Short summary

Intimate partner violence (IPV) is the most common form of violence against women worldwide, and IPV is a serious public health issue with significant negative short and long-term health consequences for both women and the unborn child. In this study an mHealth intervention consisting of video-counselling coupled with a smartphone safety app to promote safety behaviours is tested in addition to the routine antenatal counselling among pregnant women who have been screened IPV-positive.

Rationale

Intimate partner violence (IPV) defined as physical, sexual, or psychological harm by a current or former partner or spouse, is by the World Health Organization defined as the most common form of violence against women worldwide. IPV affects one in three women during their lifetime, with the highest prevalence of violence for women at the reproductive age.

IPV is a serious public health issue with significant negative short and long-term health consequences for both women and the unborn child such as depression or mental disorders, preterm birth, low birthweight, and perinatal death.

There is a lack of knowledge on how to intervene to prevent IPV. Studies have found that there can be barriers to communicate face-to-face about IPV for the pregnant women, whereas mobile health (mHealth) tools as mobile or tablets e.g, which facilitate remote interactions between woman and health care provides, can promote confidentiality and privacy and be a possible solution to deliver effective treatment and support to women exposed to IPV.

Objective of the project is to describe the effect of the of mHealth intervention among pregnant Danish women exposed to abuse on signs on depression, IPV-exposure and empowerment. Also, to explore the acceptability and feasibility of mHealth-intervention among pregnant women and health care providers.

Description of the cohort

Women attending antenatal care at Esbjerg Hospital, Aabenraa Hospital, Kolding Hospital and Odense University Hospital in the Region of Southern Denmark will be invited to participate in the project.

Screening for IPV have become part of routine antenatal care in the Region of Southern Denmark, where all pregnant women are asked to fill in an electronical questionnaire on pregnancy related life-style measures and quality of life (PRO data). The PRO data questionnaire includes a screening for IPV exposure based on the Abuse Assessment Screen (AAS), a 5-item screening questionnaire including physical, emotional, and sexual violence as well as threats/fear of violence during pregnancy and a short version of the Women Abuse Screening Tool (WAST-short), which is a 2-item tool that measures conflict and tension with the partner.

Pregnant women who screen positive for IPV in first trimester will be eligible for inclusion into the study. Women will be excluded if they (1) cannot be informed about the study without their partners or other family members knowing; (2) do not have the mental or physical capacity to participate in the study; (3) do not understand Danish/Spanish, or (4) do not have a smartphone.

Women who screened positive and are eligible will be invited to participate in the project, where they will be offered 3-6 specially targeted consultations via video and get access to a safety planning app. The video counseling will be provided by midwives, who have been trained in discussing and addressing IPV and will focus on conflict management, strategy planning in case of crisis situations, empowerment, and general information on partner violence. In the counselling the women will receive help in developing a safety plan, which are supported by the smartphone safety app helping to protect the women from ongoing violence.

Data and biological material

To assess the impact of the intervention on several factors, quantitative questionnaire data will be collected at study inclusion (pre intervention) and when the study finishes (post intervention). Exposure to IPV will be assessed by use of the ISA tool, and pre/post-natal depression will be assessed by use of The Edinburgh Postnatal Depression Scale (EPDS). In order to measure the women's ability to carry out safety behaviour actions, a revised version of the 22-item safety action checklist will be used, as well as the Measure of Victim Empowerment Related to Safety (MOVERS scale). Further at study inclusion, participants will be asked to fill in an electronic questionnaire concerning background characteristics. Information about the outcome of the index pregnancy, delivery method and the child weight and length will be retrieved from the patient files after the women have delivered.

In order to assess the acceptability and feasibility of video counseling and the smartphone safety app, a qualitative study will be conducted by individual in-depth interviews with participants and with the IPV counsellors conducting the video sessions. A semi-structured interview guide will be developed for the interviews using the Model for Assessment of Telemedicine Applications (MAST) as theoretical framework.

Collaborating researchers and departments

Department of Forensic Medicine of Granada; Spain

• Stella Martin de las Heras