Bystander Intervention Research Articles

Addressing unprofessional behaviors in the clinical learning environment: lessons from a multi-year virtual, intergenerational, interdisciplinary workshop

ABSTRACT Introduction Optimizing the clinical learning environment (CLE) is a medical education priority nationwide. Materials and Methods We developed a virtual, one-hour workshop engaging students, housestaff and faculty in small-group discussions of five case scenarios adapted from reported unprofessional behaviors in the CLE, plus didactics regarding mistreatment, microaggressions and bystander interventions. Results Over two sessions (2021–2022), we engaged 340 students and 73 faculty/housestaff facilitators. Post-session surveys showed significant improvement in participants’ ability to recognize and respond to challenges in the CLE. Discussion Our innovative workshop, including scenarios derived from institutional reports of unprofessional behaviors, advanced participants’ knowledge and commitment to improve the CLE.

Predictors of Bystander Intervention: Examining the Heteronormative Bias in Bystander Intervention Research

Predictors of Bystander Intervention: Examining the Heteronormative Bias in Bystander Intervention Research

Looking out for You and Me: College students’ Strategies for Preventing Sexual Assault in Drinking Contexts

Background : Sexual assault and heavy alcohol use are prevalent and interrelated public health concerns on university campuses. Surprisingly, however, few alcohol harm reduction interventions address this intersection to help students reduce both personal and community risks for sexual assault in college drinking contexts. Objectives : In the current study, students (ages 18–24) shared strategies they use to protect themselves and others from sexual assault in college drinking contexts, as well as challenges to implementing these strategies. A series of six focus groups were conducted across two universities in the U.S. (N = 35). Participants responded to open-ended questions focused on drinking and sexual assault (e.g., What are some of the things students might do to avoid or address situations where they feel pressured of coerced to hook up or have sex when they do not want to?). Results : Thematic analyses demonstrated students’ awareness of protective behavioral and bystander intervention strategies that could help reduce vulnerability to experience sexual assault for themselves or others in drinking contexts. Perceived barriers to using bystander intervention strategies included student’s own and friends’ heavy drinking (decreased inhibitions, loss of autonomy), ambiguity in deciphering risk (lack of familiarity, minimization, diffusion of responsibility), and gender (gender norms, power imbalances). Conclusions : This study informs the development of interventions that help students identify strategies and overcome barriers to reduce risks for sexual assault in college drinking contexts.

Cybervictimization in Relation to Self and Other Protection and Response Behaviors: A Cross-Sectional Look at an Age-Diverse National Sample.

This study considered whether experiencing cybervictimization is associated with increased recognition of cybervictimization intervention opportunities (i.e., witnessing others' cybervictimization), as well as greater engagement in self-protective (e.g., changing usernames and privacy settings) and other-protective cybervictimization bystander response behaviors. We collected cross-sectional self-report data from an age-diverse (M = 46.29 years, SD = 19.14, range = 15-93) national sample (n = 3002). We hypothesized that: (1) personal experiences with cybervictimization would be associated with increased reports of witnessing opportunities to intervene when others are cybervictimized, greater self-reported use of active bystander behaviors in witnessed situations, and greater use of self-protective strategies; (2) We also expected that engagement in self-protective behaviors would be positively associated with engagement in other-protective bystander behaviors in response to witnessed cybervictimization. To test our hypotheses, we estimated a structural equation model wherein four latent variables were constructed: cybervictimization experienced, witnessed opportunities to intervene, engagement in self-protective behaviors, and engagement in other-protective cybervictimization bystander behaviors. As hypothesized, cybervictimization was associated with witnessing more opportunities to intervene in other's cybervictimization, greater self-reported use of active cyber bystander behaviors, and greater engagement in self-protective strategies. However, the strength of two associations was moderated by age, with stronger relationships between cybervictimization and witnessing opportunities to intervene as well as engaging in bystander behavior for older as compared to younger participants. Contrary to hypothesis, there were no significant associations between use of self and other protective behaviors. Furthermore, greater witnessing of cybervictimization was associated with less engagement in bystander behavior in the final model. The implications for existing bystander intervention programs are described. Longitudinal studies of these associations in multiple age groups and among different cultural groups remain necessary.

