Safety decision-making and planning mobile app for intimate partner violence prevention and response: randomised controlled trial in Kenya

Abstract

IntroductionIntimate partner violence (IPV) threatens women’s health and safety globally, yet services remain underdeveloped and inaccessible. Technology-based resources exist, however, few have been adapted and tested in low-resource settings. We evaluate the efficacy of a community-partnered technology solution: culturally and linguistically adapted version of the myPlan app, a tailored safety decision-making and planning intervention, administrated by trained lay professionals.MethodsThis randomised, controlled, participant-blinded superiority trial compares safety-related outcomes at baseline, immediate post intervention and 3-month follow-up among women at risk of and experiencing IPV in Nairobi, Kenya. Women were randomised (1:1 ratio) to: (1) myPlan Kenya (intervention); or (2) standard IPV referrals (control). Primary outcomes were safety preparedness, safety behaviour and IPV; secondary outcomes include resilience, mental health, service utilisation and self-blame.ResultsBetween April 2018 and October 2018, 352 participants (n=177 intervention, n=175 control) were enrolled and randomly assigned; 312 (88.6%, n=157 intervention, n=155 control) were retained at 3 months. Intervention participants demonstrated immediate postintervention improvement in safety preparedness relative to control participants (p=0.001). At 3 months, intervention participants reported increased helpfulness of safety strategies used relative to control participants (p=0.004); IPV reduced in both groups. Among women reporting the highest level of IPV severity, intervention participants had significant increase in resilience (p<0.01) compared with controls, and significantly decreased risk for lethal violence (p<0.01).ConclusionsFacilitated delivery of a technology-based safety intervention appropriately adapted to the context demonstrates promise in improving women’s IPV-related health and safety in a low-resource, urban setting.Trial registration numberPan African Clinical Trial Registry (PACTR201804003321122).

Gender-based violence during COVID-19 among adolescent girls and young women in Nairobi, Kenya: a mixed-methods prospective study over 18 months

“…45 WHO guidelines for violence assessment and response can be integrated within community programmes and clinics serving AGYW 46 ; during pandemics and related emergencies, these strategies can be embedded in testing or support facilities. Technology-based solutions offer the added advantage of accessibility even during mobility restrictions throughout the COVID-19 and future public health emergencies; technology-based relationship safety assessment and planning tools have been found acceptable and valuable for safety planning and connection to care within Kenya, 47 and can be implemented more widely to reach AGYW even in emergencies. Further, the disruption of the COVID-19 pandemic represents a window of opportunity to disrupt the harmful social norms that maintain tolerance of IPV and other forms of violence, and the gendered economic imbalances that render women dependent on potentially harmful partners.…”

Women survivors of intimate partner violence talk about using e-health during pregnancy: a focus group study

“…Some features that women did not consider useful to include in safety planning apps were peer stories and mood rating, which were not seen as helpful. Safety planning apps have been effectively implemented with non-pregnant women [ 43 , 44 ], facilitating safety decision making [ 45 ] and reducing IPVAW exposure 23 . However, evidence on the implementation of safety planning apps in pregnant women is lacking, and these results can serve as a first step toward designing future studies on this topic.…”

Impact of the COVID-19 pandemic on intimate partner violence during pregnancy: evidence from a multimethods study of recently pregnant women in Ethiopia

“…Second, the use of safety decision-aids by providers across the continuum of care could assist in helping women assess their circumstances and level of danger, and create safety plans tailored to their situations. Safety planning with trained community health workers was found to increase safety preparedness in Kenya,32 and may be similarly valuable in rural areas of Ethiopia with trained Health Extension Workers. Clinic-based interventions to reduce and address IPV should not occur separately from other health services, but as part of larger community-led behavioural change programmes with influential community members on targeting harmful gender norms and IPV, in order to ultimately empower women and girls.…”