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

Abstract

Background

Pregnancy is a period of particular vulnerability to experience intimate partner violence against women (IPVAW). eHealth strategies have been implemented to identify women exposed to IPVAW and to combat the abuse and empower them, but there is a lack of evidence on the use of these strategies among pregnant women. This work aims to identify the needs, concerns and preferences of survivors about the use of eHealth strategies to counsel and empower pregnant victims of IPVAW in antenatal care.

Methods

A focus group of six IPVAW survivors who had been pregnant was conducted and open questions about the use of eHealth strategies were asked. The session was recorded, transcribed and thematically analyzed. We identified three main themes: needs and worries of pregnant women experiencing IPVAW, key aspects of video counseling sessions and usefulness of safety planning apps.

Results

Women highlighted the relevant role of healthcare professionals—especially midwives—in the identification of IPVAW and the wellbeing of their children as one of the main concerns. They perceived video counseling and safety planning apps as valuable resources. The preferred contents for a video counseling intervention were awareness-raising of the situation, self-esteem and legal advice. They also proposed safety and pregnant-related aspects that should be taken into account in the design of the video counseling sessions and the safety planning app.

Conclusions

Video counseling sessions and safety planning apps are potentially useful tools to counsel and empower women who experience IPVAW during pregnancy. Midwives play a key role in this endeavor.

 

Find the publication here: Fernández López, R., de-León-de-León, S., Martin-de-las-Heras, S. et al. Women survivors of intimate partner violence talk about using e-health during pregnancy: a focus group study. BMC Women's Health 22, 98 (2022). https://doi.org/10.1186/s12905-022-01669-2


Ethical Approval

Month: March 2022


The ethical approval applications have been submitted to the local Ethics Committees at the Danish and Spanish sites, respectively. The descriptions provide information on the background of the project, its aims, methodology with sub-studies, needs assessment, anticipated risks, access to patient information, informed consent, impact, funding, the ethics, safety and security of the project, the members of the research team, and relevant references. At the Spanish site, ethical approval has been received for the screening solution while approval for the video counseling solution is still pending. At the Danish site, the screening solution has been implemented throughout the region and thus no ethical approval is needed, and the ethics committee determined that approval was unnecessary for the video counseling intervention.

 

As the deliverable is confidential, it has not been made available here.


Joint Training Workshop

Month: March 2022


A joint training workshop was conducted on February 1, 2021, as part of the counsellors’ training and the preparation for launching the STOP intervention. The purpose of the workshop was to provide training as well as an inspirational session to the counsellors (the Danish midwives and Spanish psychologist) who are responsible for carrying out the counselling sessions with women exposed to intimate partner violence (IPV).

The keynote speakers invited to the workshop were professors from Johns Hopkins University School of Nursing who are experts in the field of implementing online interventions for women exposed to IPV. They spoke about:

  • The target group for the STOP-project, and on how to work with the women in their own homes and about the content and implementation of a safety planning app.
  • Routine assessment/inquiry (screening), and how this creates a good opportunity for disclosure, seeking help early and a place for those who are not ready for drastic actions and the shelter. At the same time, the challenge with routine assessment is often the implementation. They underlined the importance of how the counsellors introduce the screening, (e.g., by introducing the theme as part of standard procedure: “Because domestic violence happens to so many women, we are asking ALL the women…”.)

They also offered practical advice on how a safety planning app can be implemented (e.g., if the woman cannot use her own phone because of a controlling partner she might be able to borrow a phone from a friend or a family member.)

The workshop provided an excellent opportunity to learn from researchers and scientists who have implemented similar interventions. The keynote presentations confirmed that what we have developed so far in the STOP-project makes sense, and the challenges we have anticipated seem reasonable. The speakers also offered insight into how they have measured the effect of their interventions, which gave us input regarding how to best measure the effect of the STOP-intervention. Finally, the joint training workshop was an opportunity to create a network within the field of IPV, and the foundation for possible future collaboration, in case we are to have a STOP-project 2.0.

As the deliverable is confidential, it is not made available here.


Participatory Workshop

Month: March 2022


The purpose of the participatory workshops was to gather information and input from relevant stakeholders in both Spain and Denmark to develop the STOP intervention covering both the Video Counselling and Safety Planning app.

The workshops are considered a very important source for information guiding the development of the intervention.

  • The Spanish workshop was completed on September 30, 2020, with six participants from different Spanish NGO’s.
  • The Danish workshop was completed on September 17, 2020, with six participants from different Danish NGO’s.

The focus of both workshops was to discuss and receive input about the needs of woman exposed to IPV, the content of the video counselling service, and desired features of the safety planning app. The participants were presented with the app, “MyPlan”, that has been identified as the safety planning app to be used in STOP.

To conduct the interviews a few changes has been implemented to meet the requirements of COVID-19 guidelines. Despite these changes, the workshop participants provided valuable input in line with input that would have been delivered in the originally planned setting. Thus, the input gathered has guided the development of the intervention as it was set out in the project description.

The workshops were to be conducted by the WP3 leader and in a physical format. However, COVID-19 restrictions required some changes. The Spanish workshop was carried out by project partners from UGR due to travel restrictions between Denmark and Spain. The UGR team had received a workshop guideline and thorough instructions prior to the workshops to ensure alignment between the Danish and Spanish workshops. The WP3 leader participated via video to support the workshop if necessary. In the Danish workshop, one participant was not able to join in person and therefore, a video connection was established.

