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

点击翻译按钮获取中文摘要

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.