Longitudinal impacts of an online safety and health intervention for women experiencing intimate partner violence: randomized controlled trial

The effect of a digital intervention on symptoms of depression in pregnant women exposed to Intimate partner violence in Denmark and Spain (STOP study)

INTRODUCTION AND OBJECTIVE

Intimate Partner Violence (IPV) during pregnancy is a significant public health concern associated with adverse maternal and fetal health outcomes, including increased risk of depression. This study aimed to assess the effectiveness of a digital empowerment-based intervention in reducing symptoms of depression among IPV-exposed pregnant women.

STUDY DESIGN

This intervention study was nested within a cohort study conducted in Denmark and Spain. Pregnant women attending antenatal care were digital screened for IPV using the Abuse Assessment Screen (AAS) and the Women's Abuse Screening Tool (WAST). Those screening positive were offered a digital intervention comprising 3-6 video consultations with trained IPV counsellors and access to a safety planning app. Changes in depression scores from baseline to follow-up were evaluated using mixed model regression.

RESULTS

From February 2021-October 2022, 1,545 pregnant women (9.6 %) screened positive for IPV within our population (8.5 % in Denmark and 17.0 % in Spain) with 485 (31.4 %) meeting the criteria for the intervention. Of those eligible, 104 (21.4 %) accepted the intervention, and 55 completed it (13.1 %). Post-intervention, a significant reduction in Edinburgh Postnatal Depression Scale (EPDS) was found, with a mean difference of -3.9 (95 % CI: -5.3; -2.4), compared to the average pre-intervention score of 11.3. Stratifying the analyses across sociodemographic variables did not alter the overall result, indicating a reduction in EPDS scores irrespective of setting or sociodemographic factors. Notably, the intervention was most effective for women initially presenting with EPDS scores above the depression cut-off.

CONCLUSION

The findings suggest that a brief digital intervention is associated with a reduction in depression symptoms among pregnant women exposed to IPV, particularly among those with high depressive scores. This highlights the potential of digital interventions in delivering counseling and shows efficacy when administered by both midwives and psychologists in diverse settings. However, the absence of a control group underscores the need for caution in interpreting the results.

Using a health equity lens to measure patient experiences of care in diverse health care settings

People who are structurally disadvantaged and marginalized often report poor health care experiences, such as inequitable treatment, due to intersecting forms of stigma and discrimination. There are many measures of patient experiences of care, however, few are designed to measure equity-oriented health care. In alignment with ongoing calls to integrate actions in support of health equity, we report on the development and testing of patient-reported experience measures that explicitly use a health equity and intersectional lens. Our analysis focuses on two different scales: the Equity-Oriented Health Care Scale-Ongoing, which was evaluated in primary health care settings where patients have an ongoing relationship with providers over time, and the Equity-Oriented Health Care Scale-Episodic, which was tested in an emergency department where care is provided on an episodic basis. Item Response Theory was used to develop and refine the scales. The psychometric properties of each scale were also evaluated. The Equity-Oriented Health Care Scale-Ongoing was first tested with a cohort of 567 patients. The Equity-Oriented Health Care Scale-Episodic was subsequently tested in an emergency department setting with 284 patients. Results of the Item Response Theory analysis for each scale yielded a brief index that captured the level of equity-oriented care when care is ongoing (12 items) or episodic (9 items). Both scales showed evidence of internal consistency and concurrent validity, based on a high correlation with quality of care. They are brief, easy-to-administer patient-reported experience measures that can support organizations to monitor quality of care. Their availability enhances the possibility of measuring equity-oriented health care in diverse contexts and can provide nuanced understandings of quality of care through an intersectional and equity lens.

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.

Longitudinal effectiveness of a woman-led, nurse delivered health promotion intervention for women who have experienced intimate partner violence: iHEAL randomized controlled trial

BACKGROUND

Intimate partner violence (IPV) threatens the safety, health and quality of life of women worldwide. Comprehensive IPV interventions that are tailored, take a long-term view of women's needs, including health concerns, and maximize choice and control, have the potential to effectively address heath and safety concerns. Few such interventions have been tested, including in the Canadian context.

METHODS

A parallel randomized controlled trial of adult (age 19 + years), English-speaking, Canadian women with histories of IPV randomized either to iHEAL, a tailored health promotion intervention delivered by Registered Nurses over 6-7 months, or to community service information (usual care control). Primary (Quality of Life, PTSD symptoms) and secondary outcomes (Depression, Confidence in Managing Daily Life, Chronic Pain, IPV Severity) were measured at baseline and 6, 12 and 18 months post-intervention via an online survey. Generalized estimating equations were used to test for differences by study arm in intention-to-treat (full sample) and per protocol (1 + iHEAL visit) analyses focussing on short-term (immediately post-intervention) and longer-term (1 year post-intervention) effects. Selected process evaluation data were summarized using descriptive statistics.