Why Do Bystanders Report Intimate Partner Violence? Insights into Real-Life Reasoning from Those Who Actually Intervened.

As intimate partner violence (IPV) often remains unknown to police, bystanders can play a crucial role in prevention and further escalation of IPV. However, little is known about what brings them into action by reporting incidents of IPV to authorities. As such, we use statements of bystanders who filed reports about IPV incidents to an official domestic violence agency in the Netherlands (N = 78), to investigate the reasoning and motivations for reporting their suspicions. Results show that the reasons for bystanders to report IPV differ depending on the relational dynamics between partners. In situations perceived as intimate terrorism, involving a hierarchical abusive relationship between a man offender and a woman victim, bystanders primarily reported when previous helping initiatives proved inefficient, and they did so to prevent further harm, often particularly in relation to the woman victim. In situations perceived as situational couple violence, involving a symmetrical abusive relationship, bystanders primarily reported when escalation appeared, and they did so to prevent further harm to involved children. We conclude that bystanders report IPV incidents when the need for help is clear, and their motivation for acting concerns the well-being of victims. Our findings add to the growing body of evidence about real-life bystander intervention in emergencies and highlight the need for understanding intervention as context-specific in order to design effective intervention initiatives.

Facilitators and Barriers of Bystander Intervention Intent in Image-Based Sexual Abuse Contexts: A Focus Group Study with a University Sample.

Image-based sexual abuse (IBSA) encompasses the taking, sharing, and/or threatening to share nude or sexual images of others without their consent. The prevalence of IBSA is growing rapidly due to technological advancements, such as access to smartphones, that have made engagement in such activities easier. Bystanders offer an important means of intervention, but little is known about what facilitates or inhibits bystander action in these contexts. To address this gap in the literature, seven focus groups (n = 35) were conducted to explore the factors that facilitate and inhibit bystander action in the context of three different IBSA scenarios (taking, sharing, and making threats to share nude or sexual images without consent). Using thematic analysis, eight themes were identified, suggesting that the perceived likelihood of intervention increased with greater feelings of responsibility, empathy with the victim, reduced feelings of audience inhibition, greater feelings of safety, greater anger toward the IBSA behavior, closer relationships with the victim and perpetrator, the incident involving a female victim and male perpetrator, and perception of greater benefits of police involvement. These findings are considered alongside the physical sexual violence literature in highlighting the similarities and nuances across the different contexts. Implications for the development of policies and educational materials are discussed in relation to encouraging greater bystander intervention in IBSA contexts.

How Do Bystanders Help in Drinking Situations: The Bystanders to Alcohol Risk Scale--Strategies.

Bystander intervention (BI) is a promising approach for promoting collective behavior change that has been applied to several domains, including sexual assault, bullying, and more recently, problematic alcohol use. Accurately measuring the strategies that bystanders use to reduce others' alcohol-related risk is an essential step toward improving bystanders' ability to reduce alcohol-related harm in their communities, but current measures of BI are not easily modifiable and applicable for alcohol-related BI. The current study aimed to develop a valid and reliable measure of the bystander construct most proximal to the reduction of risk: bystander strategies. Young adults (N = 1,011) who reported being around someone who showed signs of alcohol intoxication in the past 3 months were recruited via Qualtrics Panels to participate in an online survey; a subsample (n = 345) completed a 2-week follow-up. Psychometric evaluation included exploratory and confirmatory factor analyses, item response theory analyses, convergent validity, and test-retest reliability. An initial set of 52 items was reduced to 17 items, representing two different factors. The first factor, Level 1, reflected strategies used during circumstances of acute risk. The second factor, Level 2, reflected strategies used to reduce risk for more longstanding problems with alcohol. Both factors demonstrated good model fit, strong internal consistency, evidence of convergent validity, and moderate test-retest reliability. This novel measure can contribute to the production of knowledge about the use and efficacy of peer-focused strategies and the value of BI training for alcohol use.

Applying the Bystander Intervention Model to Racial Microaggressions in College Students

Applying the Bystander Intervention Model to Racial Microaggressions in College Students

Development and Validation of the Bystander Engagement Scale for Witnessed Intimate Partner Violence: A South Korean Version.

