Factors influencing the implementation of integrated prevention programming in the United States military

Abstract

The link between sexual assault (SA) and alcohol misuse (AM) documented in both military and civilian settings suggests that integrating SA and AM prevention programming could be more effective than current siloed approaches. The Department of Defense recognizes the need for integrated programming to address multiple harmful behaviors. This study explored integrating SA and AM in existing prevention efforts, identified barriers to and recommendations for implementation, and investigated possible strategies to enhance site-level leadership buy-in for future integrated programming. We conducted 8 focus groups (n = 40) with cadets and service members, and 15 semi-structured interviews with site leadership and staff at a service academy and a military base. We conducted a qualitative thematic analysis and compared themes across settings. SA and AM prevention were not formally integrated at either site. Participants emphasized the need for integrated efforts to address common risk factors. Concerns about victim blaming highlighted the importance of careful content development and staff selection. Barriers included time constraints, unengaging formats, and resource limitations. Smaller, interactive, discussion-based training formats were preferred. Ensuring the right individuals lead integrated prevention efforts was seen as essential. Demonstrating program effectiveness and resource savings were key to securing leadership buy-in. These findings highlight the need for well-coordinated strategies that engage leadership and ensure skilled program delivery to maximize integrated prevention programming effectiveness in the military.