RESULTS

Of 331 women enrolled, 175 were randomized to iHEAL (135 who engaged in 1 + visits) and 156 to control. Women who received iHEAL showed significantly greater short-term improvement in Quality of Life compared to the control group, with these effects maintained 1 year later. Changes in PTSD Symptoms also differed significantly by group, with weaker initial effects that were stronger 1 year post-intervention. Significant moderate, short- and longer-term group effects were also observed for Depression and Confidence in Managing Daily Life. IPV Severity decreased for both groups, with significant immediate effects in favour of the intervention group that grew stronger 1 year post-intervention. There were no changes in Chronic Pain.

CONCLUSION

iHEAL is an effective, acceptable and safe intervention for diverse groups of women with histories of IPV. Trial results provide a foundation for implementation and ongoing evaluation in health care settings and systems. Delayed effects noted for PTSD Symptoms and IPV Severity suggest that longer-term assessment of these outcomes may be needed in trials of IPV interventions.

TRIAL REGISTRATION

Clinicaltrials.gov ID NCT03573778 (Registered on June 29, 2018).

Engaging Parents in Technology-Assisted Interventions for Childhood Adversity: Systematic Review

BACKGROUND

Youth mental health problems are a major public health concern and are strongly associated with adverse childhood experiences (ACEs). Technology-assisted parenting programs can intervene with ACEs that are within a parent's capacity to modify. However, engagement with such programs is suboptimal.

OBJECTIVE

This review aims to describe and appraise the efficacy of strategies used to engage parents in technology-assisted parenting programs targeting ACEs on the behavioral and subjective outcomes of engagement.

METHODS

Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines, we conducted a systematic review of peer-reviewed papers that described the use of at least 1 engagement strategy in a technology-assisted parenting program targeting ACEs that are within a parent's capacity to modify. A total of 8 interdisciplinary bibliographic databases (CENTRAL, CINAHL, Embase, OVID MEDLINE, OVID PsycINFO, Scopus, ACM, and IEEE Xplore) and gray literature were searched. The use of engagement strategies and measures was narratively synthesized. Associations between specific engagement strategies and engagement outcomes were quantitatively synthesized using the Stouffer method of combining P values.

RESULTS

We identified 13,973 articles for screening. Of these, 156 (1.12%) articles were eligible for inclusion, and 29 (18.2%) of the 156 were associated with another article; thus, 127 studies were analyzed. Preliminary evidence for a reliable association between 5 engagement strategies (involving parents in a program's design, delivering a program on the web compared to face-to-face, use of personalization or tailoring features, user control features, and provision of practical support) and greater engagement was found. Three engagement strategies (professional support features, use of videos, and behavior change techniques) were not found to have a reliable association with engagement outcomes.

CONCLUSIONS

This review provides a comprehensive assessment and description of the use of engagement strategies and engagement measures in technology-assisted parenting programs targeting parenting-related ACEs and extends the current evidence with preliminary quantitative findings. Heterogeneous definition and measurement of engagement and insufficient engagement outcome data were caveats to this synthesis. Future research could use integrated definitions and measures of engagement to support robust systematic evaluations of engagement in this context.

TRIAL REGISTRATION

PROSPERO CRD42020209819; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209819.

Adherence to behavioural intervention in RCT study by the women experiencing domestic violence and attending ANC in a public hospital in India-an analysis

Background

The paper aims to identify the factors for effective implementation and adherence to the behavioural intervention package by women experiencing domestic violence (DV) and attending ANC in a public hospital.

Methods

A qualitative study was undertaken with 211 pregnant women experiencing DV and attending antenatal care (ANC) at the LN Hospital, New Delhi. The intervention was given to women recruited under the RCT study. The narratives were analysed under two broad themes, impeding and facilitating factors, with nine sub-themes.

Findings

Impeding factors are external factors generated by the structural interaction of the participants, whereas facilitating factors are supplied internally in the trial to eliminate the influence of impeding factors and singulate the factors under study. Our results show that despite the plethora of impeding factors (nine), the overall sum impact of impeding factors falls short of the positive impact of facilitating factors (nine), which were minor adjustments but reinforce participation in the trial and adherence with 97% follow-up rates.

Interpretation

Our study findings are expected to reset the treatment protocol, which entails converting impeding factors into facilitating factors for appropriate adherence and compliance and adequate access and utilization of public services. The sensitization of healthcare providers to the impact of the quality of human interaction on the patient and its impact on the uptake of healthcare services and adherence is needed, particularly in the public hospitals of India.