Bystanders play a crucial role in assisting and rescuing victims of intimate partner violence (IPV) or sexual assault, thereby preventing further harm. Consequently, an increasing amount of research has focused on improving bystander interventions in such situations. While many existing scales that measure bystanders' willingness to intervene and their behaviors are likely tailored to Western settings and primarily focused on preventing sexual assaults, pursuing diversity to make these scales applicable to a variety of contexts is necessary. This study aimed to develop and validate a scale from South Korean samples that measure the likely level of bystander engagement in witnessed IPV situations, named the Bystander Engagement Scale for Witnessed Intimate Partner Violence (BESW-IPV). Preliminary items, developed to describe various IPV situations that a bystander might witness, underwent content validity testing through expert review and cognitive focus group interviews. Afterward, the scale was administered to 311 participants from the target population in South Korea. The scale's factor structure was assessed through exploratory factor analysis (EFA) and confirmed through confirmatory factor analysis (CFA). The reliability and validity were rigorously assessed. The final version of the BESW-IPV comprised 28 items. Through EFA, "direct IPV indicators" and "indirect IPV indicators" were identified. Together, these factors accounted for 76.10% of the total variance. CFA affirmed that the final model offers an acceptable fit. The scale's convergent and discriminant validities were also well established. The Cronbach's alpha and the McDonald's omega values were 0.98 and 0.99, respectively. In contrast to many existing tools that measure bystander intervention predominantly within the confines of Western educational settings, we believe that the BESW-IPV can be applied in broader contexts, especially in patriarchal environments. Further research is required to translate and validate this tool in different cultural contexts.

“Liking,” “Commenting,” and “Reposting”: Psychological Factors Associated to Online Animal Abuse

Abstract Advancements in technology and internet accessibility bring potential for new forms of offending behavior. Social Networking Sites (SNS) provide platforms for nonhuman animal abuse to be displayed and interacted with. There is a dearth of research into the characteristics of animal abuse perpetrated with the intent to be displayed on SNS. The aim of this study was to explore the psychological correlates of engagement with SNS content depicting animal abuse and likelihood to create new animal abuse content. One hundred and eighty-five university students completed an online questionnaire, which included their self-reported likelihood to engage with images of animal abuse on SNS (i.e., “like,” “comment,” “share,” and/or recreate). We found high levels of animal-oriented callousness, as opposed to other predicted factors (e.g., narcissism), were significantly related to likelihood to recreate animal abuse for display on SNS. The implications of the findings such as factors associated with bystander intervention are discussed.

Effect of COVID-19 on the prevalence of bystanders performing cardiopulmonary resuscitation: A systematic review and meta-analysis.

The importance of bystander cardiopulmonary resuscitation (CPR) during out-of-hospital cardiac arrests is especially important in the context of coronavirus disease 2029 (COVID-19) because it can significantly influence survival outcomes. The objective of this meta-analysis was to examine the primary outcomes of bystander CPR during the pandemic and pre-pandemic periods. A search was conducted in the PubMed Central, Scopus, and EMBASE databases, as well as the Cochrane Central Register of Controlled Trials database, up to December 10, 2023. In cases where the value of I² was greater than or equal to 50% or the Q-test indicated that the p-value was less than or equal to 0.05, the studies were considered to be heterogeneous. Sensitivity assessment was performed using the leave-one-out methodology. The study protocol was registered in PROSPERO with the ID number CRD42023494912. Twenty-five articles were included in this meta-analysis. Pooled analysis showed that bystander CPR frequency during the COVID-19 pandemic was 38.8%, compared to 44.8% for the pre-pandemic period (odds ratio: 1.04; 95% confidence interval: 0.93-1.16; p = 0.48). The article's conclusions indicate that the COVID-19 pandemic influenced a reduction in bystander CPR compared to the pre-pandemic period, but this difference was not statistically significant. Further research is recommended to understand attitudes, including the fears of witnesses, before performing CPR on patients with suspected or confirmed infectious diseases. The study highlights the importance of bystander intervention in emergency situations and the impact of a pandemic on public health response behaviors.

