DOVE

Exploring the ethical and social aspects of using mHealth technology in urban and rural home visitation programmes for women affected by domestic violence

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 Obiettivo del progetto (Objective)

'Domestic violence against women is highly prevalent and recognised as a global public health issue. Internationally there has been greater focus on the development and evaluation of interventions to address domestic violence in health care settings, paticularly primary and maternity care. To date, much of the evidence on health sector interventions to address domestic violence comes from the United States and there are few published studies in Europe. Futhermore, there are gaps in the research evidence with regards to domestic violence interventions in home visitation programmes for women with young children.

In the USA, a team of researchers at the University of Virgina and John Hopkins University are testing a domestic violence intervention in home visitation programme using mHealth technology called eMOCHA DOVE (Domestic Violence Enhanced Home Visitation) in a five-year randomised controlled trial. The intervention will be tested in urban and rural sites in Baltimore and Virginia. This is the first study internationally to use mHealth technology to deliver a domestic violence intervention by home visitors. eMOCHA DOVE will assist home visitors in accurately identifying domestic violence and providing an intervention using a well tested empowerment model. The control group will receive the standard DOVE intervention which is adminstered by the home visitor using paper and pencil technique.

The use of mHealth to deliver domestic violence interventions in health care and home visitation is new and warrants further investigation. It is not yet known whether mHealth will help or hinder the outcome of interventions for women and children. The fellowship provides an opportunity to conduct ethnographic research within a federally funded trial to explore the potential bioethical and social aspects with regards to issues such as safety, trust, impact on patient/provider relationship and communication and information sharing and confidentiality.'

Introduzione (Teaser)

Perinatal home visitation programmes that implement screening for domestic abuse can benefit from findings on best practice and the possible use of mobile health (mHealth) technology.

Descrizione progetto (Article)

Domestic violence against women is a widespread global public health issue. On an international level, there has been an increase on the development and evaluation of interventions that address domestic violence in health care settings. This is especially the case in primary and maternity care. During pregnancy and postpartum, the risk for intimate partner violence (IPV) increases. As a result, IPV can have long-term consequences on the health of women and children. Information is lacking regarding the best methods for identifying and supporting abused women in home settings, especially while maintaining privacy and being accurate and sensitive.

The EU-funded DOVE project is working to change that. A qualitative study is nested within a trial that tests the effectiveness of an intervention administered by trained home visitors with the use of paper assessment and the development of safety plans. This is being compared with the same materials being delivered by mHealthtechnology (i.e. a computer tablet), The qualitative study explores the views of home visitors and clients.

The nested qualitative study involves 51 interviews and observations of home visitation. Additionally, the work has entailed literature searches, formal and informal training, presentations and published papers. Initial findings indicate that using a computer tablet is a safe and confidential way for abused women to reveal their experiences without the risk of judgement. Prior to the DOVE intervention, women were often not disclosing IPV to professionals. Furthermore, women in rural are often isolated from help due to limited support services or access to transportation.

Research findings will make a significant contribution to perinatal home visitation programmes that receive funding. The DOVE intervention is also having a broader societal impact on women with no history of IPV, conveying the important message that IPV is unacceptable and that women can get help.