Funding

Funds received for the research are from the Indian Council of Medical Research (ICMR), New Delhi, Government of India.

Barriers and facilitators of using health information technologies by women: a scoping review

BACKGROUND AND AIM

Health information technologies play a vital role in addressing diverse health needs among women, offering a wide array of services tailored to their specific requirements. Despite the potential benefits, the widespread utilization of these technologies by women faces numerous barriers and challenges. These barriers can cause women to either reduce their usage of health technologies or refrain from using them altogether. Therefore, this review was done with the aim of identifying and classifying barriers and facilitators.

METHODS

Some databases, including PubMed, Web of Sciences, and Scopus were searched using related keywords. Then, according to the inclusion and exclusion criteria, the articles were evaluated and selected. Finally, the barriers and facilitators were identified and classified.

RESULTS

Out of 14,399 articles, finally 35 articles were included in the review. In general, 375 barriers (232 items) and facilitators (143 items) were extracted from the studies. After merging similar items, 121 barriers (51 items) and facilitators (70 items) identified were organized into five main themes (management, technological, legal and regulatory, personal, and data and information management). The most important barriers were "privacy, confidentiality, and security concerns" (n = 24), "deficiencies and limitations of infrastructure, software, hardware, and network" (n = 19), "sociocultural challenges" (n = 15), and "poor economic status" (n = 15). Moreover, the most important facilitators were "increasing awareness, skills and continuous education of women" (n = 17, in personal theme), "providing training services" (n = 14, in management theme), "simple, usable, and user-friendly design of technologies" (n = 14, in technological theme), and "providing financial or non-financial incentives (motivation) for women" (n = 14, in personal theme).

CONCLUSION

This review showed that in order to use technologies, women face many barriers, either specific to women (such as gender inequality) or general (such as lack of technical skills). To overcome these barriers, policymakers, managers of organizations and medical centers, and designers of health systems can consider the facilitators identified in this review.

Key Factors in Helpfulness and Use of the SAFE Intervention for Women Experiencing Intimate Partner Violence and Abuse: Qualitative Outcomes From a Randomized Controlled Trial and Process Evaluation

BACKGROUND

Many women experience at least one type of intimate partner violence and abuse (IPVA), and although various support options are available, we still know relatively little about web-based interventions for IPVA survivors. We conducted a qualitative evaluation of the SAFE eHealth intervention for women experiencing IPVA in the Netherlands, complementing the quantitative evaluation of self-efficacy, depression, anxiety, and multiple feasibility aspects.

OBJECTIVE

This study assessed users' experiences and what, according to them, were useful and helpful aspects of the intervention.

METHODS

The intervention consisted of modules with information on relationships and IPVA, help options, physical and mental health, and social support. It also contained interactive elements such as exercises, stories from survivors, a chat, and a forum. A randomized controlled trial was conducted with an intervention arm receiving the complete version of the intervention and a control arm receiving only a static version with the modules on relationships and IPVA and help options. We gathered data through open questions from surveys (for both study arms; n=65) and semistructured interviews (for the intervention study arm; n=10), all conducted on the web, during the randomized controlled trial and process evaluation. Interview data were coded following the principles of open thematic coding, and all qualitative data were analyzed using qualitative content analysis.

RESULTS

Overall, most users positively rated the intervention regarding safety, content, and suiting their needs, especially participants from the intervention study arm. The intervention was helpful in the domains of acknowledgment, awareness, and support. However, participants also identified points for improvement: the availability of a simplified version for acute situations; more attention for survivors in the aftermath of ending an abusive relationship; and more information on certain topics, such as technological IPVA, support for children, and legal affairs. Furthermore, although participants expressed a prominent need for interactive contact options such as a chat or forum, the intervention study arm (the only group that had these features at their disposal) mainly used them in a passive way-reading instead of actively joining the conversation. The participants provided various reasons for this passive use.

CONCLUSIONS

The positive outcomes of this study are similar to those of other web-based interventions for IPVA survivors, and specific points for improvement were identified. The availability of interactive elements seems to be of added value even when they are used passively. This study provides in-depth insight into the experiences of female IPVA survivors with the SAFE eHealth intervention and makes suggestions for improvements to SAFE and comparable web-based interventions for IPVA as well as inspiring future research. Furthermore, this study shows the importance of a varied assessment of an intervention's effectiveness to understand the real-world impact on its users.

TRIAL REGISTRATION

Netherlands Trial Register NTR7313; https://tinyurl.com/3t7vwswz.

