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Key Takeaway
Training probably slightly improves nurses' harassment prevention knowledge, but skill gains rest on low-certainty evidence.
This systematic review examined whether education and training interventions help healthcare workers, specifically nurses, prevent and manage sexual harassment. Only studies involving nurses were identified, and all compared one form of training against another rather than against no intervention.
Knowledge of sexual harassment prevention probably increased slightly with training (mean difference 4.74, 95% CI 1.21 to 8.28; 168 participants), based on moderate-certainty evidence. Management skills showed smaller, less certain gains: coping behaviour (MD 6.36, 95% CI -6.84 to 19.56) and prevention strategy (MD 11.70, 95% CI 2.56 to 20.85), both rated low certainty.
No studies reported adverse events, discontinuations, or tolerability. Secondary outcomes such as harassment incidence, anxiety, depression, burnout, sick leave, turnover, and organisational climate were not adequately addressed.
Limitations include the small number of participants, broad confidence intervals, and the absence of comparisons against no intervention, waitlist, or minimal intervention. No dedicated funding was reported.
Overall, the evidence supports offering sexual harassment education and training to healthcare workers, but the magnitude of benefit for management skills remains uncertain and should not be overstated.
How this fits prior evidence
This finding addresses a gap in the evidence regarding workplace safety and mental health for healthcare workers. While previous coverage has addressed mental health outcomes in specific populations such as brain injury patients, adolescents with HIV, and psychiatric patients, this review specifically addresses the efficacy of educational interventions to mitigate sexual harassment in healthcare settings.
Working in healthcare is demanding, and many nurses face the risk of sexual harassment. To address this, some organizations use education and training programs to give staff the tools they need to manage and prevent harassment in the workplace.
A review of data from 170 nurses found that these training programs likely increase knowledge of how to prevent harassment. The results also suggest that training might slightly improve management skills, such as how staff cope with incidents or use prevention strategies. However, the evidence for these management skills is less certain than the evidence for general knowledge.
While the results are promising, the study had some limitations. The number of participants was small, and the results were based on a narrow group of nurses. Because the study did not compare training against no intervention at all, the findings are not definitive. Still, the evidence supports offering these training programs to healthcare workers to help them feel safer and better prepared.
What this means for you:
Training programs can slightly improve a nurse's knowledge and skills for managing sexual harassment at work.
Common questions
Does training actually help nurses handle harassment?
The data shows that training programs likely increase a nurse's knowledge of how to prevent sexual harassment. It may also slightly improve their management skills, such as how they cope with incidents or use prevention strategies. However, the evidence for these specific management skills is currently considered to be of low certainty.
Who is this training intended for?
The findings are based on a study of 170 nurses working in healthcare settings. While the results are promising for healthcare workers in general, the study specifically looked at nurses to see if education and training could help them manage and prevent sexual harassment.
Is the evidence for these programs very strong?
The evidence for increased knowledge is of moderate certainty, but the evidence for improved management skills is lower. The study also had a small number of participants and did not compare the training to a group that received no training at all.
Rationale Sexual harassment is common among healthcare workers and is associated with poor mental health, job dissatisfaction, and workforce attrition. Education and training may help prevent sexual harassment, but their effectiveness in healthcare settings has not been systematically evaluated. Objectives To assess the effectiveness of education and training interventions on knowledge and skills for managing sexual harassment, and to assess their impact on the incidence of sexual harassment towards healthcare workers in healthcare settings. Search methods We searched CENTRAL, MEDLINE, Embase, PsycINFO, AMED, CINAHL, Scopus, ClinicalTrials.gov, and the WHO ICTRP, together with reference checking and contact with study authors, to identify eligible studies. The latest search date was March 2025. Eligibility criteria We included randomised controlled trials (RCTs) involving healthcare workers comparing education or training interventions with control (no intervention, waiting list, placebo, or minimal intervention) or different types of education or training to prevent sexual harassment in healthcare settings. Outcomes Our critical outcomes were knowledge and skills in managing sexual harassment and the incidence of all types of sexual harassment perpetrated by patients, visitors, coworkers, and management. Important outcomes were anxiety, depression, burnout, sick leave, staff turnover, disability, and perception of the organisational climate related to harassment. Risk of bias We used the Cochrane RoB 2 tool to assess risk of bias. Synthesis methods We synthesised results for each outcome using random‐effects model meta‐analysis. We used GRADE to assess the certainty of evidence for each outcome. Included studies We included two studies from Taiwan with a total of 170 nurses. Most participants were young women with little work experience. The intervention group received education to prevent sexual harassment, and the comparison group received a different type of education to prevent sexual harassment. We found no studies that had a comparison group without any active educational or training components. Synthesis of results Education and training interventions to prevent sexual harassment compared to control (no intervention, waiting list, placebo, or minimal intervention) in healthcare workers No studies addressed this comparison. Education and training interventions to prevent sexual harassment compared to other education and training interventions for healthcare workers We found two studies reporting on education and training interventions to prevent sexual harassment compared to other education and training interventions in healthcare workers. Educational interventions to prevent sexual harassment probably increase sexual harassment prevention knowledge slightly ('sexual harassment prevention', mean difference (MD) 4.74, 95% confidence interval (CI) 1.21 to 8.28; P = 0.71; I2 = 0%; 2 