# Left Write Hook: trial protocol for a community-based type II hybrid effectiveness-implementation cluster randomised controlled trial of a boxing and writing-based intervention for adult survivors of child sexual abuse and gender-based violence in Australia

## TL;DR

This study tests a new peer-led program combining boxing and writing to help survivors of child sexual abuse and gender-based violence in Australia improve their health and self-efficacy.

## Contribution

The study introduces a novel peer-led intervention combining expressive writing and trauma-informed boxing for trauma survivors.

## Key findings

- The trial will assess changes in self-efficacy and mental and physical health outcomes over 8 weeks.
- Implementation will be evaluated using the RE-AIM framework to measure reach, effectiveness, adoption, and maintenance.
- Data will be publicly shared via Open Science Framework after the trial concludes.

## Abstract

Sexual and gender-based violence can have long-term impacts on the physical and mental health of survivors, with demonstrated impairments to immune, endocrine and nervous systems, and increased risk of chronic conditions such as cardiovascular disease, depression and post-traumatic stress. Moreover, survivors commonly experience low self-efficacy and lack of perceived control over their lives. Creating space for survivors to feel empowered through a multidimensional approach to health promotion, considering both physical and psychological influences on health, is necessary to reduce chronic disease.

In this type II hybrid effectiveness-implementation cluster randomised controlled trial, we evaluate a novel peer-led intervention that combines expressive writing and trauma-informed boxing, Left Write Hook, against trauma-informed boxing alone—an intervention approach that is currently accessible in the community and has been shown to improve both mental and physical health. 20 clusters of 8–10 adults (n=150) with a self-reported history of child sexual abuse or other gender-based violence will be recruited in Melbourne, Australia, through health services and the community. Clusters will be randomly assigned to complete either 8× weekly group sessions of Left Write Hook (intervention) involving both expressive writing and trauma-informed boxing led by a trained peer facilitator, or 8× weekly group boxing sessions led by a trauma-informed boxing facilitator (control). Implementation will be evaluated against the PRISM Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. The primary effectiveness outcome is change in self-efficacy from preintervention to postintervention (8 weeks). Secondary effectiveness outcomes are changes in symptoms of complex post-traumatic stress disorder, trauma-related cognition and indicators of physical fitness (strength, flexibility, aerobic fitness and balance). Assessment will be completed online or over the phone with a member of the research team at preintervention (0 weeks), postintervention (8 weeks) and at 1 month following completion of the intervention (12 weeks). The primary implementation outcome is the fidelity of the train-the-champion implementation strategy for intervention training and delivery, and the secondary implementation outcome is adoption of the intervention and training delivery.

Ethical approval was received from the Human Research Ethics Committee of The University of Melbourne (2024-28998-60131-11) and the Alfred Hospital Ethics Committee (110810). Results will be disseminated via publication in a peer-reviewed journal, and data will be made available via Open Science Framework at the conclusion of the trial.

ACTRN12624000862549.