Women survivors of intimate partner violence talk about using e-health during pregnancy: a focus group study. BMC Womens Health. 2022 Mar 31;22(1):98.
STOP publication
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.
Video Consultations and Safety App Targeting Pregnant Women Exposed to Intimate Partner Violence in Denmark and Spain: Nested Cohort Intervention Study (STOP Study). JMIR Form Res. 2023 Mar. 20;7:e38563.
STOP publication
Abstract
Background: Intimate partner violence (IPV) during pregnancy is a public health issue with wide-ranging consequences for both the mother and fetus, and interventions are needed. Therefore, the Stop Intimate Partner Violence in Pregnancy (STOP) cohort was established with the overall aim to identify pregnant women exposed to IPV through digital screening and offer women screening positive for IPV a digital supportive intervention.
Objective: The aim of this study was to (1) introduce the design and profile of the STOP cohort study, (2) assess the feasibility of implementing digital IPV screening among pregnant women, and (3) assess the feasibility of implementing a digital supportive intervention targeting pregnant women exposed to IPV.
Methods: Pregnant women attending antenatal care in the Region of Southern Denmark and in Andalucía, Spain were offered digital screening for IPV using validated scales (Abuse Assessment Screen and Women Abuse Screening Tool). Women who screened positive were eligible to receive a digital supportive intervention. The intervention consisted of 3-6 video consultations with an IPV counselor and a safety planning app. In Denmark, IPV counselors were antenatal care midwives trained by a psychologist specialized in IPV, whereas in Spain, the counselor was a psychologist.
Results: Data collection started in February 2021 and was completed in October 2022. Across Denmark and Spain, a total of 19,442 pregnant women were invited for IPV screening and 16,068 women (82.65%) completed the screening. More women in Spain screened positive for exposure to IPV (350/2055, 17.03%) than in Denmark (1195/14,013, 8.53%). Among the women who screened positive, only 31.39% (485/1545) were eligible to receive the intervention with only 104 (21.4%) of these women ultimately receiving it.
Conclusions: Digital screening for IPV among pregnant women is feasible in an antenatal care context in Denmark and Spain; however, a digital supportive intervention during pregnancy appears to have limited feasibility as only a minor subgroup of women who screened positive for eligibility received the intervention. More research is needed on how to best support pregnant women exposed to IPV if universal IPV screening is to be implemented in antenatal care.
E-health psychological intervention in pregnant women exposed to intimate partner violence (eIPV): A protocol for a pilot randomised controlled trial. PLoS One. 2023 Mar 17;18(3):e0282997.
STOP publication
Abstract
Intimate partner violence (IPV) during pregnancy, a condition as common as obstetrics conditions like gestational diabetes, is associated with maternal and neonatal complications. Systematic detection of IPV is not well established in antenatal screening probably because the effectiveness of protective interventions has not been evaluated. E-health interventions may be beneficial among mothers exposed to IPV. Prior to performing a full-scale effectiveness trial for such an intervention, a pilot study is required to assess the feasibility of randomising a sufficiently large number of women exposed to IPV during pregnancy. The eIPV trial is a randomised pilot study nested within a cohort of consenting mothers who screen positive for IPV in the first antenatal visit at <12 weeks’ gestation and accept an e-health package (psychological counselling by videoconference) in Spain and Denmark. Twenty eligible mothers from the above cohort will be randomised to either intervention or control. The intervention group will receive the e-health package as part of the cohort. The control group will be invited to accept a delay in the intervention (e-health package eight weeks later). After consenting to delay, the control group will provide comparative data without losing the opportunity of obtaining the intervention. We will determine estimates of rates of informed consent to randomization, and the rates of adherence and dropout following randomization. Qualitative interviews will be conducted to examine the women’s perception about the benefit of the intervention, reasons for acceptability and non-adherence, and obstacles to recruitment, randomisation and consent. The results will inform the trial feasibility and variance of key clinical outcome measures for estimation of sample size of the full-scale effectiveness trial.
Screening for domestic violence among pregnant women and their partner – a literature review. Danish National Board of Health. 2024 Mar.
