I-DECIDE: An Online Intervention Drawing on the Psychosocial Readiness Model for Women Experiencing Domestic Violence

A Trauma-Informed HIV Intervention (LinkPositively) to Improve HIV Care Among Black Women Affected by Interpersonal Violence: Protocol for a Pilot Randomized Controlled Trial

BACKGROUND

Black women bear a disproportionate burden of HIV, accounting for nearly 60% of new diagnoses among US women. Black women living with HIV often experience mutually reinforcing epidemics, known as syndemics, including interpersonal violence and substance use. Syndemics are associated with decreased HIV care engagement and treatment adherence and worsening HIV outcomes. Few HIV services and resources are tailored to be culturally and gender-responsive and trauma informed for Black women living with HIV. Technology-based, psychoeducational, and peer navigation programs offer promising pathways to tailored HIV support and improved HIV care outcomes. Therefore, the web-based, trauma-informed intervention LinkPositively was developed in collaboration with Black women living with HIV to promote uptake of HIV care and ancillary support services.

OBJECTIVE

This study primarily determines the feasibility and acceptability of the LinkPositively intervention among Black women living with HIV affected by interpersonal violence. The secondary aim is to examine the preliminary impact of the LinkPositively intervention on retention in HIV care, antiretroviral therapy adherence, and viral suppression while evaluating the role of mechanism of change variables (eg, social support) in the associations.

METHODS

The LinkPositively trial is a pilot randomized controlled trial conducted in California, United States, among 80 adult Black women living with HIV who have experienced interpersonal violence. Core components of LinkPositively include one-on-one peer navigation with phone and SMS text message check-ins; 5 weekly one-on-one video sessions to build coping and care navigation skills; and a mobile app that contains a peer support social networking platform, an educational database with healthy living and self-care tips, a GPS-enabled HIV and ancillary care resource locator, and a medication self-monitoring and reminder system. Participants are randomly assigned to the intervention (n=40) or control (Ryan White standard of care; n=40) arm, with follow-up at 3 and 6 months. At each assessment, participants complete an interviewer-administered survey and submit hair samples for the assessment of HIV medication adherence. All research staff and investigators adhere to ethical principles and guidelines for conducting research activities. Data will be analyzed using generalized estimating equations.

RESULTS

Final development and testing of the LinkPositively app were completed in July 2021. As of May 2023, we have screened 97 women for eligibility. Of the 97 women screened, 27 (28%) were eligible and have been enrolled in the study. The dissemination of preliminary results will occur in 2024.

CONCLUSIONS

This trial will advance HIV prevention science by harnessing technology to promote engagement in HIV care while improving social support through peers and social networking-all while being trauma informed for Black women living with HIV with experiences of interpersonal violence. If shown to be feasible and acceptable, LinkPositively has the potential to improve HIV care outcomes among Black women, a marginalized key population.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/46325.

The Rapid Uptake of Digital Technologies at Domestic Violence and Sexual Assault Organizations During the COVID-19 Pandemic

Emerging evidence suggests that the COVID-19 pandemic disproportionately impacted survivors of domestic violence and sexual assault (DV/SA). This research note explores DV/SA service providers' (n = 20) perceptions of how their organizations responded to the pandemic. Results of a thematic content analysis indicated that survivors were adversely affected by sheltering with abusive partners and by external environmental conditions. Organizations responded to shifting community needs by adapting face-to-face services to virtual formats and revising pre pandemic safety planning protocols. School-based prevention programming required significant adjustments. Therefore, the pandemic catalyzed the integration and optimization of emerging technologies and provided opportunities for organizational innovation.

Online Guidance for Domestic Violence Survivors and Service Providers: A COVID-19 Content Analysis

To assess COVID-19 information and services available to domestic violence service providers, survivors, and racially and culturally specific communities in the U.S., a content analysis of 80 national and state/territorial coalition websites was performed in June 2020. COVID-19 information was available on 84% of websites. National organizations provided more information for survivors related to safety and mental health and for racially and culturally specific communities. State/territorial coalitions provided more information for providers on COVID-19 and general disaster preparedness. COVID-19 and social distancing measures implemented to control it diminished help-seeking in unique ways. Greater online access to information and resources may be needed to address changing needs of survivors during disasters and emergencies.

Uses of mHealth in Injury Prevention and Control: a Critical Review

Purpose of Reviews

The purpose of this review was to summarize the current state of the literature on the use of "mHealth" (the use of mobile devices for health promotion) for injury prevention and control.

Recent Findings

mHealth is being used to measure, predict, and prevent the full spectrum of injuries. However, most literature remains preliminary or in a pilot stage. Use of best-of-class design principles (e.g., user-centered design, theory-based development) is uncommon, and wide-scale dissemination of effective monitoring or intervention tools is rare.

