Intimate partner violence: integrating mHealth interventions into perinatal home visiting programmes in the USA

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Intimate partner violence (IPV) during pregnancy and the postpartum is common and is linked to poor health outcomes for the mother and the infant. Between 3% and 11% of pregnant women experience physical violence from a partner during their pregnancy, with higher rates reported during the postpartum.

Although interventions for women exposed to IPV have been developed in antenatal clinic settings, there is scant evidence regarding interventions for postpartum women. Increasingly, mHealth interventions have been developed to address sensitive and stigmatised issues, such as HIV and depression, which have been shown to reduce feelings of stigma that can occur during face to face counselling.

Technology based interventions for women affected by IPV have been tested, to a limited extent, in clinical settings and in the general population using internet based resources. In the United States, perinatal home visiting is a community health strategy that provides an opportunity for care providers to identify and support women and children exposed to IPV. However, little is known about the potential benefits or challenges of using technology-based IPV interventions in this setting.

Domestic Violence Enhanced Home Visitation Program (DOVE) 

As part of a Marie Curie Global Fellowship funded by the European Union, this nested qualitative study explored the relationship between technology and humans in relation to the Domestic Violence Enhanced Home Visitation Program (DOVE), an empowerment intervention to prevent IPV during pregnancy, which has been integrated into perinatal home visiting programs in the United States.

DOVE is a multisite randomised controlled trial which compares a home visitor-led method of screening for IPV and delivering an empowerment intervention (using paper-based materials), with a mHealth version of DOVE. Data generation included non-participant observations of home visits and in-depth interviews with women and perinatal home visitors in rural and urban sites, as well as interviews with the DOVE programme designers. Drawing on theories of technological determinism and the Social Construction of Technology (SCOT), the study explored how perinatal home visitors and women integrated the technology into a non-clinic setting where the development of trusting relationship is central to the care provided.

The DOVE technology was constructed as either an impersonal artefact that was an impediment to discussion of IPV or the conduit through which interpersonal connection could be deepened, thereby facilitating discussion about IPV. Women and home visitors’ comfort with either method was positively influenced by having established trust and rapport. The technology helped to reduce the anticipated stigma that women experience when disclosing abuse. The didactic intervention video was a limiting feature as the content could not be tailored to accommodate the fluidity of women’s circumstances.

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Women valued the opportunity to discuss IPV experiences and access support regardless of the method used. Risk assessment and safety planning were viewed as important features of the intervention, whether abuse was past or ongoing. Users and developers of technology-based IPV interventions need to consider the context in which they are being implemented and the importance of the patient-provider relationship in promoting behaviour change, in order to realise the full benefits. Home visitor training is needed to ensure that mHealth interventions for IPV complement and enhance the therapeutic relationship.

People

Dr Loraine J Bacchus, Principal Investigator

Collaborators 

Professor Linda Bullock, School of Nursing, University of Virginia

Professor Phyllis Sharps, School of Nursing, John Hopkins University

Professor Jacquelyn Campbell, School of Nursing, John Hopkins University

Resources 

Opening the Door: An Educational Film for Care Providers about Supporting Families Dealing with Intimate Partner Violence
Using data from the interviews with women and home visitors, an educational film was developed depicting common challenges that home visitors face and strategies for dealing with them. This film was used during reinforcement training activities with home visitors involved in the trial. The film was made in collaboration with the Department of Drama and the Media Lab at the University of Virginia. It is currently being used more widely to train perinatal home visitors in the States of Missouri and Virginia to identify and respond to women affected by IPV.

Publications 

Infusing technology into a perinatal home visitation intervention for women experiencing intimate partner violence in urban and rural settings in the USA: exploring the interpretive flexibility of an mHealth intervention.

Opening the door”: a qualitative interpretive study of women’s experiences of being asked about intimate partner violence and receiving an intervention during perinatal home visits in rural and urban settings in the USA. (Not open access)

Images of DOVE mHealth. Pictures Credit: University of Virginia, School of Nursing 2016

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