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Original research
Safety decision-making and planning mobile app for intimate partner violence prevention and response: randomised controlled trial in Kenya
  1. Michele R Decker1,2,3,
  2. Shannon N Wood1,
  3. Zaynab Hameeduddin1,
  4. S Rachel Kennedy2,
  5. Nancy Perrin2,
  6. Catherine Tallam4,
  7. Irene Akumu4,
  8. Irene Wanjiru4,
  9. Ben Asira4,
  10. Ariel Frankel5,
  11. Benjamin Omondi4,
  12. James Case2,
  13. Amber Clough2,
  14. Richard Otieno4,
  15. Morris Mwiti4,
  16. Nancy Glass2,5,6
  1. 1Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
  3. 3Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  4. 4Ujamaa Africa, Nairobi, Kenya
  5. 5International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  6. 6Center for Global Health, Johns Hopkins University, Baltimore, Maryland, USA
  1. Correspondence to Dr Michele R Decker; mdecker{at}jhu.edu

Abstract

Introduction Intimate 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.

Methods This 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.

Results Between 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).

Conclusions Facilitated 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 number Pan African Clinical Trial Registry (PACTR201804003321122).

  • public health
  • randomised control trial
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgh-2019-002091

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    Footnotes

    • Handling editor Seye Abimbola

    • Contributors MD and NG designed this study. MD, ZH and SW drafted the paper. NG, MD and AC designed the intervention content. NAP provided power calculations and analysis oversight. BA ran the project in the field, with CT, IA, IW and SRK responsible for recruitment, intervention adaptation, piloting and formative work. SW led analysis. ZH, SRK and AF led training, protocol development, data quality, technical support and structured community input. BO contributed to the conceptualisation of the trial and facilitated interaction between the teams on scientific issues. RO and MM identified and facilitated connection with field partners. JC conducted all study-related programming including the intervention app and randomisation. All authors contributed to the drafting and critical review of the manuscript, and reviewed the final draft.

    • Funding This study was funded by Ideas42 (PI Decker).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Patient consent for publication Not required.

    • Ethics approval The Johns Hopkins Bloomberg School of Public Health Institutional Review Board and the Kenya National Commission for Science Technology and Innovation approved the protocol.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon request. The authors will make data available to scientists planning specified and agreed further analyses; for access, contact the corresponding author.