Examining the Effectiveness, Acceptability, and Feasibility of Virtually Delivered Trauma-Focused Domestic Violence and Sexual Violence Interventions: A Rapid Evidence Assessment

The COVID-19 pandemic has forced a rapid shift to virtual delivery of treatment and care to individuals affected by domestic violence and sexual violence. A rapid evidence assessment (REA) was undertaken to examine the effectiveness, feasibility and acceptability of trauma-focused virtual interventions for persons affected by domestic violence and sexual violence. The findings from this review will provide guidance for service providers and organizational leaders with the implementation of virtual domestic violence and sexual violence-focused interventions. The REA included comprehensive search strategies and systematic screening of and relevant articles. Papers were included into this review (1) if they included trauma-focused interventions; (2) if the intervention was delivered virtually; and (3) if the article was published in the English-language. Twenty-one papers met inclusion criteria and were included for analysis. Findings from the rapid review demonstrate that virtual interventions that incorporate trauma-focused treatment are scarce. Online interventions that incorporate trauma-focused treatment for this at-risk group are limited in scope, and effectiveness data are preliminary in nature. Additionally, there is limited evidence of acceptability, feasibility and effectiveness of virtual interventions for ethnically, culturally, and linguistically diverse populations experiencing domestic violence and sexual violence. Accessing virtual interventions was also highlighted as a barrier to among participants in studies included in the review. Despite the potential of virtual interventions to respond to the needs of individuals affected by domestic violence and/or sexual violence, the acceptability and effectiveness of virtual trauma-focused care for a diverse range of populations at risk of violence are significantly understudied.

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.

Video Consultations and Safety App Targeting Pregnant Women Exposed to Intimate Partner Violence in Denmark and Spain: Nested Cohort Intervention Study (STOP Study)

BACKGROUND

Intimate partner violence (IPV) during pregnancy is a public health issue with wide-ranging consequences for both the mother and fetus, and interventions are needed. Therefore, the Stop Intimate Partner Violence in Pregnancy (STOP) cohort was established with the overall aim to identify pregnant women exposed to IPV through digital screening and offer women screening positive for IPV a digital supportive intervention.

OBJECTIVE

The aim of this study was to (1) introduce the design and profile of the STOP cohort study, (2) assess the feasibility of implementing digital IPV screening among pregnant women, and (3) assess the feasibility of implementing a digital supportive intervention targeting pregnant women exposed to IPV.

METHODS

Pregnant women attending antenatal care in the Region of Southern Denmark and in Andalucía, Spain were offered digital screening for IPV using validated scales (Abuse Assessment Screen and Women Abuse Screening Tool). Women who screened positive were eligible to receive a digital supportive intervention. The intervention consisted of 3-6 video consultations with an IPV counselor and a safety planning app. In Denmark, IPV counselors were antenatal care midwives trained by a psychologist specialized in IPV, whereas in Spain, the counselor was a psychologist.

RESULTS

Data collection started in February 2021 and was completed in October 2022. Across Denmark and Spain, a total of 19,442 pregnant women were invited for IPV screening and 16,068 women (82.65%) completed the screening. More women in Spain screened positive for exposure to IPV (350/2055, 17.03%) than in Denmark (1195/14,013, 8.53%). Among the women who screened positive, only 31.39% (485/1545) were eligible to receive the intervention with only 104 (21.4%) of these women ultimately receiving it.

CONCLUSIONS

Digital screening for IPV among pregnant women is feasible in an antenatal care context in Denmark and Spain; however, a digital supportive intervention during pregnancy appears to have limited feasibility as only a minor subgroup of women who screened positive for eligibility received the intervention. More research is needed on how to best support pregnant women exposed to IPV if universal IPV screening is to be implemented in antenatal care.

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.

E-health psychological intervention in pregnant women exposed to intimate partner violence (eIPV): A protocol for a pilot randomised controlled trial

Intimate partner violence (IPV) during pregnancy, a condition as common as obstetrics conditions like gestational diabetes, is associated with maternal and neonatal complications. Systematic detection of IPV is not well established in antenatal screening probably because the effectiveness of protective interventions has not been evaluated. E-health interventions may be beneficial among mothers exposed to IPV. Prior to performing a full-scale effectiveness trial for such an intervention, a pilot study is required to assess the feasibility of randomising a sufficiently large number of women exposed to IPV during pregnancy. The eIPV trial is a randomised pilot study nested within a cohort of consenting mothers who screen positive for IPV in the first antenatal visit at <12 weeks' gestation and accept an e-health package (psychological counselling by videoconference) in Spain and Denmark. Twenty eligible mothers from the above cohort will be randomised to either intervention or control. The intervention group will receive the e-health package as part of the cohort. The control group will be invited to accept a delay in the intervention (e-health package eight weeks later). After consenting to delay, the control group will provide comparative data without losing the opportunity of obtaining the intervention. We will determine estimates of rates of informed consent to randomization, and the rates of adherence and dropout following randomization. Qualitative interviews will be conducted to examine the women's perception about the benefit of the intervention, reasons for acceptability and non-adherence, and obstacles to recruitment, randomisation and consent. The results will inform the trial feasibility and variance of key clinical outcome measures for estimation of sample size of the full-scale effectiveness trial.

