Realist evaluation of violence prevention education in health care


In brief

  • Health care workers are at risk for physical and verbal violence from those they provide care for, with higher rates of violence-related injuries compared to workers in other occupations.
  • In BC, a provincial educational program (Provincial Violence Prevention Curriculum) has been rolled out to staff within most high and medium risk health care settings.
  • Evaluating the success of the program using traditional methods and measures has been difficult due to the variety and complex nature of the different places where individuals work, and the fact that in many places most violence is not reported.
  • This project uses a realist evaluation approach to focus on practical explanations of how, why, for whom, and in what circumstances the violence prevention education is effective in preventing violence and related injuries.

Project status – COVID-19

  • The project is still very much alive and active. The team successfully completed data collection in July 2019, with the exception of several focus groups conducted in September and October. More than 80 interviews and focus groups were held across nine research sites in Island, Fraser, and Vancouver Coastal health authorities.
  • From the transcripts of the sessions the information has been thoroughly coded and analyzed and initial findings were to be presented to the Project Advisory Group in early spring 2020 when the COVID-19 pandemic was declared and health authorities faced a new urgent health and safety priority. Every obstacle is an opportunity and the team has used the time since mid-March productively to further review and refine the evaluation findings and explore creative ways of sharing information in a safe and virtual way. When BC health authorities are positioned to focus once again on the issue of workplace violence we look forward to sharing the project findings with the Advisory group and develop plans for recommendations and sharing the information across all of the health authorities.
  • A sincere thank you to all the people who have given their genuine and generous support to this work, including WorkSafeBC, Project Advisory Group members, content experts, interview and focus group participants, and clinical leaders and assistants who posted/shared information about the project and/or arranged meeting spaces. In this unusual time we hope you are all staying well and that together we are kind, calm and safe.

Frequently asked questions

Who is doing and funding the research?

The evaluation is being conducted by researchers at the Partnership for Work, Health & Safety at the University of BC and is funded by WorkSafeBC.

Why is it being done?

Everyone involved in providing health care in BC is concerned about violence against health care workers and wants to take action to prevent the violence and protect the safety of staff. Understanding how the education is or is not effective, for whom, and in what circumstances, helps leaders to make wise decisions about programs and policies to address the violence.

Where is it being done?

The evaluation of violence prevention education is focused on violence from patients in emergency departments and interviews and focus groups were conducted at one rural, one community and one urban tertiary site in each of three health authorities:

  • Fraser Health: Surrey Memorial Hospital, Langley Memorial Hospital, and Fraser Canyon Hospital
  • Vancouver Coastal Health: Vancouver General Hospital, Lion’s Gate Hospital, and Squamish General Hospital
  • Island Health: Royal Jubilee Hospital, Cowichan District hospital, Port Hardy Hospital

Who participated and what was involved?

Individual confidential interviews of about 1 hour were held with frontline emergency staff who: have worked in the emergency department for at least one year, attended the BC violence prevention education within the past five years, and interact with patients related to care. Focus groups of about one hour were held with violence prevention educators, acute care leaders, and Joint Occupational Health and Safety (JOSH) Committee members. Individuals in both interviews and focus groups were asked what circumstances influenced whether individuals learned and were able to apply violence prevention education and why.

How were people invited to participate?

Posters were placed in emergency departments at the research sites and individuals wishing to participate in an interview voluntarily contacted the research team at the number/email given. Potential focus group participants received an email and replied to the research team if they wished to participate.

What were the benefits for participants?

Participation was an opportunity for concerned health care workers to contribute to solutions to prevent violence from patients. To preserve confidentiality of participants, interviews were held outside of scheduled work hours. At the end of the interview individuals received a $75 gift card in appreciation. Where possible focus groups were held within existing meetings during work time and at the end of the session participants received a $20 gift card in appreciation.

When did it happen?

Interviews and focus groups were held between January and July 2019.

What is the Realist approach?

A realist approach to understanding how education is effective is based on the belief that as humans we have both a shared understanding of our experiences in the world and an individual interpretation of those experiences. Not all programs work for all people in all situations and the realist approach to evaluation looks for patterns of where education is and is not effective, in what circumstances, how and why. This information helps in the developing and revising programs and policies. A realist approach to evaluation was developed and is widely used in the United Kingdom. For more information please visit www.ramesesproject.org.


Learn more about our other work on violence prevention in health care: Violence prevention programs in health care

Contact: sharon.provost@ubc.ca

a place of mind, The University of British Columbia

School of Population and Public Health
2206 East Mall,
Vancouver, BC, V6T 1Z3, Canada
Tel: 604-822-2772
Partnership for Work, Health and Safety
2206 East Mall,
Vancouver, BC, V6T 1Z3, Canada
Tel: 604-822-8544

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