The Longitudinal Impact of an Internet Safety Decision Aid for Abused Women

Effectiveness of the myPlan Teen App, a Digital Healthy Relationship and Safety Planning Intervention With Adolescent Aged 15-17 Years

PURPOSE

To determine the effectiveness of myPlan Teen app compared to usual care on the use of helpful safety behaviors, dating violence victimization and perpetration, depression, and suicide behavior.

METHODS

A longitudinal randomized clinical trial with 617 adolescents randomized to myPlan Teen or usual care. Participants in both groups completed surveys using validated measures at baseline, 3, 6-, and 12-months post-baseline. The study analysis examined the difference between the intervention and control groups in change over time in outcomes.

RESULTS

myPlan Teen significantly increased the use and helpfulness of safety behaviors among adolescents compared to the control group. Intervention users also significantly reduced the perpetration of physical and sexual violence and suicide behaviors. Although both groups experienced decreases in victimization and depression over the 12 months, the differences were not significantly different by group.

DISCUSSION

myPlan Teen, a digitally delivered intervention, is one of the few interventions targeting dating violence in adolescence that has proven effective.

The digital MySteps intervention for abused women at risk for firearm-related injuries and homicides: Findings from the feasibility, acceptability and preliminary efficacy trial

Background

Firearms are the leading cause of victimization of abused women by intimate partner homicide and intimate partner homicide-suicides in the US. This calls for evidence-based intervention strategies to prevent firearm-related injuries or mortality and address the firearms-related safety needs of women in abusive relationships. My Safety Steps (MySteps) was designed to comprehensively assess women's firearm-related risks, and current safety needs and to prevent women's harm from their abuser's access or ownership of a firearm through a digitally delivered firearm-focused safety planning intervention. This paper describes the development, feasibility, acceptability, and preliminary evaluation of the digital BSHAPE intervention among women survivors of intimate partner violence (IPV).

Methods

Using a pretest post-test control group design, the study was conducted with 103 participants with 55 women randomly assigned to the MySteps arm and 48 women to the standard of care control arm. The feasibility and acceptability outcomes assessed were enrollment, adherence, and perceptions of the intervention. Preliminary evaluation outcomes included the partner's access to a firearm, women's self-efficacy beliefs, and empowerment. Further, qualitative follow-up interviews were conducted with 30 survivors of IPV in the MySteps arm to follow up on the use and helpfulness of safety strategies provided in MySteps.

Results and conclusion

The intervention was found to be feasible, and acceptable and demonstrated improved outcomes for survivors of IPV at risk from their partner's firearm. Women provided feedback for further refinement. The findings of this study will be useful in further refining MySteps and testing it in a full-scale randomized controlled trial.

Patterns of Technology-Based Abuse Among Adult Intimate Partner Violence Survivors and Associations with Offline Abuse

Research about technology-based abuse (TBA) has primarily relied on youth-focused survey research, leading to gaps in knowledge about the experiences of TBA among adult populations. However, studies among adult intimate partner violence (IPV) survivors suggest that TBA is a pervasive problem warranting attention. This study builds on the limited existing literature about adult experiences of TBA by examining patterns of TBA among adult abuse survivors (n = 377). Latent class analysis showed three distinct patterns of TBA: technology-based emotional abuse, technology-based monitoring, and technology-based control. Multinomial regression analyses demonstrated that TBA co-occurs with offline IPV. Findings reinforce the significant role of TBA in adult IPV survivors' lives and highlight the importance of assessing for TBA among survivors.

A Clinical Decision Support Tool for Intimate Partner Violence Screening Among Women Veterans: Development and Qualitative Evaluation of Provider Perspectives

BACKGROUND

Women veterans, compared to civilian women, are especially at risk of experiencing intimate partner violence (IPV), pointing to the critical need for IPV screening and intervention in the Veterans Health Administration (VHA). However, implementing paper-based IPV screening and intervention in the VHA has revealed substantial barriers, including health care providers' inadequate IPV training, competing demands, time constraints, and discomfort addressing IPV and making decisions about the appropriate type or level of intervention.

OBJECTIVE

This study aimed to address IPV screening implementation barriers and hence developed and tested a novel IPV clinical decision support (CDS) tool for physicians in the Women's Health Clinic (WHC), a primary care clinic within the Veterans Affairs Palo Alto Health Care System. This tool provides intelligent, evidence-based, step-by-step guidance on how to conduct IPV screening and intervention.

METHODS

Informed by existing CDS development frameworks, developing the IPV CDS tool prototype involved six steps: (1) identifying the scope of the tool, (2) identifying IPV screening and intervention content, (3) incorporating IPV-related VHA and clinic resources, (4) identifying the tool's components, (5) designing the tool, and (6) conducting initial tool revisions. We obtained preliminary physician feedback on user experience and clinical utility of the CDS tool via the System Usability Scale (SUS) and semistructured interviews with 6 WHC physicians. SUS scores were examined using descriptive statistics. Interviews were analyzed using rapid qualitative analysis to extract actionable feedback to inform design updates and improvements.

RESULTS

This study includes a detailed description of the IPV CDS tool. Findings indicated that the tool was generally well received by physicians, who indicated good tool usability (SUS score: mean 77.5, SD 12.75). They found the tool clinically useful, needed in their practice, and feasible to implement in primary care. They emphasized that it increased their confidence in managing patients reporting IPV but expressed concerns regarding its length, workflow integration, flexibility, and specificity of information. Several physicians, for example, found the tool too time consuming when encountering patients at high risk; they suggested multiple uses of the tool (eg, an educational tool for less-experienced health care providers and a checklist for more-experienced health care providers) and including more detailed information (eg, a list of local shelters).

CONCLUSIONS

Physician feedback on the IPV CDS tool is encouraging and will be used to improve the tool. This study offers an example of an IPV CDS tool that clinics can adapt to potentially enhance the quality and efficiency of their IPV screening and intervention process. Additional research is needed to determine the tool's clinical utility in improving IPV screening and intervention rates and patient outcomes (eg, increased patient safety, reduced IPV risk, and increased referrals to mental health treatment).

A systematic review on eHealth technology personalization approaches

Despite the widespread use of personalization of eHealth technologies, there is a lack of comprehensive understanding regarding its application. This systematic review aims to bridge this gap by identifying and clustering different personalization approaches based on the type of variables used for user segmentation and the adaptations to the eHealth technology and examining the role of computational methods in the literature. From the 412 included reports, we identified 13 clusters of personalization approaches, such as behavior + channeling and environment + recommendations. Within these clusters, 10 computational methods were utilized to match segments with technology adaptations, such as classification-based methods and reinforcement learning. Several gaps were identified in the literature, such as the limited exploration of technology-related variables, the limited focus on user interaction reminders, and a frequent reliance on a single type of variable for personalization. Future research should explore leveraging technology-specific features to attain individualistic segmentation approaches.

Harnessing Health Information Technology in Domestic Violence in the United States: A Scoping Review

Objectives

The following scoping review aims to identify and map the existing evidence for HIT interventions among women with DV experiences in the United States. And provide guidance for future research, and facilitate clinical and technical applications for healthcare professionals.

Methods

Five databases, PubMed, EBSCOhost CINAHL, Ovid APA PsycINFO, Scopus and Google Scholar, were searched from date of inception to May 2023. Reviewers extracted classification of the intervention, descriptive details, and intervention outcomes, including physical safety, psychological, and technical outcomes, based on representations in the included studies.

Results

A total of 24 studies were included, identifying seven web-based interventions and four types of abuse. A total of five studies reported safety outcomes related to physical health. Three studies reported depression, anxiety, and post-traumatic stress disorder as psychological health outcomes. The effectiveness of technology interventions was assessed in eight studies.

Conclusion

Domestic violence is a major public health issue, and research has demonstrated the tremendous potential of health information technology, the use of which can support individuals, families, and communities of domestic violence survivors.

Efficacy of Psychosocial Interventions for Survivors of Intimate Partner Violence: A Systematic Review and Meta-Analysis

Survivors of intimate partner violence (IPV) face serious health-related, social and economic consequences. Prior meta-analyses indicate efficacy of psychosocial interventions for support of IPV survivors, but their results are affected by methodological limitations. Extensive subgroup analyses on the moderating effects of intervention and study characteristics are lacking. To address these limitations in an up-to-date and comprehensive meta-analytic review, four literature databases (PsycInfo, Medline, Embase, and CENTRAL, March 23, 2022) were searched for randomized-controlled trials examining the efficacy of psychosocial interventions compared to control groups in improving safety-related, mental health, and psychosocial outcomes in IPV survivors. Weighted effects on IPV, depression, posttraumatic stress disorder (PTSD), and psychosocial outcomes were calculated under random-effects assumption. Subgroup analyses were performed to investigate moderating effects of predefined intervention and study characteristics. Study quality was rated. In all, 80 studies were included in qualitative synthesis, and 40 studies in meta-analyses. Psychosocial interventions significantly reduced symptoms of depression (SMD: -0.15 [95% confidence interval, CI [-0.25, -0.04]; p = .006], I2 = 54%) and PTSD (SMD: -0.15 [95% CI [-0.29, -0.01]; p = .04], I2 = 52%), but not IPV reexperience (SMD: -0.02 [95% CI [ -0.09, 0.06]; p = .70], I2 = 21%) compared to control conditions at post. High-intensive and integrative interventions, combining advocacy-based and psychological components, were favorable subgroups. Yielded effects were modest and not maintained long term. The quality of evidence was low and potential harms remain unclear. Future research should adopt higher standards of research conduct and reporting and must account for the complexity and diversity of IPV experiences.

A Review of Intimate Partner Violence Interventions Relevant to Women During the COVID-19 Pandemic

Women have experienced increased rates of intimate partner violence (IPV) since the onset of the COVID-19 global pandemic, and at the same time requirements for physical distancing and/or remote delivery of services have created challenges in accessing services. We synthesized research evidence from 4 systematic reviews and 20 individual studies to address how IPV interventions can be adapted within the context of the pandemic. As many interventions have been delivered via various technologies, access to technology is of particular importance during the pandemic. Our results can inform the provision of services during the remainder of the COVID-19 pandemic including how to support women who have little access to in-person services.

