Being Safe, Healthy and Positively Empowered (BSHAPE): A Technology-Based Multicomponent Intervention to Improve Outcomes for Immigrant Women with Cumulative Exposures to Violence

移徙前后遭受人际暴力以及得不到或得不到充分的照顾， 对移民妇女的健康产生了重大的负面影响， 美国的移民女性。在移徙前后或累积暴露于 人际暴力是同时发生的精神和身体健康问题的高风险（例如，创伤后应激障碍， 艾滋病毒/性传播感染）和安全问题，如生活在不安全的家庭或处于不安全的关系中。可是 由于孤立、羞耻、不信任健康等因素，很少有妇女向正规服务提供者寻求帮助。 专业或缺乏知识。因此，需要基于证据的数字干预措施， 有累积暴力和精神健康症状的移民妇女的护理需求， 在正式服务环境之外获取。一个基于互联网和手机的创伤信息 干预（安全、健康和积极赋权（BSHAPE））旨在改善结果 对于有累积暴力暴露和精神健康症状的移民妇女。的结果 BSHAPE试点研究发现BSHAPE干预是可行和可接受的。参加的妇女 在BSHAPE中显示出改善的结果，如减少压力，增强自我效能，改善 心理健康和与安全有关的赋权。拟议的研究将采用顺序、混合的方法 纵向设计，以评估BSHAPE在大规模试验中的疗效。在第一阶段，研究将进一步 完善BSHAPE，使其更便于用户使用，更具吸引力，更容易获得和适应来自 不同的背景为此，本研究将利用试点研究的结果以及从 参加BSHAPE试点试验的妇女。将从文化专家那里获得投入， 来自不同原籍国的移民妇女，采用定性方法。在第二阶段，研究 将采用纵向随机对照试验设计，将676名女性随机分配至BSHAPE组（n=338） 或对照组（n=338）。将在3、6和12个月时评估健康和安全性相关结局 跟进据推测，参与BSHAPE将导致改善心理健康，减少压力， 加强了自我照顾，并改善了遭受暴力侵害的移民妇女的安全。在 此外，研究亦会探讨干预措施对主要成效的潜在中介及调节因素。 该研究将导致基于证据的数字BSHAPE干预，旨在提供远程 支持得不到充分服务和处于社会边缘地位的移民妇女， 居住在美国资源贫乏和服务不足的地区。干预也有可能成为更多 移民妇女幸存者可能无法获得标准护理服务， 社会文化、经济、交通和移民方面的障碍。

Pre-and post-migration exposures to interpersonal violence and inadequate or lack of access to care can have a significant negative impact on immigrant women’s health and contribute to health disparities among immigrant women in the US. Immigrant women with pre-and post-migration or cumulative exposures to interpersonal violence are at high risk for co-occurring mental and physical health problems (e.g., PTSD, HIV/STI) and safety issues such as living in unsafe households or being in unsafe relationships. However, very few women seek help from formal service providers due to factors such as isolation, shame, mistrust of health professionals or lack of knowledge. Thus, there is need for evidence-based digital interventions that address care needs of immigrant women with cumulative exposures to violence and mental health symptoms and can be accessed outside formal services settings. A trauma-informed internet and mobile-phone based intervention (Being Safe, Healthy, and Positively Empowered (BSHAPE) was designed to improve outcomes for immigrant women with cumulative exposures to violence and mental health symptoms. The findings from the BSHAPE pilot study found BSHAPE intervention to be feasible, and acceptable. Women who participated in BSHAPE showed improvement in outcomes such as reduced stress, enhanced self-efficacy, improved mental health and safety-related empowerment. The proposed study will use a sequential, mixed methods longitudinal design to evaluate efficacy of BSHAPE in a large-scale trial. In the first phase, the study will further refine BSHAPE to make it more user friendly, engaging, accessible and adaptive to immigrant women from diverse backgrounds. For this, the study will use findings from the pilot study and the feedback obtained from women who participated in the BSHAPE pilot trial. The input will be obtained from cultural experts and immigrant women from diverse countries of origin using a qualitative approach. In the second phase, the study will use a longitudinal randomized controlled trial design to randomize 676 women to the BSHAPE arm (n=338) or the control arm (n=338). The health and safety related outcomes will be assessed at 3, 6 and 12 months follow up. It is hypothesized the participation in BSHAPE will lead to improved mental health, reduced stress, enhanced self-care, and improved safety among immigrant women with cumulative exposures to violence. In addition, the study will explore potential mediators and moderators of the intervention effect on key outcomes. The study will result in an evidence based digital BSHAPE intervention that will be designed to provide remote support to underserved and marginalized immigrant women with unmet needs for care, particularly those residing in low resource and underserved areas in the US. The intervention also has the potential to be more accessible and acceptable to immigrant women survivors who may not access standard care services due to socio-cultural, economic, transportation and immigration-related barriers.