%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e70508 %T Adolescent Cyberbullying and Cyber Victimization: Longitudinal Study Before and During COVID-19 %A Schulz,Peter Johannes %A Boldi,Marc-Olivier %A van Ackere,Ann %+ Faculty of Communication, Culture and Society, Università della Svizzera Italiana, Via G. Buffi 13, Lugano, 6900, Switzerland, 41 58666724, schulzp@usi.ch %K cyberbullying and cyber victimization among adolescents %K COVID-19 %K panel study %K longitudinal data analysis %K parental communication %K exposure to violent media content %D 2025 %7 25.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Adolescent cyberbullying has been a persistent issue, exacerbated by the shift to remote learning and increased screen time during the COVID-19 pandemic. These changes have sparked concerns about potential increases in cyberbullying and its associated risks. Objective: This study aims to explore how factors such as age, exposure to violent media, parental communication quality, internet access, sex, and sibling relationships influence cyberbullying behavior at school. Additionally, we examine how the COVID-19 pandemic may have altered these dynamics. Methods: Leveraging a panel dataset, we examine the same group of adolescents both before and during the pandemic. The analysis focused on identifying relationships between the selected factors and cyberbullying perpetration and victimization, with an emphasis on the dynamics introduced by the COVID-19 pandemic. Results: Perceived quality of parental communication was found to reduce the risk of both cyberbullying perpetration and victimization, with the former effect becoming more pronounced during the COVID-19 pandemic. Exposure to violent media increased both cyberbullying perpetration and victimization, but the effect on perpetration decreased during the COVID-19 pandemic. The well-established correlation between internet access and both cyberbullying perpetration and victimization remained unaffected by COVID-19. Surprisingly, adolescents with siblings were less likely to become victims or perpetrators of school-related cyberbullying, irrespective of the pandemic. Conclusions: In hindsight, COVID-19, functioning as a kind of natural experiment, has provided us with a unique opportunity to examine the effects of a global event, forcing major behavioral changes on the persistent challenge of cyberbullying in middle schools. %M 40132197 %R 10.2196/70508 %U https://www.jmir.org/2025/1/e70508 %U https://doi.org/10.2196/70508 %U http://www.ncbi.nlm.nih.gov/pubmed/40132197 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e63772 %T Public Attitudes Toward Violence Against Doctors: Sentiment Analysis of Chinese Users %A Zheng,Yuwen %A Tian,Meirong %A Chen,Jingjing %A Zhang,Lei %A Gao,Jia %A Li,Xiang %A Wen,Jin %A Qu,Xing %+ Institute of Hospital Management, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China, 86 13880713452, quxing@wchscu.edu.cn %K doctor-patient conflict %K sentiment analysis %K latent Dirichlet allocation %K LDA %K social media analysis %K public health crisis %D 2025 %7 20.3.2025 %9 Original Paper %J JMIR Med Inform %G English %X Background: Violence against doctors attracts the public’s attention both online and in the real world. Understanding how public sentiment evolves during such crises is essential for developing strategies to manage emotions and rebuild trust. Objective: This study aims to quantify the difference in public sentiment based on the public opinion life cycle theory and describe how public sentiment evolved during a high-profile crisis involving violence against doctors in China. Methods: This study used the term frequency-inverse document frequency (TF-IDF) algorithm to extract key terms and create keyword clouds from textual comments. The latent Dirichlet allocation (LDA) topic model was used to analyze the thematic trends and shifts within public sentiment. The integrated Chinese Sentiment Lexicon was used to analyze sentiment trajectories in the collected data. Results: A total of 12,775 valid comments were collected on Sina Weibo about public opinion related to a doctor-patient conflict. Thematic and sentiment analyses showed that the public’s sentiments were highly negative during the outbreak period (disgust: 10,201/30,433, 33.52%; anger: 6792/30,433, 22.32%) then smoothly changed to positive and negative during the spread period (sorrow: 2952/8569, 34.45%; joy: 2782/8569, 32.47%) and tended to be rational and peaceful during the decline period (joy: 4757/14,543, 32.71%; sorrow: 4070/14,543, 27.99%). However, no matter how emotions changed, each period's leading tone contained many negative sentiments. Conclusions: This study simultaneously examined the dynamics of theme change and sentiment evolution in crises involving violence against doctors. It discovered that public sentiment evolved alongside thematic changes, with the dominant negative tone from the initial stage persisting throughout. This finding, distinguished from prior research, underscores the lasting influence of early public sentiment. The results offer valuable insights for medical institutions and authorities, suggesting the need for tailored risk communication strategies responsive to the evolving themes and sentiments at different stages of a crisis. %M 40111382 %R 10.2196/63772 %U https://medinform.jmir.org/2025/1/e63772 %U https://doi.org/10.2196/63772 %U http://www.ncbi.nlm.nih.gov/pubmed/40111382 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60075 %T Exploring the Use of an Augmented Reality Device Learning Tool for Multidisciplinary Staff Training on Domestic Abuse and Sexual Violence: Postintervention Qualitative Evaluation %A Karunaratne,Dilroshini %A Whittock,Jessica %A Moore,Amber %A Dasigan,Krishna %A Chevolleau,Jasmine %A Bartholomew,Brent %A Kelly,Nikki %A Cohen,Charlotte E %K augmented reality %K virtual reality %K medical technology %K domestic abuse %K sexual violence %K medical education %K training %K domestic violence %K violence %K assault %K victim %K survivor-centered %K staff %K community stakeholders %K social care %K innovation %D 2025 %7 19.3.2025 %9 %J JMIR Form Res %G English %X Background: Legislative policies published by National Health Service, England and the UK Government focus on prioritizing the creation of a stronger system. These frameworks emphasize on the improvement of health care staff’s ability to identify and refer domestic abuse (DA) survivors as key areas for supporting workforce development. Health care staff are often the first professional contact of survivors of DA, and insufficient staff training is a key barrier to survivors being identified and directed to support. The Microsoft HoloLens2 is a mixed-reality headset that allows virtual objects (holograms) to be integrated into the real world. Mixed-reality headsets are being increasingly used within medical education and have the advantage of independent operation, reducing the staffing requirements for teaching. The HoloLens2 can be used to project HoloPatients (HPs), which resemble clinically unwell patients, into the classroom. Two of these HPs have been specifically designed to portray survivors of DA and sexual violence (SV). Objective: This study explored potential uses of the HP in DA and SV training as a potential survivor-centered educational initiative that could be used as an adjunct to existing training for health care professionals and community sector workers. Methods: Frontline staff and community stakeholders from the national health service, DA, and law enforcement sectors were invited on 3 separate occasions (n=14, 12, 22) to a HoloLens2 demonstration that displayed 9 HPs. The patient voice was to be outlined by personalized scripts, co-created alongside sector charities, ensuring survivor engagement and participation. Participants were given the opportunity to wear the headset and familiarize themselves with the technology during the sessions. A post-intervention evaluation research model was used to explore the feasibility and functionality of the HP as an educational tool. Results: Thematic analysis described the HP as a “realistic,” “adjustable” tool that “creates a safe learning environment.” Participants suggested it could be useful in “pre-exposure preparation” by “improving communication” and allowing different approaches to be trialed in a safe environment. The use of survivor scripts was described as a useful tool to “bring the survivor into the learning space” in a safe way. Participants identified the HP as a suitable tool for workers inside and outside health care, including social sectors such as law enforcement (32%). Conclusions: The HP acts as a low-risk, adaptable tool for trainees to develop skills in a safe environment. This study demonstrates that professionals perceived the HoloLens as an innovative means to amplify the lived experience voice. Further research will evaluate this additional impact on trainees’ confidence and responses to survivors disclosing DA and SV within different disciplines to drive improved outcomes. Trial Registration: Permission to conduct this study granted by the Research Innovation and Quality Improvement Team at Chelsea and Westminster NHS Foundation Trust %R 10.2196/60075 %U https://formative.jmir.org/2025/1/e60075 %U https://doi.org/10.2196/60075 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60102 %T Optimizing Engagement With a Smartphone App to Prevent Violence Against Adolescents: Results From a Cluster Randomized Factorial Trial in Tanzania %A Janowski,Roselinde %A Cluver,Lucie D %A Shenderovich,Yulia %A Wamoyi,Joyce %A Wambura,Mwita %A Stern,David %A Clements,Lily %A Melendez-Torres,G J %A Baerecke,Lauren %A Ornellas,Abigail %A Chetty,Angelique Nicole %A Klapwijk,Jonathan %A Christine,Laetitia %A Mukabana,Ateamate %A Te Winkel,Esmee %A Booij,Anna %A Mbosoli,Gervas %A Lachman,Jamie M %+ Department of Social Policy and Intervention, University of Oxford, Barnett House, 32-37 Wellington Square, Oxford, OX1 2ER, United Kingdom, 44 01865270325, roselinde.janowski@spi.ox.ac.uk %K digital health %K engagement %K parenting %K adolescents %K low- and middle-income country %K violence against children %K Multiphase Optimization Strategy %K randomized factorial experiment %K mobile phone %D 2025 %7 10.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Violence and abuse exert extensive health, social, and economic burdens on adolescents in low- and middle-income countries. Digital parenting interventions are promising for mitigating risks at scale. However, their potential for public health impact hinges on meaningful engagement with the digital platform. Objective: The objective of this study was to evaluate the impact of 3 intervention design and implementation factors aimed at increasing engagement with a noncommercialized, offline-first smartphone app for caregivers of adolescents in Tanzania, in partnership with the United Nations Children’s Fund, the World Health Organization, and the Tanzanian national government. Methods: Following Multiphase Optimization Strategy (MOST) principles, we conducted a 2×2×2 cluster randomized factorial trial involving caregivers of adolescents aged 10 to 17 years. Caregivers were recruited by community representatives from 16 urban and periurban communities (ie, clusters) in the Mwanza region of Tanzania. Each cluster was randomized to 1 of 2 levels of each factor: guidance (self-guided or guided via facilitator-moderated WhatsApp groups), app design (structured or unstructured), and preprogram digital support (basic or enhanced). Primary outcomes were automatically tracked measures of engagement (app launches, modules completed, and home practice activities reviewed), with secondary outcomes including modules started, time spent in the app, and positive behaviors logged. Generalized linear mixed-effects models assessed the impact of experimental factors on engagement. Results: Automatically tracked engagement data from 614 caregivers were analyzed, of which 205 (33.4%) were men. Compared to self-guided participants, receiving guidance alongside the app led to significantly more app launches (mean ratio [MR] 2.93, 95% CI 1.84-4.68; P<.001), modules completed (MR 1.29, 95% CI 1.05-1.58; P=.02), modules started (MR 1.20, 95% CI 1.02-1.42; P=.03), time spent in the app (MR 1.45, 95% CI 1.39-1.51; P<.001), and positive behavior logs (MR 2.73, 95% CI 2.07-3.60; P<.001). Compared to the structured design, unstructured design use resulted in significantly more modules completed (MR 1.49, 95% CI 1.26-1.76; P<.001), home practice activity reviews (MR 7.49, 95% CI 5.19-10.82; P<.001), modules started (MR 1.27, 95% CI 1.06-1.52; P=.01), time spent in the app (MR 1.84, 95% CI 1.70-1.99; P<.001), and positive behavior logs (MR 55.68, 95% CI 16.48-188.14; P<.001). While analyses did not detect an effect of enhanced digital support on directly observed engagement, the combination of enhanced digital support and guidance positively influenced engagement across a range of outcomes. Conclusions: This study is the first to systematically optimize engagement with a digital parenting intervention in a low- and middle-income country. Our findings offer important learnings for developing evidence-based, scalable digital interventions in resource-constrained settings. Trial Registration: Pan-African Clinical Trial Registry PACTR202210657553944; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=24051 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-023-15989-x %M 40063069 %R 10.2196/60102 %U https://www.jmir.org/2025/1/e60102 %U https://doi.org/10.2196/60102 %U http://www.ncbi.nlm.nih.gov/pubmed/40063069 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66769 %T The Development of an Instagram Reel-Based Bystander Intervention Message Among College Students: Formative Survey and Mixed Methods Pilot Study %A Couto,Leticia %K bystander intervention %K message development %K sexual health %K college %K student %K sexual violence %K bystander %K reel-based %K Instagram %K social media %K short message %K formative research %K mixed methods %K social norms %K perceived behavior %K qualitative %K behavioral health %K digital health %D 2025 %7 27.1.2025 %9 %J JMIR Form Res %G English %X Background: Bystander intervention is a common method to address the ubiquitous issue that is sexual violence across college campuses. Short messages that incentivize bystander intervention behavior can be another tool to fight sexual violence. Objective: This study aimed to conduct formative research surrounding social norms and bystander barriers to pilot and develop Instagram (Meta) reel-based messages addressing bystander intervention among college students. Methods: The first step was to conduct a formative survey to identify peer norms and actual behavior of the intended population. Once that data were collected, a mixed methods message pilot was conducted by a survey where participants randomly saw 5 of the 12 messages developed, assessing them for credibility, perceived message effect, and intended audience. Results: The formative survey was conducted among 195 college students from the same institution, and the pilot test was conducted among 107 college students. The formative survey indicated a discrepancy between perceived peer behavior and actual behavior of the participants in all 3 measures, allowing for the development of normative messaging. The pilot testing indicated the credibility was acceptable (eg, mean 3.94, SD 1.15 on a 5-point scale) as well as the perceived message effect (eg, mean 4.26, SD 0.94 on a 5-point scale). Intended audiences were also identified and reached. Qualitative results indicated that the messages may have lacked credibility, although the quantitative results suggest otherwise. Conclusions: Participants understood the messages concerned bystander intervention, and perceived message effects results indicated the messages to be effective in assisting bystander intervention engagement by normative messaging. Messages were considered credible and reached the intended audience. The qualitative results provided further insights on how the messages can be adapted before being tested for effects. Future research should focus on further adapting the messages and testing their effects among the studied population. %R 10.2196/66769 %U https://formative.jmir.org/2025/1/e66769 %U https://doi.org/10.2196/66769 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58611 %T A Digital Parenting Intervention With Intimate Partner Violence Prevention Content: Quantitative Pre-Post Pilot Study %A Schafer,Moa %A Lachman,Jamie %A Zinser,Paula %A Calderón Alfaro,Francisco Antonio %A Han,Qing %A Facciola,Chiara %A Clements,Lily %A Gardner,Frances %A Haupt Ronnie,Genevieve %A Sheil,Ross %+ Centre for Evidence Based Intervention, Department of Social Policy and Intervention, University of Oxford, Barnett House, 32-37 Wellington Square, Oxford, OX1 2ER, United Kingdom, 44 01865 2703, moa.schafer@spi.ox.ac.uk %K intimate partner violence %K SMS text messaging %K chatbot %K user engagement %K parenting %K violence %K mobile phone %D 2025 %7 3.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Intimate partner violence (IPV) and violence against children are global issues with severe consequences. Intersections shared by the 2 forms of violence have led to calls for joint programming efforts to prevent both IPV and violence against children. Parenting programs have been identified as a key entry point for addressing multiple forms of family violence. Building on the IPV prevention material that has been integrated into the parenting program ParentText, a digital parenting chatbot, this pilot study seeks to explore parents’ engagement with the IPV prevention content in ParentText and explore preliminary changes in IPV. Objective: This study aimed to assess parents’ and caregivers’ level of engagement with the IPV prevention material in the ParentText chatbot and explore preliminary changes in experiences and perpetration of IPV, attitudes toward IPV, and gender-equitable behaviors following the intervention. Methods: Caregivers of children aged between 0 and 18 years were recruited through convenience sampling by research assistants in Cape Town, South Africa, and by UNICEF (United Nations Children's Fund) Jamaica staff in 3 parishes of Jamaica. Quantitative data from women in Jamaica (n=28) and South Africa (n=19) and men in South Africa (n=21) were collected electronically via weblinks sent to caregivers’ phones using Open Data Kit. The primary outcome was IPV experience (women) and perpetration (men), with secondary outcomes including gender-equitable behaviors and attitudes toward IPV. Descriptive statistics were used to report sociodemographic characteristics and engagement outcomes. Chi-square tests and 2-tailed paired dependent-sample t tests were used to investigate potential changes in IPV outcomes between pretest and posttest. Results: The average daily interaction rate with the program was 0.57 and 0.59 interactions per day for women and men in South Africa, and 0.21 for women in Jamaica. The rate of completion of at least 1 IPV prevention topic was 25% (5/20) for women and 5% (1/20) for men in South Africa, and 21% (6/28) for women in Jamaica. Exploratory analyses indicated significant pre-post reductions in overall IPV experience among women in South Africa (P=.01) and Jamaica (P=.01) and in men’s overall harmful IPV attitudes (P=.01) and increases in men’s overall gender-equitable behaviors (P=.02) in South Africa. Conclusions: To the best of our knowledge, this is the first pilot study to investigate user engagement with and indicative outcomes of a digital parenting intervention with integrated IPV prevention content. Study findings provide valuable insights into user interactions with the chatbot and shed light on challenges related to low levels of chatbot engagement. Indicative results suggest promising yet modest reductions in IPV and improvements in attitudes after the program. Further research using a randomized controlled trial is warranted to establish causality. %M 39753219 %R 10.2196/58611 %U https://formative.jmir.org/2025/1/e58611 %U https://doi.org/10.2196/58611 %U http://www.ncbi.nlm.nih.gov/pubmed/39753219 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63777 %T Digital Platform for Pediatric Mental Health Support During Armed Conflicts: Development and Usability Study %A Segal,Hila %A Benis,Arriel %A Saar,Shirley %A Shachar-Lavie,Iris %A Fennig,Silvana %K pediatric mental health %K digital platform %K pediatricians %K prevention %K early intervention %D 2024 %7 26.12.2024 %9 %J JMIR Form Res %G English %X Background: The prevalence of mental health disorders among children and adolescents presents a significant public health challenge. Children exposed to armed conflicts are at a particularly high risk of developing mental health problems, necessitating prompt and robust intervention. The acute need for early intervention in these situations is well recognized, as timely support can mitigate long-term negative outcomes. Pediatricians are particularly suited to deliver such interventions due to their role as primary health care providers and their frequent contact with children and families. However, barriers such as limited training and resources often hinder their ability to effectively address these issues. Objectives: This study aimed to describe the rapid development of a digital mental health tool for community pediatricians, created in response to the urgent need for accessible resources following the October 7th terror attack in Israel. The goal was to create a comprehensive resource that addresses a wide range of emotional and behavioral challenges in children and adolescents, with a particular focus on those affected by armed conflict and significant trauma exposure. In addition, the study aimed to evaluate the platform’s usability and relevance through feedback from primary users, thereby assessing its potential for implementation in pediatric practice. Methods: A digital platform was developed using a collaborative approach that involved pediatricians and mental health professionals from various hospital clinics. The initial framework for the modules was drafted based on key emotional and behavioral issues identified through prior research. Following this, the detailed content of each module was cocreated with input from specialized mental health clinics within the hospital, ensuring comprehensive and practical guidance for community pediatricians. A focus group of 7 primary users, selected for their relevant hospital and community roles, provided feedback on the platform’s user experience, content relevance, and layout. The evaluation was conducted using a structured questionnaire complemented by qualitative comments. Results: Fifteen detailed modules were created, each providing information, including anamnesis, initial intervention strategies, parental guidance, and referral options. The focus group feedback demonstrated high satisfaction, indicating a very good user experience (mean 4.57, SD 0.53), content relevance (mean 4.71, SD 0.48), and layout suitability (mean 4.66, SD 0.52). Specific feedback highlighted the value of concise, actionable content and the inclusion of medication information. Participants expressed a strong willingness to regularly use the platform in their practice (mean 4.40, SD 0.53), suggesting its potential for broad application. Conclusions: This study demonstrates the effectiveness of a collaborative development process in creating a digital tool that addresses the mental health needs of children in crisis situations. The positive feedback from pediatricians indicated that the platform has the potential to become a valuable resource for early recognition, crisis intervention, and parental support in community pediatric settings. Future research will focus on broader implementation and assessing the platform’s impact on clinical outcomes. %R 10.2196/63777 %U https://formative.jmir.org/2024/1/e63777 %U https://doi.org/10.2196/63777 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60530 %T Characteristics and Popularity of Videos of Abusive Head Trauma Prevention: Systematic Appraisal %A Goethals,Luc %A Prokofieva Nelson,Victoria %A Fenouillet,Fabien %A Chevreul,Karine %A Bergerat,Manon %A Lebreton,Christine %A Refes,Yacine %A Blangis,Flora %A Chalumeau,Martin %A Le Roux,Enora %+ Obstetrical, Perinatal and Pediatric Epidemiology Research team (EPOPé), Centre of Research in Epidemiology and Statistics (CRESS), Université Paris Cité, Inserm, 123 Bd de Port-Royal, Paris, 75014, France, 33 0699222119, luc.goethals@inserm.fr %K abusive head trauma %K child physical abuse %K shaken baby syndrome %K SBS %K primary prevention %K web-based videos %K digital tools %K head trauma %K prevention %K video %K internet %K infant %K mortality %K morbidity %K parent %K caregivers %K communication %D 2024 %7 10.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Numerous strategies for preventing abusive head trauma (AHT) have been proposed, but controlled studies failed to demonstrate their effectiveness. Digital tools may improve the effectiveness of AHT prevention strategies by reaching a large proportion of the adult population. Objective: This study aimed to describe the characteristics of videos of AHT prevention published on the internet, including their quality content, and to study their association with popularity. Methods: From a systematic appraisal performed in June 2023, we identified videos addressing the primary prevention of AHT in children younger than 2 years that were published in English or French on the internet by public organizations or mainstream associations. We analyzed the characteristics of the videos; their quality with the Global Quality Scale (GQS); and their association with an index of popularity, the Video Power Index, using multivariable quasi-Poisson modeling. Results: We included 53 (6.6%) of the 804 videos identified. Videos were mainly published by public organizations (43/53, 81%). The median time spent on the web was 6 (IQR 3-9) years, the median length was 202 (IQR 94-333) seconds, and the median GQS score was 4 (IQR 3-4). Infants were often depicted (42/53, 79%), including while crying (35/53, 66%) and being shaken (21/53, 40%). The characterization of shaking as an abuse and its legal consequences were cited in 47% (25/53) and 4% (2/53) of videos, respectively. The main prevention strategies in the videos were to raise awareness of the noxious outcome of shaking (49/53, 93%) and convince viewers of the effectiveness of coping strategies for infants’ cries (45/53, 85%). The Video Power Index was positively correlated with the GQS (r=0.38; P=.007) and was independently associated with depicting an infant being shaken (P=.03; β=1.74, 95% CI 1.06-2.85) and the use of text or headers (P=.04; β=2.15, 95% CI 1.08-4.26). Conclusions: AHT prevention videos had high quality but did not frequently deal with parental risk factors. The characteristics identified as being associated with the popularity of AHT prevention videos could help improve the impact of future prevention programs by enhancing their popularity. %M 39657172 %R 10.2196/60530 %U https://www.jmir.org/2024/1/e60530 %U https://doi.org/10.2196/60530 %U http://www.ncbi.nlm.nih.gov/pubmed/39657172 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60963 %T Global and Regional Prevalence of Domestic Violence During the COVID-19 Pandemic and Its Determinants: Protocol for a Systematic Review and Meta-Analysis %A Bidhendi-Yarandi,Razieh %A Biglarian,Akbar %A Nosrati Nejad,Farhad %A Roshanfekr,Payam %A Behboudi-Gandevani,Samira %+ Faculty of Nursing and Health Sciences, Nord University, Postbox 1490, Bodø, 8049, Norway, 47 75517670, samira.behboudi-gandevani@nord.no %K COVID-19 %K domestic violence %K systematic review and meta-analysis %K lockdowns %K pandemic effects %K intimate partner violence %K elder abuse %K child abuse %K vulnerable populations %D 2024 %7 9.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Domestic violence is one of the most significant global public health priorities. This social problem could be accelerated by global catastrophes such as the COVID-19 pandemic. The structural changes due to the imposition of health measures, combined with personal and social problems, may worsen the situation. Objective: This study aims to investigate the global and regional prevalence of domestic violence during the COVID-19 pandemic and its determinants. Methods: We will perform a comprehensive review of the literature in PubMed, PsycINFO, Embase, Cochrane COVID-19 Register, and Applied Social Sciences Index and Abstracts, up to July 2024. This review will adhere to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. Observational studies will be considered eligible if they have a population-based design, report the number of cases or prevalence of domestic violence during the COVID-19 pandemic, and report potential determinants. Studies in languages other than English, those with unclear data, case reports, conference proceedings, reviews, and letters will be excluded. To assess the methodological quality, a standardized critical appraisal checklist for studies reporting prevalence data will be used. A robust Bayesian approach will be applied using the STATA software package (version 14; STATA Inc) and JASP 0.19.1 (GNU Affero General Public License [GNU AGPL]) software. Results: The search and screening for the systematic literature review are anticipated to be finished in October 2024. Data extraction, quality appraisal, and subsequent data synthesis will begin in November 2024. The review is expected to be completed by April 2025, and the study results will be published in 2025. Conclusions: This systematic review and meta-analysis will address significant gaps in understanding the pandemic’s impact on domestic violence, providing a comprehensive assessment of its prevalence and contributing factors. Despite some limitations, the study incorporates diverse data sources and vulnerable groups to offer a detailed and accurate picture. The findings will inform targeted interventions and policy responses to mitigate the impact of future global crises on domestic violence rates. Trial Registration: PROSPERO CRD42022351634; https://tinyurl.com/yth37jkx International Registered Report Identifier (IRRID): PRR1-10.2196/60963 %M 39652848 %R 10.2196/60963 %U https://www.researchprotocols.org/2024/1/e60963 %U https://doi.org/10.2196/60963 %U http://www.ncbi.nlm.nih.gov/pubmed/39652848 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54966 %T Using Artificial Intelligence to Detect Risk of Family Violence: Protocol for a Systematic Review and Meta-Analysis %A de Boer,Kathleen %A Mackelprang,Jessica L %A Nedeljkovic,Maja %A Meyer,Denny %A Iyer,Ravi %+ Department of Psychological Sciences, Swinburne University of Technology, 34 Wakefield Street, Hawthorn, 3122, Australia, 61 9214 3836, kdeboer@swin.edu.au %K family violence %K artificial intelligence %K natural language processing %K voice signal characteristics %K public health %K behaviors %K research literature %K policy %K prevalence %K detection %K social policy %K prevention %K machine learning %K mental health %K suicide risk %K psychological distress %D 2024 %7 2.