STOP publication
Abstract
This report summarises the scientific literature concerning screening tools for domestic violence targeted pregnant women, their partners, new parents and perpetrators of violence. Further, the report summarises barriers and facilitators for health care professionals to screen for domestic violence during antenatal and post-partum care and for the target group and key issues in relation to ethnic minority groups. The report has been made by researchers from the University of Southern Denmark on behalf of the Danish Health Authorities and the Danish Agency for Recruitment and Integration. The report is in Danish but has an English summary (chapter #3).
Ditte S Linde, Karen Andreasen, Nina B Hansen, Lea Ankerstjerne, Lea M Helmer-Hansen, Morten Sodemann, Vibeke Rasch, Ask Elklit.
Read more here; https://sundhedsstyrelsen.dk/da/udgivelser/2024/Opsporing-af-vold
Interventions against domestic violence targeted pregnant women, their partners and perpetrators – a literature review. Danish National Board of Health. 2024 Mar.
STOP publication
Abstract
This report summarises the scientific literature concerning interventions against domestic violence targeted pregnant women, their partners, new parents and perpetrators of violence. Further, the report summarises barriers and facilitators for health care professionals to initiate interventions against domestic violence and key issues in relation to ethnic minority groups. The report has been made by researchers from the University of Southern Denmark on behalf of the Danish Health Authorities and the Danish Agency for Recruitment and Integration. The report is in Danish but has an English summary (chapter #3)
Ditte S Linde, Karen Andreasen, Nina B Hansen, Anne K Normann, Lea M Helmer-Hansen, Morten Sodemann, Vibeke Rasch, Ask Elklit.
Read more here: https://www.sst.dk/da/Fagperson/Graviditet-og-smaaboern/Vold-i-naere-relationer/Om-vold-i-naere-relationer
Prevalence and associated factors of intimate partner violence against pregnant women who attend antenatal care in Denmark and Spain: A digital approach (under review Acta Obstetricia et Gynecologica Scandinavica)
STOP publication
Abstract
Intimate partner violence (IPV) against women is a global health issue. Exposure to IPV during pregnancy leads to health-related problems for both the mother and the newborn. However, current knowledge on its occurrence is heterogeneous and assessing the problem using standardized tools in different contexts is needed. This study aimed to estimate the prevalence and associated factors of IPV in pregnant women in Denmark and Spain through digital tools. A cross-sectional design was used to systematically screen for IPV among pregnant women attending antenatal care by use the standardized screening tools, Woman Abuse Screening Tool and Abuse Assessment Screen. A total of 17 220 women in Denmark and 2222 women in Spain were screened. The response rate was high in both countries (74.7 % and 92.5 %, respectively). IPV was reported by 6.6% (n = 854) of pregnant women in Denmark, and 13.7% (n = 282) in Spain. Logistic regressions estimated crude and adjusted odds ratio with 95% confidence intervals of the relationship between sociodemographic variables and IPV. In both countries having a marital status other than married and lack of social support were risk factors of IPV. Additionally, in Denmark, pregnant women older than 40 years, unemployed or foreign, were at higher risk, while having higher educational levels was a protective factor. In Spain, having at least one child prior to the current pregnancy was a risk factor of IPV. These results contribute to a more comprehensive understanding of the occurrence of IPV during pregnancy in Denmark and Spain and highlight the feasibility of digital systematic screening in antenatal settings across Europe.
Rodrigo Fernández-López, Karen Andreasen, Lea Ankerstjerne, Stella Martín-de-las-Heras, Vibeke Rasch, Jesús L. Megías, Ditte S. Linde, Sabina de-León-de-León, Berit Schei, Chunsen Wu, Alba Oviedo-Gutiérrez, Antonella Ludmila Zapata-Calvente.
Keywords: Intimate partner violence; Prevalence; Screening; Digital tools; Pregnancy; Antenatal care
The Effect of a Digital Intervention on Symptoms of Depression in Pregnant Women Exposed to Intimate Partner Violence in Denmark and Spain (STOP study). European Journal of Obstetrics & Gynecology and Reproductive Biology (in press)
STOP publication
Abstract
Objective: To assesses the effectiveness of a digital intervention for pregnant women exposed to Intimate Partner Violence (IPV) in reducing symptoms of depression
Design: Intervention study nested in a cohort study
Setting: Denmark and Spain
Population: Pregnant women attending antenatal care
Methods: Routine digital IPV screening was conducted during antenatal care using the AAS and WAST screening tools. Pregnant women who screened positive were offered a digital intervention in the form of 3-6 video consultations with trained IPV counselors and access to a safety planning app. Changes in depression scores from baseline to follow-up were assessed using linear mixed regression.