Impact of a national initiative to provide civilian cardiopulmonary resuscitation training courses on the rates of bystander intervention by citizens and survival after out-of-hospital cardiac arrest

BackgroundThe impact of a national initiative to provide cardiopulmonary resuscitation (CPR) education to the public on the rates of citizen-initiated CPR and survival following out-of-hospital cardiac arrest (OHCA) remains uncertain. MethodsWe examined 358,025 cases of citizen-witnessed OHCA with presumed cardiac origin, recorded in the Japanese nationwide registry from 2005 to 2020. We assessed the relationship between the number of individuals certified in CPR courses, citizen interventions, and neurologically favorable survival at one month. ResultsThe cumulative number of certified citizens has linearly increased from 9,930,327 in 2005 to 34,938,322 in 2020 (incidence rate ratio for annual number = 1.03, p < 0.001), encompassing 32.3% of the Japanese population aged 15 and above. Similarly, the prevalence of citizen-initiated CPR has consistently increased from 40.6% in 2005 to 56.8% in 2020 (P for trend < 0.001). Greater citizen CPR engagement was significantly associated with better outcome in initial shockable rhythm patients [chest compression only: odds ratio (OR) 1.24; 95% confidence interval (CI) 1.02–1.51; P = 0.029; chest compression with rescue breathing: OR 1.33; 95% CI 1.08–1.62; P = 0.006; defibrillation with chest compression: OR 2.27; 95% CI 1.83–2.83; P < 0.001; defibrillation with chest compression and rescue breathing: OR 2.15; 95% CI 1.70–2.73; P < 0.001 vs. no citizen CPR]. ConclusionsThe incidence of citizen-initiated CPR across Japan has consistently and proportionately increased with the rising number of individuals certified in CPR courses. Greater citizen CPR involvement has been linked to neurologically favorable survival, particularly in cases with an initial shockable rhythm.

Sexual violence in nightlife and positive bystander intervention in an English city

BackgroundNightlife environments are high risk settings for sexual violence and bystander intervention programmes are being developed in response. However, more research is needed to understand nightlife-related sexual violence, and factors that influence bystander interventions. This study examined nightlife patron’s experiences of sexual violence and associated factors; and relationships between attitudes towards, awareness and experience of sexual violence, and confidence to intervene.MethodsCross-sectional on-street survey of nightlife patrons (N = 307, aged 18+) on a night out in an English city. Surveys (7.30pm-1.30am; Wednesday-Saturday) established sexual violence awareness, myth acceptance, and experience, and confidence to intervene. Participant’s socio-demographics, nightlife alcohol consumption, and frequency of nightlife usage were collected.Results58.0% had ever experienced sexual violence whilst on a night out. In adjusted analyses, sexual violence was higher amongst females (adjusted odds ratio [AOR] 4.0; p < 0.001), and regular nightlife patrons (AOR 2.1; p < 0.05). The majority agreed that they would feel confident asking someone who has experienced sexual violence if they are okay/would like support (92.2%). In adjusted analyses, confidence to intervene was higher amongst those who agreed that sexual violence was an issue in nightlife (AOR 3.6; p < 0.05), however it reduced as sexual violence myth acceptance increased (AOR 0.5; p < 0.05).ConclusionSexual violence is a pertinent issue in nightlife. Programmes aiming to address nightlife-related sexual violence must address the wider social norms that promote sexual violence, and ensure patrons understand the extent and significance of the issue, to increase confidence to positively intervene.

Masculinities and the Lived Understandings of Bystander Responses to Everyday Violence

Among criminologists there has been an expanded contemporary interest in measures that encourage bystander intervention in the social settings of escalating and potentially violent incidents. These broadly include partner abuse and domestic disputes, as well as confrontational social interaction and other forms of targeted harassment and violence (racist, sexist, homophobic, ableist etc.), in everyday life. This article considers the likely success or failure of seeking to foster such measures as a core strategy of violence prevention, with discussion of the author’s Sydney-based study of the understandings of violence arising from young men’s lived experience of its various forms. It particularly concentrates on the results of focus groups conducted with a mixed sample of young men (aged 16-25 years) between 2018-2020. These participants had personal engagements with violence and potential violence, that shaped their reservations and doubts about regular intervention and general male anti-violence advocacy as reasonable and achievable social practices.