The being safe, health and positively empowered pilot randomized controlled trial: A digital multicomponent intervention for immigrant women with cumulative exposures to violence

OBJECTIVES

Pre- and postmigration exposures to violence are significant social determinants of immigrant women's health, safety, and well-being, with Black immigrant women being at high risk because of many coming from conflict-zone countries. The existing literature does not report the development and testing of a multicomponent digital intervention to address safety and health issues among immigrant women with cumulative exposures to violence. This pilot randomized controlled trial evaluated preliminary efficacy of a multicomponent digital intervention (BSHAPE) to improve health and safety outcomes for immigrant women with cumulative violence exposures, posttraumatic stress disorder and/or depression symptoms, and human immune deficiency virus (HIV) risk behaviors.

METHOD

The intervention was developed based on formative qualitative work and input from women. In the randomized controlled trial, 144 Black immigrant women, average age being 33.6 years, were randomly assigned to either the BSHAPE arm (n = 72) or a control arm (n = 72). Data were collected at four time points over 12 months. A generalized estimating equation analysis was performed to examine group differences in change in outcomes over time.

RESULTS

Compared to the control arm, participants in BSHAPE showed significant improvement in multiple outcome measures (e.g., HIV/STI risk).

CONCLUSION

This pilot trial of BSHAPE showed promising results for immigrant women with lifetime exposures to violence, poor mental health, and HIV risk. The study also provided useful information to further improve BSHAPE for a full-scale efficacy trial. The digital BSHAPE can be especially advantageous for violence-affected immigrant women who face numerous barriers to accessing in-person care for their safety and health needs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Systematic review and data synthesis on the treatment of sexual violence victimization by an intimate partner

This study aims to conduct a systematic review and synthesis on the treatment of sexual violence victimization by an intimate partner evaluating specifically the impact of treatment on mental health outcomes of female sexual intimate partner violence (IPV) survivors. We followed the Cochrane Handbook for Systemic Reviews of Interventions guidelines for the process of conducting systematic reviews. We were unable to conduct meta-analyses due to the substantial heterogeneity of the interventions for IPV. A qualitative summary of 6 controlled studies identified no benefit to the treatment of sexual coercion, posttraumatic stress disorder, depression, or anxiety for female sexual IPV survivors. However, we are limited by a paucity of data for each outcome on this subject. In conclusion, sexual coercion is a complex issue that has adverse effects on mental health and the well-being of the survivors. More research is needed that investigates what kind of interventions are effective for this specific population.

Integrating intimate partner violence prevention content into a digital parenting chatbot intervention during COVID-19: Intervention development and remote data collection

BACKGROUND

Intimate partner violence (IPV) is a serious public health issue which experienced a sharp incline during the onset of COVID-19. Increases in other forms of violence, such as violence against children (VAC), have also been linked to the pandemic, and there have been calls for greater prevention efforts that tackle both forms of violence concurrently. The COVID-19 crisis has highlighted the urgent need for evidence-based and scalable violence prevention interventions that target multiple forms of family violence. Parenting programmes have shown promising results in preventing various forms of family violence, including IPV and VAC, and have recently experienced an expansion in delivery, with digital intervention formats growing. This paper describes the development and evaluation of the IPV prevention content designed and integrated into ParentText, a chatbot parenting intervention adapted from Parenting for Lifelong Health programmes.

METHODS

The ParentText IPV prevention content was developed using the Six Steps in Quality Intervention Development (6SQuID) framework. This involved targeted literature searches for key studies to identify causal factors associated with IPV and determining those with greatest scope for change. Findings were used to develop the intervention content and theory of change. Consultations were held with academic researchers (n = 5), practitioners (n = 5), and local community organisations (n = 7), who reviewed the content. A formative evaluation was conducted with parents in relationships (n = 96) in Jamaica to better understand patterns in user engagement with the intervention and identify strategies to further improve engagement.

RESULTS

Using the 6SQuID model, five topics on IPV prevention were integrated into the ParentText chatbot. Text-messages covering each topic, including additional materials such as cartoons and videos, were also developed. The formative evaluation revealed an average user-engagement length of 14 days, 0.50 chatbot interactions per day, and over half of participants selected to view additional relationship content.

CONCLUSIONS

This article provides a unique contribution as the first to integrate IPV prevention content into a remotely delivered, digital parenting intervention for low-resource settings. The findings from this research and formative evaluation shed light on the promising potential of chatbots as scalable and accessible forms of violence prevention, targeting multiple types of family violence.

Digital self-help for people experiencing intimate partner violence: a qualitative study on user experiences and needs including people with lived experiences and services providers

BACKGROUND

Intimate partner violence (IPV) is a prevalent public health issue associated with multiple physical and mental health consequences for survivors. Digital interventions can provide low-threshold support to those experiencing IPV, but existing digital interventions have limited efficacy in improving the safety and mental health of IPV survivors. Digitally adapting an integrative intervention with advocacy-based and psychological content holds promise for increasing the efficacy of digital interventions in the context of IPV.

METHODS

This study examines the needs, acceptability and usability of an integrative digital intervention for people affected by IPV. We used the think-aloud method and semi-structured interviews with a sample of six people with lived experiences of IPV and six service providers. We analyzed the data using thematic analysis.

RESULTS

We identified the increasing general acceptance of digital support tools and the limited capacity of the current support system as societal context factors influencing the acceptance of and needs regarding digital interventions in the context of IPV. An integrative digital self-help intervention offers several opportunities to complement the current support system and to meet the needs of people affected by IPV, including the reduction of social isolation, a space for self-reflection and coping strategies to alleviate the situation. However, potentially ongoing violence, varying stages of awareness and psychological capacities, and as well as the diversity of IPV survivors make it challenging to develop a digital intervention suitable for the target group. We received feedback on the content of the intervention and identified design features required for intervention usability.

CONCLUSION

An integrative digital self-help approach, with appropriate security measures and trauma-informed design, has the potential to provide well-accepted, comprehensive and continuous psychosocial support to people experiencing IPV. A multi-modular intervention that covers different topics and can be personalized to individual user needs could address the diversity of the target population. Providing guidance for the digital intervention is critical to spontaneously address individual needs. Further research is needed to evaluate the efficacy of an integrative digital self-help intervention and to explore its feasibility it in different settings and populations.

Effectiveness of the SAFE eHealth Intervention for Women Experiencing Intimate Partner Violence and Abuse: Randomized Controlled Trial, Quantitative Process Evaluation, and Open Feasibility Study

BACKGROUND

Intimate partner violence and abuse (IPVA) is a pervasive societal issue that impacts many women globally. Web-based help options are becoming increasingly available and have the ability to eliminate certain barriers in help seeking for IPVA, especially in improving accessibility.

OBJECTIVE

This study focused on the quantitative evaluation of the SAFE eHealth intervention for women IPVA survivors.

METHODS

A total of 198 women who experienced IPVA participated in a randomized controlled trial and quantitative process evaluation. Participants were largely recruited on the internet and signed up through self-referral. They were allocated (blinded for the participants) to (1) the intervention group (N=99) with access to a complete version of a help website containing 4 modules on IPVA, support options, mental health, and social support, and with interactive components such as a chat, or (2) the limited-intervention control group (N=99). Data were gathered about self-efficacy, depression, anxiety, and multiple feasibility aspects. The primary outcome was self-efficacy at 6 months. The process evaluation focused on themes, such as ease of use and feeling helped. In an open feasibility study (OFS; N=170), we assessed demand, implementation, and practicality. All data for this study were collected through web-based self-report questionnaires and automatically registered web-based data such as page visits and amount of logins.

RESULTS

We found no significant difference over time between groups for self-efficacy, depression, anxiety, fear of partner, awareness, and perceived support. However, both study arms showed significantly decreased scores for anxiety and fear of partner. Most participants in both groups were satisfied, but the intervention group showed significantly higher scores for suitability and feeling helped. However, we encountered high attrition for the follow-up surveys. Furthermore, the intervention was positively evaluated on multiple feasibility aspects. The average amount of logins did not significantly differ between the study arms, but participants in the intervention arm did spend significantly more time on the website. An increase in registrations during the OFS (N=170) was identified: the mean amount of registrations per month was 13.2 during the randomized controlled trial and 56.7 during the OFS.

CONCLUSIONS

Our findings did not show a significant difference in outcomes between the extensive SAFE intervention and the limited-intervention control group. It is, however, difficult to quantify the real contribution of the interactive components, as the control group also had access to a limited version of the intervention for ethical reasons. Both groups were satisfied with the intervention they received, with the intervention study arm significantly more so than the control study arm. Integrated and multilayered approaches are needed to aptly quantify the impact of web-based IPVA interventions for survivors.

TRIAL REGISTRATION

Netherlands Trial Register NL7108 NTR7313; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7313.

A systematic review of ethical challenges and opportunities of addressing domestic violence with AI-technologies and online tools

Domestic violence remains a pressing complex social problem of people of any gender, age, socio-economic status, and ethno-cultural background, an issue that worsened worldwide during the COVID-19 pandemic. Digital, online, or artificial intelligence-based smart technological services, applications, and tools provide novel approaches in addressing domestic violence, including intimate partner violence. This systematic literature review analyses the ethical challenges and opportunities these (protective) digital and smart technologies provide to the stakeholders involved. Our results highlight that the public health and societal issue are the leading narratives of domestic violence, which is predominantly interpreted as gender-based violence. The review highlights an emerging trend of the role of machine learning- and artificial intelligence-based approaches in identifying and preventing domestic violence. However, we argue that little recommendation is available to professionals about how to use these approaches in a responsible way, and that the smartness of high-tech technologies is often challenged by basic-level technologies from perpetrators, creating an imbalance that also limits an impactful development of a comprehensive socio-technical regime that serves the safety and resilience of families in their communal setting.