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite the implementation of prevention strategies, family violence continues to be a prevalent issue worldwide. Current strategies to reduce family violence have demonstrated mixed success and innovative approaches are needed urgently to prevent the occurrence of family violence. Incorporating artificial intelligence (AI) into prevention strategies is gaining research attention, particularly the use of textual or voice signal data to detect individuals at risk of perpetrating family violence. However, no review to date has collated extant research regarding how accurate AI is at identifying individuals who are at risk of perpetrating family violence. Objective: The primary aim of this systematic review and meta-analysis is to assess the accuracy of AI models in differentiating between individuals at risk of engaging in family violence versus those who are not using textual or voice signal data. Methods: The following databases will be searched from conception to the search date: IEEE Xplore, PubMed, PsycINFO, EBSCOhost (Psychology and Behavioral Sciences collection), and Computers and Applied Sciences Complete. ProQuest Dissertations and Theses A&I will also be used to search the grey literature. Studies will be included if they report on human adults and use machine learning to differentiate between low and high risk of family violence perpetration. Studies may use voice signal data or linguistic (textual) data and must report levels of accuracy in determining risk. In the data screening and full-text review and quality analysis phases, 2 researchers will review the search results and discrepancies and decisions will be resolved through masked review of a third researcher. Results will be reported in a narrative synthesis. In addition, a random effects meta-analysis will be conducted using the area under the receiver operating curve reported in the included studies, assuming sufficient eligible studies are identified. Methodological quality of included studies will be assessed using the risk of bias tool in nonrandomized studies of interventions. Results: As of October 2024, the search has not commenced. The review will document the state of the research concerning the accuracy of AI models in detecting the risk of family violence perpetration using textual or voice signal data. Results will be presented in the form of a narrative synthesis. Results of the meta-analysis will be summarized in tabular form and using a forest plot. Conclusions: The findings from this study will clarify the state of the literature on the accuracy of machine learning models to identify individuals who are at high risk of perpetuating family violence. Findings may be used to inform the development of AI and machine learning models that can be used to support possible prevention strategies. Trial Registration: PROSPERO CRD42023481174; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=481174 International Registered Report Identifier (IRRID): PRR1-10.2196/54966 %M 39621402 %R 10.2196/54966 %U https://www.researchprotocols.org/2024/1/e54966 %U https://doi.org/10.2196/54966 %U http://www.ncbi.nlm.nih.gov/pubmed/39621402 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60918 %T Evaluating an App-Based Intervention for Preventing Firearm Violence and Substance Use in Young Black Boys and Men: Usability Evaluation Study %A Emezue,Chuka %A Dan-Irabor,Dale %A Froilan,Andrew %A Dunlap,Aaron %A Zamora,Pablo %A Negron,Sarah %A Simmons,Janiya %A Watkins,Jayla %A Julion,Wrenetha A %A Karnik,Niranjan S %+ Department of Women, Children and Family Nursing, Rush University Medical Center, 600 S Paulina St AAC Suite 1064A, Armour Academic Center, Chicago, IL, 60612, United States, 1 312 942 6151, chuka_emezue@rush.edu %K telemedicine %K mobile app %K adolescent %K violence %K substance-related disorder %K African American %K user-computer interface %K software validation %K software development %K mobile phone %D 2024 %7 26.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Young Black male individuals are 24 times more likely to be impacted by firearm injuries and homicides but encounter significant barriers to care and service disengagement, even in program-rich cities across the United States, leaving them worryingly underserved. Existing community-based interventions focus on secondary and tertiary prevention after firearm violence has occurred and are typically deployed in emergency settings. To address these service and uptake issues, we developed BrotherlyACT—a nurse-led, culturally tailored, multicomponent app—to reduce the risk and effects of firearm injuries and homicides and to improve access to precrisis and mental health resources for young Black male individuals (aged 15-24 years) in low-resource and high-violence settings. Grounded in Acceptance and Commitment Therapy, the app provides life skills coaching, safety planning, artificial intelligence–powered talk therapy, and zip code–based service connections directly to young Black male individuals at risk for violence and substance use. Objective: The primary aim of this study is to evaluate the usability, engagement, and satisfaction of BrotherlyACT among target young Black male users and mobile health (mHealth) experts, using a combination of formative usability testing (UT) and heuristic evaluation (HE). Methods: Using a convergent mixed methods approach, we evaluated the BrotherlyACT app using HE by 8 mHealth specialists and conducted UT with 23 participants, comprising 15 young Black male users (aged 15-24 years), alongside 4 adult internal team testers and 4 high school students who were part of our youth advisory board. UT included the System Usability Scale and thematic analysis of think-aloud interviews and cognitive walkthroughs. HE involved mHealth experts applying the Nielsen severity rating scale (score 0-3, with 3 indicating a major issue). All testing was conducted via REDCap (Research Electronic Data Capture) and Zoom or in person. Results: Qualitative usability issues were categorized into 8 thematic groups, revealing only minor usability concerns. The app achieved an average System Usability Scale score of 79, equivalent to an A-minus grade and placing it in the 85th percentile, indicating near-excellent usability. Similarly, the HE by testers identified minor and cosmetic usability issues, with a median severity score of 1 across various heuristics (on a scale of 0-3), indicating minimal impact on user experience. Overall, minor adjustments were recommended to enhance navigation, customization, and guidance for app users, while the app’s visual and functional design was generally well received. Conclusions: BrotherlyACT was considered highly usable and acceptable. Testers in the UT stage gave the app a positive overall rating and emphasized that several key improvements were made. Findings from our UT prompted revisions to the app prototype. Moving forward, a pilot study with a pretest-posttest design will evaluate the app’s efficacy in community health and emergency care settings. International Registered Report Identifier (IRRID): RR2-10.2196/43842 %M 39589765 %R 10.2196/60918 %U https://formative.jmir.org/2024/1/e60918 %U https://doi.org/10.2196/60918 %U http://www.ncbi.nlm.nih.gov/pubmed/39589765 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e65199 %T Measuring Technology-Facilitated Sexual Violence and Abuse in the Chinese Context: Development Study and Content Validity Analysis %A Pak,Sharon Hoi Lam %A Wu,Chanchan %A Choi,Kitty Wai Ying %A Choi,Edmond Pui Hang %+ School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 5/F, Academic Building, 3 Sassoon Road, Pokfulam, Hong Kong, China (Hong Kong), 852 39176972, h0714919@connect.hku.hk %K technology-facilitated sexual violence and abuse %K TFSVA %K image-based sexual abuse %K sexual abuse %K content validity %K measurement %K questionnaire %K China %D 2024 %7 19.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Technology-facilitated sexual violence and abuse (TFSVA) encompasses a range of behaviors where digital technologies are used to enable both virtual and in-person sexual violence. Given that TFSVA is an emerging and continually evolving form of sexual abuse, it has been challenging to establish a universally accepted definition or to develop standardized measures for its assessment. Objective: This study aimed to address the significant gap in research on TFSVA within the Chinese context. Specifically, it sought to develop a TFSVA measurement tool with robust content validity, tailored for use in subsequent epidemiological studies within the Chinese context. Methods: The first step in developing the measurement approach for TFSVA victimization and perpetration was to conduct a thorough literature review of existing empirical research on TFSVA and relevant measurement tools. After the initial generation of items, all the items were reviewed by an expert panel to assess the face validity. The measurement items were further reviewed by potential research participants, who were recruited through snowball sampling via online platforms. The assessment results were quantified by computing the content validity index (CVI). The participants were asked to rate each scale item in terms of its relevance, appropriateness, and clarity regarding the topic. Results: The questionnaire was reviewed by 24 lay experts, with a mean age of 27.96 years. They represented different genders and sexual orientations. The final questionnaire contained a total of 89 items. Three key domains were identified to construct the questionnaire, which included image-based sexual abuse, nonimage-based TFSVA, and online-initiated physical sexual violence. The overall scale CVI values of relevance, appropriateness, and clarity for the scale were 0.90, 0.96, and 0.97, respectively, which indicated high content validity for all the instrument items. To ensure the measurement accurately reflects the experiences of diverse demographic groups, the content validity was further analyzed by gender and sexual orientation. This analysis revealed variations in item validity among participants from different genders and sexual orientations. For instance, heterosexual male respondents showed a particularly low CVI for relevance of 0.20 in the items related to nudity, including “male’s chest/nipples are visible” and “the person is sexually suggestive.” This underscored the importance of an inclusive approach when developing a measurement for TFSVA. Conclusions: This study greatly advances the assessment of TFSVA by examining the content validity of our newly developed measurement. The findings revealed that our measurement tool demonstrated adequate content validity, thereby providing a strong foundation for assessing TFSVA within the Chinese context. Implementing this tool is anticipated to enhance our understanding of TFSVA and aid in the development of effective interventions to combat this form of abuse. %M 39561365 %R 10.2196/65199 %U https://formative.jmir.org/2024/1/e65199 %U https://doi.org/10.2196/65199 %U http://www.ncbi.nlm.nih.gov/pubmed/39561365 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56392 %T Factors Influencing Domestic Human Trafficking in Africa: Protocol for a Scoping Review %A Belaid,Loubna %A Sarmiento,Ivan %A Dion,Anna %A Rojas Cardenas,Andrés %A Cockcroft,Anne %A Andersson,Neil %+ École Nationale d'Administration Publique, 4750 Henri Julien, Montreal, QC, H2T2C8, Canada, 1 5148493989 ext 3810, loubna.belaid@enap.ca %K domestic human trafficking %K Africa %K scoping review protocol %K protocol %K human trafficking %K trafficking %K modern slavery %K human rights violation %K discourse analysis %K exploitation %K fuzzy cognitive map %D 2024 %7 18.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Human trafficking is a human rights violation in every region of the world. The African continent is not spared. Every year, millions of people experience significant health and social consequences. International organizations and governments combating human trafficking are hindered by a lack of knowledge about what factors influence domestic (within-country) human trafficking. Objective: This study aims to conduct a scoping review to collate and synthesize literature on factors influencing domestic trafficking in Africa. Methods: We will follow Arksey and O’Malley’s framework to answer the question about reported influences on domestic human trafficking and their relative weight. The search strategy will explore PubMed, CINAHL, Web of Science, and Scopus. A total of 2 independent researchers will select quantitative, qualitative, or mixed methods studies that examine relationships influencing domestic human trafficking. We will document our results by following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. We will extract a list of all reported relationships between identified factors influencing domestic human trafficking in each study. Based on a discourse analysis approach, we will weigh the strengths of the relationships based on how frequently they are reported across the included studies. We will summarize the findings as fuzzy cognitive maps depicting the relationships reported in the literature. The maps represent the influences between concepts (nodes) linked by arrows (edges) going from each cause to its outcomes. These maps are helpful visual summaries of the factors associated with domestic human trafficking, allowing a comparison with maps to be created by stakeholder groups. Results: This project received financial support in March 2023. We expect to start the project in March 2024. We recruited 2 research staff members to conduct the scoping review and expect to publish the results in March 2025. Conclusions: The review will provide a comprehensive understanding of factors influencing domestic human trafficking in Africa. The overlap of human trafficking with other forms of exploitation, the limited literature on domestic human trafficking, and the likely diversity of factors are challenges for the review. We propose strategies to address these challenges. International Registered Report Identifier (IRRID): PRR1-10.2196/56392 %M 39556420 %R 10.2196/56392 %U https://www.researchprotocols.org/2024/1/e56392 %U https://doi.org/10.2196/56392 %U http://www.ncbi.nlm.nih.gov/pubmed/39556420 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49761 %T #TraumaTok—TikTok Videos Relating to Trauma: Content Analysis %A Woolard,Alix %A Paciente,Rigel %A Munro,Emily %A Wickens,Nicole %A Wells,Gabriella %A Ta,Daniel %A Mandzufas,Joelie %A Lombardi,Karen %+ The Kids Research Institute Australia, 15 Hospital Avenue, Nedlands, 6009, Australia, 61 63191823, alix.woolard@thekids.org.au %K trauma %K traumatic events %K traumatic stress %K TikTok %K public health %K social media %K content analysis %D 2024 %7 7.11.2024 %9 Short Paper %J JMIR Form Res %G English %X Background: Experiencing a traumatic event can significantly impact mental and emotional well-being. Social media platforms offer spaces for sharing stories, seeking support, and accessing psychoeducation. TikTok (ByteDance), a rapidly growing social media platform, is increasingly used for advice, validation, and information, although the content of this requires further study. Research is particularly needed to better understand TikTok content relating to trauma and the potential implications for young viewers, considering the distressing nature of the subject and the possibility of users experiencing vicarious trauma through exposure to these videos. Objective: This study aims to explore the content of trauma-related videos on TikTok, focusing on hashtags related to trauma. Specifically, this study analyzes how TikTok videos present information, advice, stories, and support relating to trauma. Methods: A quantitative cross-sectional descriptive content analysis was performed on TikTok in December 2022. A total of 5 hashtags related to trauma were selected: #trauma, #traumatized, #traumatok, #traumatic, and #traumabond, with the top 50 videos from each hashtag analyzed (total N=250 videos). A standardized codebook was developed inductively to analyze the content of the videos, while an existing generic codebook was used to collect the video features (eg, age of people in the video) and metadata (likes, comments, and shares) for each video. Results: A total of 2 major content themes were identified, which were instructional videos (54/250, 21.6%) and videos disclosing personal stories (168/250, 67.3%). The videos garnered significant engagement, with a total of 296.6 million likes, 2.3 million comments, and 4.6 million shares, indicating that users find this content engaging and useful. Alarmingly, only 3.7% (9/250) of videos included a trigger warning, despite many featuring highly distressing stories that young people and those with trauma may be exposed to. Conclusions: The study highlights the potential risks of vicarious trauma due to trauma dumping without trigger warnings on TikTok, and the need for further research to assess the accuracy of advice and information in these videos. However, it also underscores the platform’s potential to foster social connections, provide validation, and reduce stigma around mental health issues. Public health professionals should leverage social media to disseminate accurate mental health information, while promoting user education and content moderation to mitigate potential harms. People often use social media, such as TikTok to share advice, stories, and support around mental health, including their experiences with trauma. Out of 250 videos, most were either giving advice (54/250, 21.6%) or sharing personal experiences (168/250, 67.3%). The study found many videos lacked warnings about upsetting content, which could potentially harm young viewers or people suffering from trauma. While TikTok can help people feel connected and reduce the stigma around mental health, it is important to seek support from professionals when needed. %M 39509697 %R 10.2196/49761 %U https://formative.jmir.org/2024/1/e49761 %U https://doi.org/10.2196/49761 %U http://www.ncbi.nlm.nih.gov/pubmed/39509697 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e58127 %T Mobile Apps for the Personal Safety of At-Risk Children and Youth: Scoping Review %A Bowen-Forbes,Camille %A Khondaker,Tilovatul %A Stafinski,Tania %A Hadizadeh,Maliheh %A Menon,Devidas %+ Health Technology and Policy Unit, School of Public Health, Edmonton Clinic Health Academy, 11405 St 87 Avenue NW, Edmonton, AB, T6G 1C9, Canada, 1 587 712 2086, bowenfor@ualberta.ca %K children %K youth %K personal safety apps %K smartphones %K mobile apps %K violence %K bullying %K suicide prevention %K youth support %K homeless support %K mobile phone %D 2024 %7 5.11.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Personal safety is a widespread public health issue that affects people of all demographics. There is a growing interest in the use of mobile apps for enhancing personal safety, particularly for children and youth at risk, who are among the most vulnerable groups in society. Objective: This study aims to explore what is known about the use of mobile apps for personal safety among children and youth identified to be “at risk.” Methods: A scoping review following published methodological guidelines was conducted. In total, 5 databases (Scopus, SocINDEX, PsycINFO, Compendex, and Inspec Archive) were searched for relevant scholarly articles published between January 2005 and October 2023. The gray literature was searched using Google and Google Scholar search engines. The results were reported using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. For summarizing the features and users’ experiences of the apps, a published framework for evaluating the quality of mobile health apps for youth was used. Results: A total of 1986 articles were identified, and 41 (2.1%) were included in the review. Nine personal safety apps were captured and categorized into 4 groups based on the goals of the apps, as follows: dating and sexual violence prevention (n=4, 44% of apps), bullying and school violence prevention (n=2, 22% of apps), self-harm and suicide prevention (n=2, 22% of apps), and homeless youth support (n=1, 11% of apps). Of the 41 articles, 25 (61%) provided data solely on app descriptions and features, while the remaining 16 (39%) articles provided data on app evaluations and descriptions. Outcomes focused on app engagement, users’ experiences, and effectiveness. Four articles reported on app use, 3 (75%) of which reported relatively high app use. Data on users’ experience were obtained from 13 studies. In general, participants found the app features to be easy to use and useful as educational resources and personal safety tools. Most of the views were positive. Negative perceptions included redundancy of app features and a lack of usefulness. Five apps were evaluated for effectiveness (n=2, 40% dating and sexual violence prevention; n=2, 40% self-harm and suicide prevention; and n=1, 20% bullying and school violence prevention) and were all associated with a statistically significant reduction (P=.001 to .048) in harm or risk to participants at the 95% CI. Conclusions: Although many personal safety apps are available, few studies have specifically evaluated those designed for youth. However, the evidence suggests that mobile safety apps generally appear to be beneficial for reducing harm to at-risk children and youth without any associated adverse events. Recommendations for future research have been made to strengthen the evidence and increase the availability of effective personal safety apps for children and youth. %M 39499918 %R 10.2196/58127 %U https://mhealth.jmir.org/2024/1/e58127 %U https://doi.org/10.2196/58127 %U http://www.ncbi.nlm.nih.gov/pubmed/39499918 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57886 %T The Implementation of the Advocacy Intervention for Midlife and Older Women Who Have Experienced Intimate Partner Violence: Protocol for a Randomized Controlled Trial %A Weeks,Lori %A Allen,Kathleen %A Holtmann,Catherine %A Leger,Joni %A Dupuis-Blanchard,Suzanne %A MacQuarrie,Colleen %A Macdonald,Marilyn %A Moody,Elaine %A Stilwell,Christie %A Helpard,Heather %A Gagnon,Danie %+ School of Health Administration, Dalhousie University, Sir Charles Tupper Medical Building, 2nd Floor, 5850 College Street, PO Box 15000, Halifax, NS, B3H 4R2, Canada, 1 902 494 7114, lori.weeks@dal.ca %K intimate partner violence %K intervention %K virtual %K midlife %K aging %D 2024 %7 30.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Midlife and older women who experience intimate partner violence (IPV) often have less access to supports and services than younger women. There is far less focus on research and supports for midlife and older women compared to younger women experiencing IPV, and often, neither elder abuse nor IPV services meet their needs. Few interventions are available to meet the needs of midlife and older women. Objective: The goal of this randomized controlled trial is to test the effectiveness of an advocacy intervention for midlife and older women who experience IPV and to learn from the experiences of those who implement and participate in the program. Methods: This trial is a 2-arm, unblinded, parallel, pragmatic randomized controlled trial with a qualitative component. Eligible participants will be women who live in the Maritime provinces of Canada (New Brunswick, Nova Scotia, and Prince Edward Island), who are in midlife and older (aged approximately ≥50 years), and who are currently in a relationship with an abusive partner or have recently left an abusive partner. Facilitators will be trained to deliver the intervention. The intervention will be entirely virtual and will consist of 2 components: (1) an empowerment component, which will involve sharing resources and information with the women; and (2) a social support component, which will include providing support and encouragement to women for 12 weeks. Quantitative effectiveness data will be collected from all trial participants at baseline, 3 months after the intervention, and 9 months after the intervention about the incidence and severity of IPV, physical and mental health, and safety behaviors and strategies. Qualitative interviews will be conducted with the facilitators and intervention group participants. Control group participants will receive a static, nontailored version of the advocacy intervention for midlife and older women (AIM) intervention materials after baseline data collection. Results: A total of 12 facilitators have been trained to deliver the AIM intervention to trial participants. Participant recruitment and data collection will be completed in January 2025. Data analysis will continue throughout the data collection period, and the results will be disseminated by December 2025. Conclusions: This research will result in the adaptation and testing of a program to support and empower midlife and older women in the Maritime provinces of Canada who experience IPV. Trial Registration: International Standard Randomized Controlled Trial Registry ISRCTN30646991; https://doi.org/10.1186/ISRCTN30646991 International Registered Report Identifier (IRRID): DERR1-10.2196/57886 %M 39476849 %R 10.2196/57886 %U https://www.researchprotocols.org/2024/1/e57886 %U https://doi.org/10.2196/57886 %U http://www.ncbi.nlm.nih.gov/pubmed/39476849 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64412 %T Short-Term Outcomes of a Healthy Relationship Intervention for the Prevention of Sexual Harassment and Sexual Assault in the US Military: Pilot Pretest-Postest Study %A Hernandez,Belinda %A Shegog,Ross %A Markham,Christine %A Emery,Susan %A Baumler,Elizabeth %A Thormaehlen,Laura %A Andina Teixeira,Rejane %A Rivera,Yanneth %A Pertuit,Olive %A Kanipe,Chelsey %A Witherspoon,Iraina %A Doss,Janis %A Jones,Victor %A Peskin,Melissa %+ Department of Health Promotion and Behavioral Science, The University of Texas Health Science Center at Houston School of Public Health, 7411 John Smith Dr., Suite 1100, San Antonio, TX, 78229, United States, 1 210 276 9021, belinda.hernandez@uth.tmc.edu %K sexual assault prevention %K sexual harassment prevention %K healthy relationships %K military %K technology-based interventions %K intervention mapping %D 2024 %7 29.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual harassment (SH) and sexual assault (SA) are serious public health problems among US service members. Few SH and SA prevention interventions have been developed exclusively for the military. Code of Respect (X-CoRe) is an innovative web-based, multilevel, SA and SH intervention designed exclusively for the active-duty Air Force. The program’s goal is to increase Airmen’s knowledge and skills to build and maintain respectful relationships, ultimately reducing SH and SA and enhancing Airmen’s overall well-being and mission readiness. Objective: This pilot study aimed to assess the short-term psychosocial impact (eg, knowledge, attitudes, and self-efficacy) of the web-based component of X-CoRe on a sample of junior enlisted and midlevel Airmen. Methods: Airmen from a military installation located in the Northeastern United States were recruited to complete the 10 web-based modules in X-CoRe (9/15, 60% male; 7/15, 54% aged 30-35 years). Participants were given pretests and posttests to measure short-term psychosocial outcomes associated with SH and SA. Descriptive statistics and paired 2-tailed t tests were conducted to assess differences from preintervention to postintervention time points. Results: After completing X-CoRe, participants had a significantly greater understanding of active consent (P=.04), confidence in their healthy relationship skills (P=.045), and confidence to intervene as bystanders (P=.01). Although not statistically significant (P>.05), mean scores in attitudes about SH, couple violence, and cyberbullying; perceptions of sexual misconduct as part of military life; and relationship skills self-efficacy with a romantic partner and friend also improved. Conclusions: The findings from this study demonstrate X-CoRe’s effectiveness in improving critical determinants of SH and SA, making it a promising intervention for SH and SA prevention. More rigorous research is needed to determine X-CoRe’s impact on SH and SA victimization and the long-term impact on associated psychosocial determinants. %M 39471370 %R 10.2196/64412 %U https://formative.jmir.org/2024/1/e64412 %U https://doi.org/10.2196/64412 %U http://www.ncbi.nlm.nih.gov/pubmed/39471370 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e53557 %T User-Centered Design for Designing and Evaluating a Prototype of a Data Collection Tool to Submit Information About Incidents of Violence Against Sex Workers: Multiple Methods Approach %A Ditmore,Melissa H %A Florez-Arango,Jose Fernando %K mobile health %K sex worker %K user-centered design methods %K usability %K heuristic analysis %K cognitive walkthrough %K aggression %K abuse %K occupational health %K reporting %K prototype %K heuristics %K human-centered design %K implementation %K barriers %K enablers %K data collection %K digital health %K underreporting %D 2024 %7 9.10.2024 %9 %J JMIR Hum Factors %G English %X Background: Sex workers face an epidemic of violence in the United States. However, violence against sex workers in the United States is underreported. Sex workers hesitate to report it to the police because they are frequently punished themselves; therefore, an alternative for reporting is needed. Objective: We aim to apply human-centered design methods to create and evaluate the usability of the prototype interface for ReportVASW (violence against sex worker, VASW) and identify opportunities for improvement. Methods: This study explores ways to improve the prototype of ReportVASW, with particular attention to ways to improve the data collection tool. Evaluation methods included cognitive walkthrough, system usability scale, and heuristic evaluation. Results: End users were enthusiastic about the idea of a website to document violence against sex workers. ReportVASW scored 90 on the system usability scale. The tool scored neutral on consistency, and all other responses were positive toward the app, with most being strong. Conclusions: Many opportunities to improve the interface were identified. Multiple methods identified multiple issues to address. Most changes are not overly complex, and the majority were aesthetic or minor. Further development of the ReportVASW data collection tool is worth pursuing. %R 10.2196/53557 %U https://humanfactors.jmir.org/2024/1/e53557 %U https://doi.org/10.2196/53557 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e43563 %T Functional Impairment in Individuals Exposed to Violence Based on Electronical Forensic Medical Record Mining and Their Profile Identification: Controlled Observational Study %A Lerner,Ivan %A Chariot,Patrick %A Lefèvre,Thomas %+ Department of Legal and Social Medicine, Hôpital Jean-Verdier, Assistance publique - Hôpitaux de Paris, avenue du 14 juillet, Bondy, 93140, France, 33 148026508, lefevre.thomas@gmail.com %K reproducibility %K interpersonal violence %K functional impairment %K psychological trauma %K clustering %K intimate partner violence %D 2024 %7 27.9.