Summary

mHealth for injury prevention holds promise, but further work is needed across the full spectrum of development and translation.

Women's EmotionS, Trauma and EmpowErMent (W-ES.T.EEM) study protocol: a psychoeducational support intervention for victims of domestic violence - a randomised controlled trial

INTRODUCTION

Intimate partner violence (IPV) is a widespread phenomenon that affects the physical and mental well-being of victims. Several barriers prevented sufferers from receiving face-to-face interventions. These obstacles increased with the advent of the COVID-19 pandemic, and online psychological intervention can represent a valid solution to increase the well-being of IPV victims. This manuscript describes the study protocol for a single blind randomised controlled trial that examines the efficacy of a web-based psychoeducational intervention for IPV victims that integrates dialectical behavioural therapy and the empowerment approach.

METHODS AND ANALYSIS

Eighty-six women who were victims of IPV during the COVID-19 outbreak will be recruited by the Interdepartmental Center for Family Research (CIRF) staff from the several antiviolence centres located in Italy. Participants will be randomly allocated to the Women's EmotionS, Trauma and EmpowErMent experimental group or the treatment as usual control condition. Both interventions will be administered individually to each woman.

ETHICS AND DISSEMINATION

The study protocol was approved by the Ethics Committee of the University of Padua (protocol no 4300). Written informed consent will be obtained from all research participants before study entry. Study results will be published as peer-reviewed articles. Any relevant protocol changes will be reported in the published articles. The results will be reported anonymously.

TRIAL REGISTRATION NUMBER

ISRCTN12880309.

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.

An Evidence Synthesis of Covert Online Strategies Regarding Intimate Partner Violence

This systematic review synthesizes evidence of how people use the internet to deploy covert strategies around escaping from, or perpetrating, intimate partner violence (IPV). Online tools and services can facilitate individuals leaving abusive relationships, yet they can also act as a barrier to departure. They may also enable abusive behaviors. A comprehensive literature search of published and unpublished studies in electronic databases was conducted. Two researchers independently screened abstracts and full texts for study eligibility and evaluated the quality of included studies. The systematic review includes 22 studies (9 qualitative and 11 cross-sectional studies, a randomized control trial [RCT] and a nonrandomized study [NRS]) published between 2004 and 2017. Four covert behaviors linked to covert online strategies around IPV were identified: presence online, granular control, use of digital support tools and services, and stalking and surveillance. The same technology that provides individuals with easy access to information and supportive services related to IPV, such as digital devices, tools, and services, also enables perpetrators to monitor or harass their partners. This review takes a rigorous interdisciplinary approach to synthesizing knowledge on the covert strategies adopted by people in relation to IPV. It has particular relevance to practitioners who support survivors in increasing awareness of the role of digital technologies in IPV, to law enforcement agencies in identifying new forms of evidence of abuse, and in enabling designers of online/social media applications to take the needs and vulnerabilities of IPV survivors into account.

Antenatal-Based Pilot Psychosocial Intervention to Enhance Mental Health of Pregnant Women Experiencing Domestic and Family Violence in Nepal

Survivors of domestic and family violence (DFV) report poorer quality of life and worsening mental health. This study evaluated the effect of a counseling and education intervention on the mental health and help-seeking behaviors among pregnant women living with DFV. A parallel pilot randomized controlled trial was performed among 140 pregnant women attending an antenatal clinic of a tertiary hospital of Nepal. Using computer-generated random numbers, participants were randomized to the intervention group (a counseling session, an information booklet about DFV, and contact details of the counselor) or a control group (usual care plus a booklet containing contact details of local DFV support services). Outcome measures included mental health, quality of life (QOL), self-efficacy, social support, and safety planning behaviors. Analyses followed intention-to-treat, using the generalized estimating equation model. Intervention participants showed significant improvements in anxiety (β = -3.24, p < .001) and depression (β = -3.16, p < .001) at postintervention. Such improvements were also sustained at follow-up assessment (p < .001). Significant group and time interaction for QOL, social support, use of safety behaviors, and self-efficacy (p < .05) revealed a greater increase in these outcome measures among intervention participants at both follow-up assessments compared with the control group. This pilot integrated intervention showed promising outcomes in improving the mental health, social support, and the use of safety behaviors among women with DFV. This intervention could be incorporated into regular antenatal care as a strategy to identify and support victims of DFV. Larger controlled trials with longer follow-up are needed to support and expand on the current findings regarding the effectiveness of a psychosocial intervention targeting victims of DFV in resource-constrained settings.

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.

Mental health solutions for domestic violence victims amid COVID-19: a review of the literature

BACKGROUND

Due to COVID-19, domestic violence victims face a range of mental health challenges, possibly resulting in substantial human and economic consequences. However, there is a lack of mental health interventions tailored to domestic violence victims and in the context of COVID-19. In this study, we aim to identify interventions that can improve domestic violence victims' mental health amid the COVID-19 pandemic to address the research gap.

