understanding of the study’s purpose; voluntariness, nature, extent and 
duration of participation; extent of confidentiality; right to anonymity; and right 
to withdraw any time. Online consent will be obtained before participants will be 
allowed to view and participate in the online survey for the impact evaluation 
portion of this study. 
Potential 
Risks/Discomfort
s 
College men may experience stress or adverse psychological reactions to 
survey questions about sexual violence perpetration or prior experiences of 
violence exposure. 
Protection against Potential Risks.  Procedures to protect participants 
against risk include: 
1. CCIHP will identify and retrain field staff with prior experience 
conducting qualitative research on gender-based violence. Local staff will be 
prepared to handle potential risks.  
2. Every effort will be made to enhance disclosure and to ensure the 
accuracy of collected data.131 for example, we will avoid questions with abstract 
or value‐laden terms (e.g., “abuse”) and use questions that guide SSI 
participants through specific instances of sexual violence. Also, we will match 
female participants with mature, female interviewers who are similar in age and 
 
Table 2. Primary (Behavioral) and Secondary (Knowledge/Attitudinal/Emotional) Outcomes at Baseline, Posttest, and Six-Month Follow-Up 
Construct 
Scale 
Sample item 
# Resp 
Primary Outcomes 
 
 
Bystander self-efficacy 
ROLB self-efficacy to intervene in SV101 
When I hear a sexist comment I indicate displeasure 
8 1-7 .
Bystander intervention 
ROLB self-behavior subscale101 
I walk into my room & roommates are watching porn 
5 1-7 .
Intimate Partner Violence Revised Conflict Tactics Scale (CTS2) SV102 
Used force to make partner have sex 
7 1–6 .
Sexual Violence 
Sexual Experiences Survey Rev. (SES-R), SV103 
I put my penis, fingers, objects into so’s butt w/o…consent 
8 0–3 
Secondary Outcomes (Knowledge, Attitudinal, Emotional Mediators) 
 
 
Knowledge of law 
Knowledge of legal defns of assault/rape scale104 Sex intercourse w/so <16 [is legal if] he/she gives consent 
9 T/F 
Knowledge of consent 
Knowledge of informed consent to have sex68 
If a woman dsn’t physically resist sex, she has given consent 14 T/F 
Norms degrading wn 
ROLB other-behavior subscale101 
Rmate suggests…give alcohol to your date to ‘loosen her up’ 5 1-7 .
Gender attitudes 
Hostility Toward Women Scale105,106 
…many times women flirt w/men just to tease/hurt them 
10 T/F .
Gender attitudes 
Hyper-Gender Ideology Scale short form (HGIS)107If men pay for a date, they deserve smthng in return 
19 1–5 .
Rape attitudes 
College Data Rape Attitude & Behavior Survey108 …sex jokes and innuendos are only fun & harmless 
20 1-5 .
Rape attitudes 
Illinois Rape Myth Acceptance (IRMA)48 
Rape happens when a man’s sex drive gets out of ctrl 
17 1-5 .
Dating violence attitudes Attitudes Toward Male Dating Violence Scale109 A guy should not insult his girlfriend 
39 1-5 .
Empathy for rape victims Rape Empathy Scale (RES)54 
In general,…rape is not…provoked by the rape victim 
19 1-5 .
Control Variables 
 
 
 
Alcohol use 
National College Health Assessment Survey110 
# drinks consumed when last partied 
1 
# 
Sexual behavior 
Safe Sex Behavior Questionnaire (SSBQ)111  
I engage in sex intercourse on the first date 
7 1-4 .
Sexual communication 
Communication self-efficacy 112 (to discuss sex) I can discuss…using condoms w/any sex partner 
4 1-10 .
Total items and time required 
192 42 m
Note. SV = sexual violence; α indicates the reliability of the scale in other samples. 

