No More Shame: Investigating the effect of changing health providers recognition and response to elder abuse on associated stigma

Sub-acute health providers that work at participating hospital sites will be given access to a multicomponent intervention ("No More Shame") comprising a screening tool, online training focused on elder abuse, and a site champion. The training course was developed through co-design methods, with input from different stakeholders (older people, family carers of older people, and health providers). The screening tool, Australian Elder Abuse Screening Instrument (AUSI), was co-designed and piloted. The training course comprises 4 modules. The first module is about knowledge of elder abuse, and therefore includes a definition of elder abuse, types of elder abuse, who perpetrates elder abuse, etc. The second module focuses on the drivers elder abuse e.g. ageism as a key driver. The third module is about screening for abuse, taking into consideration sensitive enquiry, timing, who should screen for abuse, and additionally how to use the screening tool. The fourth module focuses on management of abuse, including the types of responses and referral pathways available. The mode of training used will be multimedia slides with a combination of text, short videos, voiceovers, quizzes, scenario-based reflective exercises, and links to further resources (e.g., national and state-based elder abuse services, helplines, advocacy groups, and informational videos discussing elder abuse). The training will be accessed by participants entering a username and password on the National Ageing Research Institute's online learning management system. The training will be self-paced and will take approximately 50-60 minutes in total to complete. Adherence to the training will be monitored via the online learning management system's reporting and analytics features. Participants will be asked to undertake the online training within ~1 month of receiving access, to a encourage significant proportion of training uptake prior to implementation of the screening tool. However, participants will continue to have access and be able to complete the training for the duration of the trial. Additionally, health providers who did not initially participate at baseline but express interest in undertaking the training will be granted access to the online training, and will be able to administer the screening tool. The screening tool is designed to screen for elder abuse using a traffic light coded system due to the very sensitive nature of the topic. This strategy was employed to minimise the amount of sensitive questions that the patient is asked by the health provider. Therefore, the screening tool takes approximately 5 minutes to complete for patients that are in the green zone. For other patients, where their responses prompt further screening questions, the screening tool can take 10-15 minutes to complete. The screening tool will be a hard copy or electronic questionnaire, based on whether the hospital site has a paper-based or electronic system for each patient file. Health providers will be trained on how to use the screening tool during the online training course. Health provider participants in the intervention arm will be asked to use the screening tool with each newly admitted eligible patient for the 9-month duration of the randomised control trial. Adherence to the screening tool will be evaluated via qualitative data collected during a multi-method process evaluation. The process evaluation will be conducted approximately 3 months after implementation of the screening tool. A member of the research team will visit the intervention sites and observe how the screening tool works in practice, and interview the site champion and 2-3 health provider participants to gather qualitative information about use of the screening tool on the wards. Additionally, the site champion will collect quantitative data about how many times the screening tool has been administered during the 9-month trial period via an audit of patient records. After the 9-month trial follow-up, health provider participants allocated to the intervention group will be asked to rate the acceptability of the intervention (i.e., online elder abuse training, AUSI screening tool, site champion) on a scale of 0-100 (with 0 being completely unacceptable to 100 being completely acceptable). The site champion will recruit both health provider and older adult participants. The site champion will only screen and consent older adult participants, as health provider participants will complete an online screening form and be required to provide e-consent. The site champion will be involved in data collection, encouraging and providing support on uptake of the screening tool amongst health provider participants. The site champion will contribute to community of practice through regular meetings.