Main Outcome Measure: Symptoms of depression were assessed using the Edinburgh Postnatal Depression Scale (EPDS).
Results: From February 2021 to October 2022, 1,545 pregnant women (9.6%) screened positive for IPV (8.5% in Denmark and 17.0% in Spain). Of 485 women (31.4%) eligible, 104 (21.4%) accepted the intervention, and 55 completed it (52.9%). The intervention significantly reduced symptoms of depression with a mean difference of -3.9 (95% CI: -5.3; -2.4) in EPDS scores pre- versus post-intervention. Stratified analyses across sociodemographic variables did not affect the overall result, indicating a reduction in EPDS scores regardless of location or sociodemographic factors. Notably, the intervention was most effective for women initially presenting with EPDS scores above the depression cut-off.
Conclusion: Video consultations and access to a safety planning app is associated with a reduction in depression scores among pregnant women exposed to partner violence, particularly among those with high depressive scores.
Karen Andreasen, Rodrigo Fernandez-Lopez, Chunsen Wu, Ditte S Linde, Alba Oviedo-Gutiérrez, Jesús L Megías, Stella Martín-de-las-Heras, Antonella L Zapata-Calvente, Lea Ankerstjerne, Sabina de-León-de-León, Sarah Dokkedahl, Berit Schei, Vibeke Rasch.
Keywords: Intimate partner violence; domestic violence; telemedicine; mHealth; depression; mental health; antenatal care
Cohort profile: the Danish STOP-VIO-PREG cohort study of self-reported violence among pregnant women utilizing Patient Reported Outcomes and Danish Register (under review BMJ Open)
STOP publication
Abstract
The Danish STOP-VIO-PREG cohort was built on Patient Reported Outcome (PROdata) to investigate self-reported violence among pregnant women in Denmark.
The main aims of this cohort are to estimate the prevalence of self-reported violence among pregnant women and identify specific risk factors associated with violence. In addition, we investigate the association between self-reported violence among pregnant women and adverse pregnancy outcomes. Pregnant women attending antenatal care in the Region of Southern Denmark, or the Capital Region have been invited to fill out a PROdata questionnaire containing the Abuse Assessment Screen (AAS) before their first visit to the antenatal care unit. Enrollment took place from December 2019 to September 2022. After enrollment, data was linked with multiple Danish registers. In total, 28,697 women received the PROdata questionnaire, and 23,768 (82,8%) responded to the AAS. The PROdata provides a wide range of information on self-reported violence allowing us to estimate the prevalence of violence in this cohort. Measurements of covariates on sociodemographic characteristics and pregnancy adversities have been included from the nationwide Danish registers. In addition, the registers provided data on socioeconomic characteristics, which enabled us to compare women who screened positive, negative or who did not respond. In the future, PROdata and the cohort associated with the registry data offer a valuable data platform that opens up numerous distinctive research opportunities. Two papers are in preparation, one on risk factors for self-reported violence and another on self-reported violence and pregnancy adversities, particularly preterm birth and low birth weight, Future perspectives are: (1) increasing inclusion of immigrants in PROdata by by translating the questionnaire to relevant languages, (2) including other variables from the PROdata in the analysis, like mental health (WHO5), (3) looking at the psychiatric hospital visits over time for the women who report violence, and (4) doing a second register enrichment of the cohort to follow up on the offspring.
Lea B.S. Ankerstjerne, Ditte Linde, Berit Schei, Karen Andreasen, Chunsen Wu, Kristine M Renault, Hanne Kristine Hegaard, Janet Fanslow, Vibeke Rasch.
Keywords: Intimate partner violence, violence, pregnancy, adverse pregnancy outcomes, non-responders, violence prevalence, registry, Patient Reported Outcomes (PRO), Denmark, digital screening, offspring, Abuse Assessment Screen.