SAFE: Een eHealth interventie voor vrouwen die slachtoffer zijn van partnergeweld

Intimate Partner Violence (IPV) is defined as any physical, sexual, psychological, or economic violence that occurs between former or current spouses or partners. It is a common social problem worldwide, and one that is distinctly gendered. The prevalence of IPV is particularly alarming in light of its association with a range of negative health outcomes for women and children. Research consistently shows that abused women are at increased risk of depression, anxiety, posttraumatic stress disorder, and suicide [8], as well as physical problems. About one out of three women have experienced either physical and/or intimate partner violence or non-partner sexual violence in their lifetime. In the Netherlands at least 20% of women have been ever physically abused by a former or current partner, 11% is victim of sexual violence by a former or current partner and one out of eight of all Dutch women have been raped ever during their lifetime. Children growing up in a violent home are more often direct victims of child abuse and are exposed to violence acts as well. Being a witness of intimate partner violence has similar consequences as to being a direct victim of child abuse. One in three will become a perpetrator or victim themselves in their future partner relationships: the intergenerational transmission of violence.



Despite the negative outcomes of being a victim of IPV, there is limited evidence of effectiveness for interventions in health care settings, with inconclusive results in terms of the effects on women’s physical and psychosocial well-being. Many women feel uncomfortable revealing their experience with IPV, even if the issue is raised in a sensitive manner by the health professional. They may feel that the abuse is not serious enough to mention or worry about disclosure if their abusive partner sees the same health care professional. The pathway to disclosure can be long and challenging for women, and by the time the health professional becomes aware of the abuse, if at all, they may have missed a valuable opportunity to intervene earlier and more effectively.



EHealth is a rapidly developing and upcoming mode of therapy. Although eHealth is still in its infancy, more attention has been paid to the theory and different categories of eHealth interventions in recent years. In a recent systematic review of online health interventions, Webb, Joseph, Yardley, and Michie (2010) examined the role of theoretical background, behaviour change techniques, and mode of delivery on the intervention’s effectiveness. They found that increased use of theory to inform the intervention led to a greater effect size. In terms of behaviour change techniques, the most valuable were found to be information provision, self-monitoring, and problem solving, with action planning and the provision of feedback also having significant positive effects. Interventions that provided an ‘enriched information environment’ and offered automated tailored feedback were found to have significant effects on behaviour change. From the literature, we know that peer and social support are effective methods to change behaviour, both offline and online. Social support, furthermore, has proven to be effective in adults exposed to violence and is associated with good mental and physical health outcomes. Offering an IPV intervention in an online format may assist in overcoming some of the barriers encountered in health care settings. Online interventions are being increasingly used as a way of self-managing health conditions, with promising results. Overall, evidence suggests that eHealth cognitive therapy interventions for depression and anxiety are effective, especially if healthcare providers are involved. Lintvedt et al. (2013) point out that an internet-based intervention is constantly available and accessible from any location. This flexibility allows women to access the intervention at unexpected times when an abusive partner is not present, as opposed to the health care setting where they must schedule an appointment. Delivering an intervention online also allows women to self-identify and self-manage without disclosure to a third party. This may be particularly beneficial for women who are unable to disclose the abuse to a health care professional and are not ready to attend a specialized support service. The internet provides an anonymous environment where women can safely search for information and explore possibilities for help. Women who do not have safe Internet access at home often have access in other locations such as family or friends’ homes, public libraries, or community agencies or access the Internet wirelessly using a Smartphone.



Victims of IPV, living in an unsafe and unhealthy situation, are faced with a broad range of physical and emotional symptoms. Standard and easy-accessible care to facilitate change into a safer situation is lacking. The project aims to launch an internet-based self-support intervention to enhance awareness and decision making, for women exposed to IPV named SAFE. As low threshold access is important, we aim to make SAFE freely available and as accessible as possible for functionally illiterates, migrants and other non-native Dutch-speaking participants (by collaboration with the national institute Pharos).



Our hypotheses is that using SAFE will lead in victims to an increased awareness of being in an unhealthy situation with possibilities to change, an increase of self-efficacy and perceived support, a decrease of (mental) health symptoms such as depression and anxiety and lastly to person-tailored changes in their violent living situation. The project consists of several parts:



1. The development of SAFE, based on victim’s experiences, expert opinions, comparable eHealth interventions and literature.

2. A blinded randomized controlled parallel-group trial to evaluate the effectiveness and efficacy of the SAFE intervention (RCT),

3. A process evaluation of SAFE to gain insight into meaningful usage parameters to evaluate the use of a fully automatic web-based intervention, including feasibility measures, and using mixed-methods.

The Research Questions following are:

1. What are key elements of SAFE, an eHealth intervention for women exposed to IPV, according to victims and experts?

2. Is SAFE an effective intervention to increase awareness, self-efficacy and perceived support?

3. Is SAFE an effective intervention to lower (mental) health symptoms in women exposed to IPV?

4. Does SAFE lead to change concerning their violent living situation?

5. Is SAFE a feasible tool to deliver care to women exposed to IPV?

Victims of IPV, living in an unsafe and unhealthy situation, are faced with a broad range of physical and emotional symptoms. Standard and easy-accessible care to facilitate change into a safer situation is lacking. The project aims to launch an internet-based self-support intervention to enhance awareness and decision making, for women exposed to IPV named SAFE.

Our hypotheses is that using SAFE will lead in victims to an increased awareness of being in an unhealthy situation with possibilities to change, an increase of self-efficacy and perceived support, a decrease of (mental) health symptoms such as depression and anxiety and lastly to person-tailored changes in their violent living situation.



The Research Questions following are:

1. What are key elements of SAFE, an e-health intervention for women exposed to IPV, according to victims and experts?

2. Is SAFE an effective intervention to increase awareness, self-efficacy and perceived support?

3. Is SAFE an effective intervention to lower (mental) health symptoms in women exposed to IPV?

4. Does SAFE lead to change concerning their violent living situation?

5. Is SAFE a feasible tool to deliver care to women exposed to IPV?

This registration concerns the RCT, answering the following questions:

1. “Is SAFE an effective intervention to increase awareness, self-efficacy and perceived support?”

2. “Is SAFE an effective intervention to lower (mental) health symptoms in women exposed to IPV?”

Data will be collected at baseline (T0), after completion of every of the four modules (T1), and six months after completion of all modules (T2). All data will be self-reported online. Automated reminders will be prompted after 1 week and after 2 weeks.

SAFE, a selfsupport eHealth intervention for women exposed to intimate partner violence, which has yet to be developed