MAIN TEXT

Drawing insights from established COVID-19 review frameworks and a comprehensive review of PubMed literature, we obtained information on interventions that can address domestic violence victims' mental health challenges amid COVID-19. We identified practical and timely solutions that can be utilized to address mental health challenges domestic violence victims face amid COVID-19, mainly focusing on (1) decreasing victims' exposure to the abuser and (2) increasing victims' access to mental health services.

CONCLUSION

Domestic violence is a public health crisis that affects all demographics and could result in significant morbidity and mortality. In addition to emphasizing mental health challenges faced by domestic violence victims, multidisciplinary interventions are identified that could provide timely and practical solutions to domestic violence victims amid the pandemic, which range from tailored shelter home strategies, education programs, escape plans, laws and regulations, as well as more technology-based mental health solutions. There is a significant need for more multipronged and multidisciplinary strategies to address domestic violence amid and beyond the pandemic, particularly interventions that could capitalize on the ubiquity and cost-effectiveness of technology-based solutions.

"Leaving Was a Process, Not an Event": The Lived Experience of Dating and Domestic Violence in 140 Characters

One of the most frequent refrains heard in the public discourse on intimate partner violence (IPV) is why do they stay? The literature has demonstrated that IPV victims face multiple barriers to safely exiting their relationships. Currently, there has been a limited examination of the role social media can play in elucidating the lived experience of IPV. With 25% of the population using Twitter, there are opportunities to examine its utility for deepening understandings of IPV. Using data generated from the #WhyIStayed Twitter campaign, the purpose of this study is to examine Twitter users' reasons for staying in their abusive relationships. The study sample (n = 3,086) is composed of a random sample of 61,725 English speaking tweets globally that employed the #WhyIStayed and #WhyILeft hashtags. We analyzed all tweets using thematic content analysis methods. This process involved multiple rounds of coding. In response to #WhyIStayed, Tweeters worldwide shared the barriers they faced that made leaving their abusive partners difficult. Seven primary themes emerged that influenced their decision-making processes: (a) impact of IPV on personal well-being, (b) lack of awareness regarding the dynamics of abusive relationships, (c) not identifying as a stereotypical IPV victim, (d) fear of reinforcing racial stereotypes, (e) internalizing social scripts regarding relationships, (f) structural barriers, and (g) leaving takes time. Twitter messages have the capacity to function as micronarratives that recount the complex barriers IPV victims confront when negotiating their relationships. This analysis provides a multifaceted description of the challenges associated with leaving abusive relationships that can augment existing theoretical frameworks on victim readiness. Furthermore, these findings demonstrate the myriad ways that societal representations of domestic violence (DV) serve as impediments for victims leaving their abusive relationships. Therefore, social media has the potential to provide a platform for capturing the lived experience of IPV.

Psychological therapies for women who experience intimate partner violence

BACKGROUND

Intimate partner violence (IPV) against women is prevalent and strongly associated with mental health problems. Women experiencing IPV attend health services frequently for mental health problems. The World Health Organization recommends that women who have experienced IPV and have a mental health diagnosis should receive evidence-based mental health treatments. However, it is not known if psychological therapies work for women in the context of IPV and whether they cause harm.

OBJECTIVES

To assess the effectiveness of psychological therapies for women who experience IPV on the primary outcomes of depression, self-efficacy and an indicator of harm (dropouts) at six- to 12-months' follow-up, and on secondary outcomes of other mental health symptoms, anxiety, quality of life, re-exposure to IPV, safety planning and behaviours, use of healthcare and IPV services, and social support.

SEARCH METHODS

We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR), CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, and three other databases, to the end of October 2019. We also searched international trials registries to identify unpublished or ongoing trials and handsearched selected journals, reference lists of included trials and grey literature.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), quasi-RCTs, cluster-RCTs and cross-over trials of psychological therapies with women aged 16 years and older who self-reported recent or lifetime experience of IPV. We included trials if women also experienced co-existing mental health diagnoses or substance abuse issues, or both. Psychological therapies included a wide range of interventions that targeted cognition, motivation and behaviour compared with usual care, no treatment, delayed or minimal interventions. We classified psychological therapies according to Cochrane Common Mental Disorders's psychological therapies list.

DATA COLLECTION AND ANALYSIS

Two review authors extracted data and undertook 'Risk of Bias' assessment. Treatment effects were compared between experimental and comparator interventions at short-term (up to six months post-baseline), medium-term (six to under 12 months, primary outcome time point), and long-term follow-up (12 months and above). We used standardised mean difference (SMD) for continuous and odds ratio (OR) for dichotomous outcomes, and used random-effects meta-analysis, due to high heterogeneity across trials.