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Little is known about the functional consequences of violence when directly assessed as a primary outcome, and even less about how consistently these consequences are evaluated in a judicial context. The World Health Organization (WHO) highlighted the importance of a functional approach to health in 2001 with the release of the International Classification of Functioning, Disability, and Health (ICF). In most European countries, forensic physicians assess individuals exposed to violence to evaluate the outcomes of violence, providing certified medical evidence for magistrates’ sentencing decisions. This evaluation involves a mix of objective, subjective, and contextual elements, such as reported symptoms of fear, pain, and details of the assault. Quantifying these subjective elements with scales could enhance their interpretation and application in a judicial context. Objective: This study aims to (1) characterize and (2) assess 6 scales measuring subjective elements of functional impairment among individuals exposed to violence. Methods: We conducted a retrospective study that included individuals exposed to violence examined in a French department of forensic medicine over 12 months. A typology of violence encountered in medical settings was built based on the mining of electronic health records and the use of pattern recognition algorithms. The optimal number of violence types was determined using a robust and stable clustering approach, involving sample resampling and a multimetric scheme. Patients were then paired according to their homogeneous profiles, and the intra- and interrater reproducibility of the scales was evaluated. Results: All pain, fear, and life threat scales were significantly associated with higher functional impairment, suggesting that these measures contribute to the overall assessment of functional impairment. The intra- and interrater reproducibility of scales among similar situations of violence was measured, ranging from mild to good, with coefficients of concordance between 0.46-0.66 and 0.43-0.66, respectively. Individuals reporting intimate partner violence showed higher scores in both fear and perception of a life threat during the assault and medical interview, while individuals reporting battery by multiple unknown assailants presented higher scores only in perception of a life threat during the assault. We identified 5 remarkably stable profiles of situations of violence, consistent with clinical practice. Conclusions: Pain, fear, and life threat scales were related to functional impairment according to expert knowledge and demonstrated fair reproducibility under real-life conditions for similar situations of violence. Subjective elements related to functional impairment in individuals exposed to violence can be quantified using Likert scales during medical interviews. %M 39331422 %R 10.2196/43563 %U https://publichealth.jmir.org/2024/1/e43563 %U https://doi.org/10.2196/43563 %U http://www.ncbi.nlm.nih.gov/pubmed/39331422 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57633 %T A Clinical Decision Support Tool for Intimate Partner Violence Screening Among Women Veterans: Development and Qualitative Evaluation of Provider Perspectives %A Rossi,Fernanda S %A Wu,Justina %A Timko,Christine %A Nevedal,Andrea L %A Wiltsey Stirman,Shannon %+ Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1070 Arastradero Rd, Stanford, CA, 94304, United States, 1 650 721 3990, fsrossi@stanford.edu %K intimate partner violence %K clinical decision support %K intimate partner violence screening %K women veterans %D 2024 %7 25.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Women veterans, compared to civilian women, are especially at risk of experiencing intimate partner violence (IPV), pointing to the critical need for IPV screening and intervention in the Veterans Health Administration (VHA). However, implementing paper-based IPV screening and intervention in the VHA has revealed substantial barriers, including health care providers’ inadequate IPV training, competing demands, time constraints, and discomfort addressing IPV and making decisions about the appropriate type or level of intervention. Objective: This study aimed to address IPV screening implementation barriers and hence developed and tested a novel IPV clinical decision support (CDS) tool for physicians in the Women’s Health Clinic (WHC), a primary care clinic within the Veterans Affairs Palo Alto Health Care System. This tool provides intelligent, evidence-based, step-by-step guidance on how to conduct IPV screening and intervention. Methods: Informed by existing CDS development frameworks, developing the IPV CDS tool prototype involved six steps: (1) identifying the scope of the tool, (2) identifying IPV screening and intervention content, (3) incorporating IPV-related VHA and clinic resources, (4) identifying the tool’s components, (5) designing the tool, and (6) conducting initial tool revisions. We obtained preliminary physician feedback on user experience and clinical utility of the CDS tool via the System Usability Scale (SUS) and semistructured interviews with 6 WHC physicians. SUS scores were examined using descriptive statistics. Interviews were analyzed using rapid qualitative analysis to extract actionable feedback to inform design updates and improvements. Results: This study includes a detailed description of the IPV CDS tool. Findings indicated that the tool was generally well received by physicians, who indicated good tool usability (SUS score: mean 77.5, SD 12.75). They found the tool clinically useful, needed in their practice, and feasible to implement in primary care. They emphasized that it increased their confidence in managing patients reporting IPV but expressed concerns regarding its length, workflow integration, flexibility, and specificity of information. Several physicians, for example, found the tool too time consuming when encountering patients at high risk; they suggested multiple uses of the tool (eg, an educational tool for less-experienced health care providers and a checklist for more-experienced health care providers) and including more detailed information (eg, a list of local shelters). Conclusions: Physician feedback on the IPV CDS tool is encouraging and will be used to improve the tool. This study offers an example of an IPV CDS tool that clinics can adapt to potentially enhance the quality and efficiency of their IPV screening and intervention process. Additional research is needed to determine the tool’s clinical utility in improving IPV screening and intervention rates and patient outcomes (eg, increased patient safety, reduced IPV risk, and increased referrals to mental health treatment). %M 39321455 %R 10.2196/57633 %U https://formative.jmir.org/2024/1/e57633 %U https://doi.org/10.2196/57633 %U http://www.ncbi.nlm.nih.gov/pubmed/39321455 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e62952 %T Public Mass Shootings: Counterfactual Trend Analysis of the Federal Assault Weapons Ban %A Lundberg,Alex Lars %A Fox,James Alan %A Mohammad,Hassan %A Mason,Maryann %A Salina,Doreen %A Victorson,David %A Parra-Cardona,Ruben %A Post,Lori Ann %K assault weapons %K FAWB %K federal assault weapons ban %K firearms %K guns %K large-capacity magazine %K LCM %K gun policy %K public mass shootings %K weapon %K weapons %K shooting %K shootings %K prevention %K efficacy %K surveillance %K public health %K linear regression %K homicide %K gun %K gun control %K gun injury %K gun injuries %K health policy %K information seeking behavior %K health informatics %D 2024 %7 20.9.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Assault weapon and large-capacity magazine bans are potential tools for policy makers to prevent public mass shootings. However, the efficacy of these bans is a continual source of debate. In an earlier study, we estimated the impact of the Federal Assault Weapons Ban (FAWB) on the number of public mass shooting events in the United States. This study provides an updated assessment with 3 additional years of firearm surveillance data to characterize the longer-term effects. Objective: This study aims to estimate the impact of the FAWB on trends in public mass shootings from 1966 to 2022. Methods: We used linear regression to estimate the impact of the FAWB on the 4-year simple moving average of annual public mass shootings, defined by events with 4 or more deaths in 24 hours, not including the perpetrator. The study period spans 1966 to 2022. The model includes indicator variables for both the FAWB period (1995‐2004) and the period after its removal (2005‐2022). These indicators were interacted with a linear time trend. Estimates were controlled for the national homicide rate. After estimation, the model provided counterfactual estimates of public mass shootings if the FAWB was never imposed and if the FAWB remained in place. Results: The overall upward trajectory in the number of public mass shootings substantially fell while the FAWB was in place. These trends are specific to events in which the perpetrator used an assault weapon or large-capacity magazine. Point estimates suggest the FAWB prevented up to 5 public mass shootings while the ban was active. A continuation of the FAWB and large-capacity magazine ban would have prevented up to 38 public mass shootings, but the CIs become wider as time moves further away from the period of the FAWB. Conclusions: The FAWB, which included a ban on large-capacity magazines, was associated with fewer public mass shooting events, fatalities, and nonfatal gun injuries. Gun control legislation is an important public health tool in the prevention of public mass shootings. %R 10.2196/62952 %U https://publichealth.jmir.org/2024/1/e62952 %U https://doi.org/10.2196/62952 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53050 %T From Tweets to Streets: Observational Study on the Association Between Twitter Sentiment and Anti-Asian Hate Crimes in New York City from 2019 to 2022 %A Wei,Hanxue %A Hswen,Yulin %A Merchant,Junaid S %A Drew,Laura B %A Nguyen,Quynh C %A Yue,Xiaohe %A Mane,Heran %A Nguyen,Thu T %+ Department of Epidemiology & Biostatistics, University of Maryland, 4254 Stadium Drive College Park, Maryland, MD, 20742-2611, United States, 1 301 405 3575, ttxn@umd.edu %K anti-Asian %K hate crime %K Twitter %K racism %K social media, machine learning, sentiment analysis %D 2024 %7 9.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Anti-Asian hate crimes escalated during the COVID-19 pandemic; however, limited research has explored the association between social media sentiment and hate crimes toward Asian communities. Objective: This study aims to investigate the relationship between Twitter (rebranded as X) sentiment data and the occurrence of anti-Asian hate crimes in New York City from 2019 to 2022, a period encompassing both before and during COVID-19 pandemic conditions. Methods: We used a hate crime dataset from the New York City Police Department. This dataset included detailed information on the occurrence of anti-Asian hate crimes at the police precinct level from 2019 to 2022. We used Twitter’s application programming interface for Academic Research to collect a random 1% sample of publicly available Twitter data in New York State, including New York City, that included 1 or more of the selected Asian-related keywords and applied support vector machine to classify sentiment. We measured sentiment toward the Asian community using the rates of negative and positive sentiment expressed in tweets at the monthly level (N=48). We used negative binomial models to explore the associations between sentiment levels and the number of anti-Asian hate crimes in the same month. We further adjusted our models for confounders such as the unemployment rate and the emergence of the COVID-19 pandemic. As sensitivity analyses, we used distributed lag models to capture 1- to 2-month lag times. Results: A point increase of 1% in negative sentiment rate toward the Asian community in the same month was associated with a 24% increase (incidence rate ratio [IRR] 1.24; 95% CI 1.07-1.44; P=.005) in the number of anti-Asian hate crimes. The association was slightly attenuated after adjusting for unemployment and COVID-19 emergence (ie, after March 2020; P=.008). The positive sentiment toward Asian tweets with a 0-month lag was associated with a 12% decrease (IRR 0.88; 95% CI 0.79-0.97; P=.002) in expected anti-Asian hate crimes in the same month, but the relationship was no longer significant after adjusting for the unemployment rate and the emergence of COVID-19 pandemic (P=.11). Conclusions: A higher negative sentiment level was associated with more hate crimes specifically targeting the Asian community in the same month. The findings highlight the importance of monitoring public sentiment to predict and potentially mitigate hate crimes against Asian individuals. %M 39250221 %R 10.2196/53050 %U https://www.jmir.org/2024/1/e53050 %U https://doi.org/10.2196/53050 %U http://www.ncbi.nlm.nih.gov/pubmed/39250221 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56249 %T School Violence Exposure as an Adverse Childhood Experience: Protocol for a Nationwide Study of Secondary Public Schools %A Rajan,Sonali %A Buttar,Navjot %A Ladhani,Zahra %A Caruso,Jennifer %A Allegrante,John P. %A Branas,Charles %+ Department of Health Studies & Applied Educational Psychology, Teachers College, Columbia University, 525 West 120th Street, Box 114, New York, NY, 10027, United States, 1 2126783458, sr2345@tc.columbia.edu %K adolescents %K adverse childhood experiences %K gun violence %K health outcomes %K injury prevention %K school violence %D 2024 %7 28.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Poor mental health and adverse childhood experiences (ACEs) predict extensive adverse outcomes in youth, including increases in long-term risk for chronic disease and injury, impaired emotional development, and poor academic outcomes. Exposure to school violence, specifically intentional gun violence, is an increasingly prevalent ACE. The anticipation of school shootings has led to the implementation of school safety and security interventions that may increase anxiety, depression, and other indicators of poor mental well-being among students and staff alike. Despite this, the association between exposure to existing school safety interventions and early adolescent student mental health outcomes, while accounting for one's history of ACEs, has not been previously investigated. Objective: The study protocol described here aims to determine whether there is a significant difference in the prevalence of mental health outcomes, perceived school safety, and academic engagement between adolescent students (grades 6-12) at schools who have experienced a school shooting and those who have not; whether existing interventions to promote school safety and security are associated with poor mental health outcomes among students and school staff; and what the strength of the association between school safety interventions and mental health outcomes among students and teachers is in schools that have experienced a school shooting versus schools that have never experienced a school shooting. Methods: This observational study will collect cross-sectional survey data from a nationwide sample of students, teachers, and principals at 12 secondary public schools across the United States. The participants come from 6 randomly selected exposure schools that have either experienced a recent (<2 years ago) intentional school shooting or have experienced an intentional school shooting less recently (>2 years ago). Data from these schools are being directly compared with 6 secondary schools that have never experienced a school shooting. Results: Institutional review board approval for this research project was obtained and the study subsequently began its recruitment and data collection phase in January 2024. Data collection is currently ongoing and the expected completion date is January 2025. The analytic plan is designed to determine if the strength of the association between school safety interventions and mental health outcomes differs among students and school staff in schools with varying levels of school violence exposure. Analyses will be used to evaluate the role of ACEs on the relationships among exposure to an intentional school shooting, exposure to school safety strategies, and student outcomes (ie, mental health and well-being, perceptions of school safety, and educational outcomes). Conclusions: The results from this study promise to generate meaningful and novel findings on the extent to which having a prior history of ACEs moderates the relationships among exposure to intentional school gun violence, school safety strategies, and student outcomes (ie, mental health and well-being, and perceptions of school safety). Trial Registration: ClinicalTrials.gov NCT06153316; https://clinicaltrials.gov/study/NCT06153316 International Registered Report Identifier (IRRID): DERR1-10.2196/56249 %M 39196631 %R 10.2196/56249 %U https://www.researchprotocols.org/2024/1/e56249 %U https://doi.org/10.2196/56249 %U http://www.ncbi.nlm.nih.gov/pubmed/39196631 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59918 %T Implementation and Impact of Intimate Partner Violence Screening Expansion in the Veterans Health Administration: Protocol for a Mixed Methods Evaluation %A Portnoy,Galina A %A Relyea,Mark R %A Dichter,Melissa E %A Iverson,Katherine M %A Presseau,Candice %A Brandt,Cynthia A %A Skanderson,Melissa %A Bruce,LeAnn E %A Martino,Steve %+ VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, United States, 1 2039325711, galina.portnoy@va.gov %K screening %K intimate partner violence %K implementation %K evaluation %K national rollout %K health care %K quality improvement %K veterans %D 2024 %7 28.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Intimate partner violence (IPV) is a significant public health problem with far-reaching consequences. The health care system plays an integral role in the detection of and response to IPV. Historically, the majority of IPV screening initiatives have targeted women of reproductive age, with little known about men’s IPV screening experiences or the impact of screening on men’s health care. The Veterans Health Administration (VHA) has called for an expansion of IPV screening, providing a unique opportunity for a large-scale evaluation of IPV screening and response across all patient populations. Objective: In this protocol paper, we describe the recently funded Partnered Evaluation of Relationship Health Innovations and Services through Mixed Methods (PRISM) initiative, aiming to evaluate the implementation and impact of the VHA’s IPV screening and response expansion, with a particular focus on identifying potential gender differences. Methods: The PRISM Initiative is guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) and Consolidated Framework for Implementation Research (CFIR 2.0) frameworks. We will use mixed methods data from 139 VHA facilities to evaluate the IPV screening expansion, including electronic health record data and qualitative interviews with patients, clinicians, and national IPV program leadership. Quantitative data will be analyzed using a longitudinal observational design with repeated measurement periods at baseline (T0), year 1 (T1), and year 2 (T2). Qualitative interviews will focus on identifying multilevel factors, including potential implementation barriers and facilitators critical to IPV screening and response expansion, and examining the impact of screening on patients and clinicians. Results: The PRISM initiative was funded in October 2023. We have developed the qualitative interview guides, obtained institutional review board approval, extracted quantitative data for baseline analyses, and began recruitment for qualitative interviews. Reports of progress and results will be made available to evaluation partners and funders through quarterly and end-of-year reports. All data collection and analyses across time points are expected to be completed in June 2026. Conclusions: Findings from this mixed methods evaluation will provide a comprehensive understanding of IPV screening expansion at the VHA, including the implementation and impact of screening and the scope of IPV detected in the VHA patient population. Moreover, data generated by this initiative have critical policy and clinical practice implications in a national health care system. International Registered Report Identifier (IRRID): PRR1-10.2196/59918 %M 39194059 %R 10.2196/59918 %U https://www.researchprotocols.org/2024/1/e59918 %U https://doi.org/10.2196/59918 %U http://www.ncbi.nlm.nih.gov/pubmed/39194059 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57600 %T Assessment of Sexual Violence Risk Perception in Men Who Have Sex With Men: Proposal for the Development and Validation of “G-Date” %A Angelone,D J %A Mitchell,Damon %A Wells,Brooke %A Korovich,Megan %A Nicoletti,Alexandra %A Fife,Dustin %+ Department of Psychology, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, United States, 1 856 256 4500 ext 53780, angeloned@rowan.edu %K sexual violence %K risk perception %K laboratory analog %K dating and sexual networking apps %K men who have sex with men %D 2024 %7 19.8.2024 %9 Proposal %J JMIR Res Protoc %G English %X Background: Sexual violence (SV) is a significant problem for sexual minorities, including men who have sex with men (MSM). The limited research suggests SV is associated with a host of syndemic conditions. These factors tend to cluster and interact to worsen one another. Unfortunately, while much work has been conducted to examine these factors in heterosexual women, there is a lack of research examining MSM, especially their SV risk perception. Further, MSM are active users of dating and sexual networking (DSN) mobile apps, and this technology has demonstrated usefulness for creating safe spaces for MSM to meet and engage partners. However, mounting data demonstrate that DSN app use is associated with an increased risk for SV, especially given the higher likelihood of using alcohol and other drugs before sex. By contrast, some researchers have demonstrated that DSN technology can be harnessed as a prevention tool for HIV; unfortunately, no such work has progressed regarding SV. Objective: This study aims to (1) use qualitative and quantitative methods to tailor an existing laboratory paradigm of SV risk perception in women for MSM using a DSN mobile app framework and (2) subject this novel paradigm to a rigorous validation study to confirm its usefulness in predicting SV, with the potential for use in future prevention endeavors. Methods: To tailor the paradigm for MSM, a team of computer scientists created an initial DSN app (G-Date) and incorporated ongoing feedback about the usability, feasibility, and realism of this tool from a representative sample of MSM. We used focus groups and interviews to assist in the development of G-Date, including by identifying relevant stimuli, developing the cover story, and establishing the appropriate study language. To confirm the paradigm’s usefulness, we are conducting an experimental study with web-based and face-to-face participants to determine the content, concurrent, and predictive validities of G-Date. We will evaluate whether certain correlates of SV informed by syndemics and minority stress theories (eg, history of SV and alcohol and drug use) affect the ability of MSM to detect SV risk within G-Date and how paradigm engagement influences behavior in actual DSN app use contexts. Results: This study received funding from the National Institute on Alcohol Abuse and Alcoholism on September 10, 2020, and ethics approval on October 19, 2020, and we began app development for aim 1 immediately thereafter. We began data collection for the aim 2 validation study in December 2022. Initial results from the validation study are expected to be available after December 2025. Conclusions: We hope that G-Date will enhance our understanding of factors associated with SV risk and serve as a useful step in creating prevention programs for this susceptible population. %M 39159453 %R 10.2196/57600 %U https://www.researchprotocols.org/2024/1/e57600 %U https://doi.org/10.2196/57600 %U http://www.ncbi.nlm.nih.gov/pubmed/39159453 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58322 %T Using the Preparation Phase of the Multiphase Optimization Strategy to Design an Antiextremism Program in Bahrain: Formative and Pilot Research %A Rulison,Kelly %A Weaver,GracieLee %A Milroy,Jeffrey %A Beamon,Emily %A Kelly,Samantha %A Ameeni,Ali %A Juma,Amina %A Abualgasim,Fadhel %A Husain,Jaafar %A Wyrick,David %+ Prevention Strategies, 9 Provence Ct, Greensboro, NC, 27410, United States, 1 3366885770, kelly@preventionstrategies.com %K Antiextremism %K peaceful coexistence %K intervention %K evaluation %K international %K multiphase optimization strategy %K preparation phase %K extremism %K extremist %K peace %K peaceful %K resistance %K violent %K violence %K radical %K radicalism %K Bahrain %K education %K educational %K school %K schools %K student %K students %K drug %K drugs %K abuse %K substance %D 2024 %7 17.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Extremism continues to raise concerns about conflict and violent attacks that can lead to deaths, injuries, trauma, and stress. Adolescents are especially vulnerable to radicalization by extremists. Given its location in a region that often experiences extremism, Bahrain developed 4 peaceful coexistence lessons and 4 antiextremism lessons to be implemented as part of their Drug Abuse Resistance Education (D.A.R.E.) program. Objective: The aim of this study is to report the results of the preparation phase of the multiphase optimization strategy (MOST) to develop a peaceful coexistence program and an antiextremism program implemented by D.A.R.E. officers in Bahrain. Methods: We developed conceptual models for the peaceful coexistence and antiextremism programs, indicating which mediators each lesson should target, the proximal outcomes that should be shaped by these mediators, and the distal and ultimate outcomes that the intervention should change. We recruited 20 middle schools to pilot test our research protocol, survey measures, and the existing intervention lessons. A total of 854 seventh and ninth grade students completed a pretest survey, 4 peaceful coexistence intervention lessons, and an immediate posttest survey; and a total of 495 ninth grade students completed the pretest survey, 4 antiextremism lessons, and an immediate posttest survey. A series of 3-level models, nesting students within classrooms within schools, tested mean differences from pretest to posttest. Results: Pilot test results indicated that most measures had adequate reliability and provided promising evidence that the existing lessons could change some of the targeted mediators and proximal outcomes. Specifically, students who completed the peaceful coexistence lessons reported significant changes in 5 targeted mediating variables (eg, injunctive norms about intolerance, P<.001) and 3 proximal outcomes [eg, social skills empathy (P=.008); tolerance beliefs (P=.041)]. Students who completed the antiextremism lessons reported significant changes in 3 targeted mediators [eg, self-efficacy to use resistance skills themselves (P<.001)], and 1 proximal outcome (ie, social skills empathy, P<.001). Conclusions: An effective antiextremism program has the potential to protect youth from radicalization and increase peaceful coexistence. We used the preparation phase of MOST to (1) develop a conceptual model, (2) identify the 4 lessons in each program as the components we will evaluate in the optimization phase of MOST, (3) pilot test the existing lessons, our newly developed measures, and research protocol, and (4) determine that our optimization objective will be all effective components. We will use these results to revise the existing lessons and conduct optimization trials to evaluate the efficacy of the individual lessons. %M 39018090 %R 10.2196/58322 %U https://formative.jmir.org/2024/1/e58322 %U https://doi.org/10.2196/58322 %U http://www.ncbi.nlm.nih.gov/pubmed/39018090 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54605 %T Investigating the Efficacy of a Community Support Network Rehabilitation Intervention for Improving Resiliency, Quality of Life, and Neurocognitive Function in Survivors of Intimate Partner Violence–Caused Brain Injury: Protocol for a Feasibility Study %A Adhikari,Shambhu Prasad %A Stranges,Tori N %A Tehrani,Setareh Nouri Zadeh %A Porter,Shaun %A Mason,Karen %A van Donkelaar,Paul %+ School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada, 1 250 863 3230, paul.vandonkelaar@ubc.ca %K brain injury %K cognitive functions %K community support network %K intimate partner violence %K quality of life %K rehabilitation %D 2024 %7 24.