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

亲密伴侣暴力是一个普遍而严重的公共卫生问题。在全球范围内，30%的 女性经历过身体或性亲密伴侣暴力(IPV)，超过三分之一的女性 杀人案是由亲密伴侣实施的。IPV在全球范围内对健康和社会产生负面影响 生命周期，因此了解如何最好地部署有效的、基于技术的干预措施以推进 妇女幸存者的复原力、健康和安全。在满足以下人员的健康和安全需求方面存在明显差距 在资源匮乏的情况下，幸存者通过正式和非正式的支助系统。羞愧、自责和缺乏 积极主动的社区反应阻止妇女披露IPV和获得安全规划 以及能够提高弹性、安全性和健康的支持。在高资源环境中，交互式、 名为MyPlan的个性化安全决策应用程序(App)已被发现在增加对 有用的安全策略、感知到的支持和安全。用户输入以下信息：a)关系健康；b) 安全优先事项；以及c)关系中暴力/危险的严重性，该应用程序生成个性化的安全 根据这些输入进行规划，并提供与当地资源的链接。我们的团队最近修改了MyPlan应用程序，使其成为第一个 在肯尼亚内罗毕的城市住区实施LMIC，那里的移动电话接入率超过94%。这个 由此产生的myPlanKenia最近通过随机对照试验进行了疗效评估，结果为阳性 初步干预对幸存者的安全准备和复原力的影响。我们的利益相关者拥有 确定了应用程序分发和实施的两种不同的组织类型：正规部门通常 负责应对IPV，以及以社区为基础的非正式网络，在这些网络中，妇女往往首先寻求支持。 因此，这项为期5年的研究的目标是：1)通过正式系统传播myPlanKenia应用程序 (例如，卫生、教育、司法)和肯尼亚内罗毕的非正式社区网络，以及文件和 比较覆盖范围和采用率，2)比较我的计划肯尼亚在6个月内实施的性质和强度 按组织特征(正式与非正式， 组织对IPV响应的准备情况和与IPV相关的态度)，以及3)评估 我的计划肯尼亚关于一群妇女的复原力、健康和安全的推荐，指的是我的计划肯尼亚 基于IPV披露或评估具有IPV相关风险的APP。我们的研究将解决缺乏 传播途径上存在的有效健康和安全干预措施的证据，以预防和 回应IPV。我们的研究在告知APP传播的过程和影响方面是全面的，并且 跨越了从传播到有效性的整个过程。调查结果将为传播的优化提供信息 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.