MAIN RESULTS

We included 33 psychological trials involving 5517 women randomly assigned to experimental (2798 women, 51%) and comparator interventions (2719 women, 49%). Psychological therapies included 11 integrative therapies, nine humanistic therapies, six cognitive behavioural therapy, four third-wave cognitive behavioural therapies and three other psychologically-orientated interventions. There were no trials classified as psychodynamic therapies. Most trials were from high-income countries (19 in USA, three in Iran, two each in Australia and Greece, and one trial each in China, India, Kenya, Nigeria, Pakistan, Spain and UK), among women recruited from healthcare, community, shelter or refuge settings, or a combination of any or all of these. Psychological therapies were mostly delivered face-to-face (28 trials), but varied by length of treatment (two to 50 sessions) and staff delivering therapies (social workers, nurses, psychologists, community health workers, family doctors, researchers). The average sample size was 82 women (14 to 479), aged 37 years on average, and 66% were unemployed. Half of the women were married or living with a partner and just over half of the participants had experienced IPV in the last 12 months (17 trials), 6% in the past two years (two trials) and 42% during their lifetime (14 trials). Whilst 20 trials (61%) described reliable low-risk random-sampling strategies, only 12 trials (36%) described reliable procedures to conceal the allocation of participant status. While 19 trials measured women's depression, only four trials measured depression as a continuous outcome at medium-term follow-up. These showed a probable beneficial effect of psychological therapies in reducing depression (SMD -0.24, 95% CI -0.47 to -0.01; four trials, 600 women; moderate-certainty evidence). However, for self-efficacy, there may be no evidence of a difference between groups (SMD -0.12, 95% CI -0.33 to 0.09; one trial with medium-term follow-up data, 346 women; low-certainty evidence). Further, there may be no difference between the number of women who dropped out from the experimental or comparator intervention groups, an indicator of no harm (OR 1.04, 95% CI 0.75 to 1.44; five trials with medium-term follow-up data, 840 women; low-certainty evidence). Although no trials reported adverse events from psychological therapies or participation in the trial, only one trial measured harm outcomes using a validated scale. For secondary outcomes, trials measured anxiety only at short-term follow-up, showing that psychological therapies may reduce anxiety symptoms (SMD -0.96, 95% CI -1.29 to -0.63; four trials, 158 women; low-certainty evidence). However, within medium-term follow-up, low-certainty evidence revealed that there may be no evidence between groups for the outcomes safety planning (SMD 0.04, 95% CI -0.18 to 0.25; one trial, 337 women), post-traumatic stress disorder (SMD -0.24, 95% CI -0.54 to 0.06; four trials, 484 women) or re-exposure to any form of IPV (SMD 0.03, 95% CI -0.14 to 0.2; two trials, 547 women).

AUTHORS' CONCLUSIONS

There is evidence that for women who experience IPV, psychological therapies probably reduce depression and may reduce anxiety. However, we are uncertain whether psychological therapies improve other outcomes (self-efficacy, post-traumatic stress disorder, re-exposure to IPV, safety planning) and there are limited data on harm. Thus, while psychological therapies probably improve emotional health, it is unclear if women's ongoing needs for safety, support and holistic healing from complex trauma are addressed by this approach. There is a need for more interventions focused on trauma approaches and more rigorous trials (with consistent outcomes at similar follow-up time points), as we were unable to synthesise much of the research.

Perspectives of Victims of Gender Violence

The purpose of the current study was to explore the experiences of women who have been affected by violence and received mental health care. A qualitative phenomenological design was used with in-depth interviews and personal letters in a sample of 29 women from a public mental health center of Madrid, Spain, who were affected by physical, mental, and/or sexual abuse. The analysis revealed three themes: (1) Living With Fear; (2) Feeling Guilty; and (3) Experiencing the Imposition of So-Called "Womanly Duties" (i.e., being a maid, babysitter, and/or sexual slave). The current study highlights the importance of developing educational programs for the prevention of abuse. [Journal of Psychosocial Nursing and Mental Health Services, 58(6), 30-39.].

Guidance for reporting intervention development studies in health research (GUIDED): an evidence-based consensus study

OBJECTIVE

To improve the quality and consistency of intervention development reporting in health research.

DESIGN

This was a consensus exercise consisting of two simultaneous and identical three-round e-Delphi studies (one with experts in intervention development and one with wider stakeholders including funders, journal editors and public involvement members), followed by a consensus workshop. Delphi items were systematically derived from two preceding systematic reviews and a qualitative interview study.

PARTICIPANTS

Intervention developers (n=26) and wider stakeholders (n=18) from the UK, North America and Europe participated in separate e-Delphi studies. Intervention developers (n=13) and wider stakeholders (n=13) participated in a 1-day consensus workshop.