Blaming the Victim, the Bystander, the Perpetrator, or the Institution: Student Allocation of Responsibility for Sexual Assault when Programming Hypothetically Varies

ABSTRACT Guided by theories of socialization and just policy theory, we explore how students allocate blame when sexual assault prevention programming hypothetically varies, net of the effects of evaluators’ traits. Using a survey instrument containing a series of vignettes, we ask whether university students’ (N = 254) perceptions of responsibility attributed to victims, perpetrators, bystanders, and university administrators varies by hypothetical program trainee and also by the hypothetical implementation of any program versus no program. Findings indicate that students allocate more blame to bystanders and perpetrators when hypothetical programming includes bystander training but that programs that train victims are not associated with increased victim blaming. Administrators are blamed less when bystander intervention is included in programming. However, compared to when no training is hypothetically implemented, students allocate more blame to victims and bystanders when any programming is present and less to administrators. Among respondent-level controls, victim blaming is consistently predicted by evaluators’ rape myth acceptance. Implications for future work, theoretical development, and policy are discussed.

Peer-Led Groups in Sexual Assault Prevention Programming: Myth Adherence and Self-Defense Efficacy within Gender and Race

Participants ( n = 520) in a study of two on-campus peer-led sexual assault prevention programs focused on bystander intervention and risk reduction were assessed. This study focused on myth reduction, as well as self-defense self-efficacy. Demographics allowed for within-group comparisons along gender and race. Among men who attended Bro Code, Black men had significantly lower sexual assault myth adherence on many rape myths than the control group, not true of white men. Those women who attended Girls Night Out (GNO) had significantly lower sexual assault myth adherence than the control group. While greater reductions in myth adherence were seen in white women than among Black women, Black women had significantly lower overall sexual assault myth adherence (in both control and sample). As a side note, we found that women who attended GNO had lower general intimate partner violence myth acceptance in addition to lower sexual assault myth acceptance, with some variation on individual myths. Finally, those women who attended self-defense training were significantly more likely to endorse self-defense self-efficacy. Results were then explored through the lens of cultural, gender, intersectional, and community-based contexts. Future research needs and implications are discussed.

Bystander Intervention in Bullying and Sexual Harassment Training: Mixed-Method Evaluation of NAB IT!

The goal of the current pilot study was to examine the effects of bystander intervention training on a sample of 27 high school students who were selected by their peers as opinion leaders. Measures of bystander intervention knowledge, attitudes, and behaviors were included in the within-subjects design. Sixteen of the students also participated in focus groups to provide feedback about their experiences with the training. Results showed that participating students reported increases in knowledge about bullying and sexual harassment, confidence in intervening, acceptance of responsibility, knowing what to do, and acting to intervene (including direct intervention, providing support, and reporting to an adult) from pre-to posttest. Themes from focus groups indicated that students found the training relevant and helpful, particularly for focusing on both bullying and sexual harassment and for providing opportunities to learn and practice multiple intervention strategies. Barriers to intervening based on the type of violence (e.g., physical vs. relational or verbal) and relationship with the people involved were also themes. Directions for future research and implications for practice, such as focusing on dissemination to the larger student body and implementing bystander intervention training within the context of a positive school climate that emphasizes social and emotional competencies, are discussed.

Bystander intervention is associated with reduced early mortality among injury victims in Cameroon.

