An Adaptive Intervention to Improve Health, Safety and Empowerment Outcomes Among Immigrant Women with Intimate Partner Violence Experiences

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Intimate partner violence (IPV) disproportionately affects immigrant women. However, immigrant women remain an understudied and underserved population in need for evidence-based rigorously evaluated culturally competent interventions that address their health and safety needs. This study uses a sequential, multiple assignment, randomized trial (SMART design) to rigorously evaluate an adaptive culturally informed intervention tailored to needs of immigrant women with IPV experiences. For the first stage randomization, the study will use data collected by the ongoing weWomen randomized controlled trial (RCT) (1R01HD081179- 01A1) in which abused immigrant women are being randomized to the WWmyPlan online intervention or the usual care control arm and safety, mental health and empowerment outcomes are assessed at 3, 6 and 12 months following up. In this study, women who do not report significant improvement in safety (i.e., reduction in IPV) and in empowerment from baseline to 12 months (i.e., non-responders) in the weWomen RCT will be re- randomized to a second stage randomization with augmented intervention components (i.e., text messages and phone calls). Data on outcomes (safety and empowerment) will be assessed at 6 and 12 months of re- randomization. In Phase 1 (formative phase), using a concurrent mixed methods design, we will conduct in- depth interviews with current weWomen participants on the utility of WWmyPlan online intervention components (qualitative) and analyze moderators of intervention response in the safety and empowerment outcomes at 12 months follow-up in the ongoing weWomen RCT (quantitative). Further, based on input from experts on IPV among immigrant women and from diverse groups of immigrant survivors of IPV, we will culturally tailor and pre-test the content of the augmented components (text messaging and phone calls) (qualitative). In Phase 2 (Enhanced intervention evaluation) phase, by re-randomizing participants, we will assess the relative effectiveness of two strategies for augmenting WWmyPlan (text only or a combination of text and phone) on safety and empowerment outcomes among the non-responders of the WWmyPlan intervention. In addition, the study will compare the non-responder group of women to the responder group of WWmplan intervention to determine if the strategies of augmentation brought the non-responders to the level of responders on safety and empowerment. In Phase 3 (Dissemination and Implementation), the study will identify facilitators and barriers to the adoption, implementation and maintenance of use of the original and augmented intervention by programs serving immigrant women and design strategies to decrease barriers and build on strengths. For this, the study will collect data from providers serving immigrants and organizational leaders as well as immigrant survivors of IPV who received WWmyPlan only and those who received the augmented components. The intervention will result in an evidence-based culturally informed intervention for immigrant survivors of IPV for use by practitioners serving immigrant women.