Concerned friends of intimate partner violence survivors: results from the myPlan randomized controlled trial on college campuses

BACKGROUND

Nearly half of intimate partner violence (IPV) survivors experience their first abusive relationship at college age (18-24 years). Most often they disclose the violence to friends. Existing college campus "bystander" interventions training peers to safely intervene have been effective in sexual assault prevention; similar interventions have rarely been tested for IPV. Therefore, we evaluated the effectiveness of an interactive, personalized safety decision and planning tool, myPlan app, on decisional conflict, decisional preparedness, confidence in intervening, supportive safety behaviors, and IPV attitudes with concerned friends of abused college women.

METHODS

We recruited college students (age 18-24, N = 293) of any gender who had a female-identified friend who had recently experienced IPV ("concerned friends") from 41 Oregon and Maryland colleges/universities. Participants were randomized to myPlan (n = 147) or control (usual web-based resources; n = 146). Outcomes included decisional conflict, decisional preparedness, confidence to intervene, safety/support behaviors, and IPV attitudes.

RESULTS

At baseline, concerned friends described the abused person as a close/best friend (79.1%); 93.7% had tried at least one strategy to help. Most (89.2%) reported concerns their friend would be seriously hurt by the abuser; 22.7% reported extreme concern. Intervention participants had greater improvements in decisional conflict (specifically, understanding of their own values around the decision to intervene and help a friend) and decisional preparedness immediately after their first use of myPlan, and a significantly greater increase in confidence to talk with someone about their own relationship concerns at 12 months. At 12-month follow-up, both intervention and control groups reported increased confidence to intervene, and did not differ significantly in terms of percentage of safety/support strategies used, whether strategies were helpful, or IPV attitudes.

CONCLUSIONS

A technology-based intervention, myPlan, was effective in reducing one aspect of decisional conflict (improving clarity of values to intervene) and increasing decisional preparedness to support a friend in an unsafe relationship. Information on IPV and related safety strategies delivered through the myPlan app or usual web-based resources both increased confidence to intervene with a friend. College students in the myPlan group were more likely to talk with someone about concerns about their own relationship, demonstrating potential for IPV prevention or early intervention.

TRIAL REGISTRATION

Clinicaltrials.gov ID: NCT02236663, registration date 10/09/2014.

Post-separation abuse: A concept analysis

AIM

To report an analysis of the concept of post-separation abuse and its impact on the health of children and adult survivors.

DESIGN

Concept analysis.

DATA SOURCES

A literature search was conducted via PubMed, Cochrane and Embase and identified articles published from 1987 to 2021.

METHODS

Walker and Avant's (2019) eight stage methodology was used for this concept analysis, including identifying the concept, determining the purpose of analysis, identifying uses of the concept, defining attributes, identifying a model case and contrary case, antecedents and consequences and defining empirical referents.

RESULTS

Post-separation abuse can be defined as the ongoing, willful pattern of intimidation of a former intimate partner including legal abuse, economic abuse, threats and endangerment to children, isolation and discrediting and harassment and stalking. An analysis of literature identified essential attributes including fear and intimidation; domination, power and control; intrusion and entrapment; omnipresence; and manipulation of systems. Antecedents to post-separation abuse include patriarchal norms, physical separation, children, spatiality and availability, pre-separation IPV and coercive control and perpetrator characteristics. Consequences include lethality, adverse health consequences, institutional violence and betrayal, such as loss of child custody and economic deprivation.

CONCLUSION

This concept analysis provides a significant contribution to the literature because it advances the science for understanding the phenomenon of post-separation abuse. It will aid in developing risk assessment tools and interventions to improve standards of care for adult and children survivors following separation from an abusive partner.

IMPACT

This concept analysis of post-separation abuse provides a comprehensive insight into the phenomenon and a theoretical foundation to inform instrument development, future research and intervention. Post-separation abuse is a complex, multi-faceted phenomenon that requires differential social, legal and healthcare systems responses to support the health and well-being of survivors and their children.

Vaccine Hesitancy Among Canadian Mothers: Differences in Attitudes Towards a Pediatric COVID-19 Vaccine Among Women Who Experience Intimate Partner Violence

OBJECTIVES

Vaccine hesitancy (VH) in maternal decision-making is important to understand to achieve community immunity targets and optimize pediatric COVID-19 vaccine adoption. COVID-19 is exacerbating the risk of intimate partner violence (IPV) for women in abusive relationships, a known risk factor for maternal VH. This project aimed to: (1) determine if IPV impacts maternal VH in Canada; and (2) understand maternal attitudes towards routine childhood vaccines and a pediatric COVID-19 vaccine in Canada.

METHODS

As part of a cross-sectional, quantitative study, 129 women completed an online survey. IPV was assessed using the Abuse Assessment Screen and the revised, short-form Composite Abuse Scale. The Parent Attitudes about Childhood Vaccines scale evaluated maternal attitudes towards routine vaccinations and a COVID-19 vaccine. Questions informed by the World Health Organization's Increasing Vaccination Model (IVM) evaluated perceived barriers and facilitators to COVID-19 vaccination.

RESULTS

In total, 14.5% of mothers were hesitant towards routine childhood vaccines, while 97.0% were hesitant towards a COVID-19 vaccine. Experiencing IPV was significantly associated with maternal COVID-19 VH (W = 683, p < 0.05). Social processes were identified as instrumental barriers and facilitators to COVID-19 vaccination, meaning that social norms and information sharing among social networks are critical in maternal vaccination decision-making.

CONCLUSIONS FOR PRACTICE

This study provides novel evidence of maternal IPV significantly impacting VH and the presence of strong maternal VH specific to a COVID-19 vaccine in the Canadian context. Further research is required to fully understand the factors that build confidence and mitigate hesitancy in mothers, especially mothers who have experienced IPV.

Telehealth for Women's Preventive Services for Reproductive Health and Intimate Partner Violence: a Comparative Effectiveness Review

BACKGROUND

Telehealth delivery of preventive health services may improve access to care; however, its effectiveness and adverse effects are unknown. We conducted a comparative effectiveness review on the effectiveness and harms of telehealth interventions for women's reproductive health and intimate partner violence (IPV) services.

METHODS

We searched MEDLINE, Cochrane Library, CINAHL, and Scopus for English-language studies (July 2016 to May 2022) for randomized controlled trials (RCTs) and observational studies of telehealth strategies for women's reproductive health and IPV versus usual care. Two investigators identified studies and abstracted data using a predefined protocol. Study quality was assessed using study design-specific standardized methods; disagreements were resolved through consensus.

RESULTS

Eight RCTs, 1 nonrandomized trial, and 7 observational studies (n=10 731) were included (7 studies of contraceptive care and 9 of IPV services). Telehealth interventions to supplement contraceptive care demonstrated similar rates as usual care for contraceptive use, sexually transmitted infections, and pregnancy (low strength of evidence [SOE]); evidence on abortion was insufficient. Outcomes were also similar between telehealth interventions to replace or supplement IPV services and comparators for repeat IPV, depression, posttraumatic stress disorder, fear of partner, coercive control, self-efficacy, and safety behaviors (low SOE). In these studies, telehealth barriers included limited internet access, digital literacy, technical challenges, and confidentiality concerns. Strategies to ensure safety increased telehealth use for IPV services. Evidence on access, health equity, or harms was lacking.

DISCUSSION

Telehealth interventions for contraceptive care and IPV services demonstrate equivalent clinical and patient-reported outcomes versus in-person care, although few studies are available. Effective approaches for delivering these services and how to best mobilize telehealth, particularly for women facing barriers to care remain uncertain.

TRIAL REGISTRATION

PROSPERO CRD42021282298.

Information and communications technology use to prevent and respond to sexual and gender-based violence in low- and middle-income countries: An evidence and gap map

Background

The use of information and communications technologies (ICT) in low- and middle-income countries (LMIC) has increased significantly in the last several years, particularly in health, including related areas such as preventing and responding to sexual and gender-based violence (SGBV) against women and children. While the evidence for ICT effectiveness has grown significantly in the past 5 years in other aspects of health, it has not for effectiveness of using ICT for the prevention and response to SGBV against women and children in LMIC.

Objectives

The primary goal of this evidence and gap map (EGM) is to establish a baseline for the state of the evidence connected with the use of ICT for preventing and responding to SGBV against women and children in LMIC. Objectives that contribute to the achievement of this goal are: (1)identifying evidence of effectiveness for the use of ICT targeting the prevention of, and response to, SGBV against women and children in LMIC;(2)identifying key gaps in the available ICT for SGBV prevention and/or response evidence;(3)identifying research methodology issues reflected in the current evidence;(4)identifying any clusters of evidence in one or more ICT interventions suitable for systematic review;(5)identifying enabling factors associated with effective interventions using ICT for the prevention of, and response to, SGBV against women and children in LMIC; and(6)providing a structured and accessible guide to stakeholders for future investment into interventions and research using ICT for SGBV prevention and response in LMIC.

Search Methods

The date of the last search from which records were evaluated, and any studies identified were incorporated into the EGM was July 11, 2021. Twenty (20) databases were searched, and identified under "Methods."

Selection Criteria

We conducted systematic searches of multiple academic databases using search terms and criteria related to the use of ICT for prevention and/or response to SGBV against women and children. Although excluded, we did consider studies conducted in higher-income countries (HIC) only to provide context and contrast for the EGM discussion of the eligible studies from LMIC.

Data Collection and Analysis

The EGM search process included five phases: (1) initial search of academic databases conducted by two researchers simultaneously; (2) comparison of search results, and abstract screening by two researchers collaboratively; (3) second screening by reviewing full articles of the studies identified in the first screening by two reviewers independently; (4) comparison of results of second screening; resolution of discrepancies of screening results; and (5) data extraction and analysis.