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Globally, approximately 1 in 3 women experience intimate partner violence (IPV) in their lifetime. Brain injury (BI) is a common, yet often unrecognized, consequence of IPV. BIs caused by IPV tend to be mild, occur repetitively over the course of months or years, are remote in time, and result in chronic symptoms. Similar to BI from other causes, therapeutic treatment for women with IPV-caused BI (IPV-BI) is crucial to help resolve any physical or cognitive impairments, enhance the quality of life (QoL), and minimize longer-term neurodegeneration. Objective: This study aims to investigate the feasibility and efficacy of a community support network (CSN) rehabilitation intervention regarding its impact on resiliency, QoL, and neurocognitive function. Methods: In this pre- and postexperimental design, women (aged 18 to 50 years) who are survivors of IPV and IPV-BI will be recruited from various community organizations serving survivors of IPV. Exclusion criteria will include current pregnancy and any diagnosed neurological disorder known to affect cerebrovascular, neurocognitive, or sensorimotor function. A CSN rehabilitation intervention that includes aerobic exercise, cognitive training, mindfulness meditation, and counseling will be administered. A trauma-informed approach will be integrated into the design and implementation of the program. Furthermore, the program will include a participant navigator who will provide trauma- and violence-informed advocacy and systems navigation support to participants, in addition to facilitating a monthly peer support group. The intervention will be provided for 2.5 hours a day and 2 days a week for 3 months. Participants will complete psychological assessments and provide clinic-demographic information in the first assessment. In the second (before intervention), third (after intervention), and fourth (at follow-up) sessions, they will complete tests of resiliency, QoL, and neurocognition. The estimated sample size is 100. The objective of this study will be accomplished by quantitatively measuring resiliency, QoL, and neurocognition before and immediately after the intervention. A follow-up assessment will occur 3 months after the completion of the intervention to evaluate the maintenance of any improvements in function. One-way ANOVAs will be used to evaluate the intervention outcome across the testing times. Relationships among various variables will be explored using regression analysis. Results: We anticipate that the CSN rehabilitation intervention will be effective in improving resiliency, QoL, and neurocognitive function in women who have experienced IPV-BI. Furthermore, we anticipate that this intervention will be feasible in terms of study recruitment, adherence, and retention. Conclusions: The CSN rehabilitation intervention will have a positive impact on resiliency, QoL, and neurocognitive functions in survivors of IPV-BI. Subsequently, a comparative study will be conducted by recruiting a control group receiving usual care. International Registered Report Identifier (IRRID): PRR1-10.2196/54605 %M 38788207 %R 10.2196/54605 %U https://www.researchprotocols.org/2024/1/e54605 %U https://doi.org/10.2196/54605 %U http://www.ncbi.nlm.nih.gov/pubmed/38788207 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50552 %T Bridging and Bonding Social Capital by Analyzing the Demographics, User Activities, and Social Network Dynamics of Sexual Assault Centers on Twitter: Mixed Methods Study %A Xue,Jia %A Zhang,Qiaoru %A Zhang,Yun %A Shi,Hong %A Zheng,Chengda %A Fan,Jingchuan %A Zhang,Linxiao %A Chen,Chen %A Li,Luye %A Shier,Micheal L %+ Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada, 1 416 946 5429, jia.xue@utoronto.ca %K social media %K Twitter %K sexual assault %K nonprofits %K Canada %K violence %K geolocation %K communication %D 2024 %7 27.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media platforms have gained popularity as communication tools for organizations to engage with clients and the public, disseminate information, and raise awareness about social issues. From a social capital perspective, relationship building is seen as an investment, involving a complex interplay of tangible and intangible resources. Social media–based social capital signifies the diverse social networks that organizations can foster through their engagement on social media platforms. Literature underscores the great significance of further investigation into the scope and nature of social media use, particularly within sectors dedicated to service delivery, such as sexual assault organizations. Objective: This study aims to fill a research gap by investigating the use of Twitter by sexual assault support agencies in Canada. It seeks to understand the demographics, user activities, and social network structure within these organizations on Twitter, focusing on building social capital. The research questions explore the demographic profile, geographic distribution, and Twitter activity of these organizations as well as the social network dynamics of bridging and bonding social capital. Methods: This study used purposive sampling to investigate sexual assault centers in Canada with active Twitter accounts, resulting in the identification of 124 centers. The Twitter handles were collected, yielding 113 unique handles, and their corresponding Twitter IDs were obtained and validated. A total of 294,350 tweets were collected from these centers, covering >93.54% of their Twitter activity. Preprocessing was conducted to prepare the data, and descriptive analysis was used to determine the center demographics and age. Furthermore, geolocation mapping was performed to visualize the center locations. Social network analysis was used to explore the intricate relationships within the network of sexual assault center Twitter accounts, using various metrics to assess the network structure and connectivity dynamics. Results: The results highlight the substantial presence of sexual assault organizations on Twitter, particularly in provinces such as Ontario, British Columbia, and Quebec, underscoring the importance of tailored engagement strategies considering regional disparities. The analysis of Twitter account creation years shows a peak in 2012, followed by a decline in new account creations in subsequent years. The monthly tweet activity shows November as the most active month, whereas July had the lowest activity. The study also reveals variations in Twitter activity, account creation patterns, and social network dynamics, identifying influential social queens and marginalized entities within the network. Conclusions: This study presents a comprehensive landscape of the demographics and activities of sexual assault centers in Canada on Twitter. This study suggests that future research should explore the long-term consequences of social media use and examine stakeholder perceptions, providing valuable insights to improve communication practices within the nonprofit human services sector and further the missions of these organizations. %M 38536222 %R 10.2196/50552 %U https://www.jmir.org/2024/1/e50552 %U https://doi.org/10.2196/50552 %U http://www.ncbi.nlm.nih.gov/pubmed/38536222 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45563 %T The Impact of COVID-19 and Exposure to Violent Media Content on Cyber Violence Victimization Among Adolescents in South Korea: National Population-Based Study %A Lee,Eugene %A Schulz,Peter J %A Lee,Hye Eun %+ Department of Communication & Media, Ewha Womans University, #403 Ewha-POSCO, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, Republic of Korea, 82 3277 6937, hyeeunlee77@ewha.ac.kr %K cyber violence %K adolescents %K victimization %K perpetration %K COVID-19 %D 2024 %7 22.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Because of the COVID-19 pandemic and consequent stay-at-home mandates, adolescents faced isolation and a decline in mental health. With increased online activity during this period, concerns arose regarding exposure to violent media content and cyber victimization among adolescents. Yet, the precise influence of pandemic-related measures on experiences of cyber violence remains unclear. Hence, it is pertinent to investigate whether the pandemic altered the dynamics of cyber violence victimization for individuals. Objective: This study aims to investigate the effects of COVID-19 and exposure to violent media content on cyber violence victimization among adolescents in South Korea. Methods: We used national survey data from 2019 (n=4779) and 2020 (n=4958) to investigate the potential impact of COVID-19 on the prevalence of cyber violence among young adolescents. The data encompassed responses from elementary fourth-grade students to senior high school students, probing their exposure to violent media content, average internet use, as well as experiences of victimization and perpetration. Results: The analysis revealed a noteworthy decline in cyber victimization during 2020 compared with 2019 (B=–0.12, t=–3.45, P<.001). Furthermore, being a perpetrator significantly contributed to cyber victimization (B=0.57, t=48.36, P<.001). Additionally, younger adolescents (β=–.06, t=–6.09, P<.001), those spending more time online (β=.18, t=13.83, P<.001), and those exposed to violent media (β=.14, t=13.89, P<.001) were found to be more susceptible to victimization. Conclusions: Despite the widespread belief that cyber violence among adolescents surged during COVID-19 due to increased online activity, the study findings counter this assumption. Surprisingly, COVID-19 did not exacerbate cyber victimization; rather, it decreased it. Given the strong correlation between cyber victimization and offline victimization, our attention should be directed toward implementing real-life interventions aimed at curbing violence originating from in-person violence at school. %M 38517467 %R 10.2196/45563 %U https://www.jmir.org/2024/1/e45563 %U https://doi.org/10.2196/45563 %U http://www.ncbi.nlm.nih.gov/pubmed/38517467 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e50864 %T Improving Health Professional Recognition and Response to Child Maltreatment and Intimate Partner Violence: Protocol for Two Mixed Methods Pilot Randomized Controlled Trials %A Kimber,Melissa %A Baker-Sullivan,Elizabeth %A Stewart,Donna E %A Vanstone,Meredith %+ Offord Centre for Child Studies, Department of Psychiatry & Behavioural Neurosciences, McMaster University, WHC 120, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada, 1 905 525 9140 ext 27220, kimberms@mcmaster.ca %K medical education %K health professions education %K child maltreatment %K intimate partner violence %K mixed methods %K pilot trial %K qualitative description %K family violence %D 2024 %7 21.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The optimal educational approach for preparing health professionals with the knowledge and skills to effectively recognize and respond to family violence, including child maltreatment and intimate partner violence, remains unclear. The Violence, Evidence, Guidance, and Action (VEGA) Family Violence Education Resources is a novel intervention that can be completed via self-directed learning or in a workshop format; both approaches focus on improving health professional preparedness to address family violence. Objective: Our studies aim to determine the acceptability and feasibility of conducting a randomized controlled trial to evaluate the effectiveness of the self-directed (experimental intervention) and workshop (active control) modalities of VEGA, as an adjunct to standard education, to improve learner (Researching the Impact of Service provider Education [RISE] with Residents) and independent practice (RISE with Veterans) health professional preparedness, knowledge, and skills related to recognizing family violence in their health care encounters. Methods: The RISE with Residents and RISE with Veterans research studies use embedded experimental mixed methods research designs. The quantitative strand for each study follows the principles of a pilot randomized controlled trial. For RISE with Residents, we aimed to recruit 80 postgraduate medical trainees; for RISE with Veterans, we intended to recruit 80 health professionals who work or have worked with Veterans (or their family members) of the Canadian military or the Royal Canadian Mounted Police in a direct service capacity. Participants complete quantitative assessments at baseline, after intervention, and at 3-month follow-up. A subset of participants from each arm also undergoes a qualitative semistructured interview with the aim of describing participants’ perceptions of the value and impact of each VEGA modality, as well as research burden. Scores on potential outcome measures will be mapped to excerpts of qualitative data via a mixed methods joint display to aid in the interpretation of findings. Results: We consented 71 individuals to participate in the RISE with Residents study. Data collection was completed on August 31, 2023, and data are currently being cleaned and prepared for analysis. As of January 15, 2024, we consented 34 individuals in the RISE with Veterans study; data collection will be completed in March 2024. For both studies, no data analysis had taken place at the time of manuscript submission. Results will be disseminated through peer-reviewed publications; academic conferences; and posting and sharing of study summaries and infographics on social media, the project website, and via professional network listserves. Conclusions: Reducing the impacts of family violence remains a pressing public health challenge. Both research studies will provide a valuable methodological contribution about the feasibility of trial methods in health professions education focused on family violence. They will also contribute to education science about the differences in the effectiveness of self-directed versus facilitator-led learning strategies. Trial Registration: ClinicalTrials.gov NCT05490121, https://clinicaltrials.gov/study/NCT05490121; ClinicalTrials.gov NCT05490004, https://clinicaltrials.gov/study/NCT05490004 International Registered Report Identifier (IRRID): DERR1-10.2196/50864 %M 38512307 %R 10.2196/50864 %U https://www.researchprotocols.org/2024/1/e50864 %U https://doi.org/10.2196/50864 %U http://www.ncbi.nlm.nih.gov/pubmed/38512307 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49557 %T Web-Based Screening, Brief Intervention, and Referral to Treatment for Traumatic Stress and Alcohol Misuse Among Survivors of Sexual Assault and Intimate Partner Violence: Usability and Acceptability Study %A Hahn,Christine %A Tilstra-Ferrell,Emily %A Salim,Selime %A Goodrum,Nada %A Rheingold,Alyssa %A Gilmore,Amanda K %A Barber,Sara %A Moreland,Angela %+ Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St. MSC 861, Charleston, SC, 29425, United States, 1 8437928209, hahnc@musc.edu %K screening, brief intervention, and referral to treatment %K brief intervention %K intimate partner violence %K sexual assault %K substance use %K alcohol use %K mobile phone %D 2024 %7 15.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Recent survivors of intimate partner violence (IPV) and sexual assault (SA) are at a high risk for traumatic stress and alcohol misuse. IPV and SA survivors face barriers to services for traumatic stress and alcohol misuse and have low service utilization rates. One way to increase access to services for this population is the use of web-based screening, brief intervention, and referral to treatment (SBIRT), an evidence-informed approach for early identification of traumatic stress and alcohol and drug misuse and connecting individuals to treatment. Objective: This study aims to assess the usability and acceptability of a web-based SBIRT called CHAT (Choices For Your Health After Trauma) tailored to address traumatic stress and alcohol misuse following past-year IPV, SA, or both. Methods: Phase 1 involved gathering feedback about usability and acceptability from focus groups with victim service professionals (22/52, 42%) and interviews with past-year survivors of IPV, SA, or both (13/52, 25%). Phase 2 involved gathering feedback about the acceptability of an adapted version of CHAT in an additional sample of recent survivors (17/52, 33%). Survey data on history of IPV and SA, posttraumatic stress disorder symptoms, alcohol and drug use, and service use were collected from survivors in both phases to characterize the samples. Qualitative content and thematic analyses of the interviews and focus group data were conducted using a coding template analysis comprising 6 a priori themes (usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance). Results: Six themes emerged during the focus groups and interviews related to CHAT: usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance. Phase 1 providers and survivors viewed CHAT as acceptable, easy to understand, and helpful. Participants reported that the intervention could facilitate higher engagement in this population as the web-based modality is anonymous, easily accessible, and brief. Participants offered helpful suggestions for improving CHAT by updating images, increasing content personalization, reducing text, and making users aware that the intervention is confidential. The recommendations of phase 1 participants were incorporated into CHAT. Phase 2 survivors viewed the revised intervention and found it highly acceptable (mean 4.1 out of 5, SD 1.29). A total of 4 themes encapsulated participant’s favorite aspects of CHAT: (1) content and features, (2) accessible and easy to use, (3) education, and (4) personalization. Six survivors denied disliking any aspect. The themes on recommended changes included content and features, brevity, personalization, and language access. Participants provided dissemination recommendations. Conclusions: Overall, CHAT was acceptable among victim service professionals and survivors. Positive reactions to CHAT show promise for future research investigating the efficacy and potential benefit of CHAT when integrated into services for people with traumatic stress and alcohol misuse after recent IPV and SA. %M 38358791 %R 10.2196/49557 %U https://formative.jmir.org/2024/1/e49557 %U https://doi.org/10.2196/49557 %U http://www.ncbi.nlm.nih.gov/pubmed/38358791 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47444 %T Early Results of an Initiative to Assess Exposure to Firearm Violence in Ambulatory Care: Descriptive Analysis of Electronic Health Record Data %A Cook,Nicole %A Hoopes,Megan %A Biel,Frances M %A Cartwright,Natalie %A Gordon,Michelle %A Sills,Marion %+ OCHIN, PO Box 5426, Portland, OR, 97228, United States, 1 503 943 2500, cookn@ochin.org %K gun violence %K firearm injury %K surveillance %K primary care %K public health %K ambulatory care %K electronic health record %K violence %K burden %K emergency department %K data %K risk factor %D 2024 %7 5.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background:  Current research on firearm violence is largely limited to patients who received care in emergency departments or inpatient acute care settings or who died. This is because standardized disease classification codes for firearm injury only represent bodily trauma. As a result, research on pathways and health impacts of firearm violence is largely limited to people who experienced acute bodily trauma and does not include the estimated millions of individuals who were exposed to firearm violence but did not sustain acute injury. Assessing and collecting data on exposure to firearm violence in ambulatory care settings can expand research and more fully frame the public health issue. Objective: The aim of the study is to evaluate the demographic and clinical characteristics of patients who self-reported exposure to firearm violence during a behavioral health visit. Methods: This study assessed early data from an initiative implemented in 2022 across a national network of ambulatory behavioral health centers to support trauma-informed care by integrating structured data fields on trauma exposure into an electronic health record behavioral health patient assessment form (SmartForm), as such variables are generally not included in standard outpatient medical records. We calculated descriptive statistics on clinic characteristics, patient demographics, and select clinical conditions among clinics that chose to implement the SmartForm and among patients who reported an exposure to firearm violence. Data on patient counts are limited to positive reports of exposure to firearm violence, and the representativeness of firearm exposure among all patients could not be calculated due to unknown variability in the implementation of the SmartForm. Results: There were 323 of 629 (51%) clinics that implemented the SmartForm and reported at least 1 patient exposed to firearm violence. In the first 11 months of implementation, 3165 patients reported a recent or past exposure to firearm violence across the 323 clinics. Among patients reporting exposure, 52.7% (n=1669) were male, 38.8% (n=1229) were Black, 45.7% (n=1445) had posttraumatic stress disorder, 37.5% (n=1186) had a substance abuse disorder (other than nicotine), and 11.7% (n=371) had hypertension. Conclusions: Current research on firearm violence using standardized data is limited to acute care settings and death data. Early results from an initiative across a large network of behavioral health clinics demonstrate that a high number of clinics chose to implement the SmartForm, resulting in thousands of patients reporting exposure to firearm violence. This study demonstrates that collecting standardized data on firearm violence exposure in ambulatory care settings is feasible. This study further demonstrates that resultant data from ambulatory settings can be used for meaningful analysis in describing populations affected by firearm violence. The results of this study hold promise for further collection of structured data on exposure to firearm violence in ambulatory settings. %M 38315521 %R 10.2196/47444 %U https://publichealth.jmir.org/2024/1/e47444 %U https://doi.org/10.2196/47444 %U http://www.ncbi.nlm.nih.gov/pubmed/38315521 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52067 %T The Impact of Forced Separations Between Women and Their Pets in Domestic Violence Situations and the Effectiveness of Crisis Response: Protocol for a Conceptual Framework %A Montgomery,Jasmine %A Lloyd,Janice %A Liang,Zhanming %+ College of Public Health, Medical and Veterinary Sciences, James Cook University, 1 James Cook Drive, Queensland, 4811, Australia, 61 47814731 ext 07, jasmine.montgomery@my.jcu.edu.au %K companion animal %K domestic violence %K forced separation %K research protocol %K animal welfare %K pets %K animal abuse %K Australia %K coercive control %K victim %K abusive partner %K abusive %K women %K trauma %K support %K animal %D 2024 %7 25.1.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Women are at high risk of experiencing trauma, guilt, and stress when forced to separate from their companion animals when fleeing domestic violence. Where little support is available for women and pets to stay together, women may be forced to delay leaving the abusive relationship or leave the pet with the abuser. Forced separation places both women and pets at substantial risk, where pets may be used as a coercive control measure. However, little evidence exists regarding the extent to which Australian services or policies offer support in these circumstances. Objective: This research aims to increase the understanding and the impacts of forced separation between women and their pets in domestic violence situations. The research will investigate the effectiveness of service responses for both women and animals, aiming to develop a policy framework that guides service improvement with the goal of enhancing outcomes for women and pets fleeing domestic violence. Methods: This protocol paper describes the process of developing a conceptual framework of 4 studies that include a scoping review, policy analysis, focus groups, and interviews that guide the design of the qualitative research project. Results: A scoping review of the literature on forced separation from pets in domestic violence, natural disasters, and homelessness situations has led to the development of a conceptual framework that guided the design of the proposed study. The review also confirmed the necessity of the proposed research project in addressing the lack of Australian national frameworks and guidance available for women and pets seeking formal support in domestic violence situations. As of August 2023, supporting organizations have commenced the distribution of the research flyers. Expected data collection will be completed between August and October 2023. The results are expected to be published in June 2025. Conclusions: Via a systematic process, the importance of the proposed study in improving the understanding of the impact of forced separation between women and their pets at times of domestic violence and the gaps in best supporting both women and their pets has been confirmed. A study design based on the learnings from previous studies and the focus of the current research has been finalized. The impact of the research project in developing an Australian national framework for best supporting women and their pets in crisis situations is anticipated. International Registered Report Identifier (IRRID): PRR1-10.2196/52067 %M 38271100 %R 10.2196/52067 %U https://www.researchprotocols.org/2024/1/e52067 %U https://doi.org/10.2196/52067 %U http://www.ncbi.nlm.nih.gov/pubmed/38271100 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49718 %T Web-Based Delivery of a Family-Based Dating Abuse Prevention Program for Adolescents Exposed to Interparental Violence: Feasibility and Acceptability Study %A McNaughton Reyes,H Luz %A Armora Langoni,Eliana G %A Sharpless,Laurel %A Moracco,Kathryn E %A Benavides,Quetzabel %A Foshee,Vangie A %+ Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599, United States, 1 9199663215, mcnaught@email.unc.edu %K dating violence %K adolescents %K family-based prevention %K web-based delivery %K feasibility and acceptability %K mobile phone %D 2023 %7 1.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Numerous studies have demonstrated that exposure to caregiver intimate partner violence (IPV) can have cascading negative impacts on children that elevate the risk of involvement in dating abuse. This cascade may be prevented by programs that support the development of healthy relationships in children exposed to IPV. This paper describes the results of a study of the web-based adaptation of an evidence-based dating abuse prevention program for IPV-exposed youth and their maternal caregivers. Core information and activities from an evidence-based program, Moms and Teens for Safe Dates, were adapted to create the web-based program (e-MTSD), which comprises 1 module for mothers only and 5 modules for mother-adolescent dyads to complete together. Objective: The primary objective of this study was to evaluate the feasibility and acceptability of the e-MTSD program and the associated research processes. We also examined the practicability of randomizing mothers to receive SMS text message reminders and an action planning worksheet, which were intended to support engagement in the program. Methods: Mothers were recruited through community organizations and social media advertising and were eligible to participate if they had at least one adolescent aged 12 to 16 years of any gender identity who was willing to participate in the program with them, had experienced IPV after their adolescent was born, and were not currently living with an abusive partner. All mothers were asked to complete the program with their adolescent over a 6- to 8-week period. Participants were randomized to receive SMS text message reminders, action planning, or both using a 2×2 factorial design. Research feasibility was assessed by tracking recruitment, randomization, enrollment, and attrition rates. Program feasibility was assessed by tracking program uptake, completion, duration, and technical problems, and acceptability was assessed using web-based surveys. Results: Over a 6-month recruitment period, 101 eligible mother-adolescent dyads were enrolled in the study and were eligible for follow-up. The median age of the adolescent participants was 14 years; 57.4% (58/101) identified as female, 32.7% (33/101) identified as male, and 9.9% (10/101) identified as gender diverse. All but one mother accessed the program website at least once; 87.1% (88/101) completed at least one mother-adolescent program module, and 74.3% (75/101) completed all 6 program modules. Both mothers and adolescents found the program to be highly acceptable; across all program modules, over 90% of mothers and over 80% of adolescents reported that the modules kept their attention, were enjoyable, were easy to do, and provided useful information. Conclusions: Findings suggest the feasibility of web-based delivery and evaluation of the e-MTSD program. Furthermore, average ratings of program acceptability were high. Future research is needed to assess program efficacy and identify the predictors and outcomes of program engagement. %M 38039070 %R 10.2196/49718 %U https://formative.jmir.org/2023/1/e49718 %U https://doi.org/10.2196/49718 %U http://www.ncbi.nlm.nih.gov/pubmed/38039070 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47354 %T Integrated Alcohol Use and Sexual Assault Prevention Program for College Men Who Engage in Heavy Drinking: Randomized Pilot Study %A Orchowski,Lindsay M %A Merrill,Jennifer E %A Oesterle,Daniel W %A Barnett,Nancy P %A Borsari,Brian %A Zlotnick,Caron %A Haikalis,Michelle P %A Bekowitz,Alan D %+ Rhode Island Hospital, 146 West River Street, Suite 11A, Providence, RI, 02904, United States, 1 401 444 7021, lindsay_orchowski@brown.edu %K sexual assault %K alcohol use %K prevention %K student %K men %K alcoholism %K college %K intervention %K program %K peer engagement %D 2023 %7 23.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual assault is prevalent on college campuses and most commonly is perpetrated by men. Problematically, there is a dearth of evidence-based prevention programs targeting men as perpetrators of sexual aggression. The Sexual Assault and Alcohol Feedback and Education (SAFE) program is an integrated alcohol and sexual assault prevention intervention for college men who engage in heavy drinking that aims to address sexual aggression proclivity and alcohol use outcomes by incorporating social norms theory, bystander intervention, and motivational interviewing. Objective: This study aims to examine the initial feasibility-, acceptability-, and efficacy-related outcomes of a randomized pilot trial of an integrated alcohol and sexual assault prevention program for college men who engage in heavy drinking. Methods: This study included 115 college men who engaged in heavy drinking, who were randomly assigned to the SAFE program or a mindfulness-based control condition (MBCC). The feasibility of implementation, adequacy of participant retention, fidelity and competency of program administration, and satisfaction and utility of the intervention were evaluated. The primary outcomes of alcohol use and sexual aggression were evaluated at 2 and 6 months after baseline. The secondary outcomes of perceived peer norms, risks for sexual aggression, and bystander intervention were also assessed. The extent to which the motivational interviewing session with personalized normative feedback facilitated changes in the proximal outcomes of drinking intentions, motivation to change, and self-efficacy was also examined. Results: The study procedures resulted in high program completion and retention (>80%), high fidelity to the program manual (>80% of the content included), high competency in program administration, and high ratings of satisfaction and program utility in addressing sexual relationships and alcohol use. Both groups reported declines in the number of drinks per week and number of heavy drinking days. Compared with the MBCC participants, the SAFE participants reported higher motivation to change alcohol use after the program, as well as greater use of alcohol protective behavioral strategies at 6 months. Compared with the MBCC participants, the SAFE participants also reported lower perceived peer engagement in sexual coercion, perceived peer comfort with sexism, and peer drinking norms at 2 and 6 months. However, no group differences were observed in sexual aggression severity, rape myth acceptance, or the labeling of sexual consent. Results regarding bystander intervention intentions were mixed, with the MBCC group showing decreased intentions at 2 months and the SAFE group reporting increased intentions at both 2 and 6 months. Conclusions: The findings provide promising evidence for the feasibility, acceptability, utility, and preliminary efficacy of the SAFE program in reducing alcohol use and positively influencing perceived peer norms and intentions for bystander intervention among college men who drink. Trial Registration: ClinicalTrials.gov NCT05773027; https://clinicaltrials.gov/study/NCT05773027 %M 37995129 %R 10.2196/47354 %U https://formative.jmir.org/2023/1/e47354 %U https://doi.org/10.2196/47354 %U http://www.ncbi.nlm.nih.gov/pubmed/37995129 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e47377 %T Systematic Violence Monitoring to Reduce Underreporting and to Better Inform Workplace Violence Prevention Among Health Care Workers: Before-and-After Prospective Study %A Veronesi,Giovanni %A Ferrario,Marco Mario %A Giusti,Emanuele Maria %A Borchini,Rossana %A Cimmino,Lisa %A Ghelli,Monica %A Banfi,Alberto %A Luoni,Alessandro %A Persechino,Benedetta %A Di Tecco,Cristina %A Ronchetti,Matteo %A Gianfagna,Francesco %A De Matteis,Sara %A Castelnuovo,Gianluca %A Iacoviello,Licia %+ Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Via Monte Generoso 71, Varese, 21100, Italy, 39 0332 217221, giovanni.veronesi@uninsubria.it %K workplace %K work %K workers %K worker %K occupational health %K safety %K report %K reporting %K incident %K abuse %K health care workers %K HCW %K violence %K surveillance %K underreporting %K risk %K guidelines %K incident report %K Italy %K prevention %K workplace violence %K hospital setting %K assault %K physical assaults %K mental health %K risk management %D 2023 %7 13.11.