Despite these changes implemented to meet the requirements of COVID-19 guidelines, the workshop participants provided valuable input in line with input that would have been delivered in the originally planned setting. Thus, the input gathered has guided the development of the intervention as it was set out in the project description.

As this deliverable is confidential, it is not available here.


Focus Group Interviews

Month: March 2022


To inform the development of the STOP intervention, focus group interviews were carried out in both Spain and Denmark with NGOs and women exposed to intimate partner violence (IPV). The purpose of the focus group interviews was to gather information and input from relevant stakeholders (NGO’s) in both Spain and Denmark to develop the STOP intervention covering both the Video Counselling and Safety Planning app.

The focus group interview with the Spanish NGO’s was completed on September 30, 2020, with six participants. The focus group interview with the Spanish women exposed to IPV was completed on October 6, 2020, with five participants.

The focus group interview with the Danish NGO’s took place on September 8, 2020, with three participants. This was followed by three additional interviews with NGO’s on the October 2, 2020, October 5, 2020 and November 2, 2020. The interview with the Danish woman exposed to IPV was completed on November 24, 2020.

The focus of the interviews was to discuss and receive input about the needs of women exposed to IPV, their existing ways of handling IPV and their concerns for a video counselling service, and the use of a safety planning app.

Based on the interviews, the following needs in terms of support have been identified:

  • Acknowledgement: The pregnant woman does not see herself as a victim of violence and finds it hard to accept.
  • Ambivalent emotions towards the partner: They have a lot of dreams and hopes regarding their relationship, and this makes it hard to accept that their “life project” to create a family is broken.
  • Fear of the system: Fear of losing custody of their child if they communicate their situation.
  • Resources: Worries about being on their own, having to do everything on their own and without financial support from the partner.
  • Low self-esteem: Finding it difficult to make decisions and taking actions to change their situation.
  • Isolation: Rebuilding their connections and relations in the world, helping them identify their network and learn about the resources available for help.
  • In order to help the woman acknowledge her situation it is very important that the counsellors listen to her, hear her story and gain her trust. Some of the participants were concerned that having the counselling via video might create distance and make it hard to gain the women’s’ trust. Others believed it might make it easier to talk about the difficult subjects because of the distance. They were also concerned about if and where the woman would be able to conduct the video counselling, due to a controlling partner or lack of access to Wi-Fi.

The participants found that the features in the safety planning app could be useful for the women. All the participants agreed that it was very important that the app would be camouflaged so the partner would not get suspicious.

All the participants agreed that a full recovery is often a long process that can take years and often the violence continues after the woman leaves the violent partner. If the STOP-intervention is a limited service, it is important that the women receive support and are encouraged to seek treatment elsewhere.

As this deliverable is confidential, it is not made available here.


Training of Counsellors

Month: March 2022


Before the video counselling intervention commenced, Danish midwives and the Spanish psychologist participated in special training sessions. The purpose of the training was to both prepare the counsellors for the STOP-intervention and to train them in conducting video counselling with pregnant women exposed to IPV.

The training of the 10 Danish midwives included:

  • Three days of training between January 11-13, 2021,
  • Two hands-on training sessions at end of February and in the beginning of March, 2021,
  • Follow up sessions (planned for when the intervention has been launched).

The training of the Spanish psychologist has included:

  • Two days of training between January 21-22, 2021,
  • Hands-on training sessions in February 2021,
  • Follow up sessions (planned for when the intervention has been launched).

Due to the Covid-19 related restrictions, all training has been conducted virtually, except for the two hands-on training sessions with the Danish midwives in February/March.

The training sessions in both countries were planned and adjusted to fit the needs of the participants. Therefore, the training of the Danish midwives, who had little or no knowledge about the STOP-project and IPV, were longer than the training of the Spanish psychologist.

In the training of the Danish midwives and the Spanish psychologist, the focus was the theoretical framework of the video counselling sessions, and specific methods in relation to the framework. The training also covered communication techniques for counselling IPV-victims, the use of a safety-planning app, and best practice when conducting video counseling.

As part of the training sessions, the participants were asked to evaluate the training and provide feedback to the lecturers. The evaluation of the training is included in this document. The overall conclusion is that most of the participants were “very satisfied” and “satisfied”.

As this deliverable is confidential, it is not made available here.


Development of Training Manual for Conducting Video Counselling

Month: March 2022


A training manual developed for the IPV counsellors who conduct video counselling in the STOP-project. The manual was developed to support the counsellors and provides information including workflow, basic guidance, and methods related to the different sessions of the intervention.

There are minor differences between the interventions in Spain and Denmark. Therefore, two separate manuals were developed: one for the Danish midwives and one for the Spanish psychologist to align the manual to the context where it is used. Both manuals include guidelines and information for the situations where the counsellor is in contact with the women exposed to IPV: pre-session, video counselling and post-intervention evaluation.

The manuals cover topics such as general contact information (on project members, midwives, and technical support), an introduction to the STOP project, guidelines and workflows for the individual sessions, a theoretical framework, description of relevant methods for awareness raising, support and empowerment, best practice for video counselling, information about danger assessment, etc.

In Denmark, the manual was printed and delivered to the 10 midwives in the STOP-project as part of a training visit. At this visit, the manual was thoroughly explained and reviewed.

In Spain, it was not possible to visit the psychologist due to the COVID-19 situation. Therefore, the manual was sent digitally, and later explained and reviewed via video conference.

As the deliverable is confidential, it is not made available here.