RESULTS

e-Delphi participants achieved consensus on 15 reporting items. Following feedback from the consensus meeting, the final inclusion and wording of 14 items with description and explanations for each item were agreed. Items focus on context, purpose, target population, approaches, evidence, theory, guiding principles, stakeholder contribution, changes in content or format during the development process, required changes for subgroups, continuing uncertainties, and open access publication. They form the GUIDED (GUIDance for the rEporting of intervention Development) checklist, which contains a description and explanation of each item, alongside examples of good reporting.

CONCLUSIONS

Consensus-based reporting guidance for intervention development in health research is now available for publishers and researchers to use. GUIDED has the potential to lead to greater transparency, and enhance quality and improve learning about intervention development research and practice.

Mental and Active Preparation: Examining Variations in Women's Processes of Preparing to Leave Abusive Relationships

Although the process of leaving abusive relationships has received increased research attention, preparing to leave is still largely understudied. Despite an emphasis on safety planning, not all women take active steps to prepare, and the characteristics and experiences of those who do or do not actively prepare are unknown. We address this gap with a secondary data analysis of interviews with 25 abused mothers in the process of leaving. All women initially engaged in mental planning, where they had emotionally disconnected from their partners. Using constructivist grounded theory techniques, we identified two distinct groups: those whose mental planning led to active planning (n = 11), and those who moved directly from mental planning to leaving (n = 14) with little time or need to actively plan. The groups differed on several individual, relationship, and child factors, which may have impacted the ability or decisions to prepare. This study supports the feminist view that survivors are not helpless victims but active agents who strategize for safety. Those who engage solely in mental planning still prepare to leave, even if they do not engage in active planning. Practitioners should consider factors affecting preparations and acknowledge mental planning as a necessary effort in leaving.

Counselling-based psychosocial intervention to improve the mental health of abused pregnant women: a protocol for randomised controlled feasibility trial in a tertiary hospital in eastern Nepal

INTRODUCTION

The strong correlation between domestic and family violence (DFV) and mental health has been well documented in studies. Pregnancy is a period when both DFV and mental distress tend to occur and/or accentuate. Although limited, available evidence from developed countries has shown continual support and education as psychological first aid that can reduce DFV and improve mental health. However, there is significantly less number of studies from resource-constrained countries; thus, there continues to be a substantial gap in knowledge and awareness regarding effective interventions for DFV.

METHODS AND ANALYSIS

A two-arm randomised trial with a nested qualitative study has been planned to assess feasibility and treatment effect estimates of a counselling-based psychosocial intervention among pregnant women with a history of abuse. A total of 140 pregnant women who meet the inclusion criteria will be recruited into the study. Block randomisation will be used to allocate women equally into two groups. The intervention group will receive a counselling session, an information booklet and continuous support by a researcher, while women in the control group will receive contact information of local support services. Feasibility measures, such as rates of recruitment, consent and retention, will be calculated. Qualitative interviews with participants and healthcare providers will explore the acceptability and usability of the intervention. Outcome measures, such as psychological distress, quality of life, social support and self-efficacy, will be measured at baseline, 4 weeks postintervention and 6 weeks postpartum.

ETHICS AND DISSEMINATION

This study has obtained ethical approval from the Griffith University Human Research Ethics Committee, the Nepal Health Research Council and the Institutional Review Board of a tertiary hospital in Dharan, Nepal. The findings will be disseminated via peer-reviewed publications and conference presentations and will be used to inform a future multicentre trial.

TRIAL REGISTRATION NUMBER

12618000307202; Pre-results.

Interventions for reducing and/or controlling domestic violence among pregnant women in low- and middle-income countries: a systematic review

BACKGROUND

Domestic violence (DV) during pregnancy is recognized as a global health problem associated with serious health consequences for both the mother and her baby. Several interventions aimed at addressing DV around the time of pregnancy have been developed in the last decade, but they are primarily from developed countries. Low- and middle-income countries (LMICs) are facing both a mounting burden of DV as well as severe resource constraints that keep them from emulating some of the effective interventions implemented in developed settings. A systematic review was conducted to examine the approaches and effects of interventions designed for reducing or controlling DV among pregnant women in LMICs.

METHODS

Electronic databases were systematically searched, and the search was augmented by bibliographic reviews and expert consultations. Two reviewers assessed eligibility and quality of the studies and extracted data independently. The third reviewer was involved to resolve any discrepancies between the reviewers. Due to the limited number of studies and varied outcomes, a meta-analysis was not possible. Primary outcomes of this review included frequency and/or severity of DV and secondary outcomes included mental health, safety behaviours, and use of community resources. In addition, findings from the critical appraisal of studies were utilised to inform the initial draft of Theory of Change (ToC).