RCTs, 168 participants; moderate‐certainty evidence) and may increase management skills slightly ('coping behaviour', MD 6.36, 95% CI −6.84 to 19.56; P = 0.43; I2 = 0%; 2 RCTs, 168 participants; low‐certainty evidence) and ('prevention strategy', MD 11.70, 95% CI 2.56 to 20.85; P = 0.22; I2 = 33%; 2 RCTs, 168 participants; low‐certainty evidence). No study evaluated the incidence of sexual harassment, anxiety, depression, burnout, sick leave, staff turnover, disability, or perception of the organisational climate related to harassment. Adverse effects were not measured or reported in the included studies. The certainty of the evidence was moderate to low. We judged the overall risk of bias as low, and we identified no inconsistency or publication bias. However, imprecision was more of a concern given the low number of participants and relatively broad CIs around the effect estimates. Authors' conclusions Healthcare workers may benefit from education and training compared to another type of education and training. The benefits were modest and were measured as increased knowledge ('sexual harassment prevention') and management skills ('coping behaviour' and 'prevention strategy'). The certainty of the evidence is moderate to low, and future studies could make the findings more robust. There is a need for future studies investigating other types of outcomes such as anxiety, depression, burnout, sick leave, staff turnover, disability, and perception of the organisational climate related to harassment. It would also be valuable to assess a wider range of healthcare workers, as we only found studies in nurses. No studies addressed the effects of education and training compared to control groups (no intervention, waiting list, placebo, or minimal intervention). The decision to offer sexual harassment education and training to healthcare workers is supported by the existing evidence. However, other contextual factors may also be considered, as well as healthcare workers' preferences to participate in educational activities. Funding This Cochrane review had no dedicated funding. Registration Registration: Cochrane Collaboration, 19th of December 2023. Title: Education and training interventions for health care workers to prevent sexual harassment. Identification number: EMID:9ba735d2b5367171. Authors: Therese K Dalsbø, Rakel Aasheim Greve, Ingrid L Jørgensen, Marita S Fønhus.Protocol: Published on the 6th of February 2025 available via Cochrane Library at https://doi.org/10.1002/14651858.CD016096 Plain language summary What are the effects of education and training for healthcare workers to prevent sexual harassment? Key messages Education and training for healthcare workers about sexual harassment probably increases sexual harassment knowledge slightly and may increase sexual harassment management skills slightly compared to another type of sexual harassment education or training. No studies compared the effect of education and training about sexual harassment with no education and training, being on a waitlist, or minimal education such as an information leaflet. This topic warrants further study. Future studies are also needed that include a wider range of healthcare workers and that look at potential harms of education and training about sexual harassment. What is sexual harassment, and why and how should it be prevented? Sexual harassment in the workplace includes any kind of unwelcome sexual attention from a patient/client, their friend/s, family member/s, other professional/s or colleague/s. It is common towards healthcare workers, with roughly 12% reporting being sexually harassed by patients and visitors. Healthcare workers can experience poor mental health and job dissatisfaction, and may even leave their job or the workforce, as a result of being sexually harassed. Preventing sexual harassment against healthcare workers is therefore important. Education and training interventions about sexual harassment may have different focus areas. One approach is to raise awareness or increase knowledge about sexual harassment. Another is to learn about strategies to prevent it, or training on actions against it. Training and education can be in‐person, digital, or a combination of the two. The instructors may include peers, leaders, or trained professionals, either formally or informally. What did we want to find out? We wanted to find out if education and training could increase knowledge and management skills about sexual harassment. We also looked at the rate of occurrence of sexual harassment; harms such as anxiety, depression, burnout, sick leave, staff turnover, and disability; and considered how the healthcare worker felt about their workplace related to sexual harassment. What did we do? We searched for studies comparing education and training about sexual harassment with: no education and training, being on a waitlist, or minimal education such as an information leaflet; or another type of education or training about sexual harassment. We compared and summarised the results of the studies and rated our confidence in the evidence based on factors such as study methods and sizes. What did we find? We found no studies comparing education and training about sexual harassment with no education and training, being on a waitlist, or minimal education such as an information leaflet. We found two studies comparing education and training about sexual harassment with another type of education or training about sexual harassment. Both studies were from Taiwan and included a total of 170 nurses, mainly young women with little work experience. One group of nurses received in‐person training and an interactive education computer program. The nurses in the comparison group received education only via a brochure and video. Education and training about sexual harassment: probably slightly increases sexual harassment prevention knowledge ('sexual harassment prevention'; 2 studies, 168 people); and may slightly improve nurses' management skills ('coping behaviour' (2 studies, 168 people) and 'prevention strategy' (2 studies, 168 people)). No study looked at the rate of occurrence of sexual harassment; harms such as anxiety, depression, burnout, sick leave, staff turnover, and disability; or considered how the healthcare worker felt about their workplace related to sexual harassment. What are the limitations of the evidence? Our confidence in the evidence is moderate to low, mainly because we found only two studies including small numbers of people. Future studies are needed that include a wider range of healthcare workers and that look at potential harms of education and training about sexual harassment. Also, future studies could compare education and training about sexual harassment versus no education and training, being on a waitlist, or minimal education such as an information leaflet. How up to date is this evidence? The evidence is current to March 2025. Visual summary Unlock the full review Close Save citation to: RefWorks SciWheel