Addressing Health Inequities in Digital Clinical Trials: A Review of Challenges and Solutions From the Field of HIV Research

Clinical trials are considered the gold standard for establishing efficacy of health interventions, thus determining which interventions are brought to scale in health care and public health programs. Digital clinical trials, broadly defined as trials that have partial to full integration of technology across implementation, interventions, and/or data collection, are valued for increased efficiencies as well as testing of digitally delivered interventions. Although recent reviews have described the advantages and disadvantages of and provided recommendations for improving scientific rigor in the conduct of digital clinical trials, few to none have investigated how digital clinical trials address the digital divide, whether they are equitably accessible, and if trial outcomes are potentially beneficial only to those with optimal and consistent access to technology. Human immunodeficiency virus (HIV), among other health conditions, disproportionately affects socially and economically marginalized populations, raising questions of whether interventions found to be efficacious in digital clinical trials and subsequently brought to scale will sufficiently and consistently reach and provide benefit to these populations. We reviewed examples from HIV research from across geographic settings to describe how digital clinical trials can either reproduce or mitigate health inequities via the design and implementation of the digital clinical trials and, ultimately, the programs that result. We discuss how digital clinical trials can be intentionally designed to prevent inequities, monitor ongoing access and utilization, and assess for differential impacts among subgroups with diverse technology access and use. These findings can be generalized to many other health fields and are practical considerations for donors, investigators, reviewers, and ethics committees engaged in digital clinical trials.

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.

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.

Trauma- and Violence-Informed Care: Orienting Intimate Partner Violence Interventions to Equity

Purposeof Review

Intimate partner violence (IPV) is a complex traumatic experience that often co-occurs, or is causally linked, with other forms of structural violence and oppression. However, few IPV interventions integrate this social-ecological perspective. We examine trauma- and violence-informed care (TVIC) in the context of existing IPV interventions as an explicitly equity-oriented approach to IPV prevention and response.

Recent Findings

Systematic reviews of IPV interventions along the public health prevention spectrum show mixed findings, with those with a theoretically grounded, structural approach that integrates a trauma lens more likely to show benefit.

Summary

TVIC, embedded in survivor-centered protocols with an explicit theory of change, is emerging as an equity-promoting approach underpinning IPV intervention. Explicit attention to structural violence and the complexity of IPV, systems and sites of intervention, and survivors’ diverse and intersectional lived experiences has significant potential to transform policy and practice.

"If I'd Had Something Like SAFE at the Time, Maybe I Would've Left Him Sooner."-Essential Features of eHealth Interventions for Women Exposed to Intimate Partner Violence: A Qualitative Study

Approximately one in three women worldwide experiences intimate partner violence and abuse (IPVA) in her lifetime. Despite its frequent occurrence and severe consequences, women often refrain from seeking help. eHealth has the potential to remove some of the barriers women face in help seeking and disclosing. To guarantee the client-centeredness of an (online) intervention it is important to involve the target group and people with expertise in the development process. Therefore, we conducted an interview study with survivors and professionals, in order to assess needs, obstacles, and wishes with regard to an eHealth intervention for women experiencing IPVA. Semi-structured interviews were conducted with 16 women (8 survivors and 8 professionals) between 22 and 52 years old, with varied experiences of IPVA and help. Qualitative data was analyzed using a grounded theory approach and open thematic coding. During analysis we identified a third stakeholder group within the study population: survivor-professionals, with both personal experiences of and professional knowledge on IPVA. All stakeholder groups largely agree on the priorities for an eHealth intervention: safety, acknowledgment, contact with fellow survivors, and help. Nevertheless, the groups offer different perspectives, with the survivor-professionals functioning as a bridge group between the survivors and professionals. The groups prioritize different topics. For example, survivors and survivor-professionals highlighted the essential need for safety, while professionals underlined the importance of acknowledgment. Survivor-professionals were the only ones to emphasize the importance of addressing various life domains. The experiences of professionals and survivors highlight a broad range of needs and potential obstacles for eHealth interventions. Consideration of these findings could improve the client-centeredness of existing and future (online) interventions for women experiencing IPVA.

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.