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Monitoring workplace violence (WPV) against health care workers (HCWs) through incident reporting is crucial to drive prevention, but the actual implementation is spotty and experiences underreporting. Objective: This study aims to introduce a systematic WPV surveillance in 2 public referral hospitals in Italy and assess underreporting, WPV annual rates, and attributes “before” (2016-2020) and “after” its implementation (November 2021 to 2022). Methods: During 2016-2020, incident reporting was based on procedures and data collection forms that were neither standardized between hospitals nor specific for aggressions. We planned and implemented a standardized WPV surveillance based on (1) an incident report form for immediate and systematic event notification, adopting international standards for violence definitions; (2) second-level root cause analysis with a dedicated psychologist, assessing violence determinants and impacts and offering psychological counseling; (3) a web-based platform for centralized data collection; and (4) periodic training for workforce coordinators and newly hired workers. We used data from incident reports to estimate underreporting, defined as an observed-to-expected (from literature and the “before” period) WPV ratio less than 1, and the 12-month WPV rates (per 100 HCWs) in the “before” and “after” periods. During the latter period, we separately estimated WPV rates for first and recurrent events. Results: In the “before” period, the yearly observed-to-expected ratios were consistently below 1 and as low as 0.27, suggesting substantial violence underreporting of up to 73%. WPV annual rates declined in 1 hospital (from 1.92 in 2016 to 0.57 in 2020) and rose in the other (from 0.52 to 1.0), with the divergence being attributable to trends in underreporting. Available data were poorly informative to identify at-risk HCW subgroups. In the “after” period, the observed-to-expected ratio rose to 1.14 compared to literature and 1.91 compared to the “before” period, consistently in both hospitals. The 12-month WPV rate was 2.08 (95% CI 1.79-2.42; 1.52 and 2.35 in the 2 hospitals); one-fifth (0.41/2.08, 19.7%) was due to recurrences. Among HCWs, the youngest group (3.79; P<.001), nurses (3.19; P<.001), and male HCWs (2.62; P=.008) reported the highest rates. Emergency departments and psychiatric wards were the 2 areas at increased risk. Physical assaults were more likely in male than female HWCs (45/67, 67.2% vs 62/130, 47.7%; P=.01), but the latter experienced more mental health consequences (46/130, 35.4% vs 13/67, 19.4%; P=.02). Overall, 40.8% (53/130) of female HWCs recognized sociocultural (eg, linguistic or cultural) barriers as contributing factors for the aggression, and 30.8% (40/130) of WPV against female HCWs involved visitors as perpetrators. Conclusions: A systematic WPV surveillance reduced underreporting. The identification of high-risk workers and characterization of violence patterns and attributes can better inform priorities and contents of preventive policies. Our evaluation provides useful information for the large-scale implementation of standardized WPV-monitoring programs. %M 37955961 %R 10.2196/47377 %U https://publichealth.jmir.org/2023/1/e47377 %U https://doi.org/10.2196/47377 %U http://www.ncbi.nlm.nih.gov/pubmed/37955961 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e50444 %T Resilience-Informed Community Violence Prevention and Community Organizing Strategies for Implementation: Protocol for a Hybrid Type 1 Implementation-Effectiveness Trial %A Blackburn,Natalie A %A Ramos,Stefany %A Dorsainvil,Michele %A Wooten,Camara %A Ridenour,Ty A %A Yaros,Anna %A Johnson-Lawrence,Vicki %A Fields-Johnson,Dana %A Khalid,Nzinga %A Graham,Phillip %+ RTI International, 3040 Cornwallis Rd, Research Triangle Park, NC, 27709, United States, 1 919 485 1466, nblackburn@rti.org %K ACEs %K community organizing %K community violence %K implementation-effectiveness trial %K resilience %D 2023 %7 7.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Community violence is a persistent and challenging public health problem. Community violence not only physically affects individuals, but also its effects reverberate to the well-being of families and entire communities. Being exposed to and experiencing violence are adverse community experiences that affect the well-being and health trajectories of both children and adults. In the United States, community violence has historically been addressed through a lens of law enforcement and policing; the impact of this approach on communities has been detrimental and often ignores the strengths and experiences of community members. As such, community-centered approaches to address violence are needed, yet the process to design, implement, and evaluate these approaches is complex. Alternatives to policing responses are increasingly being implemented. However, evidence and implementation guidance for community-level public health approaches remain limited. This study protocol seeks to address community violence through a resilience framework—Adverse Community Experiences and Resilience (ACE|R)—being implemented in a major US city and leveraging a strategy of community organizing to advance community violence prevention. Objective: The objective of this research is to understand the impact of community-level violence prevention interventions. Furthermore, we aim to describe the strategies of implementation and identify barriers to and facilitators of the approach. Methods: This study uses a hybrid type 1 effectiveness-implementation design. Part 1 of the study will assess the effectiveness of the ACE|R framework plus community organizing by measuring impacts on violence- and health-related outcomes. To do so, we plan to collect quantitative data on homicides, fatal and nonfatal shootings, hospital visits due to nonaccidental injuries, calls for service, and other violence-related data. In Part 2 of the study, to assess the implementation of ACE|R plus community organizing, we will collect process data on community engagement events, deliver community trainings on community leadership and organizing, and conduct focus groups with key partners about violence and violence prevention programs in Milwaukee. Results: This project received funding on September 1, 2020. Prospective study data collection began in the fall of 2021 and will continue through the end of 2023. Data analysis is currently underway, and the first results are expected to be submitted for publication in 2024. Conclusions: Community violence is a public health problem in need of community-centered solutions. Interventions that center community and leverage community organizing show promise in decreasing violence and increasing the well-being of community members. Methods to identify the impact of community-level interventions continue to evolve. Analysis of outcomes beyond violence-specific outcomes, including norms and community beliefs, may help better inform the short-term and proximal impacts of these community-driven approaches. Furthermore, hybrid implementation-effectiveness trials allow for the inevitable contextualization required to disseminate community interventions where communities drive the adaptations and decision-making. International Registered Report Identifier (IRRID): DERR1-10.2196/50444 %M 37934578 %R 10.2196/50444 %U https://www.researchprotocols.org/2023/1/e50444 %U https://doi.org/10.2196/50444 %U http://www.ncbi.nlm.nih.gov/pubmed/37934578 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e49359 %T Identifying Rare Circumstances Preceding Female Firearm Suicides: Validating A Large Language Model Approach %A Zhou,Weipeng %A Prater,Laura C %A Goldstein,Evan V %A Mooney,Stephen J %+ Department of Epidemiology, School of Public Health, University of Washington, Hans Rosling Center for Population Health, 3980 15th Ave NE, Seattle, WA, 98195, United States, 1 206 685 1643, sjm2186@uw.edu %K female firearm suicide %K large language model %K document classification %K suicide prevention %K suicide %K firearm suicide %K machine learning %K mental health for women %K violent death %K mental health %K language models %K women %K female %K depression %K suicidal %D 2023 %7 17.10.2023 %9 Short Paper %J JMIR Ment Health %G English %X Background: Firearm suicide has been more prevalent among males, but age-adjusted female firearm suicide rates increased by 20% from 2010 to 2020, outpacing the rate increase among males by about 8 percentage points, and female firearm suicide may have different contributing circumstances. In the United States, the National Violent Death Reporting System (NVDRS) is a comprehensive source of data on violent deaths and includes unstructured incident narrative reports from coroners or medical examiners and law enforcement. Conventional natural language processing approaches have been used to identify common circumstances preceding female firearm suicide deaths but failed to identify rarer circumstances due to insufficient training data. Objective: This study aimed to leverage a large language model approach to identify infrequent circumstances preceding female firearm suicide in the unstructured coroners or medical examiners and law enforcement narrative reports available in the NVDRS. Methods: We used the narrative reports of 1462 female firearm suicide decedents in the NVDRS from 2014 to 2018. The reports were written in English. We coded 9 infrequent circumstances preceding female firearm suicides. We experimented with predicting those circumstances by leveraging a large language model approach in a yes/no question-answer format. We measured the prediction accuracy with F1-score (ranging from 0 to 1). F1-score is the harmonic mean of precision (positive predictive value) and recall (true positive rate or sensitivity). Results: Our large language model outperformed a conventional support vector machine–supervised machine learning approach by a wide margin. Compared to the support vector machine model, which had F1-scores less than 0.2 for most infrequent circumstances, our large language model approach achieved an F1-score of over 0.6 for 4 circumstances and 0.8 for 2 circumstances. Conclusions: The use of a large language model approach shows promise. Researchers interested in using natural language processing to identify infrequent circumstances in narrative report data may benefit from large language models. %M 37847549 %R 10.2196/49359 %U https://mental.jmir.org/2023/1/e49359 %U https://doi.org/10.2196/49359 %U http://www.ncbi.nlm.nih.gov/pubmed/37847549 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48607 %T Examining the Supports and Advice That Women With Intimate Partner Violence Experience Received in Online Health Communities: Text Mining Approach %A Hui,Vivian %A Eby,Malavika %A Constantino,Rose Eva %A Lee,Heeyoung %A Zelazny,Jamie %A Chang,Judy C %A He,Daqing %A Lee,Young Ji %+ Center for Smart Health, School of Nursing, The Hong Kong Polytechnic University, HJ 544, Hung Hom, Kowloon, Hong Kong, China (Hong Kong), 852 27664691, vivianc.hui@polyu.edu.hk %K intimate partner violence %K text mining %K social media %K online health communities %K linguistic features %D 2023 %7 9.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Intimate partner violence (IPV) is an underreported public health crisis primarily affecting women associated with severe health conditions and can lead to a high rate of homicide. Owing to the COVID-19 pandemic, more women with IPV experiences visited online health communities (OHCs) to seek help because of anonymity. However, little is known regarding whether their help requests were answered and whether the information provided was delivered in an appropriate manner. To understand the help-seeking information sought and given in OHCs, extraction of postings and linguistic features could be helpful to develop automated models to improve future help-seeking experiences. Objective: The objective of this study was to examine the types and patterns (ie, communication styles) of the advice offered by OHC members and whether the information received from women matched their expressed needs in their initial postings. Methods: We examined data from Reddit using data from subreddit community r/domesticviolence posts from November 14, 2020, through November 14, 2021, during the COVID-19 pandemic. We included posts from women aged ≥18 years who self-identified or described experiencing IPV and requested advice or help in this subreddit community. Posts from nonabused women and women aged <18 years, non-English posts, good news announcements, gratitude posts without any advice seeking, and posts related to advertisements were excluded. We developed a codebook and annotated the postings in an iterative manner. Initial posts were also quantified using Linguistic Inquiry and Word Count to categorize linguistic and posting features. Postings were then classified into 2 categories (ie, matched needs and unmatched needs) according to the types of help sought and received in OHCs to capture the help-seeking result. Nonparametric statistical analysis (ie, 2-tailed t test or Mann-Whitney U test) was used to compare the linguistic and posting features between matched and unmatched needs. Results: Overall, 250 postings were included, and 200 (80%) posting response comments matched with the type of help requested in initial postings, with legal advice and IPV knowledge achieving the highest matching rate. Overall, 17 linguistic or posting features were found to be significantly different between the 2 groups (ie, matched help and unmatched help). Positive title sentiment and linguistic features in postings containing health and wellness wordings were associated with unmatched needs postings, whereas the other 14 features were associated with postings with matched needs. Conclusions: OHCs can extract the linguistic and posting features to understand the help-seeking result among women with IPV experiences. Features identified in this corpus reflected the differences found between the 2 groups. This is the first study that leveraged Linguistic Inquiry and Word Count to shed light on generating predictive features from unstructured text in OHCs, which could guide future algorithm development to detect help-seeking results within OHCs effectively. %M 37812467 %R 10.2196/48607 %U https://www.jmir.org/2023/1/e48607 %U https://doi.org/10.2196/48607 %U http://www.ncbi.nlm.nih.gov/pubmed/37812467 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44211 %T Firearm Possession Rates in Home Countries and Firearm Suicide Rates Among US- and Foreign-Born Suicide Decedents in the United States: Analysis of Combined Data from the National Violent Death Reporting System and the Small Arms Survey %A Song,In Han %A Lee,Jin Hyuk %A Shin,Jee Soo %+ ICONS Convergence Academy, Yonsei University, Appenzeller Hall #205, Seoul, 03722, Republic of Korea, 82 221236217, isong@yonsei.ac.kr %K firearm suicide %K US born %K foreign born %K means of suicide %K firearm possession rate %K suicide decedents %D 2023 %7 29.9.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Suicide by firearms is a serious public health issue in the United States. However, little research has been conducted on the relationship between cultural backgrounds and suicide by firearms, specifically in those born and raised in the United States compared to those who have immigrated to the United States. Objective: To better understand the relationship between cultural backgrounds and suicide, this study aimed to examine firearm suicide rates among US- and foreign-born suicide decedents based on the firearm possession rate in the decedent’s home country. Methods: Multivariate logistic regression was performed to analyze data of 28,895 suicide decedents from 37 states obtained from the 2017 National Violent Death Reporting System data set. The firearm possession rate in the home countries of foreign-born suicide decedents was obtained from the 2017 Small Arms Survey. Results: The firearm suicide rate was about twice as high among US-born suicide decedents compared to their foreign-born counterparts. Meanwhile, suicide by hanging was about 75% higher among foreign-born compared to US-born suicide decedents. Those from countries with a low-to-medium firearm possession rate were significantly less likely to use firearms compared to US-born suicide decedents (adjusted odds ratio [AOR]=0.45, 95% CI 0.31-0.65, and AOR=0.46, 95% CI 0.39-0.53, respectively). Meanwhile, firearm suicide rates were not different between US- and foreign-born suicide decedents from countries with a similarly high firearm possession rate. Conclusions: The results suggest that there is an association between using firearms as a means of suicide and the firearm possession rate in the decedent’s home country. Suicide by firearms in the United States needs to be understood in the sociocultural context related to firearm possession. %M 37773604 %R 10.2196/44211 %U https://publichealth.jmir.org/2023/1/e44211 %U https://doi.org/10.2196/44211 %U http://www.ncbi.nlm.nih.gov/pubmed/37773604 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42647 %T Key Factors in Helpfulness and Use of the SAFE Intervention for Women Experiencing Intimate Partner Violence and Abuse: Qualitative Outcomes From a Randomized Controlled Trial and Process Evaluation %A van Gelder,Nicole E %A Ligthart,Suzanne A %A van Rosmalen-Nooijens,Karin A W L %A Prins,Judith B %A Oertelt-Prigione,Sabine %+ Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Geert Grooteplein Noord 21, Nijmegen, 6525 EZ, Netherlands, 31 243618181, nicole.vangelder@radboudumc.nl %K intimate partner violence and abuse %K domestic violence and abuse %K eHealth %K web based %K web-based intervention %K help seeking %K interview %K qualitative %K randomized controlled trial %K process evaluation %D 2023 %7 21.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Many women experience at least one type of intimate partner violence and abuse (IPVA), and although various support options are available, we still know relatively little about web-based interventions for IPVA survivors. We conducted a qualitative evaluation of the SAFE eHealth intervention for women experiencing IPVA in the Netherlands, complementing the quantitative evaluation of self-efficacy, depression, anxiety, and multiple feasibility aspects. Objective: This study assessed users’ experiences and what, according to them, were useful and helpful aspects of the intervention. Methods: The intervention consisted of modules with information on relationships and IPVA, help options, physical and mental health, and social support. It also contained interactive elements such as exercises, stories from survivors, a chat, and a forum. A randomized controlled trial was conducted with an intervention arm receiving the complete version of the intervention and a control arm receiving only a static version with the modules on relationships and IPVA and help options. We gathered data through open questions from surveys (for both study arms; n=65) and semistructured interviews (for the intervention study arm; n=10), all conducted on the web, during the randomized controlled trial and process evaluation. Interview data were coded following the principles of open thematic coding, and all qualitative data were analyzed using qualitative content analysis. Results: Overall, most users positively rated the intervention regarding safety, content, and suiting their needs, especially participants from the intervention study arm. The intervention was helpful in the domains of acknowledgment, awareness, and support. However, participants also identified points for improvement: the availability of a simplified version for acute situations; more attention for survivors in the aftermath of ending an abusive relationship; and more information on certain topics, such as technological IPVA, support for children, and legal affairs. Furthermore, although participants expressed a prominent need for interactive contact options such as a chat or forum, the intervention study arm (the only group that had these features at their disposal) mainly used them in a passive way—reading instead of actively joining the conversation. The participants provided various reasons for this passive use. Conclusions: The positive outcomes of this study are similar to those of other web-based interventions for IPVA survivors, and specific points for improvement were identified. The availability of interactive elements seems to be of added value even when they are used passively. This study provides in-depth insight into the experiences of female IPVA survivors with the SAFE eHealth intervention and makes suggestions for improvements to SAFE and comparable web-based interventions for IPVA as well as inspiring future research. Furthermore, this study shows the importance of a varied assessment of an intervention’s effectiveness to understand the real-world impact on its users. Trial Registration: Netherlands Trial Register NTR7313; https://tinyurl.com/3t7vwswz %M 37603391 %R 10.2196/42647 %U https://www.jmir.org/2023/1/e42647 %U https://doi.org/10.2196/42647 %U http://www.ncbi.nlm.nih.gov/pubmed/37603391 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45917 %T Feasibility and Effectiveness of an Intervention to Reduce Intimate Partner Violence and Psychological Distress Among Women in Nepal: Protocol for the Domestic Violence Intervention (DeVI) Cluster-Randomized Trial %A Shrestha,Rachana %A Sapkota,Diksha %A Mehra,Devika %A Ekström,Anna Mia %A Deuba,Keshab %+ Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18A, Widerströmska Huset, Stockholm, 171 77, Sweden, 977 9843064279, keshab.deuba@ki.se %K intimate partner violence %K intervention %K violence prevention %K mental health %K cluster-randomized trial %K depression %K anxiety %K posttraumatic stress disorder %K low-income country %K women %K Nepal %D 2023 %7 15.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Intimate partner violence (IPV) disproportionately affects people in low-and middle-income countries (LMICs), such as Nepal. Women experiencing IPV are at higher risk of developing depression, anxiety, and posttraumatic stress disorder. The shortage of trained frontline health care providers, coupled with stigma related to IPV and mental health disorders, fuels low service uptake among women experiencing IPV. The Domestic Violence Intervention (DeVI) combines the Problem Management Plus counseling program developed by the World Health Organization with a violence prevention component. Objective: This study aims to implement and evaluate the feasibility, acceptability, and effectiveness of DeVI in addressing psychological distress and enabling the secondary prevention of violence for women experiencing IPV. Methods: A parallel cluster-randomized trial will be conducted across 8 districts in Madhesh Province in Nepal, involving 24 health care facilities. The study will include women aged 18-49 years who are either nonpregnant or in their first trimester, have experienced IPV within the past 12 months, have a 12-item General Health Questionnaire (GHQ-12) score of 3 or more (indicating current mental health issues), and have lived with their husbands or in-laws for at least 6 months. A total sample size of 912 was estimated at 80% power and α<.05 statistical significance level to detect a 15% absolute risk reduction in the IPV frequency and a 50% reduction in the GHQ-12 score in the intervention arm. The health care facilities will be randomly assigned to either the intervention or the control arm in a 1:1 ratio. Women visiting the health care facilities in the intervention and control arms will be recruited into the respective arms. In total, 38 participants from each health care facility will be included in the trial to meet the desired sample size. Eligible participants allocated to either arm will be assessed at baseline and follow-up visits after 6, 17, and 52 weeks after baseline. Results: This study received funding in 2019. As of December 29, 2022, over 50% of eligible women had been recruited from both intervention and control sites. In total, 269 eligible women have been enrolled in the intervention arm and 309 eligible women in the control arm. The trial is currently in the recruitment phase. Data collection is expected to be completed by December 2023, after which data analysis will begin. Conclusions: If the intervention proves effective, it will provide evidence of how nonspecialist mental health care providers can address the harmful effects of IPV in resource-constrained settings with a high burden of IPV, such as Nepal. The study findings could also contribute evidence for integrating similar services into routine health programs in LMICs to prevent IPV and manage mental health problems among women experiencing IPV. Trial Registration: ClinicalTrials.gov NCT05426863; https://clinicaltrials.gov/ct2/show/NCT05426863 International Registered Report Identifier (IRRID): DERR1-10.2196/45917 %M 37581909 %R 10.2196/45917 %U https://www.researchprotocols.org/2023/1/e45917 %U https://doi.org/10.2196/45917 %U http://www.ncbi.nlm.nih.gov/pubmed/37581909 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44760 %T Online Help-Seeking Among Youth Victims of Sexual Violence Before and During COVID-19 (2016-2021): Analysis of Hotline Use Trends %A Goodman,Kimberly L %A Kamke,Kristyn %A Mullin,Tara M %+ Rape, Abuse, and Incest National Network, 1220 L St NW, Suite 505, Washington, DC, 20009, United States, 1 202 587 5347, kimberlyg@rainn.org %K child sexual abuse %K hotlines %K COVID-19 %K help-seeking %K online services %K child abuse %K mental health well-being %K child support %K sexual abuse %K mental health service %K sexual violence %D 2023 %7 11.8.2023 %9 Short Paper %J JMIR Public Health Surveill %G English %X Background: Three years since the onset of COVID-19, pandemic-related trends in child sexual abuse (CSA) remain poorly understood. Common administrative surveillance metrics may have underestimated abuse during the pandemic, given youths’ limited access to mandatory reporters. Research using anonymous service-use data showed increased violence-related online help-seeking but overlooked youth-specific help-seeking for CSA during COVID-19. Understanding pandemic-related trends in CSA can inform abuse detection practices and mental health service provision for youth victims. Objective: The purpose of this study was to harness anonymous help-seeking data from the National Sexual Assault Online Hotline (NSAOH) to glean insights about CSA occurrence in the United States during the COVID-19 pandemic. Methods: We used an archival sample of victims who contacted NSAOH from 2016 to 2021 (n=41,561). We examined differences in the proportion of youth and adult victims contacting NSAOH during the first COVID-19 year (March 2020 to February 2021) compared to the prior year (March 2019 to February 2020; n=11,719). Further, we compared key characteristics of hotline interactions among youth victims during the first COVID-19 year to the prior year (n=5913). Using joinpoint regression analysis, we examined linear trends in the number of monthly sampled youth and adult victims (excluding victims of unknown age) from 2016 to 2021 who discussed any victimization event (n=26,904) and who discussed recent events (ie, events occurring during the pandemic; n=9932). Results: Most youth victims were abused by family members prior to (1013/1677, 60.4%) and after (2658/3661, 72.6%) the onset of COVID-19. The number of youth victims contacting NSAOH spiked in March 2020 and peaked in November 2020 for all youth (slope=28.2, 95% CI 18.7-37.7) and those discussing recent events (slope=17.4, 95% CI 11.1-23.6). We observed a decline in youth victims into spring 2021 for all youth (slope=–56.9, 95% CI –91.4 to –22.3) and those discussing recent events (slope=–33.7, 95% 47.3 to -20.0). The number of adult victims discussing any victimization event increased steadily from January 2018 through May 2021 (slope=3.6; 95% CI 2.9-4.2) and then declined (slope=–13.8, 95% CI –22.8 to –4.7). Trends were stable for adults discussing recent events. Conclusions: This study extends the use of hotline data to understand the implications of the pandemic on CSA. We observed increased youth help-seeking through the NSAOH coinciding with the onset of COVID-19. Trends persisted when limiting analyses to recent victimization events, suggesting increased help-seeking reflected increased CSA during COVID-19. These findings underscore the utility of anonymous online services for youth currently experiencing abuse. Further, the findings support calls for increased youth mental health services and efforts to incorporate online chat into youth-targeted services. %M 37566446 %R 10.2196/44760 %U https://publichealth.jmir.org/2023/1/e44760 %U https://doi.org/10.2196/44760 %U http://www.ncbi.nlm.nih.gov/pubmed/37566446 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46325 %T A Trauma-Informed HIV Intervention (LinkPositively) to Improve HIV Care Among Black Women Affected by Interpersonal Violence: Protocol for a Pilot Randomized Controlled Trial %A Stockman,Jamila K %A Anderson,Katherine M %A Fernandez DeSoto,Alexandra %A Campbell,Danielle M %A Tsuyuki,Kiyomi %A Horvath,Keith J %+ Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, United States, 1 858 822 4652, jstockman@health.ucsd.edu %K HIV %K peer navigation %K social networking %K Black women %K interpersonal violence %K web application %K randomized controlled trial %K mobile phone %D 2023 %7 5.