14 
 
experienced at discussing sensitive issues. Similarly, male interviewers will 
interview male study participants, or will be interviewed in private via the online 
survey platform. 
3. Before starting a SSI or quantitative online survey, participants will be 
told their responses are confidential and they can, at any time, stop the interview 
and request assistance using the contact information provided on the consent 
forms. 
4. Before starting a FGD, participants will be told the guidelines for 
participation, such as “please do not discuss what was said during the group 
with others outside this group,” “be respectful of each other’s comments and do 
not talk over each other,” “if you do not want to answer a question, you do not 
have to,” and “if you need to leave, please let us know by raising your hand and 
we can help you leave the group.”  
5. We will state that participants have the right to withdraw any time during 
their SSI, FGD, survey, or viewing of the program. 
6. SSIs and FGDs will be audiotaped. The digital file will be transcribed 
verbatim; participants will be identified numerically. Transcribed files will be 
stored on a password-protected computer in a locked office at CCIHP, 
accessible only to study staff. After data analysis, digital files will be destroyed 
to protect confidentiality. 
7. Counseling services will be offered to participants experiencing adverse 
psychological reactions associated with participating in SSIs, FGDs, or review 
of the program materials. Services will be provided by the Center for Studies 
and Applied Sciences in Gender – Family – Women and Adolescent (CSAGA) 
a non-governmental, non-profit organization that promotes the rights of women 
and children vulnerable to violence and discrimination. CSAGA operates 6 
counseling hotlines and a counseling hotline by the Ministry of Labour and 
Social affairs (for children). CCIHP also operates a website and free online 
counseling for youth on gender, sexuality, and sexual violence. A resource list 
with numbers and websites for counseling services will be provided for all 
participants. 
8. Procedures to minimize loss of confidentiality include encryption to 
maintain the confidentiality of participants’ identity and their data. Collected data 
will be identified only by identification numbers with no personal identifiers. 
Personal identifiers will be redacted from transcripts, and pseudonyms will 
replace names. Confidential data will be kept in a locked office file cabinet with 
restricted access. Names will be stored in a separate locked cabinet and will 
not be linked to study data. 
9. We will work with our respective IRBs to obtain a Certificate of 
Confidentiality. 
Benefits 
Study participants will receive no direct benefit from their involvement in 
this research. The insights gained from this study, however, should improve 
college men’s engagement in prevention of sexual violence against women. 
Considering the extensive protections to be undertaken to minimize potential 
risks to participants in this research, and the substantial anticipated benefits for 
future research and policy development, no problems are anticipated that 
outweigh the advantages of the proposed research. 
Compensation 
Each participant will receive graduated payments for completing the 
baseline, immediate posttest, and six-month follow-up assessments ($6, $8, 
$10; total $24). Using only participants’ emails, we will create PayPal accounts 
(www.PayPal.com) and automatically deposit payments for participants. In 

15 
 
other internet-based studies,113 this payment method has reduced costs and 
expedited payment versus issuing checks. Several options are available: 1) 
using 
only 
participants’ 
emails, 
we 
will 
create 
PayPal 
accounts 
(www.PayPal.com) and automatically deposit payments for participants; 2) 
phone card for participants: phone card number will be emailed to participants 
according to their email submission after completion of each questionnaire; and 
3) payment for participants through hosting website of the adapted program 
through an e-financial solution. In Vietnam, several e-finance platforms are 
available, but it would depend on the host that we may use. 
Data 
Management and 
monitoring 
Data systems will be designed to handle the concurrent collection, 
processing, secure storage, and analysis of project data. New data will be 
aggregated progressively via a web-based data-entry application (REDCap). 
Each participant will be assigned a unique number identifying him across 
waves. The web application will transmit data entered by each participant 
through an encrypted network connection to a centralized database running on 
a secure network and infrastructure, ensuring secure electronic data movement. 
A CCIHP programmer will create, and a CCIHP data manager will run, 
applications for more refined range/ consistency checks in the centralized 
database. Systematic data collection errors can be identified, resolved, and 
documented using a workflow module of the REDCap application. Some 
statistical software can access data in the central database and store derived 
variables there. For analyses done with external statistical software, de-
identified data will be extracted and held on HIPAA compliant secure networks 
and computing workstations. 