Main Results

The EGM includes 10 studies published in English of which 4 were systematic, literature or scoping reviews directly addressing some aspect of the use of ICT for SGBV prevention and/or response in women and girls. The six individual studies were, or are being, conducted in LMIC (a condition for eligibility). No eligible studies addressed children as a target group, although a number of the ineligible studies reported on the use of ICT for intermediate outcomes connected with violence against children (e.g., digital parenting). Yet, such studies did not explicitly attach those intermediate outcomes to SGBV prevention or response outcomes. Countries represented among the eligible individual studies include Cambodia, Kenya, Nepal Democratic Republic of Congo (DRC), and Lebanon. Of the 10 eligible studies (individual and reviews), most focused on intimate partner violence against women (IPV). Intervention areas among the eligible studies include safety planning using decision algorithms, educational and empowerment messaging regarding norms and attitudes towards gender-based violence (GBV), multi-media radio drama for social behavior change, the collection of survivor experience to inform SGBV/GBV services, and the collection of forensic evidence connected to the perpetration of SGBV. Thirty-one studies which otherwise would have been eligible for the evidence and gap map (EGM) were conducted in HIC (identified under "Excluded Reviews"). None of the eligible studies reported results related to effectiveness of using ICT in a control setting, for the primary prevention of SGBV as an outcome, but rather reported on outcomes such as usability, secondary and tertiary prevention, feasibility, access to services and other outcomes primarily relating to the development of the interventions. Two studies identified IPV prevention as a measurable outcome within their protocols, but one of these had not yet formally published results regarding primary prevention as an outcome. The other study, while reporting on the protocol (and steps to adapt the ICT application, previously reported as effective in HIC contexts to a specific LMIC context), has not yet as of the date of writing this EGM, published outcome results related to the reduction of IPV. Of the four reviews identified as eligible, two are better characterized as either a literature review or case study rather than as traditional systematic reviews reporting on impact outcomes with methodologically rigorous protocols.

Authors' Conclusions

The evidence baseline for using ICT to prevent and/or respond to SGBV against women and children in LMIC is nascent. Promising areas for future study include: (1) how ICT can contribute changing gender and social norms related to SGBV and primary prevention; (2) mobile phone applications that promote safety and security; (3) mobile technology for the collection and analysis of survivors' experience with SGBV response services; and (4) digital tools that support the collection of forensic evidence for SGBV response and secondary prevention. Most striking is the paucity of eligible studies examining the use of ICT in connection with preventing or responding to SGBV against children. In light of the exponential increase in the use of ICT by children and adolescents, even in LMIC, greater attention should be given to examining how ICT can be used during adolescence to address gender norms that lead to SGBV. While there appears to be interest in using ICT for SGBV prevention and/or response in LMIC, other than several ad hoc studies, there is little evidence of if, and how effective these interventions are. Further inquiry should be made regarding if and how interventions proven effective in HIC can be adapted to LMIC contexts.

Safety Planning With Marginalized Survivors of Intimate Partner Violence: Challenges of Conducting Safety Planning Intervention Research With Marginalized Women

Intimate partner violence (IPV) disproportionately affects marginalized women in the United States. This calls for effective safety planning strategies to reduce the risk for future revictimization and address safety needs of survivors from marginalized groups. This review identified types of interventions that incorporated safety planning and were successful in reducing the risk for future revictimization among IPV survivors from diverse groups, examined elements of safety planning in effective interventions, and described challenges or limitations in safety planning intervention research with marginalized women. A systematic search of five databases was performed. The search resulted in inclusion of 17 studies for synthesis. The included studies were quantitative, U.S.-based, evaluated interventions with a safety planning component, and had an outcome of change in IPV. Effective interventions that incorporated safety planning were empowerment and advocacy focused. Elements included were comprehensive assessments of survivors' unique needs and situations, educating them about IPV, helping them identify threats to safety, developing a concrete safety plan, facilitating linkage with resources, providing advocacy services as needed, and conducting periodic safety check-ins. For survivors with mental and behavioral health issues, effective interventions included psychotherapeutic approaches along with safety planning to address survivors' co-occurring health care needs. Although most studies reported positive findings, there were limitations related to designs, methods, adequate inclusion, and representation of marginalized women and cultural considerations. This calls for additional research using rigorous and culturally informed approaches to establish an evidence base for effective interventions that specifically address the safety planning needs of marginalized survivors of IPV.

Web-based intervention to reduce intimate partner violence during perinatal period: A modified protocol in response to the COVID-19 pandemic

Perinatal women are at increased risk of intimate partner violence (IPV), associated with psychiatric disorders and partner revictimization. We describe changes that were made, in response to the COVID-19 pandemic, to an in-person randomized controlled study of perinatal women with IPV who had sought mental health treatment in the last year. All phases of the study's in-person delivered computerized protocol were modified for remote delivery. Special attention was given to study participants' privacy and safety, especially with regard to the use of technology. We describe study protocol and consent procedures that were made to accommodate remote delivery of the study. All phases of remote delivery of the study have been implemented successfully and safely. Compared to the first three months of in-person delivery, the first three months of remote recruitment found that more participants were screened (69% vs. 36%) and more were enrolled in the study (13% vs. 8%). To our knowledge, this is the first remote delivered study involving participants with IPV to use the 5-item Danger Assessment and a spyware and stalkerware survey as screening tools. We demonstrate that remote delivery can reduce the risk of compromising the safety and privacy of study participants with IPV.

Technology-based and digital interventions for intimate partner violence: A systematic review and meta-analysis

Background

A growing body of research shows the promise and efficacy of technology-based or digital interventions in improving the health and well-being of survivors of intimate partner violence (IPV). In addition, mental health comorbidities such as anxiety, post-traumatic stress disorder (PTSD), and depression occur three to five times more frequently in survivors of IPV than non-survivors, making these comorbidities prominent targets of technology-based interventions. Still, research on the long-term effectiveness of these interventions in reducing IPV victimization and adverse mental health effects is emergent. The significant increase in the number of trials studying technology-based therapies on IPV-related outcomes has allowed us to quantify the effectiveness of such interventions for mental health and victimization outcomes in survivors. This meta-analysis and systematic review provide critical insight from several randomized controlled trials (RCTs) on the overall short and long-term impact of technology-based interventions on the health and well-being of female IPV survivors.

Objectives

To synthesize current evidence on the effects of technology-based or digital interventions on mental health outcomes (depression, anxiety, and PTSD) and victimization outcomes (physical, psychological, and sexual abuse) among IPV survivors.

Search Methods

We examined multiple traditional and grey databases for studies published from 2007 to 2021. Traditional databases (such as PubMed Central, Web of Science, CINAHL Plus, and PsychINFO) and grey databases were searched between April 2019 and February 2021. In addition, we searched clinical trial registries, government repositories, and reference lists. Authors were contacted where additional data was needed. We identified 3210 studies in traditional databases and 1257 from grey literature. Over 2198 studies were determined to be duplicates and eliminated, leaving 64 studies after screening titles and abstracts. Finally, 17 RCTs were retained for meta-analysis. A pre-registered protocol was developed and published before conducting this meta-analysis.

Selection Criteria

We included RCTs targeting depression, anxiety, PTSD outcomes, and victimization outcomes (physical, sexual, and psychological violence) among IPV survivors using a technology-based intervention. Eligible RCTs featured a well-defined control group. There were no study restrictions based on participant gender, study setting, or follow-up duration. Included studies additionally supplied outcome data for calculating effect sizes for our desired outcome. Studies were available in full text and published between 2007 and 2021 in English.

Data Collection and Analysis

We extracted relevant data and coded eligible studies. Using Cochrane's RevMan software, summary effect sizes (Outcome by Time) were assessed using an independent fixed-effects model. Standardized mean difference (SMD) effect sizes (or Cohen's d) were evaluated using a Type I error rate and an alpha of 0.05. The overall intervention effects were analyzed using the Z-statistic with a p-value of 0.05. Cochran's Q test and Higgins' I 2 statistics were utilized to evaluate and confirm the heterogeneity of each cumulative effect size. The Cochrane risk of bias assessment for randomized trials (RoB 2) was used to assess the quality of the studies. Campbell Systematic Reviews registered and published this study's protocol in January 2021. No exploratory moderator analysis was conducted; however, we report our findings with and without outlier studies in each meta-analysis.

Main Results

Pooled results from 17 RCTs yielded 18 individual effect size comparisons among 4590 survivors (all females). Survivors included college students, married couples, substance-using women in community prisons, pregnant women, and non-English speakers, and sample sizes ranged from 15 to 672. Survivors' ages ranged from 19 to 41.5 years. Twelve RCTs were conducted in the United States and one in Canada, New Zealand, China (People's Republic of), Kenya, and Australia. The results of this meta-analysis found that technology-based interventions significantly reduced depression among female IPV survivors at 0-3 months only (SMD = -0.08, 95% confidence interval [CI] = -0.17 to -0.00), anxiety among IPV survivors at 0-3 months (SMD = -0.27, 95% CI = -0.42 to -0.13, p = 0.00, I 2 = 25%), and physical violence victimization among IPV survivors at 0-6 months (SMD = -0.22, 95% CI = -0.38 to -0.05). We found significant reductions in psychological violence victimization at 0-6 months (SMD = -0.34, 95% CI = -0.47 to -0.20) and at >6 months (SMD = -0.29, 95% CI = -0.39 to -0.18); however, at both time points, there were outlier studies. At no time point did digital interventions significantly reduce PTSD (SMD = -0.04, 95% CI = -0.14 to 0.06, p = .46, I 2 = 0%), or sexual violence victimization (SMD = -0.02, 95% CI = -0.14 to 0.11, I 2 = 21%) among female IPV survivors for all. With outlier studies removed from our analysis, all summary effect sizes were small, and this small number of comparisons prevented moderator analyses.

Authors' Conclusions

The results of this meta-analysis are promising. Our findings highlight the effectiveness of IPV-mitigating digital intervention as an add-on (not a replacement) to traditional modalities using a coordinated response strategy. Our findings contribute to the current understanding of "what works" to promote survivors' mental health, safety, and well-being. Future research could advance the science by identifying active intervention ingredients, mapping out intervention principles/mechanisms of action, best modes of delivery, adequate dosage levels using the treatment intensity matching process, and guidelines to increase feasibility and acceptability.