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Black women bear a disproportionate burden of HIV, accounting for nearly 60% of new diagnoses among US women. Black women living with HIV often experience mutually reinforcing epidemics, known as syndemics, including interpersonal violence and substance use. Syndemics are associated with decreased HIV care engagement and treatment adherence and worsening HIV outcomes. Few HIV services and resources are tailored to be culturally and gender-responsive and trauma informed for Black women living with HIV. Technology-based, psychoeducational, and peer navigation programs offer promising pathways to tailored HIV support and improved HIV care outcomes. Therefore, the web-based, trauma-informed intervention LinkPositively was developed in collaboration with Black women living with HIV to promote uptake of HIV care and ancillary support services. Objective: This study primarily determines the feasibility and acceptability of the LinkPositively intervention among Black women living with HIV affected by interpersonal violence. The secondary aim is to examine the preliminary impact of the LinkPositively intervention on retention in HIV care, antiretroviral therapy adherence, and viral suppression while evaluating the role of mechanism of change variables (eg, social support) in the associations. Methods: The LinkPositively trial is a pilot randomized controlled trial conducted in California, United States, among 80 adult Black women living with HIV who have experienced interpersonal violence. Core components of LinkPositively include one-on-one peer navigation with phone and SMS text message check-ins; 5 weekly one-on-one video sessions to build coping and care navigation skills; and a mobile app that contains a peer support social networking platform, an educational database with healthy living and self-care tips, a GPS-enabled HIV and ancillary care resource locator, and a medication self-monitoring and reminder system. Participants are randomly assigned to the intervention (n=40) or control (Ryan White standard of care; n=40) arm, with follow-up at 3 and 6 months. At each assessment, participants complete an interviewer-administered survey and submit hair samples for the assessment of HIV medication adherence. All research staff and investigators adhere to ethical principles and guidelines for conducting research activities. Data will be analyzed using generalized estimating equations. Results: Final development and testing of the LinkPositively app were completed in July 2021. As of May 2023, we have screened 97 women for eligibility. Of the 97 women screened, 27 (28%) were eligible and have been enrolled in the study. The dissemination of preliminary results will occur in 2024. Conclusions: This trial will advance HIV prevention science by harnessing technology to promote engagement in HIV care while improving social support through peers and social networking—all while being trauma informed for Black women living with HIV with experiences of interpersonal violence. If shown to be feasible and acceptable, LinkPositively has the potential to improve HIV care outcomes among Black women, a marginalized key population. International Registered Report Identifier (IRRID): DERR1-10.2196/46325 %M 37405824 %R 10.2196/46325 %U https://www.researchprotocols.org/2023/1/e46325 %U https://doi.org/10.2196/46325 %U http://www.ncbi.nlm.nih.gov/pubmed/37405824 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44400 %T mHealth Early Intervention to Reduce Posttraumatic Stress and Alcohol Use After Sexual Assault (THRIVE): Feasibility and Acceptability Results From a Pilot Trial %A Dworkin,Emily R %A Schallert,Macey %A Lee,Christine M %A Kaysen,Debra %+ Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St., Box 356560, Seattle, WA, 98195, United States, 1 206 221 6932, edworkin@uw.edu %K mobile health %K mHealth %K mobile apps %K prevention %K alcohol use %K trauma %K sexual violence %K rape %K mobile phone %D 2023 %7 4.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual assault is associated with increased risk for both posttraumatic stress (PTS) and alcohol misuse. Mobile health interventions have shown promise in addressing PTS and substance use in trauma survivors and might be a promising strategy in extending the reach of early interventions to individuals who have recently experienced trauma. Objective: This study assesses the feasibility and acceptability of THRIVE, a mobile health early intervention for recent survivors of sexual assault involving a cognitive behavioral app used daily over 21 days with weekly telephone coaching. Methods: Twenty adult female survivors of past–10-week sexual assault with elevated PTS and alcohol use were randomized to receive the THRIVE intervention as part of a pilot randomized controlled trial. We sought to understand feasibility by examining rates of completion of intervention activities and testing changes in participants’ self-reported knowledge of key intervention concepts from baseline to after the intervention. We assessed acceptability by collecting self-report ratings of satisfaction with the intervention and app usability in a follow-up survey. The coach took notes during coaching calls to track call content and record participant feedback; these notes were qualitatively analyzed to elaborate on the aforementioned domains. Results: Feasibility was demonstrated by moderate rates of activity completion: all participants at least opened the app, 19 (95%) of the 20 participants completed at least 1 cognitive behavioral exercise, and 16 (80%) of the 20 participants attended all 4 coaching calls. Participants completed cognitive behavioral exercises on an average of 10.40 (SD 6.52) out of 21 days. The coaching call notes documented participant comments that app-generated reminders increased completion rates. Feasibility was also demonstrated by the finding that knowledge changes occurred from baseline to after the intervention; this indicated that THRIVE was successful in conveying key concepts. Acceptability was demonstrated by high participant ratings of THRIVE’s usability; the ratings corresponded to a B+ usability grade. The coaching call notes documented that usability was increased by the coaching calls, the app exercises’ clarity, and the app exercises’ inclusion of suggestions; however, the coaching call notes also documented that some of the participants found aspects of the app exercises to be difficult or confusing. Acceptability was also demonstrated by participant ratings of satisfaction: most of the participants (15/16, 94%) rated the app as either moderately helpful or very helpful. The coaching call notes documented that the cognitive behavioral activity modules were seen as appealing and that the positive impact of the intervention contributed to participants’ satisfaction. Conclusions: These findings suggest that THRIVE is feasible and acceptable to survivors of recent sexual assault and that further testing of THRIVE is warranted. Trial Registration: ClinicalTrials.gov NCT03703258; https://clinicaltrials.gov/ct2/show/NCT03703258 %M 37402144 %R 10.2196/44400 %U https://formative.jmir.org/2023/1/e44400 %U https://doi.org/10.2196/44400 %U http://www.ncbi.nlm.nih.gov/pubmed/37402144 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42641 %T Effectiveness of the SAFE eHealth Intervention for Women Experiencing Intimate Partner Violence and Abuse: Randomized Controlled Trial, Quantitative Process Evaluation, and Open Feasibility Study %A van Gelder,Nicole E %A Ligthart,Suzanne A %A van Rosmalen-Nooijens,Karin AWL %A Prins,Judith B %A Oertelt-Prigione,Sabine %+ Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Geert Grooteplein 21 – route 117, Nijmegen, 6525 EZ, Netherlands, 31 243618181, nicole.vangelder@radboudumc.nl %K domestic violence and abuse %K eHealth %K feasibility %K help seeking %K intimate partner violence and abuse %K mental health %K randomized controlled trial %K self-efficacy %K web based %K web-based intervention %D 2023 %7 27.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Intimate partner violence and abuse (IPVA) is a pervasive societal issue that impacts many women globally. Web-based help options are becoming increasingly available and have the ability to eliminate certain barriers in help seeking for IPVA, especially in improving accessibility. Objective: This study focused on the quantitative evaluation of the SAFE eHealth intervention for women IPVA survivors. Methods: A total of 198 women who experienced IPVA participated in a randomized controlled trial and quantitative process evaluation. Participants were largely recruited on the internet and signed up through self-referral. They were allocated (blinded for the participants) to (1) the intervention group (N=99) with access to a complete version of a help website containing 4 modules on IPVA, support options, mental health, and social support, and with interactive components such as a chat, or (2) the limited-intervention control group (N=99). Data were gathered about self-efficacy, depression, anxiety, and multiple feasibility aspects. The primary outcome was self-efficacy at 6 months. The process evaluation focused on themes, such as ease of use and feeling helped. In an open feasibility study (OFS; N=170), we assessed demand, implementation, and practicality. All data for this study were collected through web-based self-report questionnaires and automatically registered web-based data such as page visits and amount of logins. Results: We found no significant difference over time between groups for self-efficacy, depression, anxiety, fear of partner, awareness, and perceived support. However, both study arms showed significantly decreased scores for anxiety and fear of partner. Most participants in both groups were satisfied, but the intervention group showed significantly higher scores for suitability and feeling helped. However, we encountered high attrition for the follow-up surveys. Furthermore, the intervention was positively evaluated on multiple feasibility aspects. The average amount of logins did not significantly differ between the study arms, but participants in the intervention arm did spend significantly more time on the website. An increase in registrations during the OFS (N=170) was identified: the mean amount of registrations per month was 13.2 during the randomized controlled trial and 56.7 during the OFS. Conclusions: Our findings did not show a significant difference in outcomes between the extensive SAFE intervention and the limited-intervention control group. It is, however, difficult to quantify the real contribution of the interactive components, as the control group also had access to a limited version of the intervention for ethical reasons. Both groups were satisfied with the intervention they received, with the intervention study arm significantly more so than the control study arm. Integrated and multilayered approaches are needed to aptly quantify the impact of web-based IPVA interventions for survivors. Trial Registration: Netherlands Trial Register NL7108 NTR7313; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7313 %M 37368485 %R 10.2196/42641 %U https://www.jmir.org/2023/1/e42641 %U https://doi.org/10.2196/42641 %U http://www.ncbi.nlm.nih.gov/pubmed/37368485 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43740 %T A Web-Based Sexual Violence, Alcohol Misuse, and Bystander Intervention Program for College Women (RealConsent): Randomized Controlled Trial %A Salazar,Laura Francisca %A Schipani-McLaughlin,Anne Marie %A Sebeh,Yesser %A Nizam,Zainab %A Hayat,Matt %+ Department of Health Policy and Behavioral Science, School of Public Health, Georgia State University, Urban LIfe Bldg, 6th floor, 140 Decatur Street, Atlanta, GA, 30303, United States, 1 4044131396, lsalazar1@gsu.edu %K gender-based violence %K prospective study %K randomized controlled trial %K rape or prevention and control %K rape or statistics and numerical data %K school based %K violence %K alcohol %K women %K efficacy %K program %K intervention %K behavior %D 2023 %7 21.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Sexual violence (SV) incidence among college women has been invariant for the past 20 years. Innovative prevention strategies that are low resource and technology driven but demonstrate efficacy are greatly needed. Objective: The aim of this study was to determine the efficacy of a novel theoretically driven internet-based intervention for first-year college students who identify as women (RealConsent) in reducing their risk of exposure to SV and alcohol misuse as well as increasing alcohol protective and bystander behaviors. Methods: This randomized controlled trial involved first-year college students who identified as women (n=881) attending 1 of 3 universities in the southeastern United States. Participants aged 18 to 20 years were randomized to RealConsent (444/881, 50.4%) or to an attention-matched placebo control (437/881, 49.6%). RealConsent is fully automated and consists of four 45-minute modules that incorporate entertainment-education media and proven behavior change techniques. The primary outcome was exposure to SV; the secondary outcomes were alcohol protective behaviors, dating risk behaviors, alcohol misuse, and bystander behavior. Study outcomes were assessed at baseline and 6-month follow-up. Results: Among participants with some exposure to SV, those in the RealConsent group experienced less exposure to SV than the placebo group (adjusted incidence rate ratio 0.48, 95% CI 0.33-0.69; P=.002). Furthermore, participants in the RealConsent group engaged in more alcohol protective behaviors (adjusted odds ratio 1.17, 95% CI 0.12-2.22; P=.03) and were less likely to binge drink (adjusted incidence rate ratio 0.81, 95% CI 0.67-0.97; P=.003). Finally, participants in the RealConsent group who had 100% dosage were more likely to engage in bystander behavior than those with <100% dosage plus placebo group (adjusted odds ratio 1.72, 95% CI 1.17-2.55; P=.006). Conclusions: A comprehensive exposure to SV, alcohol use, and bystander educational program was successful in decreasing the occurrence of exposure to SV among those most at risk and in increasing alcohol protective behaviors. Because of its web-based and mobile technologies, RealConsent can be easily disseminated and holds potential for reducing campus SV. Trial Registration: ClinicalTrials.gov NCT03726437; https://clinicaltrials.gov/ct2/show/NCT03726437 %M 37342080 %R 10.2196/43740 %U https://www.jmir.org/2023/1/e43740 %U https://doi.org/10.2196/43740 %U http://www.ncbi.nlm.nih.gov/pubmed/37342080 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45171 %T Web-Based Social Networks of Individuals With Adverse Childhood Experiences: Quantitative Study %A Cao,Yiding %A Rajendran,Suraj %A Sundararajan,Prathic %A Law,Royal %A Bacon,Sarah %A Sumner,Steven A %A Masuda,Naoki %+ Department of Mathematics, State University of New York at Buffalo, North Campus, Buffalo, NY, 14260, United States, 1 716 645 8804, naokimas@gmail.com %K adverse childhood experience %K ACE %K social networks %K Twitter %K Reddit %K childhood %K abuse %K neglect %K violence %K substance use %K coping strategy %K coping %K interpersonal connection %K web-based connection %K behavior %K social connection %K resilience %D 2023 %7 30.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Adverse childhood experiences (ACEs), which include abuse and neglect and various household challenges such as exposure to intimate partner violence and substance use in the home, can have negative impacts on the lifelong health of affected individuals. Among various strategies for mitigating the adverse effects of ACEs is to enhance connectedness and social support for those who have experienced them. However, how the social networks of those who experienced ACEs differ from the social networks of those who did not is poorly understood. Objective: In this study, we used Reddit and Twitter data to investigate and compare social networks between individuals with and without ACE exposure. Methods: We first used a neural network classifier to identify the presence or absence of public ACE disclosures in social media posts. We then analyzed egocentric social networks comparing individuals with self-reported ACEs with those with no reported history. Results: We found that, although individuals reporting ACEs had fewer total followers in web-based social networks, they had higher reciprocity in following behavior (ie, mutual following with other users), a higher tendency to follow and be followed by other individuals with ACEs, and a higher tendency to follow back individuals with ACEs rather than individuals without ACEs. Conclusions: These results imply that individuals with ACEs may try to actively connect with others who have similar previous traumatic experiences as a positive connection and coping strategy. Supportive interpersonal connections on the web for individuals with ACEs appear to be a prevalent behavior and may be a way to enhance social connectedness and resilience in those who have experienced ACEs. %M 37252791 %R 10.2196/45171 %U https://www.jmir.org/2023/1/e45171 %U https://doi.org/10.2196/45171 %U http://www.ncbi.nlm.nih.gov/pubmed/37252791 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42375 %T Risk Factors Associated With Primary Care–Reported Domestic Violence for Women Involved in Family Law Care Proceedings: Data Linkage Observational Study %A Johnson,Rhodri D %A Griffiths,Lucy J %A Cowley,Laura E %A Broadhurst,Karen %A Bailey,Rowena %+ Centre for Child & Family Justice Research, Sociology, Bowland College, Lancaster University, Bowland Ave E, Bailrigg, Lancaster, LA1 4YN, United Kingdom, 44 01524 594126, k.broadhurst@lancaster.ac.uk %K data linkage %K domestic violence %K domestic abuse %K health data %K family justice data %D 2023 %7 24.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Domestic violence and abuse (DVA) has a detrimental impact on the health and well-being of children and families but is commonly underreported, with an estimated prevalence of 5.5% in England and Wales in 2020. DVA is more common in groups considered vulnerable, including those involved in public law family court proceedings; however, there is a lack of evidence regarding risk factors for DVA among those involved in the family justice system. Objective: This study examines risk factors for DVA within a cohort of mothers involved in public law family court proceedings in Wales and a matched general population comparison group. Methods: We linked family justice data from the Children and Family Court Advisory and Support Service (Cafcass Cymru [Wales]) to demographic and electronic health records within the Secure Anonymised Information Linkage (SAIL) Databank. We constructed 2 study cohorts: mothers involved in public law family court proceedings (2011-2019) and a general population group of mothers not involved in public law family court proceedings, matched on key demographics (age and deprivation). We used published clinical codes to identify mothers with exposure to DVA documented in their primary care records and who therefore reported DVA to their general practitioner. Multiple logistic regression analyses were used to examine risk factors for primary care–recorded DVA. Results: Mothers involved in public law family court proceedings were 8 times more likely to have had exposure to DVA documented in their primary care records than the general population group (adjusted odds ratio [AOR] 8.0, 95% CI 6.6-9.7). Within the cohort of mothers involved in public law family court proceedings, risk factors for DVA with the greatest effect sizes included living in sparsely populated areas (AOR 3.9, 95% CI 2.8-5.5), assault-related emergency department attendances (AOR 2.2, 95% CI 1.5-3.1), and mental health conditions (AOR 1.7, 95% CI 1.3-2.2). An 8-fold increased risk of DVA emphasizes increased vulnerabilities for individuals involved in public law family court proceedings. Conclusions: Previously reported DVA risk factors do not necessarily apply to this group of women. The additional risk factors identified in this study could be considered for inclusion in national guidelines. The evidence that living in sparsely populated areas and assault-related emergency department attendances are associated with increased risk of DVA could be used to inform policy and practice interventions targeting prevention as well as tailored support services for those with exposure to DVA. However, further work should also explore other sources of DVA, such as that recorded in secondary health care, family, and criminal justice records, to understand the true scale of the problem. %M 37223967 %R 10.2196/42375 %U https://www.jmir.org/2023/1/e42375 %U https://doi.org/10.2196/42375 %U http://www.ncbi.nlm.nih.gov/pubmed/37223967 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46084 %T Using Twitter-Based Data for Sexual Violence Research: Scoping Review %A Xue,Jia %A Zhang,Bolun %A Zhang,Qiaoru %A Hu,Ran %A Jiang,Jielin %A Liu,Nian %A Peng,Yingdong %A Li,Ziqian %A Logan,Judith %+ Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada, 1 416 946 5429, jia.xue@utoronto.ca %K Twitter data %K sexual violence %K sexual assault %K scoping review %K review method %K data analysis %K data collection %K Twitter %K social media %K women’s health %K violence %K abuse %K public health %K domestic violence %D 2023 %7 15.5.2023 %9 Review %J J Med Internet Res %G English %X Background: Scholars have used data from in-person interviews, administrative systems, and surveys for sexual violence research. Using Twitter as a data source for examining the nature of sexual violence is a relatively new and underexplored area of study. Objective: We aimed to perform a scoping review of the current literature on using Twitter data for researching sexual violence, elaborate on the validity of the methods, and discuss the implications and limitations of existing studies. Methods: We performed a literature search in the following 6 databases: APA PsycInfo (Ovid), Scopus, PubMed, International Bibliography of Social Sciences (ProQuest), Criminal Justice Abstracts (EBSCO), and Communications Abstracts (EBSCO), in April 2022. The initial search identified 3759 articles that were imported into Covidence. Seven independent reviewers screened these articles following 2 steps: (1) title and abstract screening, and (2) full-text screening. The inclusion criteria were as follows: (1) empirical research, (2) focus on sexual violence, (3) analysis of Twitter data (ie, tweets or Twitter metadata), and (4) text in English. Finally, we selected 121 articles that met the inclusion criteria and coded these articles. Results: We coded and presented the 121 articles using Twitter-based data for sexual violence research. About 70% (89/121, 73.6%) of the articles were published in peer-reviewed journals after 2018. The reviewed articles collectively analyzed about 79.6 million tweets. The primary approaches to using Twitter as a data source were content text analysis (112/121, 92.5%) and sentiment analysis (31/121, 25.6%). Hashtags (103/121, 85.1%) were the most prominent metadata feature, followed by tweet time and date, retweets, replies, URLs, and geotags. More than a third of the articles (51/121, 42.1%) used the application programming interface to collect Twitter data. Data analyses included qualitative thematic analysis, machine learning (eg, sentiment analysis, supervised machine learning, unsupervised machine learning, and social network analysis), and quantitative analysis. Only 10.7% (13/121) of the studies discussed ethical considerations. Conclusions: We described the current state of using Twitter data for sexual violence research, developed a new taxonomy describing Twitter as a data source, and evaluated the methodologies. Research recommendations include the following: development of methods for data collection and analysis, in-depth discussions about ethical norms, exploration of specific aspects of sexual violence on Twitter, examination of tweets in multiple languages, and decontextualization of Twitter data. This review demonstrates the potential of using Twitter data in sexual violence research. %M 37184899 %R 10.2196/46084 %U https://www.jmir.org/2023/1/e46084 %U https://doi.org/10.2196/46084 %U http://www.ncbi.nlm.nih.gov/pubmed/37184899 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43842 %T A Technology-Enhanced Intervention for Violence and Substance Use Prevention Among Young Black Men: Protocol for Adaptation and Pilot Testing %A Emezue,Chuka %A Karnik,Niranjan S %A Reeder,Blaine %A Schoeny,Michael %A Layfield,Rickey %A Zarling,Amie %A Julion,Wrenetha %+ Department of Women, Children and Family Nursing, Rush University College of Nursing, 600 South Paulina St. Suite 1080, Chicago, IL, 60612, United States, 1 5739992594, chuka_n_emezue@rush.edu %K youth %K violence %K adolescent health %K mindfulness %K digital health %K usability %K Black %K African American %K men %K mobile app %D 2023 %7 1.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Black boys and men from disinvested communities are disproportionately survivors and perpetrators of youth violence. Those presenting to emergency departments with firearm-related injuries also report recent substance use. However, young Black men face several critical individual and systemic barriers to accessing trauma-focused prevention programs. These barriers contribute to service avoidance, the exacerbation of violence recidivism, substance use relapse, and a revolving-door approach to prevention. In addition, young Black men are known to be digital natives. Therefore, technology-enhanced interventions offer a pragmatic and promising opportunity to mitigate these barriers, provide vital life skills for self-led behavior change, and boost service engagement with vital community resources. Objective: The study aims to systematically adapt and pilot-test Boosting Violence-Related Outcomes Using Technology for Empowerment, Risk Reduction, and Life Skills Preparation in Youth Based on Acceptance and Commitment Therapy (BrotherlyACT), a culturally congruent, trauma-focused digital psychoeducational and service-engagement tool tailored to young Black men aged 15-24 years. BrotherlyACT will incorporate microlearning modules, interactive safety planning tools for risk assessment, goal-setting, mindfulness practice, and a service-engagement conversational agent or chatbot to connect young Black men to relevant services. Methods: The development of BrotherlyACT will occur in 3 phases. In phase 1, we will qualitatively investigate barriers and facilitators influencing young Black men’s willingness to use violence and substance use prevention services with 15-30 young Black men (aged 15-24 years) who report perpetrating violence and substance use in the past year and 10 service providers (aged >18 years; any gender; including health care providers, street outreach workers, social workers, violence interrupters, community advocates, and school staff). Both groups will be recruited from community and pediatric emergency settings. In phase 2, a steering group of topic experts (n=3-5) and a youth and community advisory board comprising young Black men (n=8-12) and service providers (n=5-10) will be involved in participatory design, alpha testing, and beta testing sessions to develop, refine, and adapt BrotherlyACT based on an existing skills-based program (Achieving Change Through Values-Based Behavior). We will use user-centered design principles and the Assessment, Decision, Administration, Production, Topical, Experts, Integration, Training, and Testing framework to guide this adaptation process (phase 2). In phase 3, a total of 60 young Black men will pilot-test the adapted BrotherlyACT over 10 weeks in a single-group, pretest-posttest design to determine its feasibility and implementation outcomes. Results: Phase 1 data collection began in September 2021. Phases 2 and 3 are scheduled to start in June 2023 and end in September 2024. Conclusions: The development and testing of BrotherlyACT is a crucial first step in expanding an evidence-based psychoeducational and service-mediating intervention for young Black men involved in violence. This colocation of services shifts the current prevention strategy from telling them why to change to teaching them how. International Registered Report Identifier (IRRID): PRR1-10.2196/43842 %M 37126388 %R 10.2196/43842 %U https://www.researchprotocols.org/2023/1/e43842 %U https://doi.org/10.2196/43842 %U http://www.ncbi.nlm.nih.gov/pubmed/37126388 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43499 %T Removing Biases in Communication of Severity Assessments of Intimate Partner Violence: Model Development and Evaluation %A Sikstrom,Sverker %A Dahl,Mats %A Claesdotter-Knutsson,Emma %+ Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Lund University, Sofia v 2E, Lund, 22285, Sweden, 46 768871765, emma.claesdotter-knutsson@med.lu.se %K debiasing %K violence %K natural language processing %K machine learning %K psychological %K physical %D 2023 %7 28.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: To support a victim of violence and establish the correct penalty for the perpetrator, it is crucial to correctly evaluate and communicate the severity of the violence. Recent data have shown these communications to be biased. However, computational language models provide opportunities for automated evaluation of the severity to mitigate the biases. Objective: We investigated whether these biases can be removed with computational algorithms trained to measure the severity of violence described. Methods: In phase 1 (P1), participants (N=71) were instructed to write some text and type 5 keywords describing an event where they experienced physical violence and 1 keyword describing an event where they experienced psychological violence in an intimate partner relationship. They were also asked to rate the severity. In phase 2 (P2), another set of participants (N=40) read the texts and rated them for severity of violence on the same scale as in P1. We also quantified the text data to word embeddings. Machine learning was used to train a model to predict the severity ratings. Results: For physical violence, there was a greater accuracy bias for humans (r2=0.22) compared to the computational model (r2=0.31; t38=–2.37, P=.023). For psychological violence, the accuracy bias was greater for humans (r2=0.058) than for the computational model (r2=0.35; t38=–14.58, P<.001). Participants in P1 experienced psychological violence as more severe (mean 6.46, SD 1.69) than participants rating the same events in P2 (mean 5.84, SD 2.80; t86=–2.22, P=.029<.05), whereas no calibration bias was found for the computational model (t134=1.30, P=.195). However, no calibration bias was found for physical violence for humans between P1 (mean 6.59, SD 1.81) and P2 (mean 7.54, SD 2.62; t86=1.32, P=.19) or for the computational model (t134=0.62, P=.534). There was no difference in the severity ratings between psychological and physical violence in P1. However, the bias (ie, the ratings in P2 minus the ratings in P1) was highly negatively correlated with the severity ratings in P1 (r2=0.29) and in P2 (r2=0.37), whereas the ratings in P1 and P2 were somewhat less correlated (r2=0.11) using the psychological and physical data combined. Conclusions: The results show that the computational model mitigates accuracy bias and removes calibration biases. These results suggest that computational models can be used for debiasing the severity evaluations of violence. These findings may have application in a legal context, prioritizing resources in society and how violent events are presented in the media. %M 37115589 %R 10.2196/43499 %U https://www.jmir.org/2023/1/e43499 %U https://doi.org/10.2196/43499 %U http://www.ncbi.nlm.nih.gov/pubmed/37115589 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38688 %T Improving Bystander Self-efficacy to Prevent Violence Against Women Through Interpersonal Communication Using Mobile Phone Entertainment Education: Randomized Controlled Trial %A Pant,Ichhya %A Kang,Bee-Ah %A Rimal,Rajiv %+ Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave NW, Washington, DC, 20052, United States, 1 404 461 9851, ipant@gwu.edu %K mHealth %K voice-response %K entertainment education %K rural %K bystander %K self-efficacy %K violence against women %K interpersonal communication %K violence %K women %K society %D 2023 %7 14.