RESULTS

Only five studies (two randomized trials and three non-randomized trials) met the eligibility criteria. The interventions consisting of supportive counselling demonstrated a reduction in DV and an improvement in use of safety behaviours. One study has embedded the DV intervention into an existing program on human immunodeficiency virus (HIV). Limited evidence could be drawn for outcomes such as quality of life and the use of community resources.

DISCUSSION

This review attempted to address the knowledge gap by collating evidence on interventions aimed at addressing DV among pregnant women in LMICs. The development of a ToC was critical in understanding how certain activities led to the desired outcomes. This ToC can guide the design of future research and development of practice guidelines. The participatory involvement of the stakeholders is recommended to refine the current ToC to support its further development for practice.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, CRD42017073938.

The weWomen and ourCircle randomized controlled trial protocol: A web-based intervention for immigrant, refugee and indigenous women with intimate partner violence experiences

Intimate partner violence (IPV), including homicides is a widespread and significant public health problem, disproportionately affecting immigrant, refugee and indigenous women in the United States (US). This paper describes the protocol of a randomized control trial testing the utility of administering culturally tailored versions of the danger assessment (DA, measure to assess risk of homicide, near lethality and potentially lethal injury by an intimate partner) along with culturally adapted versions of the safety planning (myPlan) intervention: a) weWomen (designed for immigrant and refugee women) and b) ourCircle (designed for indigenous women). Safety planning is tailored to women's priorities, culture and levels of danger. Many abused women from immigrant, refugee and indigenous groups never access services [WHY?] and research is needed to support interventions that are most effective and suited to the needs of abused women from these populations in the US. In this two-arm trial, 1250 women are being recruited and randomized to either the web-based weWomen or ourCircle intervention or a usual safety planning control website. Data on outcomes (i.e., safety, mental health and empowerment) are collected at baseline and at 3, 6, and 12 months post- baseline. It is anticipated that the findings will result in an evidence-based culturally tailored intervention for use by healthcare and domestic violence providers serving immigrant, refugee and indigenous survivors of IPV. The intervention may not only reduce risk for violence victimization, but also empower abused women and improve their mental health outcomes.

Using Baseline Data to Predict Chronic PTSD 48-months After Mothers Report Intimate Partner Violence: Outcomes for Mothers and the Intergenerational Impact on Child Behavioral Functioning

Worldwide one in three women report intimate partner violence. Many of these women report long term mental health problems, especially PTSD, which is associated with negative problem solving, isolation, somatization, depression, and anxiety. Children are impacted by their exposure to domestic violence and experience internal (i.e., depression, anxiety) and external (i.e., hostility, delinquency) behavioral clinical problems. To predict which women will experience chronic PTSD symptoms, a PTSD predictor tool was developed and applied to PTSD symptom scores four years after 300 mothers with children (age 18 months to 16 years) received assistance for the violence. At four years, 266 (89%) of the 300 mother child dyads were retained. Of those, 245 met inclusion criteria for this study and 53% had scores above the clinical threshold for PTSD. The predictor tool performed well. There was a significant association, χ² (4) = 11.83, p = .019, Cramer's V = 0.229, between mothers predicted at low/some risk for chronic PTSD and scoring below the cut-off score for diagnostic PTSD symptoms at four years. Mothers predicted to be at extreme risk for chronic PTSD reported PTSD symptoms at or above the diagnostic level at 48 months. Children whose mothers had PTSD were at greater risk for Borderline/Clinical range behavioral problems compared to children whose mothers did not have PTSD. Relative risk values ranged from 2.07 (Externalizing) to 2.30 (Internalizing). When appropriate interventions are available, the PTSD predictor tool can assist with triage and guided referral of women at risk for chronic PTSD.

Resilience in Women who Experience Domestic Violence

Violence in the family constitutes a serious social and psychological problem with harmful consequences leading, among others, to changes in the psychological functioning of the victim and, secondarily, also the perpetrator. The aim of this study was to examine resilience in women experiencing domestic violence. The "Ego Resiliency Scale" (ERS) was used to study the group of women suffering domestic violence. The study group included 52 women aged 30-65 years (mean age: 40.15) using assistance of the Crisis Intervention Centre due to experienced domestic violence. They most often reported suffering psychological and physical violence, with the husband or intimate partner being the most common perpetrator. Study women experiencing domestic violence obtained significantly lower scores on the ERS. The lowest scores on the ERS were achieved by women suffering paternal violence, while the highest - by women experiencing violence on the part of the intimate partner. Resilience of study women suffering domestic violence was lower than resilience of the general population, i.e. individuals not experiencing domestic violence. Suffered violence inflicted by the father exerted the greatest adverse impact on resilience. It seems advisable to consider resilience in the process of providing women experiencing domestic violence with psychosocial help.