Follow-up Evaluation of Psychotherapy Protocols for Women with a History of Intimate Partner Violence: Scoping Review

To investigate the methodological aspects, main results, and limitations of the follow-up evaluations of psychotherapeutic interventions for women with a history of intimate partner violence (IPV). A search was carried out in the SciELO, Scopus, PsycINFO, and Web of Science databases, using the descriptors: (“clinical trial” OR “therapy” OR “psychotherapy” OR “psychological treatment”) AND (“violence” OR “mistreatment” OR “intimate partner violence” OR “domestic violence” OR “conjugal violence”) AND (“women”). 1480 articles were retrieved and after applying the inclusion and exclusion criteria, 11 articles composed the final sample. The majority of the follow-up assessments were carried out through the reapplication of the basic instruments, with the period of 3 months post-intervention being the most used. Sample losses were identified in all the studies analyzed. The limitations and difficulties were associated with the complexity of the target population. This review identified the importance of the follow-up evaluations and the need to adapt them to ensure the effectiveness of the interventions, aiming to reach a larger number of women, strengthen protective aspects, and prevent revictimization.

Researchers or practitioners' opinion of the possibilities for creating virtual safe social spaces for violence prevention interventions for young people

Intimate partner violence (IPV) is a global concern. Interventions designed to prevent IPV are often participatory in nature, implemented in face-to-face settings and seek to create 'safe social spaces'. We however do not fully understand how safe social spaces can be created in online spaces. Our study sought to understand the possibility of creating safe social spaces online, supportive of participatory interventions, from the perspective of those developing and implementing IPV prevention interventions. We conducted in-depth interviews with a global sample of 20 researchers and practitioners. Interviews were transcribed and analysed using thematic network analysis. We found mixed results about the possibility of creating safe social spaces online. Researchers and practitioners raised issues such as sharing of devices, the difficulties in developing trust and a sense of community online, challenges in having privacy and confidentiality online and difficulty in reading non-verbal cues as some of the key considerations when creating online safe social spaces. Younger researchers and practitioners were more optimistic about creating safe social spaces online. Our results show that the creation of safe social spaces online is complex and requires further investigation.

Intimate partner violence and women living with episodic disabilities: a scoping review protocol

BACKGROUND

Violence towards women with disabilities is most commonly perpetrated by current or former intimate partners and more than half of disabled women experience intimate partner violence in their lifetime. Disabilities differ by presence, type, and complexity, yet are commonly researched collectively. A more nuanced understanding of the relationship between intimate partner violence and episodic disability is required to better support women living with these concurrent challenges. The objective of this scoping review is to investigate and synthesize the literature reporting on intimate partner violence for women living with an episodic disability to identify key concepts and knowledge gaps on this topic. Ultimately, this review aims to improve health services for this stigmatized group of women with episodic disabilities.

METHODS

This scoping review will consider all studies that focus on women (18 years of age or older) who have experienced intimate partner violence and have an episodic disability. Episodic disabilities will include multiple sclerosis, chronic fatigue syndrome, fibromyalgia, lupus, or rheumatoid arthritis. The broad review question is what is known about intimate partner violence within the context of women living with an episodic disability? Databases to be searched include MEDLINE (OVID), CINAHL, Embase, PsychInfo, and Scopus with no limits on language or time frame. Joanna Briggs Institute methodology will guide this scoping review to address the review questions outlined in the protocol. For papers that meet the inclusion criteria, data will be extracted, and findings will be presented in tables and narrative form. A PRISMA table will be included to enhance the transparency of the process. A descriptive qualitative approach to analysis will be conducted following Braun and Clarke's reflexive thematic analysis. The findings of the scoping review will be presented through a thematic narrative.

DISCUSSION

Findings from this review will be used to identify important priorities for future research based on knowledge gaps and inform both health care practices and health and social interventions for women living with intimate partner violence and episodic disabilities.

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.

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.

Technology-Facilitated Abuse Prevalence and Associations Among a Nationally Representative Sample of Young Men

PURPOSE

We undertook a study to determine the prevalence and associations of technology-facilitated abuse (TFA)-insults, harassment, coercion, or threats carried out using digital tools such as smartphones and computers-among a US nationally representative sample of young men.

METHODS

Analyses were based on 1,079 men aged 18 to 35 years who completed questionnaires during August and September of 2014 and reported ever having been in a romantic relationship. We used validated measures to assess demographics, health service use, mental health and substance use, and TFA delivered to and received from partners in the past year. We calculated survey-weighted descriptive statistics and conducted multinomial logistic regression analysis.