Longitudinal Impact of the myPlan App on Health and Safety Among College Women Experiencing Partner Violence

The objective of this study was to examine differences in change over time in health and safety outcomes among female college students randomized to myPlan, a tailored safety planning app, or usual web-based safety planning resources. Three hundred forty-six women (175 intervention, 171 control) from 41 colleges/universities in Oregon and Maryland completed surveys at baseline, 6- and 12-months from July 2015 to October 2017. Generalized estimating equations were used to test group differences across time. Both groups improved on four measure of intimate partner violence (IPV; Composite Abuse Scale [CAS], TBI-related IPV, digital abuse, reproductive coercion [RC]) and depression. Reduction in RC and improvement in suicide risk were significantly greater in the myPlan group relative to controls (p = .019 and p = .46, respectively). Increases in the percent of safety behaviors tried that were helpful significantly reduced CAS scores, indicating a reduction in IPV over time in the myPlan group compared to controls (p = .006). Findings support the feasibility and importance of technology-based IPV safety planning for college women. myPlan achieved a number of its objectives related to safety planning and decision-making, the use of helpful safety behaviors, mental health, and reductions in some forms of IPV.

'If the Partner Finds Out, then there's Trouble': Provider Perspectives on Safety Planning and Partner Interference When Offering HIV Pre-exposure Prophylaxis (PrEP) to Women Experiencing Intimate Partner Violence (IPV)

Pre-exposure prophylaxis is an effective women-controlled HIV prevention strategy but women experiencing intimate partner violencefear partners' interference and subsequent violence could limit its utility. This study explores provider perceptions of safety planning strategies to prevent escalating violence, mitigate partner interference, and promote daily oral PrEP adherence. We conducted interviews (N = 36) with healthcare providers (n = 18) and IPV service providers (n = 18) in Baltimore and New Haven. Using the Contextualized Assessment for Strategic Safety Planning model we organized data into two categories: the appraisal process and strategic safety planning. Themes revealed during the appraisal process, providers conduct routine IPV screening, facilitate HIV risk perception, and offer PrEP. Strategic safety planning utilizes concealment tactics, informal sources of support, role playing and cover stories. Future interventions to enhance PrEP services among women exposed to IPV should implement safety planning strategies, integrate PrEP care with IPV services, and employ novel PrEP modalities to maximize effectiveness.

Accounting for Multiple Nonfatal Strangulation in Intimate Partner Violence Risk Assessment

Nonfatal strangulation is a prevalent, underreported, and dangerous form of intimate partner violence (IPV). It is particularly important to assess for strangulation among abused women as this form of violence may not leave visible injury. The most severe negative physical and mental health consequences of strangulation appear to be dose-related, with those strangled multiple times or to the point of altered consciousness at higher risk of negative sequelae. This research examines the relationship between multiple strangulation, loss of consciousness due to strangulation, and risk of future near-fatal violence to modify the Danger Assessment (DA) and the Danger Assessment for Immigrant women (DA-I), IPV risk assessments intended to predict near-fatal and fatal violence in intimate relationships. Data from one study (n = 619) were used to modify the DA to include an item on multiple strangulation or loss of consciousness due to strangulation. Data from an independent validation sample (n = 389) were then used to examine the predictive validity of the updated DA and DA-I. The updated version of the DA predicts near-fatal violence at 7-8 months follow-up significantly better than the original DA. Adding multiple strangulation or loss of consciousness to the DA-I increased the predictive validity slightly, but not significantly. The DA and DA-I are intended to be used as a collaboration between IPV survivors and advocates as tools for education and intervention. Whether or not an IPV survivor has been strangled, she should be educated about the dangerous nature of strangulation and the need for medical intervention should her partner use strangulation against her. This evidence-based adaptation of the DA and DA-I may assist practitioners to assess for and intervene in dangerous IPV cases.

Feasibility of an Online-Based Safety Decision Aid for Brazilian Women Living with Intimate Partner Violence: Findings from Participatory-Action Research in a One Stop Center

Intimate partner violence (IPV) is a challenge in Brazil; the country is ranked 6th globally for femicide and one in four women experience physical and/or sexual IPV in their lifetimes. Safety decision aids (SDA) are tools for women experiencing IPV. Building upon previously developed and tested online SDA tools, we intend to adapt an SDA tool for use in Brazil. The purpose of this study was to examine the feasibility of a technology-based SDA to support Brazilian women living with IPV, tailored for the Brazilian context. Our participatory-action research approach built upon research between 2018 and 2019 at the House of the Brazilian Woman (HBW) of Curitiba, Brazil, a cross-sectoral one-stop center (OSC) providing comprehensive care for IPV survivors. Field research included observation, field notes, and in-depth interviews with twenty-eight (n = 28) participants (HBW staff and survivors). The results were grouped into four main thematic categories: advantages; uncertainties; barriers; and suggestions. The triangulated results showed that the majority of participants considered the SDA feasible, highlighting flexibility and confidentiality; information about IPV; and access to resources for formal help-seeking as advantages of the tool. Participants also expressed uncertainties about SDA's ability to increase women's safety and its accessibility for the most vulnerable. They made suggestions for improvement to meet the unique needs of Brazilian women. This study provided evidence on the potential of an SDA tailored for use within a comprehensive program of women survivors in Brazil. This step was crucial to inform the future implementation and evaluation.

Patterns of Help-seeking Strategies in Response to Intimate Partner Violence: A Latent Class Analysis

Women engage in multiple strategies to cope with the impact of intimate partner violence (IPV). Prior research has focused predominantly on women's service utilization and help seeking as individual acts, yet it is likely that women engage in distinct patterns of multiple help-seeking strategies to achieve safety. As such, the current article examines patterns of service-related help-seeking strategies survivors employ. This article also investigates demographic factors, relationship characteristics, and mental and physical health effects of IPV associated with patterns of help seeking. Using a web-based survey, data were collected from service-engaged adult female IPV survivors (n = 369) in the Southwest region of the United States. Latent class analysis (LCA), a person-centered analytical approach, was used to identify survivors' patterns of help seeking. A 3-class LCA model was determined to be the best fit for the data. Among the sample, 50% of women broadly engaged formal and informal networks, 15% primarily engaged informal networks, and 35% broadly engaged networks but avoided legal systems while seeking other formal services. Findings indicated varying and significant associations between class membership and race/ethnicity, foreign-born status, number of children, IPV severity, and mental health symptoms. The findings reinforce the need for practitioners to be aware of the varied ways women choose or avoid seeking help and explore women's preferences. Comprehensive and collaborative service networks are necessary for early detection and holistic care. Addressing structural factors is imperative for expanding the range of viable support options available to IPV survivors, particularly women of color.

Conducting Digital Intervention Research among Immigrant Survivors of Intimate Partner Violence: Methodological, Safety and Ethnical Considerations

Intimate partner violence, described as a global pandemic by the United Nations, has been found to disproportionately affect immigrant women. Many immigrant survivors of IPV are unable or unwilling to attend in-person services due to barriers related to immigration status, transportation, and social isolation. By providing remote support to women in abusive relationships, digital interventions can help address these barriers and ensure their health and safety. Research on safe and ethical approaches to digital service delivery for immigrant IPV survivors is a necessary first step to meeting these women's needs for remote support. The purpose of this qualitative study was to explore considerations and challenges of conducting digital intervention research (online, phone and text) with diverse groups of immigrant women. Data was collected via 5 focus groups and 46 in-depth interviews with immigrant survivors of IPV from different countries of origin. In addition, data was collected via key informant interviews with 17 service providers. Participants shared safety, ethical and methodological challenges to accessing interventions, such as their abusive partner being at home or lack of safe access to technology. Further, participants shared strategies for safe data collection, such as scheduling a contact time when participants are afforded privacy and deleting evidence of the intervention to retain personal safety. The findings will be informative for researchers conducting digital intervention studies or practitioners engaging in remote intervention approaches with marginalized populations such as immigrant women at high risk of violence.

Examining organization and provider challenges with the adoption of virtual domestic violence and sexual assault interventions in Alberta, Canada, during the COVID-19 pandemic

Objectives

In Canada, calls to domestic violence and sexual assault hotlines increased during the COVID-19 pandemic as stricter public health restrictions took effect in parts of the country. Moreover, the public health measures introduced to limit the transmission of COVID-19 saw many health providers abruptly pivot to providing services virtually, with little to no opportunity to plan for this switch. We carried out a qualitative research study to understand the resulting challenges experienced by providers of domestic violence and sexual assault support services.

Methods

Twenty-four semi-structured interviews were conducted to gather in-depth information from service providers and organizational leaders in the Canadian province of Alberta about the challenges they experienced adopting virtual and remote-based domestic violence and sexual assault interventions during the COVID-19 outbreak. Interview transcripts and field notes were analysed using a thematic analysis approach.

Results

Our findings highlighted multiple challenges organizations, service providers and clients experienced. These included: (1) systemic (macro-level) challenges pertaining to policies, legislation and funding availability, (2) organization and provider (meso-level) challenges related to adapting services and programmes online or for remote delivery and (3) provider perceptions of client (micro-level) challenges related to accessing virtual interventions.

Conclusions

Equity-focused policy and intersectional and systemic action are needed to enhance delivery and access to virtual interventions and services for domestic violence and sexual assault clients.

Women survivors of intimate partner violence talk about using e-health during pregnancy: a focus group study

Background

Pregnancy is a period of particular vulnerability to experience intimate partner violence against women (IPVAW). eHealth strategies have been implemented to identify women exposed to IPVAW and to combat the abuse and empower them, but there is a lack of evidence on the use of these strategies among pregnant women. This work aims to identify the needs, concerns and preferences of survivors about the use of eHealth strategies to counsel and empower pregnant victims of IPVAW in antenatal care.