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Violence against women is a major challenge worldwide and in India. Patriarchal social and gender norms suppress disclosure of violence experienced by women. Stimulating interpersonal communication about a normatively stigmatized but prevalent topic could offer an avenue toward boosting bystander self-efficacy to intervene and prevent violence against women. Objective: In this study, to reduce violence against women as the distal goal, we adopted a two-pronged strategy grounded in Carey’s model of communication, approaching the issue in an incremental way. First, we aimed to explore whether the intervention promoted interpersonal communication about violence against women as an initial step. Second, we examined whether the intervention improved women’s self-efficacy to intervene when they witness violence in their community through interpersonal communication. Our model is based on the social cognitive theory that posits observational learning (ie, hearing about other women interfering to stop violence) fosters self-efficacy, a proxy for behavior change. Methods: We conducted a randomized controlled trial of women of reproductive age using a 2-arm study design embedded within a parent trial implemented in Odisha, India. In total, 411 participants were randomly assigned to the violence against women intervention arm or a control arm if they were active mobile phone owners and assigned to the treatment arm of the parent trial. Participants received 13 entertainment education episodes daily as phone calls. The intervention included program-driven, audience-driven, and responsive interaction strategies to facilitate the active engagement of participants. Audience-driven interactions were incorporated throughout the episodes using an interactive voice response system, which allowed participants to like or replay individual episodes through voice-recognition or touch-tone keypad. Our primary analysis involved a structural equation model with interpersonal communication as a potential mediator on the pathway between intervention exposure and bystander self-efficacy to prevent violence against women. Results: The findings from structural equation modeling demonstrated the significant mediating effect of interpersonal communication on the relationship between program exposure and bystander self-efficacy. Exposure was positively related to interpersonal communication (β=.21, SE=.05; z=4.31; P<.001) and bystander self-efficacy (β=.19, SE=.05; z=3.82; P<.001). Conclusions: Our results demonstrate participant engagement in interpersonal communication following exposure to a “light” entertainment education program with audio-only format via feature phones in rural settings can result in improved self-efficacy to prevent violence against women. This elevates the role of interpersonal communication as a mechanism of behavior change in mobile phone–based interventions, given that most entertainment education interventions tend to be mass media based. Our findings also show the potential of changing the environment where witnesses of violence deem it worthy of intervention and perceive higher efficacy to stop violence in the community, rather than putting the onus on the perpetrator, to prevent any counterproductive effects. Trial Registration: Clinical Trials Registry-India CTRI/2018/10/016186; https://tinyurl.com/bddp4txc %M 37058330 %R 10.2196/38688 %U https://formative.jmir.org/2023/1/e38688 %U https://doi.org/10.2196/38688 %U http://www.ncbi.nlm.nih.gov/pubmed/37058330 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43723 %T Changes in the Demographic Distribution of Chicago Gun-Homicide Decedents From 2015-2021: Violent Death Surveillance Cross-sectional Study %A Mason,Maryann %A Khazanchi,Rushmin %A Brewer,Audrey %A Sheehan,Karen %A Liu,Yingxuan %A Post,Lori %+ Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States, 1 312 503 5142, maryann-mason@northwestern.edu %K gun-homicide surveillance %K gun-homicide decedents %K demographics %K age, gun violence %K firearm %D 2023 %7 7.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Homicide is one of the 5 leading causes of death in the United States for persons aged 1 to 44 years. In 2019, 75% of US homicides were by gun. Chicago has a gun-homicide rate 4 times the national average, and 90% of all homicides are by gun. The public health approach to violence prevention calls for a 4-step process, beginning with defining and monitoring the problem. Insight into the characteristics of gun-homicide decedents can help frame next steps, including identifying risk and protective factors, developing prevention and intervention strategies, and scaling effective responses. Although much is known about gun homicide because it is a long-standing, entrenched public health problem, it is useful to monitor trends to update ongoing prevention efforts. Objective: This study aimed to use public health surveillance data and methods to describe changes in the race/ethnicity, sex, and age of Chicago gun-homicide decedents from 2015-2021, in the context of year-to-year variation and an overall increase in the city’s gun-homicide rate. Methods: We calculated the distribution of gun-related homicide deaths by 6 race/ethnicity and sex groups (non-Hispanic Black female, non-Hispanic White female, Hispanic female, non-Hispanic Black male, non-Hispanic White male, and Hispanic male), age in years, and age by age group. We used counts, percentages, and rates per 100,000 persons to describe the distribution of deaths among these demographic groups. Comparisons of means and column proportions with tests of significance set at P≤.05 were used to describe changes in the distribution of gun-homicide decedents over time by race-ethnicity-sex and age groups. The comparison of mean age by race-ethnicity-sex group is done using 1-way ANOVA with significance set at P≤.05. Results: The distribution of gun-homicide decedents in Chicago by race/ethnicity and sex groups had been relatively stable from 2015 to 2021 with 2 notable exceptions: a more than doubling of the proportion of gun-homicide decedents who were non-Hispanic Black female (3.6% in 2015 to 8.2% in 2021) and an increase of 3.27 years in the mean age of gun-homicide decedents. The increase in mean age coincided with a decrease in the proportion of non-Hispanic Black male gun-homicide decedents between the ages of 15-19 and 20-24 years and, conversely, an increase in the proportion of non-Hispanic Black male gun-homicide decedents aged 25-34 years. Conclusions: The annual gun-homicide rate in Chicago had been increasing since 2015 with year-to-year variation. Continued monitoring of trends in the demographic makeup of gun-homicide decedents is necessary to provide the most relevant and timely information to help shape violence prevention efforts. We detected several changes that suggest a need for increased outreach and engagement marketed toward non-Hispanic Black female and non-Hispanic Black male individuals between the ages of 25-34 years. %M 37027193 %R 10.2196/43723 %U https://publichealth.jmir.org/2023/1/e43723 %U https://doi.org/10.2196/43723 %U http://www.ncbi.nlm.nih.gov/pubmed/37027193 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e34147 %T Momentary Self-esteem as a Process Underlying the Association Between Childhood Trauma and Psychosis: Experience Sampling Study %A Daemen,Maud %A van Amelsvoort,Therese %A , %A Reininghaus,Ulrich %+ Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Vijverdalseweg 1, Maastricht, 6226 NB, Netherlands, 31 (0)43 38838, maud.daemen@maastrichtuniversity.nl %K psychosis %K self-esteem %K childhood trauma %K childhood adversity %K experience sampling method %K ecological momentary assessment %D 2023 %7 5.4.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Exposure to childhood trauma is associated with an increased risk of developing and maintaining psychotic symptoms later in life. Self-esteem might be an important psychological process underlying the association between childhood trauma and psychosis, but there is only limited evidence to support this claim, especially in daily life. Objective: In this study, we aimed to investigate whether exposure to childhood trauma (physical, emotional, and sexual abuse and physical and emotional neglect) moderates the cross-sectional and temporal associations between self-esteem and psychotic experiences in patients with psychotic disorders, their first-degree relatives, and controls. Methods: We assessed momentary self-esteem and psychotic experiences in daily life using the experience sampling method in 139 patients with psychotic disorders, 118 first-degree relatives of patients with psychotic disorders, and 111 controls. Childhood trauma was measured using the Childhood Trauma Questionnaire. We fitted linear mixed models and added two-way and three-way interaction terms to test the hypotheses. Results: The association between momentary self-esteem and psychotic experiences in daily life was modified by prior exposure to high versus low levels of several types of childhood trauma, that is, physical (χ22=24.9, family-wise error-corrected P<.001) and sexual abuse (χ22=15.9, P<.001) and physical neglect (χ22=116.7, P<.001). Specifically, momentary self-esteem was associated with more intense psychotic experiences in patients exposed to high versus low levels of physical neglect, in relatives exposed to high versus low levels of physical abuse, and in relatives and controls exposed to high versus low levels of sexual abuse. When investigating temporal order, the results showed no evidence that childhood trauma modified the temporal associations between self-esteem at tn-1 and psychotic experiences at tn or those between psychotic experiences at tn-1 and self-esteem at tn. Conclusions: The association between self-esteem and psychotic experiences in daily life was found to be stronger in those exposed to high versus low levels of several types of childhood trauma (ie, physical abuse, sexual abuse, and physical neglect). %M 37018034 %R 10.2196/34147 %U https://mental.jmir.org/2023/1/e34147 %U https://doi.org/10.2196/34147 %U http://www.ncbi.nlm.nih.gov/pubmed/37018034 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38563 %T Video Consultations and Safety App Targeting Pregnant Women Exposed to Intimate Partner Violence in Denmark and Spain: Nested Cohort Intervention Study (STOP Study) %A Andreasen,Karen %A Zapata-Calvente,Antonella Ludmila %A Martín-de-las-Heras,Stella %A Bueno-Cavanillas,Aurora %A Schei,Berit %A Dokkedahl,Sarah %A de León de León,Sabina %A Fernandez Lopez,Rodrigo %A Oviedo-Gutiérrez,Alba %A Ankerstjerne,Lea Bo Sønderlund %A Megías,Jesús L %A Khan,Khalid Saeed %A Rasch,Vibeke %A Linde,Ditte S %+ Department of Gyneacology and Obstetrics, Odense University Hospital, Kloevervaenget 10, 10th floor, Odense, 5000, Denmark, 45 65414606, karen.andreasen2@rsyd.dk %K intimate partner violence %K gender-based violence %K domestic violence %K abuse %K telemedicine %K video counseling %K app %K acceptance %K safety %K feasibility %K empowerment %D 2023 %7 20.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Intimate partner violence (IPV) during pregnancy is a public health issue with wide-ranging consequences for both the mother and fetus, and interventions are needed. Therefore, the Stop Intimate Partner Violence in Pregnancy (STOP) cohort was established with the overall aim to identify pregnant women exposed to IPV through digital screening and offer women screening positive for IPV a digital supportive intervention. Objective: The aim of this study was to (1) introduce the design and profile of the STOP cohort study, (2) assess the feasibility of implementing digital IPV screening among pregnant women, and (3) assess the feasibility of implementing a digital supportive intervention targeting pregnant women exposed to IPV. Methods: Pregnant women attending antenatal care in the Region of Southern Denmark and in Andalucía, Spain were offered digital screening for IPV using validated scales (Abuse Assessment Screen and Women Abuse Screening Tool). Women who screened positive were eligible to receive a digital supportive intervention. The intervention consisted of 3-6 video consultations with an IPV counselor and a safety planning app. In Denmark, IPV counselors were antenatal care midwives trained by a psychologist specialized in IPV, whereas in Spain, the counselor was a psychologist. Results: Data collection started in February 2021 and was completed in October 2022. Across Denmark and Spain, a total of 19,442 pregnant women were invited for IPV screening and 16,068 women (82.65%) completed the screening. More women in Spain screened positive for exposure to IPV (350/2055, 17.03%) than in Denmark (1195/14,013, 8.53%). Among the women who screened positive, only 31.39% (485/1545) were eligible to receive the intervention with only 104 (21.4%) of these women ultimately receiving it. Conclusions: Digital screening for IPV among pregnant women is feasible in an antenatal care context in Denmark and Spain; however, a digital supportive intervention during pregnancy appears to have limited feasibility as only a minor subgroup of women who screened positive for eligibility received the intervention. More research is needed on how to best support pregnant women exposed to IPV if universal IPV screening is to be implemented in antenatal care. %M 36939835 %R 10.2196/38563 %U https://formative.jmir.org/2023/1/e38563 %U https://doi.org/10.2196/38563 %U http://www.ncbi.nlm.nih.gov/pubmed/36939835 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e37636 %T Violence Against Paramedics: Protocol for Evaluating 2 Years of Reports Through a Novel, Point-of-Event Reporting Process %A Mausz,Justin %A Donnelly,Elizabeth A %+ Peel Regional Paramedic Services, 1600 Bovaird Dr E, Brampton, ON, L6V 4R5, Canada, 1 905 791 7800, justin.mausz@peelregion.ca %K paramedic %K emergency medical services %K emergency %K violence %K harm %K abuse %K workplace violence %K work %K safety %K occupational health %K reporting %K epidemiology %K epidemiological %K point-of-event: development %K implementation %K mixed methods %D 2023 %7 16.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Violence against paramedics has been described as a serious public health problem with the potential for significant physical and psychological harm, but the organizational culture within the profession encourages paramedics to consider violence as just “part of the job.” Therefore, most incidents of violence are never formally documented. This limits the ability of researchers and policy makers to develop strategies that mitigate the risk and enhance paramedic safety. Objective: Following the development and implementation of a novel, point-of-event violence reporting process in February 2021, our objectives are to (1) estimate the prevalence of violence and generate a descriptive profile for incidents of reported violence; (2) identify potentially high-risk service calls based on characteristics of calls that are generally known to the responding paramedics at the point of dispatch; and (3) explore underpinning themes, including intolerance based on gender, race, and sexual orientation, that contribute to incidents of violence. Methods: Our work is situated in a single paramedic service in Ontario, Canada. Using a convergent parallel mixed methods approach, we will retrospectively review 2 years of quantitative and qualitative data gathered from the External Violence Incident Report (EVIR) system from February 1 2021 through February 28, 2023. The EVIR is a point-of-event reporting mechanism embedded in the electronic patient care record (ePCR) developed through an extensive stakeholder engagement process. When completing an ePCR, paramedics are prompted to file an EVIR if they experienced violence on the call. Our methods include using descriptive statistics to estimate the prevalence of violence and describe the characteristics of reported incidents (Objective 1), logistic regression modeling to identify high-risk service calls (Objective 2), and qualitative content analysis of incident report narratives to identify underpinning themes that contribute to violence (Objective 3). Results: As of January 1, 2023, 377 paramedics—approximately 1 in 5 active-duty paramedics in the service—have filed a total of 975 violence reports. Early analysis suggests 40% of reports involved a physical assault on the reporting paramedic. Our team is continuing to collect data with more fulsome analyses beginning in March 2023. Our findings will provide much-needed epidemiological data on the prevalence of violence against paramedics in a single paramedic service, its contributing themes, and potential risk factors. Conclusions: Our findings will contribute to a growing body of literature demonstrating that violence against paramedics is a complex problem that requires a nuanced understanding of its scope, risk factors, and contributing circumstances. Collectively, our research will inform larger, multisite prospective studies already in the planning stage and inform organizational strategies to mitigate the risk of harm from violence. International Registered Report Identifier (IRRID): DERR1-10.2196/37636 %M 36928257 %R 10.2196/37636 %U https://www.researchprotocols.org/2023/1/e37636 %U https://doi.org/10.2196/37636 %U http://www.ncbi.nlm.nih.gov/pubmed/36928257 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42811 %T The Use of Crisis Services Following the Mass School Shooting in Uvalde, Texas: Quasi-Experimental Event Study %A Weitzel,Kirsty J %A Chew,Robert F %A Miller,Adam Bryant %A Oppenheimer,Caroline W %A Lowe,Ashley %A Yaros,Anna %+ Center for Data Science and AI, RTI International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC, United States, 1 9195416000, kweitzel@rti.org %K mass shooting %K Crisis Text Line %K firearms %K mental health %K suicide %K trauma %K indirect exposure %K public health %K crisis management %K mental health support %K mass casualty %K shooting %K crisis service %D 2023 %7 8.2.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Mass shootings result in widespread psychological trauma for survivors and members of the affected community. However, less is known about the broader effects of indirect exposure (eg, media) to mass shootings. Crisis lines offer a unique opportunity to examine real-time data on the widespread psychological effects of mass shootings. Objective: Crisis Text Line is a not-for-profit company that provides 24/7 confidential SMS text message–based mental health support and crisis intervention service. This study examines changes in the volume and composition of firearm-related conversations at Crisis Text Line before and after the mass school shooting at Robb Elementary School on May 24, 2022, in Uvalde, Texas. Methods: A quasi-experimental event study design was used to compare the actual volume of firearm-related conversations received by Crisis Text Line post shooting to forecasted firearm conversation volume under the counterfactual scenario that a shooting had not occurred. Conversations related to firearms were identified among all conversations using keyword searches. Firearm conversation volume was predicted using a seasonal autoregressive integrated moving average model trained on the 3 months of data leading up to the shooting. Additionally, proportions of issue tags (topics coded post conversation by volunteer crisis counselors at Crisis Text Line after the exchange) were compared in the 4 days before (n=251) and after (n=417) the shooting to assess changes in conversation characteristics. The 4-day window was chosen to reflect the number of days conversation volume remained above forecasted levels. Results: There was a significant increase in the number of conversations mentioning firearms following the shooting, with the largest spike (compared to forecasted numbers) occurring the day after the shooting (n=159) on May 25, 2022. By May 28, the volume reverted to within the 95% CI of the forecasted volume (n=77). Within firearm conversations, “grief” issue tags showed a significant increase in proportion in the week following the shooting, while “isolation/loneliness,” “relationships,” and “suicide” issue tags showed a significant decrease in proportions the week following the shooting. Conclusions: The results suggest that the Uvalde school shooting may have contributed to an increase in demand for crisis services, above what would be expected given historical trends. Additionally, we found that these firearm-related crises conversations immediately post event are more likely to be related to grief and less likely to be related to suicide, loneliness, and relationships. Our findings provide some of the first data showing the real-time repercussions for the broader population exposed to school shooting events. This work adds to a growing evidence base documenting and measuring the rippling effects of mass shootings outside of those directly impacted. %M 36753321 %R 10.2196/42811 %U https://publichealth.jmir.org/2023/1/e42811 %U https://doi.org/10.2196/42811 %U http://www.ncbi.nlm.nih.gov/pubmed/36753321 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e35116 %T Impacts of GlobalConsent, a Web-Based Social Norms Edutainment Program, on Sexually Violent Behavior and Bystander Behavior Among University Men in Vietnam: Randomized Controlled Trial %A Yount,Kathryn M %A Cheong,Yuk Fai %A Bergenfeld,Irina %A Trang,Quach Thu %A Sales,Jessica M %A Li,Yiman %A Minh,Tran Hung %+ Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, United States, 1 4047278511, kyount@emory.edu %K behavior change communication %K bystander behavior %K campus sexual assault %K educational entertainment (edutainment) %K sexual violence %K social cognitive theory %K social norms theory %K Vietnam %K mobile phone %D 2023 %7 27.1.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Sexual violence against women is prevalent worldwide. Prevention programs that treat men as allies and integrate a bystander framework are emerging in lower income settings, but evidence of their effectiveness is conflicting. Objective: This study aimed to test the impact of GlobalConsent on sexually violent behavior and prosocial bystander behavior among university men in Vietnam. Methods: We used a double-blind, parallel intervention versus control group design with 1:1 randomization at 2 universities. A total of 793 consenting heterosexual or bisexual men aged 18-24 years who matriculated in September 2019 were enrolled and assigned randomly to GlobalConsent or an attention-control adolescent health education (AHEAD) program. GlobalConsent is an adapted, theory-based, 6-module web-based intervention with diverse behavior change techniques and a locally produced serial drama. AHEAD is a customized, 6-module attention-control program on adolescent health. Both the programs were delivered to computers and smartphones over 12 weeks. Self-reported sexually violent behaviors toward women in the prior 6 months and prosocial bystander behaviors in the prior year were measured at 0, 6, and 12 months. Results: More than 92.7% (735/793) of men in both study arms completed at least 1 program module, and >90.2% (715/793) of men completed all 6 modules. At baseline, a notable percentage of men reported any sexually violent behavior (GlobalConsent: 123/396, 31.1%; AHEAD: 103/397, 25.9%) in the prior 6 months. Among men receiving GlobalConsent, the odds of reporting a high level (at least 2 acts) of sexually violent behavior at the endline were 1.3 times the odds at baseline. Among men receiving AHEAD, the corresponding odds ratio was higher at 2.7. The odds of reporting any bystander behavior at endline were 0.7 times the odds at baseline for GlobalConsent, and the corresponding odds ratio for AHEAD was lower at 0.5. Conclusions: Compared with a health attention-control condition, GlobalConsent has sustained favorable impacts on sexually violent behavior and prosocial bystander behavior among matriculating university men in Vietnam, who would otherwise face increasing risks of sexually violent behavior. GlobalConsent shows promise for national scale-up and regional adaptations. Trial Registration: ClinicalTrials.gov NCT04147455; https://clinicaltrials.gov/ct2/show/NCT04147455 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-020-09454-2 %M 36705965 %R 10.2196/35116 %U https://publichealth.jmir.org/2023/1/e35116 %U https://doi.org/10.2196/35116 %U http://www.ncbi.nlm.nih.gov/pubmed/36705965 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 11 %P e41455 %T Examining the Use of Mobile Technology to Deliver Tailored Sexual Assault Prevention in a Classroom Environment in the Military: Development and Usability Study %A Eckhoff,Randall %A Boyce,Matthew %A Watkins,Rebecca Lee %A Kan,Marni %A Scaglione,Nichole %A Pound,Leah %A Root,Meghan %+ RTI International, 3040 East Cornwallis Rd., P.O. Box 12194, Research Triangle Park, NC, 27709, United States, 1 919 961 0990, reckhoff@rti.org %K research techniques %K mobile technology %K tablet %K iPad %K restricted %K resource limited %K Wi-Fi %K tailored learning %K military %K data security %D 2022 %7 16.11.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Advances in mobile technology over the last 10 years have expanded its use in scientific research. However, there are challenges in creating a reliable system for intervention content delivery and data collection in an environment with limited internet connectivity and limited staffing capacity. The Sexual Communication and Consent (SCC) study used tablets to provide individualized Sexual Assault Prevention and Response training in a classroom environment that was both technologically and support staff limited. Objective: We developed the SCC Basic Military Training app and a separate Sexual Assault Response Coordinator app to support individualized training within the new SCC program. This paper presents the functionality, protocols, challenges, and feasibility of deploying mobile technology in an educational environment in the military with limited resources. Methods: We developed both mobile apps targeting the Apple iOS ecosystem. The Basic Military Training app provided a screening instrument that routed the trainee into 1 of 5 specific intervention programs. Over 2 days of basic military training set 2 weeks apart, trainees received a combined 6 hours of program-specific tablet training, combined with universal, interactive classroom training, led by qualified instructors. The Sexual Assault Response Coordinator app, used to deliver supplemental content to a subgroup of trainees, was made available for voluntary and private use at the Sexual Assault Response Coordinator’s office on base. All anonymous data were manually transferred onto laptops, where the data were aggregated into files and securely transferred to the project staff for analysis. The study was conducted at the Lackland Air Force Base, Joint Base San Antonio, with 9196 trainees providing the data. Results: A total of 7742 trainees completed both the sessions of the SCC program and a series of evaluative assessments. Some trainees did not receive day 2 training, and only received day 1 training because the COVID-19 pandemic shortened the study period. Of the 190 SCC classes taught, only one class was unable to complete tablet training because of Apple licensing–related technology failure. The 360 study tablets were distributed across 3 classrooms (120 per classroom) and were handled at least 16,938 times with no reports of breakage or requiring replacement. Wi-Fi access limitations exacerbated the complexity of Apple licensing revalidation and the secure transfer of data from the classroom to project personnel. The instructor staff’s limited technical knowledge to perform certain technical tasks was challenging. Conclusions: The results demonstrated the feasibility of deploying a mobile app for tablet-based training in a military educational environment. Although successful, the study was not without technical challenges. This paper gives examples of technical lessons learned and recommendations for conducting the study differently, with the aim that the knowledge gained may be helpful to other researchers encountering similar requirements. %M 36383404 %R 10.2196/41455 %U https://mhealth.jmir.org/2022/11/e41455 %U https://doi.org/10.2196/41455 %U http://www.ncbi.nlm.nih.gov/pubmed/36383404 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e41453 %T Intimate Partner Violence and HIV Prevention Among Sexual Minority Men: Protocol for a Prospective Mixed Methods Cohort Study %A Storholm,Erik D %A Siconolfi,Dan E %A Wagner,Glenn J %A Huang,Wenjing %A Nacht,Carrie L %A Sallabank,Greg %A Felner,Jennifer K %A Wolf,Joshua %A Lee,Sarita D %A Stephenson,Rob %+ School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-4162, United States, 1 (619) 594 1836, estorholm@sdsu.edu %K intimate partner violence %K cohort study %K sexual minority men %K HIV %K sexually transmitted infections %K pre-exposure prophylaxis %K PrEP %D 2022 %7 15.