RESULTS

Overall, 4.1% of men reported delivering TFA only, 8.0% receiving TFA only, and 25.6% both delivering and receiving TFA. Men were more likely to report only delivering TFA if they identified as Hispanic (adjusted odds ratio [AOR] = 2.72; 95% CI, 1.13 to 6.57), used marijuana (AOR = 1.31; 95% CI, 1.02 to 1.68), and used prescription opioids for nonmedical reasons (AOR 2.86; 95% CI, 1.48 to 5.54). Men were more likely to report only receiving TFA if they identified as Hispanic (AOR = 2.55; 95% CI, 1.01 to 6.43) and used prescription opioids for nonmedical reasons (AOR = 2.43; 95% CI, 1.34 to 4.39), whereas a primary care connection appeared protective (AOR = 0.43; 95% CI, 0.22 to 0.86). Men were more likely to report both delivering and receiving TFA if they identified as non-Hispanic Black (AOR = 2.83; 95% CI, 1.44 to 5.58), owned a smartphone (AOR = 1.80; 95% CI, 1.05 to 3.09), had ever had mental health care visits (AOR = 1.86; 95% CI, 1.16 to 2.98), misused alcohol (AOR = 1.10; 95% CI, 1.04 to 1.17), and used prescription opioids for nonmedical reasons (AOR = 1.79; 95% CI, 1.04 to 3.08).

CONCLUSIONS

We found that TFA was prevalent among young men, with 1 in 25 reporting delivery only, 1 in 12 reporting receipt only, and 1 in 4 reporting both. Primary care physicians can consider assessing TFA among male patients and developing interventions to mitigate this behavior.VISUAL ABSTRACT.

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.

Remote evaluations of violence against women and girls interventions: a rapid scoping review of tools, ethics and safety

Although programmes and policies targeting violence against women and girls (VAWG) have increased in the past decade, there is a paucity of evidence on the effectiveness of these interventions. To expand this evidence base, researchers increasingly employ remote data collection (RDC)-including online surveys, mobile applications and telephone interviews-in their evaluations. Although RDC allows for evaluations without in-person interactions-which are restricted during crises such as the COVID-19 pandemic- information about these methods is necessary to understand their potential usefulness and limitations. This scoping review examines remote evaluations of VAWG interventions to describe the landscape of RDC methods, reflect on safety and ethical considerations, and offer best practices for RDC in VAWG research. Fourteen studies met eligibility criteria, with seven, five, and two studies employing telephone interviews, online surveys, and mobile applications, respectively. Studies commonly stated that participants were asked to use a safe email or device, but the method for verifying such safety was rarely specified. Best practices around safety included creating a 'quick escape' button for online data collection to use when another individual was present, explaining to participants how to erase browsing history and application purchases, and asking participants to specify a safe time for researchers to call. Only eight studies established referral pathways for respondents as per best practice. None of the eligible studies took place in low/middle-income countries (LMICs) or humanitarian settings, likely reflecting the additional challenges to using RDC methods in lower resource settings. Findings were used to create a best practice checklist for programme evaluators and Institutional Review Boards using RDC for VAWG interventions. The authors found that opportunities exist for researchers to safely and effectively use RDC methodologies to gather VAWG data, but that further study is needed to gauge the feasibility of these methods in LMICs and humanitarian settings.

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.

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.

"The Problem Is that We Hear a Bit of Everything…": A Qualitative Systematic Review of Factors Associated with Alcohol Use, Reduction, and Abstinence in Pregnancy

Understanding the factors that contribute to women's alcohol use in pregnancy is critical to supporting women's health and wellness and preventing Fetal Alcohol Spectrum Disorder. A systematic review of qualitative studies involving pregnant and recently postpartum women was undertaken to understand the barriers and facilitators that influence alcohol use in pregnancy (PROSPERO: CRD42018098831). Twenty-seven (n = 27) articles were identified through EMBASE, CINAHL, PsycINFO, PubMed and Web of Science. The included articles were thematically analyzed using NVivo12. The analysis was informed by Canada's Action Framework for Building an Inclusive Health System to articulate the ways in which stigma and related barriers are enacted at the individual, interpersonal, institutional and population levels. Five themes impacting women's alcohol use, abstention and reduction were identified: (1) social relationships and norms; (2) stigma; (3) trauma and other stressors; (4) alcohol information and messaging; and (5) access to trusted equitable care and essential resources. The impact of structural and systemic factors on prenatal alcohol use was largely absent in the included studies, instead focusing on individual choice. This silence risks perpetuating stigma and highlights the criticality of addressing intersecting structural and systemic factors in supporting maternal and fetal health.