Methods

A focus group of six IPVAW survivors who had been pregnant was conducted and open questions about the use of eHealth strategies were asked. The session was recorded, transcribed and thematically analyzed. We identified three main themes: needs and worries of pregnant women experiencing IPVAW, key aspects of video counseling sessions and usefulness of safety planning apps.

Results

Women highlighted the relevant role of healthcare professionals—especially midwives—in the identification of IPVAW and the wellbeing of their children as one of the main concerns. They perceived video counseling and safety planning apps as valuable resources. The preferred contents for a video counseling intervention were awareness-raising of the situation, self-esteem and legal advice. They also proposed safety and pregnant-related aspects that should be taken into account in the design of the video counseling sessions and the safety planning app.

Conclusions

Video counseling sessions and safety planning apps are potentially useful tools to counsel and empower women who experience IPVAW during pregnancy. Midwives play a key role in this endeavor.

Mobile Phone Apps for Intimate Partner and Sexual Violence Prevention and Response: Systematic Search on App Stores

Background

Since the 2008 advent of the smartphone, more than 180 billion copies of apps have been downloaded from Apple App Store, with more than 2.6 million apps available for Android and 2.2 million apps available for iOS. Many violence prevention and response apps have been developed as part of this app proliferation.

Objective

This study aims to evaluate the prevalence and quality of freely available mobile phone apps targeting intimate partner violence (IPV) and sexual violence (SV) prevention and response.

Methods

We conducted a systematic search of violence prevention and response mobile phone apps freely available in Apple App Store (iOS; March 2016) and Google Play Store (Android; July 2016). Search terms included violence prevention, sexual assault, domestic violence, intimate partner violence, sexual violence, forensic nursing, wife abuse, and rape. Apps were included for review if they were freely available, were available in English, and had a primary purpose of prevention of or response to SV or IPV regardless of app target end users.

Results

Using the Mobile Application Rating Scale (MARS), we evaluated a total of 132 unique apps. The majority of included apps had a primary purpose of sharing information or resources. Included apps were of low-to-moderate quality, with the overall subjective quality mean for the reviewed apps being 2.65 (95% CI 2.58-2.72). Quality scores for each of the 5 MARS categories ranged from 2.80 (engagement) to 4.75 (functionality). An incidental but important finding of our review was the difficulty in searching for apps and the plethora of nonrelated apps that appear when searching for keywords such as “rape” and “domestic violence” that may be harmful to people seeking help.

Conclusions

Although there are a variety of mobile apps available designed to provide information or other services related to SV and IPV, they range greatly in quality. They are also challenging to find, given the current infrastructure of app store searches, keyword prioritization, and highlighting based on user rating. It is important for providers to be aware of these resources and be knowledgeable about how to review and recommend mobile phone apps to patients, when appropriate.

Treatments for Female Victims of Intimate Partner Violence: Systematic Review and Meta-Analysis

Intimate partner violence (IPV) is an important problem that has significant detrimental effects on the wellbeing of female victims. The chronic physical and psychological effects of intimate partner violence (IPV) are complex, long-lasting, chronic, and require treatments focusing on improving mental health issues, safety, and support. Various psycho-social intervention programs are being implemented to improve survivor wellbeing. However, little is known about the effectiveness of different treatments on IPV survivors' wellbeing. For this purpose, we conducted a systematic review and meta-analysis to assess the effectiveness of interventions on improving outcomes that describe the wellbeing of adult female survivors of IPV. We searched PubMed, PsycINFO, and Cochrane Library. We explored the effectiveness of available interventions on multiple outcomes that are critical for the wellbeing of adult female victims of IPV. To provide a broad and comprehensive view of survivors' wellbeing, we considered outcomes including mental health, physical health, diminishing further violence, social support, safety, self-efficacy, and quality of life. We reviewed 2,770 citations. Among these 25 randomized-controlled-study with a total of 4,683 participants met inclusion criteria. Findings of meta-analyses on interventions indicated promising results in improving anxiety [standardized mean difference (SMD) -7.15, 95% confidence interval (CI) -8.39 to -5.92], depression (SMD -0.26, CI -0.56 to -0.05), safety (SMD = 0.43, CI 0.4 to -0.83), violence prevention (SMD = -0.92, CI -1.66 to -0.17), health (SMD = 0.39, CI 0.12 to 0.66), self-esteem (SMD = 1.33, CI -0.73 to 3.39), social support (SMD =0.40, CI 0.20 to 0.61), and stress management (SMD = -8.94, CI -10.48 to -7.40) at the post-test. We found that empowerment plays a vital role, especially when treating depression and Post-Traumatic Stress Disorder (PTSD), which are difficult to improve across interventions. We found mixed findings on self-efficacy and quality of life. The effects of IPV are long-lasting and require treatments targeting co-morbid issues including improving safety and mental health issues.

Design and Development of a Suite of Intimate Partner Violence Screening and Safety Planning Web Apps: User-Centered Approach

Background

The popularity of mobile health (mHealth) technology has resulted in the development of numerous apps for almost every condition and disease management. mHealth and eHealth solutions for increasing awareness about, and safety around, intimate partner violence are no exception. These apps allow women to control access to these resources and provide unlimited, and with the right design features, safe access when these resources are needed. Few apps, however, have been designed in close collaboration with intended users to ensure relevance and effectiveness.

Objective

The objective of this paper is to discuss the design of a suite of evidence-based mHealth and eHealth apps to facilitate early identification of unsafe relationship behaviors and tailored safety planning to reduce harm from violence including the methods by which we collaborated with and sought input from a population of intended users.

Methods

A user-centered approach with aspects of human-centered design was followed to design a suite of 3 app-based safety planning interventions.

Results

This review of the design suite of app-based interventions revealed challenges faced and lessons learned that may inform future efforts to design evidence-based mHealth and eHealth interventions.

Conclusions

Following a user-centered approach can be helpful in designing mHealth and eHealth interventions for marginalized and vulnerable populations, and led to novel insights that improved the design of our interventions.

A technology-based intervention to improve safety, mental health and empowerment outcomes for immigrant women with intimate partner violence experiences: it's weWomen plus sequential multiple assignment randomized trial (SMART) protocol

BACKGROUND

Intimate partner violence (IPV) disproportionately affects immigrant women, an understudied and underserved population in need for evidence-based rigorously evaluated culturally competent interventions that can effectively address their health and safety needs.

METHODS

This study uses a sequential, multiple assignment, randomized trial (SMART) design to rigorously evaluate an adaptive, trauma-informed, culturally tailored technology-delivered intervention tailored to the needs of immigrant women who have experienced IPV. In the first stage randomization, participants are randomly assigned to an online safety decision and planning or a usual care control arm and safety, mental health and empowerment outcomes are assessed at 3-, 6- and 12-months post-baseline. For the second stage randomization, women who do not report significant improvements in safety (i.e., reduction in IPV) and empowerment from baseline to 3 months follow up (i.e., non-responders) are re- randomized to safety and empowerment strategies delivered via text only or a combination of text and phone calls with trained advocates. Data on outcomes (safety, mental health, and empowerment) for early non-responders is assessed at 6 and 12 months post re-randomization.

DISCUSSION

The study's SMART design provides an opportunity to implement and evaluate an individualized intervention protocol for immigrant women based on their response to type or intensity of intervention. The findings will be useful for identifying what works for whom and characteristics of participants needing a particular type or intensity level of intervention for improved outcomes. If found to be effective, the study will result in an evidence-based trauma-informed culturally tailored technology-based safety decision and planning intervention for immigrant survivors of IPV that can be implemented by practitioners serving immigrant women in diverse settings.

TRIAL REGISTRATION

This trial was registered with ClinicalTrials.gov as NCT04098276 on September 13, 2019.

Development, feasibility, acceptability and preliminary evaluation of the internet and mobile phone-based BSHAPE intervention for Immigrant survivors of cumulative trauma

BACKGROUND

Cumulative trauma exposures can have a profound effect on women's health and well-being. Black immigrant women are disproportionately affected by cumulative trauma experiences that place them at risk for multiple health issues such as reproductive sexual health problems and HIV, or mental health problems such as PTSD. The trauma-informed internet and mobile phone-based Being Safe, Healthy, and Positively Empowered (BSHAPE) intervention was designed to comprehensively assess for cumulative traumatic experiences, for current safety, and to address women's co-occurring healthcare needs through educational, psychoeducational, and mindfulness-based stress-reduction components.

PURPOSE

This paper describes the development, feasibility, acceptability, and preliminary evaluation of the computer and phone delivered BSHAPE intervention among adult Black immigrant women survivors of cumulative trauma.

METHOD

Seventy women participated in the feasibility, acceptability, and preliminary evaluation of BSHAPE, with outcomes assessed at post-intervention. The feasibility and acceptability outcomes assessed were enrollment, adherence, and perceptions of the intervention. Preliminary evaluation outcomes included perceived stress, stress management, trauma coping self-efficacy, mindfulness, mental health (MH), HIV/STI risk, general empowerment, and empowerment related to safety.

CONCLUSIONS

Findings suggest that a BSHAPE intervention is feasible and acceptable. Overall, women reported satisfaction with BSHAPE and provided suggestions for improvement. Women showed significant reduction in perceptions of stress, improved stress-management, enhanced self-efficacy, reduced HIV/STI risk, and improved MH, overall empowerment, as well as empowerment related to safety. The findings of this study will be useful in further refining BSHAPE and testing it in a full-scale randomized controlled trial.

TRIAL REGISTRATION

NCT03664362.