Efficacy of a Web-Based Safety Decision Aid for Women Experiencing Intimate Partner Violence: Randomized Controlled Trial

Background

Intimate partner violence (IPV) is a human rights violation and leading health burden for women. Safety planning is a hallmark of specialist family violence intervention, yet only a small proportion of women access formal services. A Web-based safety decision aid may reach a wide audience of women experiencing IPV and offer the opportunity to prioritize and plan for safety for themselves and their families.

Objective

The aim of this study was to test the efficacy of a Web-based safety decision aid (isafe) for women experiencing IPV.

Methods

We conducted a fully automated Web-based two-arm parallel randomized controlled trial (RCT) in a general population of New Zealand women who had experienced IPV in the past 6 months. Computer-generated randomization was based on a minimization scheme with stratification by severity of violence and children. Women were randomly assigned to the password-protected intervention website (safety priority setting, danger assessment, and tailored action plan components) or control website (standard, nonindividualized information). Primary endpoints were self-reported mental health (Center for Epidemiologic Studies Depression Scale-Revised, CESD-R) and IPV exposure (Severity of Violence Against Women Scale, SVAWS) at 12-month follow-up. Analyses were by intention to treat.

Results

Women were recruited from September 2012 to September 2014. Participants were aged between 16 and 60 years, 27% (111/412) self-identified as Māori (indigenous New Zealand), and 51% (210/412) reported at baseline that they were unsure of their future plans for their partner relationship. Among the 412 women recruited, retention at 12 months was 87%. The adjusted estimated intervention effect for SVAWS was −12.44 (95% CI −23.35 to −1.54) for Māori and 0.76 (95% CI −5.57 to 7.09) for non-Māori. The adjusted intervention effect for CESD-R was −7.75 (95% CI −15.57 to 0.07) for Māori and 1.36 (−3.16 to 5.88) for non-Māori. No study-related adverse events were reported.

Conclusions

The interactive, individualized Web-based isafe decision aid was effective in reducing IPV exposure limited to indigenous Māori women. Discovery of a treatment effect in a population group that experiences significant health disparities is a welcome, important finding.

Trial Registration

Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12612000708853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12612000708853 (Archived by Webcite at http://www.webcitation/61MGuVXdK)

Designing an Internet Intervention for Emerging Adults Who Experience Troubled Relationships

This article describes how the Internet Intervention Model (IIM) was used as an organizing framework to design a theoretically based Internet intervention for emerging adults who experience troubled intimate partner relationships. In the design process, the team addressed six fundamental questions related to the several components of the IIM. Decisions made regarding the design of the intervention based on the six questions are described. We focus in particular on how the intervention is based on the Theory of Emerging Adulthood and the Theory of Narrative Identity.

Methodological and Ethical Challenges in a Web-Based Randomized Controlled Trial of a Domestic Violence Intervention

The use of Web-based methods to deliver and evaluate interventions is growing in popularity, particularly in a health care context. They have shown particular promise in responding to sensitive or stigmatized issues such as mental health and sexually transmitted infections. In the field of domestic violence (DV), however, the idea of delivering and evaluating interventions via the Web is still relatively new. Little is known about how to successfully navigate several challenges encountered by the researchers while working in this area. This paper uses the case study of I-DECIDE, a Web-based healthy relationship tool and safety decision aid for women experiencing DV, developed in Australia. The I-DECIDE website has recently been evaluated through a randomized controlled trial, and we outline some of the methodological and ethical challenges encountered during recruitment, retention, and evaluation. We suggest that with careful consideration of these issues, randomized controlled trials can be safely conducted via the Web in this sensitive area.

What is the role of health systems in responding to domestic violence? An evidence review

Objective The aim of the present study was to review and analyse academic literature and program evaluations to identify promising evidence for health system responses to domestic violence in Australia and internationally. Methods English-language literature published between January 2005 and March 2016 was retrieved from search results using the terms ‘domestic violence’ or ‘intimate partner violence’ in different combinations with other relevant terms, resulting in 1671 documents, of which 59 were systematic reviews. Electronic databases (Medline (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psycinfo, Social work Abstracts, Informit, Violence and Abuse Abstracts, Family Studies Abstracts, Cochrane Library of Systematic Reviews and EMBASE) were searched and narrative analysis undertaken. Results This review details the evidence base for the following interventions by health services responding to domestic violence: first-line responses, routine screening, risk assessment and safety planning, counselling with women, mother–child interventions, responses to perpetrators, child protection notifications, training and system-level responses. Conclusions There is growing evidence for the effectiveness of health service interventions to reduce the extent of harm caused by domestic violence. What is known about the topic? Domestic violence is a significant problem globally with enormous human, social and economic costs. Although women who have experienced abuse make extensive use of healthcare services, health services have lagged behind the policing, criminal justice and other human service domains in responding to domestic violence. What does this paper add? The present comprehensive review identifies best-practice health system responses to domestic violence. What are the implications for practitioners? Health systems can play a key role in identifying and responding to domestic violence for women who often do not access other services. There is growing evidence for the effectiveness of health service interventions to reduce the extent of harm caused by domestic violence, in particular for specialist counselling, structured risk assessment and safety planning, training for first-line responses and interventions for mothers and children affected by domestic violence.