Increased Risk of Death Triggered by Domestic Violence, Hunger, Suicide, Exhausted Health System during COVID-19 Pandemic: Why, How and Solutions

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, just like many other public health emergencies, is a well-established global health burden that has resulted in several changes in routines and lifestyles of people globally. The coronavirus disease (COVID-19) pandemic, caused by SARS-CoV-2, has directly or indirectly involved in the loss of lives of more than 3.24 million as of 6th May, 2021. The increasing threats posed by this pandemic were subsided by the swift and drastic measures put in place by different countries. As other causes of death before the emergence of COVID-19 still exist, the pandemic has further worsened their impact. The increased risks of COVID-19 deaths are not only due to the health burden it possesses, but also due to some other factors. These factors include domestic violence that becomes rampant, especially during lockdowns; hunger due to low economic development, unemployment, and loss of jobs; suicide due to depression; exhausted health system due to high level of COVID-19 cases and inability to contain it. As we move from the response phase into recovery, the pandemic's direct and broader impacts on individuals, households, and communities will influence the capacity to recover. An understanding of these impacts is therefore required to develop priorities to support recovery. This paper identifies other causes of death amidst the pandemic, such as domestic violence, hunger, suicide, and exhausted health system, and how to minimize their effects.

Can Goal-Based Health Management Improve the Health Knowledge, Health Belief and Health Behavior in People at High Risk of Stroke? A Non-Randomized Controlled Trial

PURPOSE

To examine the effectiveness of goal-based health management on health knowledge, health belief and health behavior in people at high risk of stroke.

PATIENTS AND METHODS

This is a two-armed and non-randomized controlled trial from May 31, 2020 to December 31, 2020. Participants were arranged to receive regular health care (n=126) or goal-based health management (n=126). The generalized estimation equation was used to analyze the changes in the participants' health knowledge, health belief and health behavior at baseline (T0), 1-month (T1), 3-month (T3), and 6-month (T6).

RESULTS

A total of 243 participants completed the 6-month study, of which 123 were in the control group and 120 were in the intervention group. After receiving goal-based health management, participants' health behavior (β=27.154, p<0.001), health knowledge (β=10.504, p<0.001) and health belief (β=49.057, p<0.001) scores increased significantly.

CONCLUSION

Goal-based health management can effectively improve the health knowledge, health belief and health behavior of people at high risk of stroke. We recommend that nurses can provide goal-based health management for people at high risk of stroke with support from hospitals and family members of people at high risk of stroke.

Effectiveness of ICT-based intimate partner violence interventions: a systematic review

BACKGROUND

Intimate Partner Violence is a "global pandemic". Meanwhile, information and communication technologies (ICT), such as the internet, mobile phones, and smartphones, are spreading worldwide, including in low- and middle-income countries. We reviewed the available evidence on the use of ICT-based interventions to address intimate partner violence (IPV), evaluating the effectiveness, acceptability, and suitability of ICT for addressing different aspects of the problem (e.g., awareness, screening, prevention, treatment, mental health).

METHODS

We conducted a systematic review, following PRISMA guidelines, using the following databases: PubMed, PsycINFO, and Web of Science. Key search terms included women, violence, domestic violence, intimate partner violence, information, communication technology, ICT, technology, email, mobile, phone, digital, ehealth, web, computer, online, and computerized. Only articles written in English were included.

RESULTS

Twenty-five studies addressing screening and disclosure, IPV prevention, ICT suitability, support and women's mental health were identified. The evidence reviewed suggests that ICT-based interventions were effective mainly in screening, disclosure, and prevention. However, there is a lack of homogeneity among the studies' outcome measurements and the sample sizes, the control groups used (if any), the type of interventions, and the study recruitment space. Questions addressing safety, equity, and the unintended consequences of the use of ICT in IPV programming are virtually non-existent.

CONCLUSIONS

There is a clear need to develop women-centered ICT design when programming for IPV. Our study showed only one study that formally addressed software usability. The need for more research to address safety, equity, and the unintended consequences of the use of ICT in IPV programming is paramount. Studies addressing long term effects are also needed.

Danger in danger: Interpersonal violence during COVID-19 quarantine

BACKGROUND

Intimate partner violence (IPV) is defined as physical or sexual violence, emotional abuse and stalking. It is typically experienced by women but can also be experienced by men. During quarantine due to the COVID-19, home risks to become a very dangerous place for victims of domestic violence.

METHOD

Very recent studies focusing on abusive situations during COVID emergence were identified in PubMed/Medline, Scopus, Embase.

RESULTS

During the COVID-19 outbreak people have encountered an invisible and dark enemy and an experience of impotence. Due to the feelings of frustration and agitation, aggression arises with possible transgenerational transmission of trauma and violence.

CONCLUSIONS

Especially during quarantine and COVID emergence around the world there is a need of programs aimed to prevent acts of domestic violence and to achieve accurate assessment of multiple domains of abuse (psychological, physical, sexual) provided by trained multidisciplinary staffs (including psychiatrists, psychologists, social and legal services).