"Being Married Doesn't Mean You Have to Reach the End of the World": Safety Planning With Intimate Partner Violence Survivors and Service Providers in Three Urban Informal Settlements in Nairobi, Kenya

Intimate partner violence (IPV) harms women physically, sexually, and psychologically. Safety strategies, or harm reduction techniques implemented by women undergoing recurrent violence, may help mitigate the negative health, economic, and social consequences of IPV. This study aimed to understand recommended and utilized safety strategies among three urban informal settlements in Nairobi, Kenya. Semi-structured key informant discussions (KIDs; n = 18) with community-based service providers and focus group discussions (FGDs; n = 49) with IPV survivors were conducted. All interviews were audio-recorded, transcribed, and translated verbatim from Swahili to English. Inductive thematic analysis was used to structure codes. Convergence matrices were used to analyze emergent strategies by data source (service providers vs. IPV survivors). Women preferred safety strategies that they could implement unassisted as first line of harm reduction. Strategies included removing stressors, proactive communication, avoidance behaviors, sexual and reproductive health (SRH), economic, leaving partner for safety, child safety, and securing personal property. Strategies recommended by service providers and utilized by IPV survivors differed, with clear divergence indicated for leaving the abusive relationship, SRH, and personal property strategies. Innovative strategies emerged from IPV survivors for safeguarding property. Similar to upper-income and other low and middle-income contexts, women experiencing IPV in urban informal settlements of Nairobi actively engage in behaviors to maximize safety and reduce harm to themselves and their families. Integration of strategies known to be helpful to women in these communities into community-based prevention and response is strongly encouraged. Increased synergy between recommended and implemented safety strategies can enhance programming and response efforts.

Web-Based and mHealth Interventions for Intimate Partner Violence Victimization Prevention: A Systematic Review

Mobile health (mHealth) technologies are increasingly used across health programming including intimate partner violence (IPV) prevention to optimize screening, educational outreach, and linkages to care via telehealth. We systematically evaluated current web-based and mHealth interventions, which include web- or mobile-based delivery methods for primary, secondary, and tertiary IPV victimization prevention. We searched MEDLINE/PubMed, Embase, CINAHL, PsycINFO, Open Grey, and Google Scholar for empirical studies published 1998-2019. Studies were included if they considered empirical data, participants in adult romantic relationships, IPV as a primary or secondary outcome, and an mHealth component. The Mixed Methods Appraisal Tool was used to record critical ratings of quality among studies selected for inclusion. We assessed variation in targeted populations, types of IPV addressed, and mHealth approaches used. Of 133 studies identified for full-text review, 31 were included. Computer-based screening with or without integrated education was the most common mHealth approach (n = 8, 26%), followed by safety decision aids (n = 7, 23%). Feasibility and acceptability were found to be generally high where assessed (23% of studies, n = 7). There was limited evidence around whether mHealth interventions better addressed population needs compared to conventional interventions. mHealth tools for IPV prevention are especially acceptable in health-care settings, on mobile phone platforms, or when connecting victims to health care. Despite enthusiasm in pilot projects, evidence for efficacy compared to conventional IPV prevention approaches is limited. A major strength of mHealth IPV prevention programming is the ability to tailor interventions to individual victim needs without extensive human resource expenditure by providers.

"These Questions Have Everything That Happens to me": Analysis of a Femicide Risk Assessment Tool for Abused Women in Brazil

PURPOSE

The purpose of this mixed-methods triangulation study was to assess the face validity and comprehension of a femicide risk assessment tool, the Danger Assessment-Brazil (DA-Brazil) among women seeking care in a one stop center for abused women in Curitiba, Brazil. Our secondary aim was to assess professionals' perceptions of feasibility for using the DA-Brazil in the same setting.

METHOD

Fifty-five women experiencing relationship violence completed the instrument and participated in cognitive interviews about their experience; professionals attending survivors were also interviewed.

RESULTS

The vast majority of women described the DA-Brazil instrument as being easy to comprehend (n = 41, 73.2%). Nearly half of participants (n = 26, 46.4%) had some kind of question regarding the DA-Brazil calendar, a tool to visualize abuse frequency and severity. Queries aligned with five categories: recollection of dates, scale, relationship status, terminology, and discomfort. Professionals reported that the DA-Brazil instrument would support referral decision-making.

CONCLUSION

The overall face validity and comprehension of the DA-Brazil appears to be high. The majority of challenges were around the calendar activity. Professional perceptions of the DA-Brazil suggest a high degree of feasibility for its use in Brazilian healthcare settings. In order for the DA-Brazil to effectively be administered with facilitated support there is a need for training on the best use of the instrument. Accurate assessment of femicide risk is critical in a country like Brazil with high rates of femicide. The DA-Brazil provides a valid assessment of femicide risk and has the potential to trigger early intervention for those at risk.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10896-021-00313-1.

Adolescent Perceptions of an Interactive Mobile Application to Respond to Teen Dating Violence

Although research and intervention efforts in the United States have aimed to reduce teen dating violence (TDV), 10-year prevalence estimates suggest that TDV persists. Safety planning is an advocated intervention to reduce intimate partner abuse; yet, safety planning services for adolescents have not been systematically developed or tested. Personalized safety planning interventions that reflect teens' immediate risk, priorities, and resources may be a key prevention and empowerment tool. Thus, the current study examined adolescent perceptions of an existing safety planning app, myPlan. A small convenience sample of adolescents participated in focus groups. Focus groups investigated the feasibility of an app for TDV intervention and elicited feedback on how apps can better assist adolescents experiencing dating violence. Qualitative content analysis was used to identify themes and patterns in the data. The following themes emerged: (a) careful and thoughtful inclusion of diverse adolescents, (b) capturing unique safety dilemmas encountered by adolescents, (c) clarifying the signs of an unhealthy and abusive relationship, and (d) resources for immediate help. Adolescents were thoughtful in their consideration of the myPlan app and articulated specific ways in which future applications could be more responsive to their lived experiences and challenges. Mobile app or electronic interventions that are developed with an eye toward empowering adolescents to understand how abusive behaviors may manifest in their relationships, weigh the risk and benefits of intervening, and are informed about local resources available to them for help may be most successful in reducing TDV.

Exploring the Impact of Technology-Facilitated Abuse and Its Relationship with Domestic Violence: A Qualitative Study on Experts' Perceptions

Technology-facilitated abuse can be a serious form of domestic violence. Little is known about the relationship between technology-facilitated abuse and other types of domestic violence, or the impact technology-facilitated abuse has on survivors. The aim of this interpretative descriptive study is to understand domestic violence specialist service providers’ perspectives on the impact of technology-facilitated abuse, and the link between technology-facilitated abuse and other forms of domestic violence. A qualitative approach using 15 semi-structured interviews were undertaken with Australian domestic violence specialist practitioners, and three themes were identified through data coding using inductive thematic analysis. Another form of control describes technology-facilitated abuse behaviors as enacting controlling behaviors using new mediums. Amplifies level of fear characterizes the impact of technology-facilitated abuse. A powerful tool to engage others describes opportunities technology offers perpetrators to abuse through engaging others. Findings highlight technology-facilitated abuse’s complexity and integral role in domestic violence and can assist clinicians to understand the impact and harm that can result from technology-facilitated abuse.

Evidence for changing intimate partner violence safety planning needs as a result of COVID-19: results from phase I of a rapid intervention

OBJECTIVES

The aim of the study was to examine the need for modified safety planning strategies in response to COVID-19-related increases in intimate partner violence (IPV) as the initial phase of adapting an IPV safety planning intervention in Toronto, Ontario.

METHODS

A rapid, systematic review was conducted to elucidate existing safety planning strategies used during public health emergencies. These were supplemented with strategies from an expert panel. A survey of IPV survivors and service providers gauged the helpfulness of each strategy during COVID-19.

RESULTS

Together, the systematic review and expert panel yielded 26 conceptually distinct strategies, which were evaluated by 111 IPV survivors and providers. Of these, 19 (69%) were 'highly recommended', 3 (12%) were 'somewhat recommended' and 6 (23%) were not recommended for use during the COVID-19 pandemic because they might make the violence worse.

CONCLUSIONS

Safety planning needs have changed owing to the effect of COVID-19 on IPV incidence, service provision and risk factors, as well as policies restricting freedom of movement. These results will be used to modify an existing IPV safety planning mobile application for use during COVID-19 and future public health emergencies.

PROTOCOL: Technology-based and digital interventions for intimate partner violence: A meta-analysis and systematic review

Introduction

Studies show digital interventions such as mobile and wireless platforms (e.g., smartphone apps, text messaging) and web-based platforms (online support groups and telehealth services) can improve the mental health outcomes for victims/survivors of partner abuse. Depression, posttraumatic stress disorder (PTSD), and anxiety are three to five times higher among victims than nonvictims and are thus popular targets of digital interventions. Even then, the evidence is scant. The current review uses both narrative and quantitative (meta-analysis) techniques to present extensive evidence on the effects of intimate partner violence (IPV) digital interventions on the mental health outcomes among survivors of partner violence across all genders and ages, specifically, depression, anxiety, and PTSD. This is the first meta-analysis on IPV-related mental health outcomes targeted by digital interventions.

Objectives

To synthesize current evidence on the intervention and treatment effects of digital and technology-based interventions (mHealth and eHealth) addressing IPV mental health outcomes (depression, anxiety, and PTSD) among survivors of IPV. This study's research questions are as follows: (a) What are the overall average treatment effects of IPV digital interventions on IPV survivors' mental health outcomes? (b) Do these mental health outcomes vary based on methodological study designs, sample characteristics, and intervention characteristics?

Methods

An extensive search strategy will be utilized to find qualifying studies. Various electronic bibliographic databases will be searched for studies since 2009 (coinciding with the onset of mobile health interventions). Other databases, such as government databases, grey literature databases, trial registers, specialty journals, and citations in other studies will be searched. Also, we will search "grey databases," such as Google Scholar. Ethical and safety concerns preclude the randomization of IPV survivors to specific intervention conditions. Therefore, we will not exclude studies based on a lack of random assignment. Studies will be full-text accessible, published in any language (translatable into English). We will also contact researchers where needed data is missing in their report. Neither language, study location, nor study settings will be a limiter for searches. Keyword and MeSH headings will be used. Effect sizes (Hedges' g) will be estimated with a Type I error rate set at an alpha of .05.

Results

All studies will measure IPV-related mental health as an outcome and provide outcome data to calculate effect sizes for PTSD, anxiety, depression, and victimization (physical, psychological, and sexual violence).

