Intimate Partner Violence-Prevention App Gets Trial in Kenya

myPlanKenya dissemination discussion in Nairobi

myPlanKenya dissemination discussion in Nairobi

An app called myPlan has been successful in helping women in the United States identify and navigate issues around intimate partner violence—something that is experienced by more than 30 percent of women around the world. The app has also been translated to Spanish and Swahili, and has been expanded to Canada, Australia, and New Zealand.

The app helps women determine if their relationship is unsafe, and it provides safety strategies tailored to their needs with information for support services. It has recently been expanded to address male victims of domestic abuse, and more research in that area is underway. Nancy Glass, a professor in the Johns Hopkins School of Nursing and associate director of the Johns Hopkins Center for Global Health, led the team that originally designed the app more than a decade ago.

Michele Decker

Michele Decker

Glass and Michele Decker, the co-leads of the Alliance’s Gender Equity & Justice theme, were in Nairobi recently to share the initial results of the myPlanKenya trial—the app’s first adaptation and evaluation in alow- and middle-income country setting.

“Many people in abusive relationships don’t want to leave the relationship, they just want the abuse to end. And in many settings, including Kenya, disrupting the family and leaving the relationship can risk significant social sanctions. So moving beyond the focus on separating safely—via short-term crisis shelters, protective orders or legal pathways to separation—in this context the emphasis was really on staying safely,” said Decker, the lead investigator and an Associate Professor in the Department of Population, Family and Reproductive Health at the Bloomberg School of Public Health, and Women’s Health & Rights program of the Center for Public Health & Human Rights.

The women in the trial also expressed a strong interest in strategies that could keep their children safe and limit their exposure to violence, such as creating a code system with neighbors and giving children advance instructions about where to find a safe space.

“Child safety was an area of great concern for women, and clearly adds to their overall stress regarding safety and wellbeing,” Decker said.

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The myPlanKenya project began in 2017 with support from the non-profit behavioral design firm ideas42 and so far has included

  • Six focus groups with 49 women, to understand violence-related safety planning and barriers to help-seeking

  • Nine key informant discussions with 18 providers to understand strengths and gaps in the current intimate partner violence prevention and response system

  • Pilot testing of the myPlanKenya app with 18 women

  • Randomized control trial of the myPlanKenya app with more than 350 women at risk for and experiencing intimate partner violence

The myPlan app includes the following sections

  • Healthy Relationships: Aspects of healthy relationships

  • My Relationship: Women reflect on the dynamics of their own relationships

  • Red Flags: Assesses potential warning signs around the health or safety of their relationships

  • My Safety: Assesses the level of physical danger women may face in their relationships

  • My Priorities: Using a sliding scale, women are able to identify their priorities when faced with safety issues or danger in their relationships

  • My Plan: Access to customized safety strategies based on the responses given in the previous sections. Includes sections on child safety planning, health and wellbeing, confidants, and additional strategies

  • About Violence: Reviews how violence may manifest in relationships and provides relatable examples

  • Harmful Beliefs About Abuse: Information about myths or harmful beliefs about abuse

  • Resources: Helpful resources and safe places to contact for confidential, free support services

In Nairobi, myPlanKenya was found highly acceptable and feasible for survivors of partner violence. Equally importantly, it was valuable for the community health volunteers (CHVs) who received training to help others safely and confidentially use the app. The app’s trauma-informed approach provides a good model of how to communicate respect and support with survivors of domestic abuse. Collaborators in Nairobi included the NGO Ujamaa-Africa’s Mashinani Program, Wangu Kanja Foundation, and the Kenyan Ministry of Health.

“We heard from the CHVs was that they felt much more prepared to work with people experiencing abuse after working through the app with women as part of the trial – essentially this provided an added level of hands-on training for them,” Decker said. “The language in the app is non-judgmental—it’s supportive, it’s validating. The act of going through this app actually helps volunteers gain skills in effective and validating communication with survivors of violence and those at risk.”

Preliminary trial results suggest improvements in safety preparedness immediately following the intervention, and, by 3-month follow-up, sustained improvements in decisional conflict and positive changes in the helpfulness and use of safety strategies for intervention participants relative to those in the control group. The intervention also appeared to improve resilience for women who were at the highest risk for ongoing abuse. These short-term endpoints are critical steps towards longer term safety, well-being and health for survivors of violence, Decker said.

myPlanKenya dissemination discussion in Nairobi

myPlanKenya dissemination discussion in Nairobi

Glass, who was the senior co-investigator, said the Kenyan trial showed how the app could be useful even for women who don’t have regular access to a smartphone or computer. Making the app available at locations such as health care facilities, preschools, and daycares can provide widespread access opportunities.

“The trial really helped us think more about accessibility, and it helps to address some of the naysayers about women wanting to use technology around their safety and making decisions,” Glass said. “A lot of women felt very comfortable with the technology and they liked having a bit of anonymity if they were using it on their own.”

Nancy Glass

Nancy Glass

The Kenya adaptation and trial were informed in large part by a review of safety strategies for women experiencing intimate partner violence in low- and middle-income countries that was led by Shannon Wood, a PhD candidate in the Department of Population, Family, and Reproductive Health at the Bloomberg School of Public Health, and co-authoredby Glass and Decker. Their findings were recently published in the SAGE journal Trauma, Violence & Abuse.

The review found, in part, that “[intimate partner violence]-related safety and harm reduction strategies employed by women in [low- and middle-income countries] differ substantially from those utilized in [upper-income countries], with results highlighting staying rather than leaving strategies and reluctance to engage with the limited formal services that exist given cultural constraints in severing the relationship.”

Glass and Decker are pursuing further grants to examine how the app could help more women in Kenya and beyond.

“We’re seeing clearly there is interest and value in this app, and so one of the questions is how best to expand the reach in Kenya and elsewhere. For example, implementation in family planning services, and more broadly within routine healthcare given the WHO guidelines for identifying and responding to intimate partner and sexual violence in clinical care. We also plan to explore the role of social networks and lay networks in expanding reach and access: parent-teacher organizations, natural community gatherings, community leaders, and elders in disseminating the app,” said Decker.

“We’ve got a lot of questions around what would the comfort level be, what would the uptake be through a top down versus a grassroots expansion around this? And where else can it be valuable? On college campuses the relationship dynamics are a bit different, but that’s another important place for this type of work. Those are some of the next steps on the agenda.”