title: 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: Intimate 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.
  
  
  
  Our 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.
  
  
  
  We 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.
  
  
  
  We 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.
  
  
  
  Users 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.
  
  
  
  Clinicaltrials.gov NCT01688427; https://clinicaltrials.gov/ct2/show/NCT01688427 (Archived by WebCite at http://www.webcitation.org/6limSWdZP).
authors.affiliation: Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom.|School of Nursing, University of Virginia, Charlottesville, VA, United States.
authors.forename: Loraine J
authors.identifier: 0000-0002-9966-8208
authors.initials: LJ
authors.lastname: Bacchus
authors.affiliation: School of Nursing, University of Virginia, Charlottesville, VA, United States.
authors.forename: Linda
authors.identifier: 0000-0003-4082-3944
authors.initials: L
authors.lastname: Bullock
authors.affiliation: School of Nursing, Johns Hopkins University, Baltimore, MD, United States.
authors.forename: Phyllis
authors.identifier: 0000-0002-8508-5087
authors.initials: P
authors.lastname: Sharps
authors.affiliation: School of Nursing, University of Virginia, Charlottesville, VA, United States.
authors.forename: Camille
authors.identifier: 0000-0003-3066-2753
authors.initials: C
authors.lastname: Burnett
authors.affiliation: School of Nursing, University of Virginia, Charlottesville, VA, United States.
authors.forename: Donna L
authors.identifier: 0000-0002-4968-8809
authors.initials: DL
authors.lastname: Schminkey
authors.affiliation: Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Ana Maria
authors.identifier: 0000-0002-3007-9747
authors.initials: AM
authors.lastname: Buller
authors.affiliation: School of Nursing, Johns Hopkins University, Baltimore, MD, United States.
authors.forename: Jacquelyn
authors.identifier: 0000-0003-3689-4547
authors.initials: J
authors.lastname: Campbell
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006792:House Calls; D006801:Humans; D018743:Perinatal Care / Q000379:methods*; D011247:Pregnancy; D036301:Qualitative Research; D016032:Randomized Controlled Trials as Topic; D013179:Spouse Abuse / Q000517:prevention & control*; D017216:Telemedicine / Q000379:methods*; D014481:United States; D055815:Young Adult
keywords: home visitation; interpretive flexibility; intervention; intimate partner violence; mhealth; nurses; screening; technology