Conclusion

Digital interventions may clinically reduce depression, anxiety, PTSD, and IPV victimization. Summary effect sizes ranging from small to large will signal the usefulness of digital interventions to IPV survivors contending with common mental health issues. Future studies beyond this one may identify other active intervention ingredients of digital interventions, best modes of delivery, and guidelines to increase their feasibility and acceptability.

Mobile Remote Monitoring of Intimate Partner Violence Among Pregnant Patients During the COVID-19 Shelter-In-Place Order: Quality Improvement Pilot Study

BACKGROUND

Intimate partner violence (IPV) is one of the leading causes of pregnancy-related death. Prenatal health care providers can offer critical screening and support to pregnant people who experience IPV. During the COVID-19 shelter-in-place order, mobile apps may offer such people the opportunity to continue receiving screening and support services.

OBJECTIVE

We aimed to examine cases of IPV that were reported on a prenatal care app before and during the implementation of COVID-19 shelter-in-place mandates.

METHODS

The number of patients who underwent voluntary IPV screening and the incidence rate of IPV were determined by using a prenatal care app that was disseminated to patients from a single, large health care system. We compared the IPV screening frequencies and IPV incidence rates of patients who started using the app before the COVID-19 shelter-in-place order, to those of patients who started using the app during the shelter-in-place order.

RESULTS

We found 552 patients who started using the app within 60 days prior to the enforcement of the shelter-in-place order, and 407 patients who used the app at the start of shelter-in-place enforcement until the order was lifted. The incidence rates of voluntary IPV screening for new app users during the two time periods were similar (before sheltering in place: 252/552, 46%; during sheltering in place: 163/407, 40%). The overall use of the IPV screening tool increased during the shelter-in-place order. A slight, nonsignificant increase in the incidence of physical, sexual, and psychological violence during the shelter-in-place order was found across all app users (P=.56). Notably, none of the patients who screened positively for IPV had mentions of IPV in their medical charts.

CONCLUSIONS

App-based screening for IPV is feasible during times when in-person access to health care providers is limited. Our results suggest that the incidence of IPV slightly increased during the shelter-in-place order. App-based screening may also address the needs of those who are unwilling or unable to share their IPV experiences with their health care provider.

Population-Based Approaches to Prevent Domestic Violence against Women Using a Systematic Review

Objective: In this systematic review, we aimed to evaluate the existing strategies and interventions in domestic violence prevention to assess their effectiveness. Method : To select studies, Pubmed, ISI, CINAHL, PsycINFO, Cochrane, Scopus, Embase, Ovid, Science Direct, ProQuest, and Elsevier databases were searched. Two authors reviewed all papers using established inclusion/ exclusion criteria. Finally, 18 articles were selected and met the inclusion criteria for assessment. Following the Cochrane quality assessment tool and AHRQ Standards, the studies were classified for quality rating based on design and performance quality. Two authors separately reviewed the studies and categorized them as good, fair, and poor quality. Results: Most of the selected papers had fair- or poor-quality rating in terms of methodology quality. Different intervention methods had been used in these studies. Four studies focused on empowering women; 3, 4, and 2 studies were internet-based interventions, financial interventions, and relatively social interventions, respectively. Four interventions were also implemented in specific groups. All authors stated that interventions were effective. Conclusion: Intervention methods should be fully in line with the characteristics of the participants. Environmental and cultural conditions and the role of the cause of violence are important elements in choosing the type of intervention. Interventions are not superior to each other because of their different applications.

An Integrative Review of Safety Strategies for Women Experiencing Intimate Partner Violence in Low- and Middle-Income Countries

Intimate partner violence (IPV) is prevalent and a leading source of morbidity and mortality to women worldwide. Safety planning is a cornerstone of harm reduction and violence support in many upper income countries. Far less is known about safety strategies used by women in low- and middle-income countries (LMICs) where the IPV support service infrastructure may be more limited. This study aimed to review the literature regarding safety strategies in LMICs. A PubMed search was conducted using search terms "safety," "coping," "harm reduction," and "intimate partner violence." Inclusion criteria comprised IPV studies mentioning characterization and utilization of safety strategies that were written in English and conducted in an LMIC. Our search yielded 16 studies (in-depth interviews, n = 5; focus group discussions, n = 2; case study, n = 2; mixed qualitative methods, n = 4; mixed methods, n = 1; and semi-structured quantitative survey, n = 2). Four distinct themes of strategies emerged: engaging informal networks, removing the stressor/avoidance, minimizing the damage to self and family through enduring violence, and building personal resources. IPV-related safety strategies literature primarily emerged from site-specific qualitative work. No studies provided effectiveness data for utilized strategies. Across geoculturally diverse studies, results indicate that women are engaging in strategic planning to minimize abuse and maximize safety. Women highlighted that safety planning strategies were feasible and acceptable within their communities. Further research is needed to test the effectiveness of these strategies in decreasing revictimization and increasing health and well-being. Further adoption of safety strategies into violence programming could increase monitoring and evaluation efforts.

Intimate Partner Violence and Electronic Health Interventions: Systematic Review and Meta-Analysis of Randomized Trials

BACKGROUND

Intimate partner violence (IPV) is a major public health concern. eHealth interventions may reduce exposure to violence and health-related consequences as the technology provides a safe and flexible space for the target population. However, the evidence is unclear.

OBJECTIVE

The goal of the review is to examine the effect of eHealth interventions compared with standard care on reducing IPV, depression, and posttraumatic stress disorder (PTSD) among women exposed to IPV.

METHODS

We searched EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, PsycInfo, Scopus, Global Health Library, ClinicalTrials.gov, and International Clinical Trials Registry Platform for published and unpublished trials from inception until April 2019. Trials with an eHealth intervention targeting women exposed to violence were included. We assessed risk of bias using the Cochrane Risk of Bias Tool. Trials that reported effect estimates on overall IPV; physical, sexual, and psychological violence; depression; or posttraumatic stress disorder were included in meta-analyses.

RESULTS

A total of 14 trials were included in the review; 8 published trials, 3 unpublished trials and 3 ongoing trials. Of the 8 published trials, 2 were judged as overall low risk of bias trials. The trials reported 23 types of outcomes, and 7 of the trials had outcomes that were eligible for meta-analyses. Our pooled analyses found no effect of eHealth interventions on any of our prespecified outcomes: overall IPV (SMD -0.01; 95% CI -0.11 to 0.08; I2=0%; 5 trials, 1668 women); physical violence (SMD 0.01; 95% CI -0.22 to 0.24; I2=58%; 4 trials, 1128 women); psychological violence (SMD 0.07; 95% CI -0.12 to 0.25; I2=40%; 4 trials, 1129 women); sexual violence (MD 0.36; 95% CI -0.18 to 0.91; I2=0%; 2 trials, 1029 women); depression (SMD -0.13; 95% CI -0.37 to 0.11; I2=78%; 5 trials, 1600 women); and PTSD (MD -0.11; 95% CI -1.04 to 0.82; I2=0%; 5 trials, 1267 women).

CONCLUSIONS

There is no evidence from randomized trials of a beneficial effect of eHealth interventions on IPV. More high-quality trials are needed, and we recommend harmonizing outcome reporting in IPV trials by establishing core outcome sets.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42019130124; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=130124.

Informing Human Trafficking Clinical Care Through Two Systematic Reviews on Sexual Assault and Intimate Partner Violence

BACKGROUND

There is a lack of evidence on the clinical management of patients who have suffered human trafficking. Synthesizing the evidence from similar patient populations may provide valuable insight. This review summarizes findings on therapeutic interventions for survivors of sexual assault and intimate partner violence (IPV).

METHOD

We conducted two systematic reviews using the MEDLINE database. We included only randomized controlled trials of therapies with primary outcomes related to health for survivors of sexual assault and IPV. For the sexual assault review, there were 78 abstracts identified, 16 full-text articles reviewed, and 10 studies included. For the IPV review, there were 261 abstracts identified, 24 full-text articles reviewed, and 17 studies included. Analysis compared study size, intervention type, patient population, primary health outcomes, and treatment effect.

RESULTS

Although our search included physical and mental health outcomes, almost all the studies meeting inclusion and exclusion criteria focused on mental health. The interventions for sexual assault included spiritually focused group therapy, interference control training, image rehearsal therapy, sexual revictimization prevention, educational videos, cognitive behavioral therapy, and exposure therapy. The interventions in the IPV review included group social support therapy, exposure therapy, empowerment sessions, physician counseling, stress management programs, forgiveness therapy, motivational interviewing, and interpersonal psychotherapy.

CONCLUSIONS

Insights from these reviews included the importance of culturally specific group therapy, the central role of survivor empowerment, and the overwhelming focus on mental health. These key features provide guidance for the development of interventions to improve the health of human trafficking survivors.

Trying Times and Trying Out Solutions: Intimate Partner Violence Screening and Support for Women Veterans During COVID-19

Initial reports indicate widespread increases in intimate partner violence (IPV) rates during the coronavirus disease 2019 (COVID-19) pandemic. Women veterans are at particular risk for experiencing IPV, and the COVID-19 pandemic and resulting stay-at-home orders may be exacerbating this risk. IPV screening and intervention are an integral part of the care provided to women veterans in the Veteran's Health Administration (VHA). Current changes in healthcare delivery during COVID-19 may present challenges to the VHA's standard methods of initiating IPV screening and intervention with women veterans. We discuss the potential challenges VHA healthcare providers may be encountering when conducting routine IPV screening during the COVID-19 pandemic and when providing resources and support to women veterans experiencing IPV. We describe solutions to these challenges, including existing efforts led by the VHA IPV Assistance Program (IPVAP) as well as additional potential solutions. New ideas and partnerships will be critical for helping the VHA continue to assist women veterans experiencing IPV as the COVID-19 pandemic evolves. Though our focus is on women veterans and the VHA, the challenges and solutions we discuss are likely applicable to other populations experiencing IPV and other health care systems screening for IPV.