Dissemination, Implementation, and Effectiveness of an Intervention to Prevent Intimate Partner Violence

亲密伴侣暴力（IPV）是一个广泛而严重的公共卫生问题。在全球范围内，30%的合作伙伴 妇女遭受身体或性亲密伴侣暴力，三分之一以上的妇女 杀人犯是亲密伴侣。IPV对整个国家的健康和社会产生负面影响。 因此，了解如何最好地部署有效的、基于技术的干预措施， 妇女幸存者的复原力、健康和安全。在满足儿童的健康和安全需要方面存在着巨大差距， 在资源匮乏的环境中，通过正式和非正式支助系统帮助幸存者。羞愧、自责和缺乏 积极的社区反应阻止妇女披露IPV和获得安全规划 和支持，可以提高弹性，安全和健康。在高资源环境中， 已发现称为myPlan的个性化安全决策应用程序（“App”）有效地增加了 有用的安全策略，感知支持和安全。用户输入以下信息：a）关系健康状况; B） 安全优先级;以及c）关系中的暴力/危险的严重性，并且应用程序生成个性化的安全 根据这些输入与当地资源的联系制定计划。我们的团队最近调整了myPlan应用程序， 在肯尼亚内罗毕城市住区实施LMIC，移动的电话接入率超过94%。的 myPlanKenya最近通过随机对照试验进行了疗效评估， 初步干预对幸存者安全准备和复原力的影响。我们的利益相关者 确定了应用程序传播和实施的两种不同的组织类型：正规部门通常 负责IPV响应的社区网络，以及妇女通常首先寻求支持的社区非正式网络。 因此，5年研究的目标是：1）通过正式系统传播myPlanKenya应用程序 (i.e.,卫生、教育、司法）和非正式社区网络，并在肯尼亚内罗毕 比较覆盖范围和采用率，2）比较myPlan肯尼亚实施6个月后的性质和强度 按组织特征（正式与非正式， IPV响应的组织准备和IPV相关的态度），以及3）评估的有效性 myPlanKenya转介关于转介到myPlanKenya的一群妇女的复原力、健康和安全的转介 基于IPV的披露或评估有IPV相关风险的应用程序。我们的研究将解决缺乏 关于有效健康和安全干预措施的传播途径的现有证据， 回答IPV。我们的研究在为应用程序传播的过程和影响提供信息方面是全面的， 跨越从传播到有效性的整个过程。调查结果将为优化传播提供信息 以及在最需要的地区预防和应对IPV的实施战略。

Intimate partner violence (IPV) is a widespread and serious public health problem. Globally, 30% of ever-partnered women experience physical or sexual intimate partner violence (IPV), and over one third of female homicides are perpetrated by intimate partners. IPV confers negative health and social impacts across the lifespan, making it critical to understand how to best deploy effective, technology-based interventions to advance resilience, health and safety for women survivors. Glaring gaps exist in meeting the health and safety needs of survivors through the formal and informal support system in low-resource settings. Shame, self-blame and lack of a proactive community response discourage women from disclosing IPV and obtaining the safety planning and support that can improve resilience, safety, and health. In high-resource settings, an interactive, personalized safety decision application ("App"), called myPlan has been found effective in increasing use of helpful safety strategies, perceived support, and safety. Users enter information on: a) relationship health; b) safety priorities; and c) severity of violence/danger in relationship, and the app generates a personalized safety plan based on these inputs with links to local resources. Our team recently adapted the myPlan app for its first LMIC implementation in urban settlements in Nairobi, Kenya where mobile phone access exceeds 94%. The resulting myPlanKenya recently underwent efficacy evaluation via randomized controlled trial with positive preliminary intervention effects on survivor’s safety preparedness and resilience. Our stakeholders have identified two distinct organizational types for app dissemination and implementation: the formal sectors often tasked with IPV response, and the community-based, informal networks where women often turn first for support. Therefore, the objective of the 5-year study is to: 1) disseminate the myPlanKenya app through formal systems (i.e., health, education, justice) and informal, community-based networks in Nairobi, Kenya, and document and compare reach and adoption, 2) compare the nature and intensity of myPlanKenya implementation at 6-month follow-up and maintenance at 12-month follow-up by organizational characteristics (formal vs. informal, organizational readiness for IPV response and IPV-related attitudes), and 3) evaluate the effectiveness of myPlanKenya referral on resilience, health and safety among a cohort of women referred to the myPlanKenya app based on disclosure of IPV or assessed to have IPV related risks. Our study will address the paucity of evidence that exists on dissemination pathways for effective health and safety interventions to prevent and respond to IPV. Our study is comprehensive in informing both processes and impacts of app dissemination, and spanning the full pathway from dissemination to effectiveness. Findings will inform optimization of dissemination and implementation strategies for IPV prevention and response in areas of greatest need.