Infusing Technology Into Perinatal Home Visitation in the United States for Women Experiencing Intimate Partner Violence: Exploring the Interpretive Flexibility of an mHealth Intervention

Abstract

BackgroundIntimate partner violence (IPV) is common during pregnancy and the postpartum. Perinatal home visitation provides favorable conditions in which to identify and support women affected by IPV. However, the use of mHealth for delivering IPV interventions in perinatal home visiting has not been explored.ObjectiveOur objective was to conduct a nested qualitative interpretive study to explore perinatal home visitors’ and women’s perceptions and experiences of the Domestic Violence Enhanced Home Visitation Program (DOVE) using mHealth technology (ie, a computer tablet) or a home visitor-administered, paper-based method.MethodsWe used purposive sampling, using maximum variation, to select women enrolled in a US-based randomized controlled trial of the DOVE intervention for semistructured interviews. Selection criteria were discussed with the trial research team and 32 women were invited to participate. We invited 45 home visitors at the 8 study sites to participate in an interview, along with the 2 DOVE program designers. Nonparticipant observations of home visits with trial participants who chose not to participate in semistructured interviews were undertaken.ResultsWe conducted 51 interviews with 26 women, 23 home visiting staff at rural and urban sites, and the 2 DOVE program designers. We conducted 4 nonparticipant observations. Among 18 IPV-positive women, 7 used the computer tablet and 11 used the home visitor method. Among 8 IPV-negative women, 7 used the home visitor method. The computer tablet was viewed as a safe and confidential way for abused women to disclose their experiences without fear of being judged. The meanings that the DOVE technology held for home visitors and women led to its construction as either an impersonal artifact that was an impediment to discussion of IPV or a conduit through which interpersonal connection could be deepened, thereby facilitating discussion about IPV. Women’s and home visitors’ comfort with either method of screening was positively influenced by factors such as having established trust and rapport, as well as good interpersonal communication. The technology helped reduce the anticipated stigma associated with disclosing abuse. The didactic intervention video was a limiting feature, as the content could not be tailored to accommodate the fluidity of women’s circumstances.ConclusionsUsers and developers of technology-based IPV interventions need to consider the context in which they are being embedded and the importance of the patient-provider relationship in promoting behavior change in order to realize the full benefits. An mHealth approach can and should be used as a tool for initiating discussion about IPV, assisting women in enhancing their safety and exploring help-seeking options. However, training for home visitors is required to ensure that a computer tablet is used to complement and enhance the therapeutic relationship.ClinicalTrialClinicaltrials.gov NCT01688427; https://clinicaltrials.gov/ct2/show/NCT01688427 (Archived by WebCite at http://www.webcitatio...

eHealth versus equity: Using a feminist poststructural framework to explore the influence of perinatal eHealth resources on health equity

“…Despite not including their target population in the development phase, Bacchus et al. () acknowledged that Spanish speaking women are less likely to disclose their experiences with intimate partner violence, so they offered a version entirely in Spanish. Kingston et al.…”

“…Aligning with the philosophical underpinnings of FPS, Bacchus et al. () present an exemplar case of understanding the experiences of their target population, as the focus of their resource is intimate partner violence. Thus, given that their target population was explicitly facing oppression and violence by their male partners, the authors were instinctively attentive to the underlying issues with relationships of power.…”

“…Throughout the literature, eHealth resources were believed to offer a nonjudgmental space where the users valued the anonymity and opportunity to express their experiences without an immediate reaction by another person (Bacchus et al., ; Logsdon et al., ).…”

“…Eleven articles were identified in this review, whereby each discussed a parent-targeted perinatal eHealth resource. Of the articles included, five focused on perinatal depression using webbased resources (Baumel & Schueller, 2016;Forsell et al, 2017;Kingston et al, 2017;Logsdon et al, 2013) or a mobile application (Gordon, Henderson, Holmes, Wolters, & Bennett, 2016), three provided web-based education on general infant care (Kadivar, Seyedfatemi, Mokhlesabadi Farahani, Mehran, & Pridham, 2017;Salonen et al, 2011Salonen et al, , 2014, one on web-based breastfeeding education (Abbass-Dick et al, 2017), as well as a mobile application regarding perinatal intimate partner violence (Bacchus et al, 2016) and an educational Youtube video about infant procedural pain (Campbell-Yeo et al, 2017). Only one of the articles was published in 2011 and the remaining within the last 5 years, providing a timely analysis to understand the experiences of eHealth as is currently stands.…”

“…While it is difficult to fully understand the user's experience indirectly through this critical review of the literature, it is possible to gain some insight into the beliefs, values and practices based on how the user's experience is described by the authors in terms of developing, evaluating, or implementing an eHealth resource. However, it is important to note that technology does not have one static interpretation, but, similarly to power, technology is relational (Bacchus et al, 2016). Its interpretation is dependent on the varying Throughout the literature, eHealth resources were believed to offer a nonjudgmental space where the users valued the anonymity and opportunity to express their experiences without an immediate reaction by another person (Bacchus et al, 2016;Logsdon et al, 2013).…”