16 
 
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Treatment  
 
RealConsent 
Rape myth 
acceptance 
Bystander self-
efficacy 
Figure 2. Mediation Model for the Effect of RealConsent on 
Bystander Self-efficacy 

17 
 
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Fig 3. Confounders of mediation relations for CBCT treatment 
tm2 
mo1 
mo2 
t
Mediator: 
Rape Myth 
Acceptanc
Real 
Consent 
treatment 
Outcome: 
Bystander 
Efficacy 
Confounder(s) of Mediator 
to Outcome relation 
Confounder(s) of Treatment 
to Mediator relation 
m tmttm1 

18 
 
reported rate of IPV exposure (43%) with appropriate quality controls.15,123 
Our decision to use an online computer-assisted-self-interview platform 
should enhance disclosure by maximizing the possibility for privacy during 
the interview. Differential non-participation/attrition. We will explore the 
differential non-participation/attrition of men to assess for risk of response 
bias. With the baseline screening, socio-demographic, and other control 
data, we will model the response probability and use the estimated response 
probability to compute weights to correct for unit nonresponse using the 
covariates in Table 5. Estimates on the various outcomes before and after 
reweighting, and under different assumptions with respect to missing data, 
will be compared. Item non-response. For covariates with a non-response 
rate of ≥5%, we will test for differences between responders and non-
responders. We will compare non-responders and responders and may use 
multiple imputation, assuming the data are missing at random, to fill in the 
missing values.124-126 Noncompliance. As some participants in the program 
group may not receive the program, we will estimate complier-average 
causal effect (CACE) of the program by estimating two latent classes of 
compliers and non-compliers using engagement of the program as well as 
covariates and control variables.127,128 The CACE results will afford 
comparisons with and robustness assessment of those of the intent-to-treat 
analyses, and allow an examination of potential predictive factors of 
engagement with the program and its intervention implications.129 Outliers. 
We will assess the sensitivity of the results to outliers. We will exclude 
univariate outliers if their z scores exceed ±3. Multivariate outliers will be 
diagnosed using Mahalanobis distance and excluded if p<.0001. Results 
from the complete and reduced data sets will be compared. Convergence 
issues and improper solutions. We will assess the causes of convergence 
issues and improper solutions when running the path analyses, such as 
model misspecification, non-identification, and collinearity–and we will 
remediate by specifying suitable start values and model re-specifications.130 
Generalizability. To simplify logistics and enhance feasibility of the RCT, our 
study sites are two universities. This strategy does not permit generalization 
to college men in Vietnam, but the two sites enhance the overall diversity of 
the sample. We will describe our sample clearly to help others understand 
the young men to whom study findings may be relevant and generalizable. 
Confidentiality 
All key personnel have completed the Human Participant Protections 
Education for Research Teams online course, sponsored by NIH or the 
Social/Behavioral Research course through CITI.  
As previously detailed in the protections of risk section, above, we are 
careful to ensure confidentiality. Several strategies will be used to ensure the 
confidentiality of participants in the research.  
(1) Interviewers will receive strict instructions about the importance of 
maintaining confidentiality.  
(2) Interviewers will not conduct research within their own communities of 
residence.  
(3) The names of study participants will not be written on questionnaires or 
interview guides. Instead, unique numeric codes will be used to distinguish 
the questionnaires and textual transcripts of study participants.  
(4) If identifiers are needed to link a questionnaire with a household location or 
a particular study participant, these identifiers will be kept separate from the 

19 
 
questionnaires in a locked cabinet or separate, secure computer with 
access restricted to only the immediate research team.  
(5) Digital recordings that are made during the qualitative interviews will be kept 
on a password protected computer with limited access only for the 
transcribers and researchers on the project. Recordings will be destroyed 
upon completion of the study (we will keep them available during the data 
analysis in case questions arise that require a review of the recording.)  
(6) The research team will take particular care during the presentation of the 
findings to ensure that no one community or study participant can be 
identified in the transcripts. To ensure the anonymity of communities and 
study participants involved in the research, all identifying names of study 
participants and locations that are recorded in the transcripts will be 
changed to pseudonyms. 
(7) Identifiable data will be stored securely in REDCap or an equivalent HIPPA 
compliant data system. User defined access will be provided to members 
of the study team. Only de-identified data will be downloaded to password 
protected computers for further analysis. 
 
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