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

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).

Keywords: public health; randomised control trial.

Figure 1

Consolidated Standards of Reporting Trials.

Figure 2

Regression Coefficients and 95% CIs Stratified by Baseline Violence Severity, Resilience, and Past Three-month IPV-related Service Use Line indicates regression coefficient relative to line value of "1". Betas from interaction term in difference-in-difference linear regression unless noted; ^∉=p<0.10; *=p<0.05; **=p<0.01; ***p<0.001. ^±Linear regression comparing intervention to control group for exit survey safety preparedness, adjusting for baseline decisional conflict and site ^≈Linear regression comparing baseline and follow-up for intervention participants only.