Despite high injury mortality rates, Cameroon currently lacks a formal prehospital care system. In other sub-Saharan African low and middle-income countries, Lay First Responder (LFR) programs have trained non-medical professionals with high work-related exposure to injury in principles of basic trauma care. To develop a context-appropriate LFR program in Cameroon, we used trauma registry data to understand current layperson bystander involvement in prehospital care and explore associations between current non-formally trained bystander-provided prehospital care and clinical outcomes. The Cameroon Trauma Registry (CTR) is a longitudinal, prospective, multisite trauma registry cohort capturing data on injured patients presenting to four hospitals in Cameroon. We assessed prevalence and patterns of prehospital scene care among all patients enrolled the CTR in 2020. Associations between scene care, clinical status at presentation, and outcomes were tested using univariate and multivariate logistic regression. Injury severity was measured using the abbreviated injury score. Data were analyzed using Stata17. Of 2212 injured patients, 455 (21%) received prehospital care (PC) and 1699 (77%) did not receive care (NPC). Over 90% (424) of prehospital care was provided by persons without formal medical training. PC patients were more severely injured (p<0.001), had markers of increased socioeconomic status (p = 0.01), and longer transport distances (p<0.001) compared to NPC patients. Despite increased severity of injury, patients who received PC were more likely to present with a palpable pulse (OR = 6.2, p = 0.02). Multivariate logistic regression adjusted for injury severity, socioeconomic status and travel distance found PC to be associated with reduced emergency department mortality (OR = 0.14, p<0.0001). Although prehospital injury care in Cameroon is rarely performed and is provided almost entirely by persons without formal medical training, prehospital intervention is associated with increased early survival after injury. Implementation of LFR training to strengthen the frequency and quality of prehospital care has considerable potential to improve trauma survival.

Enhancing global pediatric cardiac arrest outcomes through bystander cardiopulmonary resuscitation: A comprehensive systematic review

This systematic review investigates the impact of global bystander cardiopulmonary resuscitation (CPR) on outcomes in pediatric cardiac arrest cases. Through a meticulous examination of relevant worldwide studies retrieved from PubMed spanning 2018 to 2022, employing keywords such as “worldwide Bystander CPR (BCPR),” “worldwide out-of-hospital CPR,” and “pediatric CPR” with Boolean operators “OR” and “AND,” the study incorporates 10 selected articles out of the initially identified 13. Findings reveal that bystander-initiated CPR, predominantly chest-only CPR, is administered at rates ranging from 48% to 89% globally, with no significant gender-based disparity, but a lower likelihood observed among worldwide Black children. Return of spontaneous circulation (ROSC) is achieved in 20%–35% of cases and survival to hospital discharge in 5%–10% of instances. Factors associated with worldwide prehospital ROSC include epinephrine administration, bystander intervention before emergency medical services (EMS) arrival, older age, reduced time to EMS response, and worldwide automated external defibrillators. Notably, a shorter time to EMS arrival is the sole significant predictor of worldwide survival to hospital discharge. The study discerns no substantial distinction in achieving prehospital ROSC and favorable outcomes on a global scale. The conclusion underscores the varied worldwide outcomes in out-of-hospital cardiac arrest studies, attributing these variations to multifarious confounding factors. It identifies crucial predictors of prehospital ROSC and recommends targeted CPR training for underserved communities to enhance worldwide BCPR rates and ameliorate pediatric cardiac arrest outcomes.

College Women's Perceptions of a Friend-Based Intervention to Prevent Alcohol-Involved Sexual Assault.

Sexual assault (SA), particularly alcohol-involved SA, remains prevalent among college women. Because SA often begins in social contexts, bystander intervention has become a popular approach to prevention. Bystander interventions train individuals to intervene on behalf of others, including strangers, despite research indicating that intervention is more likely to occur when the bystander has a relationship with the target. Shifting the focus to friends as potential bystanders capitalizes on the qualities of relationship and responsibility that facilitate intervention. College women (N = 35) participated in focus groups (N = 8) during which they viewed a video prototype of a friend-based motivational interviewing (FMI) intervention session conducted with a friend dyad and provided feedback about the relevance and feasibility of using such an approach to reduce SA among friends who drink together in social settings. Content analysis of focus group transcripts yielded three themes: a) Friends as Natural Bystanders; b) The Role of Alcohol in Intervention, and c) Receptivity to FMI intervention. Women indicated that they feel responsible for keeping their friends safe, and that this sense of responsibility facilitates helping behaviors. Women also described ways through which alcohol intoxication can affect helping behavior. Women expressed enthusiasm for the FMI intervention approach and identified its emphasis on friendship and flexible approaches to personal safety as strengths. Findings highlight the promise of FMI intervention approaches that capitalize on the strengths of women's friendship to create safety goals that align with participants' values and overcome barriers to intervention, including alcohol intoxication.