Perinatal Nurse Home Visiting Enhanced With mHealth Technology
Condition: Domestic Violence; Intimate Partner Violence
Study type: Interventional

Summary: 
      This research is being done to test whether mobile technology will reduce possible
      communication barriers between women and their home visitor; to improve assessing for health
      problems that could affect their pregnancy; to help in the delivery of information and
      actions to improve the health of the woman and their child.
    

Detailed description: 
      This study addresses PA-11-104 calling for Reducing Health Disparities among Minority and
      Underserved Children. The Institute of Medicine, World Health Organization and Centers for
      Disease Control and Prevention recognize that prenatal home visitation, which improves the
      well-being of mother and children, presents an opportunity to provide early intervention to
      reduce intimate partner violence (IPV) and the impact the exposure has on the children. Major
      challenges for nurses and other home visitors (HV) are to accurately identify abused women
      and facilitate their accessing resources needed to change their situation. HVs often find it
      difficult to assess and intervene for IPV in the intimacy of home settings. The use of
      mHealth technology may increase the sensitivity of screening instruments and reduce
      communication barriers between HVs and clients regarding IPV, as well as enhance
      implementation of IPV interventions and allow for a more standard delivery of an
      intervention. Building on the successful trial testing the DOVE IPV intervention in prenatal
      home visiting programs (NR009093), the investigators propose to test mHealth technology using
      an open-source application, eMOCHA, to improve assessment of IPV and to deliver the DOVE
      intervention. The proposed eMOCHA DOVE study will first (Specific Aim/Phase 1) compare
      sensitivity and specificity of two different approaches for IPV assessment; paper and pencil
      versus the eMOCHA mHealth technology. Phase 2 (Aim 2) will compare effectiveness of the DOVE
      intervention delivered in standard form (paper brochure) versus mHealth eMOCHA DOVE
      application. In Phase 1 women enrolled in a perinatal home visiting program and consenting to
      the study, will be randomized to one of the two assessment groups and assessed for IPV at
      enrollment, birth and 2 months post birth. Women who are IPV positive (IPV+) at any of the
      assessment times will be re-randomized to receive the DOVE intervention by one of the two
      approaches. 1600 Medicaid eligible pregnant women in a perinatal home visiting program (800
      from urban Baltimore and 800 from rural Virginia) will be recruited for Phase I and 400 IPV+
      women (200 from each site) for Phase II. Women participating in Phase 2 will receive 6 home
      visit interventions over 6 months. Maternal outcomes related to IPV and mental health and
      selected infant outcomes will be collected at enrollment, 3, 6, 12, and 18 months after entry
      into Phase 2. Specific Aim 1 will use logistic and linear regression models to examine the
      proportion of women experiencing IPV through mHealth technology versus paper and pencil on
      the same validated assessments. Specific Aim 2 (comparing effectiveness of two intervention
      administrations) will be assessed with logistic and linear regression models for categorical
      (proportion abused and premature infants) and continuous outcome variables (e.g. depression,
      frequency and severity of physical, psychological, sexual IPV, use of community resources)
      respectively. Study findings will assist nurse home visitation programs to use best
      approaches for routine assessment of IPV and implement empowerment interventions to reduce
      IPV and improve maternal infant health outcomes.
    

Intervention name(s): Standard IPV Assessment; Standard DOVE Intervention
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Test the effectiveness of the eMOCHA DOVE application using mHealth technology for routine assessment of IPV vs. Pencil and paper at enrollment, delivery, and 2 months post birth.; Intervention will be administered via eMOCHA tablet vs. home visitor over 6 sessions in 6 months.
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Prevention