Assessing the feasibility of a web-based domestic violence intervention using chronic disease frameworks: reducing the burden of 'treatment' and promoting capacity for action in women abused by a partner

BACKGROUND

Domestic violence shares many features with chronic disease, including ongoing physical and mental health problems and eroded self-efficacy. Given the challenges around help-seeking for women experiencing domestic violence, it is essential that they be given support to 'self-manage' their condition. The growing popularity of web-based applications for chronic disease self-management suggests that there may be opportunities to use them as an intervention strategy for women experiencing domestic violence, however, as yet, little is known about whether this might work in practice.

DISCUSSION

It is critical that interventions for domestic violence-whether web-based or otherwise-promote agency and capacity for action rather than adding to the 'workload' of already stressed and vulnerable women. Although randomised controlled trials are vital to determine the effectiveness of interventions, robust theoretical frameworks can complement them as a way of examining the feasibility of implementing an intervention in practice. To date, no such frameworks have been developed for the domestic violence context. Consequently, in this paper we propose that it may be useful to appraise interventions for domestic violence using frameworks developed to help understand the barriers and facilitators around self-management of chronic conditions. Using a case study of an online healthy relationship tool and safety decision aid developed in Australia (I-DECIDE), this paper adapts and applies two theories: Burden of Treatment Theory and Normalisation Process Theory, to assess whether the intervention might increase women's agency and capacity for action. In doing this, it proposes a new theoretical model with which the practical application of domestic violence interventions could be appraised in conjunction with other evaluation frameworks. This paper argues that theoretical frameworks for chronic disease are appropriate to assess the feasibility of implementing interventions for domestic violence in practice. The use of the modified Burden of Treatment/Normalisation Process Theory framework developed in this paper strengthens the case for I-DECIDE and other web-based applications as a way of supporting women experiencing domestic violence.

Infusing Technology Into Perinatal Home Visitation in the United States for Women Experiencing Intimate Partner Violence: Exploring the Interpretive Flexibility of an mHealth Intervention

Background

Intimate partner violence (IPV) is common during pregnancy and the postpartum. Perinatal home visitation provides favorable conditions in which to identify and support women affected by IPV. However, the use of mHealth for delivering IPV interventions in perinatal home visiting has not been explored.

Objective

Our objective was to conduct a nested qualitative interpretive study to explore perinatal home visitors’ and women’s perceptions and experiences of the Domestic Violence Enhanced Home Visitation Program (DOVE) using mHealth technology (ie, a computer tablet) or a home visitor-administered, paper-based method.

Methods

We used purposive sampling, using maximum variation, to select women enrolled in a US-based randomized controlled trial of the DOVE intervention for semistructured interviews. Selection criteria were discussed with the trial research team and 32 women were invited to participate. We invited 45 home visitors at the 8 study sites to participate in an interview, along with the 2 DOVE program designers. Nonparticipant observations of home visits with trial participants who chose not to participate in semistructured interviews were undertaken.

Results

We conducted 51 interviews with 26 women, 23 home visiting staff at rural and urban sites, and the 2 DOVE program designers. We conducted 4 nonparticipant observations. Among 18 IPV-positive women, 7 used the computer tablet and 11 used the home visitor method. Among 8 IPV-negative women, 7 used the home visitor method. The computer tablet was viewed as a safe and confidential way for abused women to disclose their experiences without fear of being judged. The meanings that the DOVE technology held for home visitors and women led to its construction as either an impersonal artifact that was an impediment to discussion of IPV or a conduit through which interpersonal connection could be deepened, thereby facilitating discussion about IPV. Women’s and home visitors’ comfort with either method of screening was positively influenced by factors such as having established trust and rapport, as well as good interpersonal communication. The technology helped reduce the anticipated stigma associated with disclosing abuse. The didactic intervention video was a limiting feature, as the content could not be tailored to accommodate the fluidity of women’s circumstances.

Conclusions

Users and developers of technology-based IPV interventions need to consider the context in which they are being embedded and the importance of the patient-provider relationship in promoting behavior change in order to realize the full benefits. An mHealth approach can and should be used as a tool for initiating discussion about IPV, assisting women in enhancing their safety and exploring help-seeking options. However, training for home visitors is required to ensure that a computer tablet is used to complement and enhance the therapeutic relationship.

ClinicalTrial

Clinicaltrials.gov NCT01688427; https://clinicaltrials.gov/ct2/show/NCT01688427 (Archived by WebCite at http://www.webcitation.org/6limSWdZP)