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

移民前后暴露于人际暴力以及不充分或缺乏获得护理的机会可能会 对移民妇女的健康产生重大负面影响，并导致 美国的移民妇女。移民妇女在移民前和移民后或累积接触 人际暴力是共同发生的心理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。然而，非常 由于孤立、羞耻、对健康的不信任等因素，很少有女性向正规服务提供者寻求帮助 专业人士或缺乏知识。因此，需要以证据为基础的数字干预，以解决 长期遭受暴力和精神健康症状的移民妇女的护理需求 可在正式服务设置之外访问。基于创伤信息的互联网和移动电话 干预(安全、健康和积极授权)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。调查结果来自 BSHAPE试点研究发现，BSHAPE干预是可行的，也是可以接受的。参与调查的女性 在BSHAPE中显示出改善的结果，如减少压力，增强自我效能，改善 心理健康和与安全相关的赋权。拟议的研究将使用顺序的、混合的方法 在一项大规模试验中评估BSHAPE疗效的纵向设计。在第一阶段，研究将进一步 改进BShape，使其更具用户友好性、吸引力、可访问性和适应性，适合来自 不同的背景。为此，研究将使用试点研究的结果和从以下方面获得的反馈 参与BSHAPE试点试验的女性。这些意见将来自文化专家和 来自不同原籍国的移民妇女使用定性方法。在第二阶段，研究 将使用纵向随机对照试验设计，将676名女性随机分配到BSHAPE手臂(n=338) 或控制臂(n=338)。与健康和安全相关的结果将在3、6和12个月时进行评估 继续跟进。据推测，参加BSHAPE将改善心理健康，减轻压力， 加强自我照顾，并改善长期遭受暴力的移民妇女的安全。在……里面 此外，这项研究还将探索干预对关键结果影响的潜在中介和调节因素。 这项研究将产生一种基于证据的数字BSHAPE干预，旨在提供远程 向服务不足和被边缘化的移民妇女提供支助，这些妇女的护理需求未得到满足，特别是那些 居住在美国资源匮乏和服务不足的地区。干预也有可能更多地 移民女性幸存者可获得和可接受的服务，她们可能因以下原因而无法获得标准护理服务 与社会文化、经济、交通和移民有关的障碍。

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.