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sexual minority men experience intimate partner violence (IPV) at rates similar to those reported by heterosexual women in the United States. Previous studies linked both IPV victimization and perpetration to HIV risk and seroconversion; however, less is known about the impact of IPV on HIV testing, sexually transmitted infection (STI) testing, pre-exposure prophylaxis (PrEP) uptake, and the persistence of PrEP use among sexual minority men experiencing IPV. Although prior work suggests that IPV may influence HIV prevention behavior, experiences of IPV are so highly varied among sexual minority men (eg, forms, frequency, and severity; steady vs casual partnerships; perpetration vs receipt; and sexual vs physical vs psychological violence) that additional research is needed to better understand the impact that IPV has on HIV risk and protective behaviors to develop more effective interventions for sexual minority men. Objective: This study aims to contribute to our understanding of the antecedents of IPV and the direct and indirect pathways between perpetration and receipt of IPV and HIV or STI risk behavior, STIs, and use of PrEP among sexual minority men experiencing IPV. Methods: This mixed methods study has 2 phases: phase 1 involved formative qualitative interviews with 23 sexual minority men experiencing IPV and 10 key stakeholders or providers of services to sexual minority men experiencing IPV to inform the content of a subsequent web-based cohort study, and phase 2 involves the recruitment of a web-based cohort study of 500 currently partnered HIV-negative sexual minority men who reside in Centers for Disease Control and Prevention–identified Ending the HIV Epidemic priority jurisdictions across the United States. Participants will be followed for 24 months. They will be assessed through a full survey and asked to self-collect and return biospecimen kits assessing HIV, STIs, and PrEP use at 0, 6, 12, 18, and 24 months. They will also be asked to complete abbreviated surveys to assess for self-reported changes in key study variables at 3, 9, 15, and 21 months. Results: Phase 1 was launched in May 2021, and the phase 1 qualitative interviews began in December 2021 and were concluded in March 2022 after a diversity of experiences and perceptions were gathered and no new ideas emerged in the interviews. Rapid analysis of the qualitative interviews took place between March 2022 and June 2022. Phase 2 recruitment of the full cohort began in August 2022 and is planned to continue through February 2024. Conclusions: This mixed methods study will contribute valuable insights into the association that IPV has with HIV risk and protective behaviors among sexual minority men. The findings from this study will be used to inform the development or adaptation of HIV and IPV prevention interventions for sexual minority men experiencing IPV. International Registered Report Identifier (IRRID): DERR1-10.2196/41453 %M 36378519 %R 10.2196/41453 %U https://www.researchprotocols.org/2022/11/e41453 %U https://doi.org/10.2196/41453 %U http://www.ncbi.nlm.nih.gov/pubmed/36378519 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e39373 %T Mental Illness Concordance Between Hospital Clinical Records and Mentions in Domestic Violence Police Narratives: Data Linkage Study %A Karystianis,George %A Cabral,Rina Carines %A Adily,Armita %A Lukmanjaya,Wilson %A Schofield,Peter %A Buchan,Iain %A Nenadic,Goran %A Butler,Tony %+ School of Population Health, University of New South Wales, Level 3, Samuels Building, Gate 11, Botany Street, UNSW Kensington Campus, Sydney, 2052, Australia, 61 93852517, g.karystianis@unsw.edu.au %K data linkage %K mental health %K domestic violence %K police records %K hospital records %K text mining %D 2022 %7 20.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: To better understand domestic violence, data sources from multiple sectors such as police, justice, health, and welfare are needed. Linking police data to data collections from other agencies could provide unique insights and promote an all-of-government response to domestic violence. The New South Wales Police Force attends domestic violence events and records information in the form of both structured data and a free-text narrative, with the latter shown to be a rich source of information on the mental health status of persons of interest (POIs) and victims, abuse types, and sustained injuries. Objective: This study aims to examine the concordance (ie, matching) between mental illness mentions extracted from the police’s event narratives and mental health diagnoses from hospital and emergency department records. Methods: We applied a rule-based text mining method on 416,441 domestic violence police event narratives between December 2005 and January 2016 to identify mental illness mentions for POIs and victims. Using different window periods (1, 3, 6, and 12 months) before and after a domestic violence event, we linked the extracted mental illness mentions of victims and POIs to clinical records from the Emergency Department Data Collection and the Admitted Patient Data Collection in New South Wales, Australia using a unique identifier for each individual in the same cohort. Results: Using a 2-year window period (ie, 12 months before and after the domestic violence event), less than 1% (3020/416,441, 0.73%) of events had a mental illness mention and also a corresponding hospital record. About 16% of domestic violence events for both POIs (382/2395, 15.95%) and victims (101/631, 16.01%) had an agreement between hospital records and police narrative mentions of mental illness. A total of 51,025/416,441 (12.25%) events for POIs and 14,802/416,441 (3.55%) events for victims had mental illness mentions in their narratives but no hospital record. Only 841 events for POIs and 919 events for victims had a documented hospital record within 48 hours of the domestic violence event. Conclusions: Our findings suggest that current surveillance systems used to report on domestic violence may be enhanced by accessing rich information (ie, mental illness) contained in police text narratives, made available for both POIs and victims through the application of text mining. Additional insights can be gained by linkage to other health and welfare data collections. %M 36264613 %R 10.2196/39373 %U https://formative.jmir.org/2022/10/e39373 %U https://doi.org/10.2196/39373 %U http://www.ncbi.nlm.nih.gov/pubmed/36264613 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e35487 %T Web-Based Delivery of a Family-Based Dating Violence Prevention Program for Youth Who Have Been Exposed to Intimate Partner Violence: Protocol for an Acceptability and Feasibility Study %A Reyes,H Luz McNaughton %A Langoni,Eliana Gabriela Armora %A Sharpless,Laurel %A Blackburn,Natalie %A McCort,Agnieszka %A Macy,Rebecca J %A Moracco,Kathryn E %A Foshee,Vangie A %+ Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 302 Rosenau Hall CB 7440, Chapel Hill, NC, 27599-7440, United States, 1 919 593 4081, mcnaught@email.unc.edu %K dating violence %K adolescents %K family-based prevention %K web-based delivery %K feasibility and acceptability %K mobile phone %D 2022 %7 5.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Children exposed to intimate partner violence (IPV) between caregivers are at an increased risk of becoming involved in dating violence during adolescence. However, to date, few adolescent dating violence (ADV) prevention programs have been developed for and evaluated with youth exposed to IPV. An exception is Moms and Teens for Safe Dates (MTSD), an evidence-based ADV prevention program for mothers or maternal caregivers (mothers) exposed to IPV and their teenagers. The MTSD program comprises a series of booklets that families complete together in a home that includes activities to promote positive family communication and healthy teenager relationships. We developed a web-adapted version of the MTSD program—entitled eMoms and Teens for Safe Dates (eMTSD)—to provide a delivery format that may increase program appeal for digitally oriented teenagers, lower dissemination costs, lower reading burden for low-literacy participants, and incorporate built-in cues and reminders to boost program adherence. Objective: This protocol is for a research study that has the following three main objectives: to assess the acceptability of eMTSD; to identify the feasibility of the research process, including program adherence and participant recruitment and assessment; and to explore the acceptability, feasibility, and preliminary efficacy of 2 features—text reminders and the creation of an action plan for engaging with the program—that may increase program uptake and completion. Methods: Approximately 100 mothers and their teenagers will be invited to complete eMTSD, which includes six 30-minute web-based modules over a 6-week period. Mothers will be recruited through community organizations and social media advertising and will be eligible to participate if they have at least 1 teenager aged 12 to 16 years living with them, have experienced IPV after the teenager was born, are not currently living with an abusive partner, and have access to an internet-enabled device. Using a factorial design, enrolled dyads will be randomized to the following four adherence support groups (n=25 dyads per group): text reminders and action planning, text reminders only, action planning only, and no adherence supports. All participants will complete brief web-based assessments at enrollment after each module is completed, after the full program is completed, and 90 days after enrollment. Program adherence will be tracked using website use metrics. Results: The data collected will be synthesized to assess the acceptability of the program and the feasibility of the study procedures. An exploratory analysis will examine the impact of adherence support on program completion levels. In November 2021, ethical approval was received and recruitment was initiated. Data collection is expected to continue until December 2022. Conclusions: The web-based delivery of a family-based healthy relationship program for teenagers exposed to IPV may offer a convenient, low-cost, and engaging approach to preventing ADV. The findings from this study are expected to guide future research. International Registered Report Identifier (IRRID): DERR1-10.2196/35487 %M 35930332 %R 10.2196/35487 %U https://www.researchprotocols.org/2022/8/e35487 %U https://doi.org/10.2196/35487 %U http://www.ncbi.nlm.nih.gov/pubmed/35930332 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e23823 %T Web-Based Alcohol and Sexual Assault Prevention Program With Tailored Content Based on Gender and Sexual Orientation: Preliminary Outcomes and Usability Study of Positive Change (+Change) %A Gilmore,Amanda K %A Leone,Ruschelle M %A Oesterle,Daniel W %A Davis,Kelly Cue %A Orchowski,Lindsay M %A Ramakrishnan,Viswanathan %A Kaysen,Debra %+ Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, PO Box 3995, Atlanta, GA, 30302, United States, 1 404 413 1416, agilmore12@gsu.edu %K sexual assault prevention %K alcohol %K college students %K sexual and gender minorities %D 2022 %7 22.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol use and sexual assault are common on college campuses in the United States, and the rates of occurrence differ based on gender identity and sexual orientation. Objective: We aimed to provide an assessment of the usability and preliminary outcomes of Positive Change (+Change), a program that provides integrated personalized feedback to target alcohol use, sexual assault victimization, sexual assault perpetration, and bystander intervention among cisgender heterosexual men, cisgender heterosexual women, and sexual minority men and women. Methods: Participants included 24 undergraduate students from a large university in the Southwestern United States aged between 18 and 25 years who engaged in heavy episodic drinking in the past month. All procedures were conducted on the web, and participants completed a baseline survey, +Change, and a follow-up survey immediately after completing +Change. Results: Our findings indicated that +Change was acceptable and usable among all participants, despite gender identity or sexual orientation. Furthermore, there were preliminary outcomes indicating the benefit for efficacy testing of +Change. Conclusions: Importantly, +Change is the first program to target alcohol use, sexual assault victimization, sexual assault perpetration, and bystander intervention within the same program and to provide personalized content based on gender identity and sexual orientation. Trial Registration: ClinicalTrials.gov NCT04089137; https://clinicaltrials.gov/ct2/show/NCT04089137 %M 35867393 %R 10.2196/23823 %U https://formative.jmir.org/2022/7/e23823 %U https://doi.org/10.2196/23823 %U http://www.ncbi.nlm.nih.gov/pubmed/35867393 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e36445 %T Excess Google Searches for Child Abuse and Intimate Partner Violence During the COVID-19 Pandemic: Infoveillance Approach %A Riddell,Corinne A %A Neumann,Krista %A Santaularia,N Jeanie %A Farkas,Kriszta %A Ahern,Jennifer %A Mason,Susan M %+ Division of Epidemiology, School of Public Health, University of California, 2121 Berkeley Way West, Room #5404, Berkeley, CA, 94720, United States, 1 5106424618, c.riddell@berkeley.edu %K child abuse %K household violence %K infoveillance %K violence %K domestic violence %K abuse %K Google %K COVID-19 %D 2022 %7 13.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has created environments with increased risk factors for household violence, such as unemployment and financial uncertainty. At the same time, it led to the introduction of policies to mitigate financial uncertainty. Further, it hindered traditional measurements of household violence. Objective: Using an infoveillance approach, our goal was to determine if there were excess Google searches related to exposure to child abuse, intimate partner violence (IPV), and child-witnessed IPV during the COVID-19 pandemic and if any excesses are temporally related to shelter-in-place and economic policies. Methods: Data on relative search volume for each violence measure was extracted using the Google Health Trends application programming interface for each week from 2017 to 2020 for the United States. Using linear regression with restricted cubic splines, we analyzed data from 2017 to 2019 to characterize the seasonal variation shared across prepandemic years. Parameters from prepandemic years were used to predict the expected number of Google searches and 95% prediction intervals (PI) for each week in 2020. Weeks with searches above the upper bound of the PI are in excess of the model’s prediction. Results: Relative search volume for exposure to child abuse was greater than expected in 2020, with 19% (10/52) of the weeks falling above the upper bound of the PI. These excesses in searches began a month after the Pandemic Unemployment Compensation program ended. Relative search volume was also heightened in 2020 for child-witnessed IPV, with 33% (17/52) of the weeks falling above the upper bound of the PI. This increase occurred after the introduction of shelter-in-place policies. Conclusions: Social and financial disruptions, which are common consequences of major disasters such as the COVID-19 pandemic, may increase risks for child abuse and child-witnessed IPV. %M 35700024 %R 10.2196/36445 %U https://www.jmir.org/2022/6/e36445 %U https://doi.org/10.2196/36445 %U http://www.ncbi.nlm.nih.gov/pubmed/35700024 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e31189 %T Student, Staff, and Faculty Perspectives on Intimate Partner and Sexual Violence on 3 Public University Campuses: Protocol for the UC Speaks Up Study and Preliminary Results %A Wagman,Jennifer A %A Amabile,Claire %A Sumstine,Stephanie %A Park,Eunhee %A Boyce,Sabrina %A Silverman,Jay %A Fielding-Miller,Rebecca %A Oaks,Laury %A Swendeman,Dallas %+ Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, 650 Charles E Young Dr S, Los Angeles, CA, 90095, United States, 1 310 825 5047, jennwagman@ucla.edu %K campus-based violence prevention %K intimate partner violence %K sexual violence %K mixed methods research %K public health approach %K prevention %K student-led %K trauma-informed research %K University of California %D 2022 %7 5.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Intimate partner and sexual violence are pervasive public health issues on college and university campuses in the United States. Research is recommended for creating and maintaining effective, relevant, and acceptable prevention programs and response services for student survivors. Objective: The University of California (UC) Speaks Up study aims to examine factors contributing to intimate partner and sexual violence on 3 UC campuses and use the findings to develop and test interventions and policies to prevent violence, promote health, and lay the groundwork for subsequent large-scale quantitative research. Methods: A mixed methods study was conducted at UC Los Angeles, UC San Diego, and UC Santa Barbara. Phase I (2017-2020) involved a resource audit; cultural consensus modeling of students’ perceptions of sexual consent; in-depth interviews (IDIs) and focus group discussions with students to understand perceptions of campus environment related to experiences as well as prevention of and responses to violence; and IDIs with faculty, staff, and community stakeholders to investigate institutional and community arrangements influencing students’ lives and experiences. Phase II (2020-ongoing) involves IDIs with student survivors to assess the use and perceptions of campus and community services. Qualitative content analysis is used to generate substantive codes and subthemes that emerge, using a thematic analysis approach. Results: In January 2019, we conducted 149 free-listing interviews and 214 web-based surveys with undergraduate and graduate and professional students for the cultural consensus modeling. Between February 2019 and June 2019, 179 IDIs were conducted with 86 (48%) undergraduate students, 21 (11.7%) graduate and professional students, 34 (19%) staff members, 27 (15.1%) faculty members, and 11 (6.1%) community stakeholders, and 35 focus group discussions (27/35, 77% with undergraduate students and 8/35, 23% with graduate and professional students) were conducted with 201 participants. Since September 2020, 50% (15/30) of the planned student survivor interviews have been conducted. This segment of data collection was disrupted by the COVID-19 pandemic. Recruitment is ongoing. Conclusions: Data analysis and phase II data collection are ongoing. The findings will be used to develop and test interventions for preventing violence, promoting health and well-being, and ensuring that survivor services are relevant and acceptable to and meet the needs of all individuals in the campus community, including those who are typically understudied. The findings will also be used to prepare for rigorous, UC–system-wide public health prevention research. International Registered Report Identifier (IRRID): DERR1-10.2196/31189 %M 35380114 %R 10.2196/31189 %U https://www.researchprotocols.org/2022/4/e31189 %U https://doi.org/10.2196/31189 %U http://www.ncbi.nlm.nih.gov/pubmed/35380114 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e35558 %T Developing Conflict Resolution Strategies and Building Resilient Midwifery Students: Protocol for a Mixed Methods Research Study %A Simpson,Naomi %A Steen,Mary %A Vernon,Rachael %A Briley,Annette %A Wepa,Dianne %+ Department of Clinical and Health Sciences, University of South Australia, Corner of North Terrace and Frome Road, Adelaide, 5000, Australia, 61 8 83026611, naomi.simpson@unisa.edu.au %K midwifery students %K workplace %K bullying %K violence %K conflict %K abuse %K resilience %D 2022 %7 18.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Workplace bullying and violence (WBV) are well-documented issues in the midwifery profession. Negative workplace culture, conflict, and bullying are the most common forms of workplace violence experienced by midwives. Workplace violence increases the risk of midwives experiencing burnout, compassion fatigue, psychological trauma, poor mental health, absenteeism, loss of passion for the midwifery profession, job dissatisfaction, and poor job retention. Midwifery students describe workplace violence in the form of physical, emotional, or verbal abuse, and bullying. Therefore, there is a justification to develop conflict resolution strategies and resilience in midwifery students prior to graduation. Objective: Our aim is to develop and facilitate a bespoke education program for South Australian midwifery students to enable them to develop skills in conflict resolution, build resilience, and identify self-care strategies. Methods: This study will undertake a preparatory phase summarizing the body of literature on midwifery students’ knowledge, understanding, and experiences of WBV. Following this, a 3-phase sequential mixed methods research design study will be undertaken. In Phase 1, quantitative data will be collected via a semistructured questionnaire and a validated conflict measurement tool, before and after attending an education workshop, and will be analyzed using descriptive and inferential statistics. Results from Phase 1 will inform and guide the development of an interview schedule for Phase 2. In Phase 2, qualitative data will be gathered by facilitating one-to-one interviews and a thematic analysis will be undertaken to gain a deeper understanding of midwifery students’ experiences of WBV. In Phase 3, data integration using triangulation will be undertaken and meta-inferences will be developed via the integration of results and findings from Phases 1 and 2. Results: The preparatory phase will commence in October 2021. Phase 1 will commence in 2022 with analysis of pre- and posteducation results anticipated to be completed by December 2022. Phase 2 will be developed from findings of the preparatory phase and results of Phase 1. An interpretation of verbatim interview transcripts is estimated to be undertaken by April 2023. Phase 3 of the study is expected to commence in May 2023, and this will involve the analysis of collective evidence gathered from Phases 1 and 2. The anticipated completion date for the study is December 2023. Conclusions: The outcomes of this research will provide insights into the prevalence and impact of WBV experienced by midwifery students. The findings of the research will report on levels of knowledge, skills, and confidence, and will assess the impact of a bespoke conflict resolution and resilience education workshop for midwifery students in managing WBV. International Registered Report Identifier (IRRID): PRR1-10.2196/35558 %M 34995202 %R 10.2196/35558 %U https://www.researchprotocols.org/2022/2/e35558 %U https://doi.org/10.2196/35558 %U http://www.ncbi.nlm.nih.gov/pubmed/34995202 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e28959 %T Mobile Phone Apps for Intimate Partner and Sexual Violence Prevention and Response: Systematic Search on App Stores %A Draughon Moret,Jessica %A Todd,Angela %A Rose,Lauren %A Pollitt,Erin %A Anderson,Jocelyn %+ Betty Irene Moore School of Nursing, University of California, Davis, 2570 48th Street, Suite 2600, Sacramento, CA, 95817, United States, 1 916 734 0511, jdmoret@ucdavis.edu %K rape %K intimate partner violence %K gender-based violence %K smartphone %K mobile phone app %D 2022 %7 8.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Since the 2008 advent of the smartphone, more than 180 billion copies of apps have been downloaded from Apple App Store, with more than 2.6 million apps available for Android and 2.2 million apps available for iOS. Many violence prevention and response apps have been developed as part of this app proliferation. Objective: This study aims to evaluate the prevalence and quality of freely available mobile phone apps targeting intimate partner violence (IPV) and sexual violence (SV) prevention and response. Methods: We conducted a systematic search of violence prevention and response mobile phone apps freely available in Apple App Store (iOS; March 2016) and Google Play Store (Android; July 2016). Search terms included violence prevention, sexual assault, domestic violence, intimate partner violence, sexual violence, forensic nursing, wife abuse, and rape. Apps were included for review if they were freely available, were available in English, and had a primary purpose of prevention of or response to SV or IPV regardless of app target end users. Results: Using the Mobile Application Rating Scale (MARS), we evaluated a total of 132 unique apps. The majority of included apps had a primary purpose of sharing information or resources. Included apps were of low-to-moderate quality, with the overall subjective quality mean for the reviewed apps being 2.65 (95% CI 2.58-2.72). Quality scores for each of the 5 MARS categories ranged from 2.80 (engagement) to 4.75 (functionality). An incidental but important finding of our review was the difficulty in searching for apps and the plethora of nonrelated apps that appear when searching for keywords such as “rape” and “domestic violence” that may be harmful to people seeking help. Conclusions: Although there are a variety of mobile apps available designed to provide information or other services related to SV and IPV, they range greatly in quality. They are also challenging to find, given the current infrastructure of app store searches, keyword prioritization, and highlighting based on user rating. It is important for providers to be aware of these resources and be knowledgeable about how to review and recommend mobile phone apps to patients, when appropriate. %M 35133285 %R 10.2196/28959 %U https://formative.jmir.org/2022/2/e28959 %U https://doi.org/10.2196/28959 %U http://www.ncbi.nlm.nih.gov/pubmed/35133285 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e27696 %T A Mobile Intervention to Link Young Female Entertainment Workers in Cambodia to Health and Gender-Based Violence Services: Randomized Controlled Trial %A Brody,Carinne %A Chhoun,Pheak %A Tuot,Sovannary %A Fehrenbacher,Anne E %A Moran,Alexander %A Swendeman,Dallas %A Yi,Siyan %+ Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore, 65 87533823, siyan@nus.edu.sg %K mHealth %K female sex workers %K HIV %K sexually transmitted infection %K linkage to services %K sexual and reproductive health %K gender-based violence %K low- and middle-income countries %D 2022 %7 4.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Female entertainment workers (FEWs) in Cambodia experience a greater prevalence of human immunodeficiency virus (HIV), other sexually transmitted infections (STIs), psychological distress, substance abuse, and gender-based violence (GBV) than the general female population. Reaching FEWs with health education and linking them to services has been difficult because of their hidden and stigmatized status. Objective: This study evaluated the efficacy of the Mobile Link intervention in improving FEWs’ health by engaging and connecting them to existing HIV, sexual and reproductive health, and GBV services. Methods: A randomized controlled trial was conducted between March 2018 and June 2019 in the capital city and 3 other provinces in Cambodia. FEWs in the intervention arm received automated twice-weekly Short Message Service messages and voice messages with health information and direct links to outreach workers. The control group received the existing standard care, including free HIV and STI counseling and testing and a toll-free helpline staffed by trained counselors. We used a stratified random sampling method to select participants from 5 study sites in the 4 selected provinces. Initially, we randomly selected 600 participants from a list of 4000 FEWs by age group (18-24 and 25-30 years) and study site using a random number generator and enrolled them in person. The primary outcome measures included self-reported HIV and STI testing, condom use, and contraceptive use assessed through a face-to-face structured interview. We also measured secondary outcomes, including contact with outreach workers, escorted referral service use, forced drinking, and GBV experiences. Intervention effects were modeled using repeated measures, multilevel mixed-effects logistic regression. Results: A total of 1118 participants were recruited and enrolled in the study. We included 218 FEWs in the intervention arm and 170 FEWs in the control arm in the per protocol analyses after removing 730 dropouts. Evidence of positive intervention effects was detected for the following secondary outcomes: contacting an outreach worker (at 30 weeks: adjusted odds ratio [AOR] 3.29, 95% CI 1.28-8.47), receiving an escorted referral (at 30 weeks: AOR 2.86, 95% CI 1.09-7.52; at 60 weeks: AOR 8.15, 95% CI 1.65-40.25), and never being forced to drink at work (at 60 weeks: AOR 3.95, 95% CI 1.62-9.60). Over time, no significant differences between intervention and control groups were observed for any primary outcomes in the fully adjusted models. Conclusions: The Mobile Link intervention effectively connected FEWs with outreach workers and escorted referrals but did not show an effect on primary outcomes. Reduced forced drinking at work was also significantly more extensive in the intervention group than in the control group. Longer-term messaging may increase access to services and impact FEWs’ health outcomes in the future. Trial Registration: Clinicaltrials.gov NCT03117842; https://clinicaltrials.gov/ct2/show/NCT03117842 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-2614-7 %M 34982716 %R 10.2196/27696 %U https://www.jmir.org/2022/1/e27696 %U https://doi.org/10.2196/27696 %U http://www.ncbi.nlm.nih.gov/pubmed/34982716 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e24114 %T Design and Development of a Suite of Intimate Partner Violence Screening and Safety Planning Web Apps: User-Centered Approach %A O'Campo,Patricia %A Velonis,Alisa %A Buhariwala,Pearl %A Kamalanathan,Janisha %A Hassan,Maha Awaiz %A Metheny,Nicholas %+ MAP Center for Urban Health Solutions, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5W 1W8, Canada, 1 4766304000, patricia.ocampo@unityhealth.to %K intimate partner violence %K web-based applications %K women %K user-centered design %D 2021 %7 21.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The popularity of mobile health (mHealth) technology has resulted in the development of numerous apps for almost every condition and disease management. mHealth and eHealth solutions for increasing awareness about, and safety around, intimate partner violence are no exception. These apps allow women to control access to these resources and provide unlimited, and with the right design features, safe access when these resources are needed. Few apps, however, have been designed in close collaboration with intended users to ensure relevance and effectiveness. Objective: The objective of this paper is to discuss the design of a suite of evidence-based mHealth and eHealth apps to facilitate early identification of unsafe relationship behaviors and tailored safety planning to reduce harm from violence including the methods by which we collaborated with and sought input from a population of intended users. Methods: A user-centered approach with aspects of human-centered design was followed to design a suite of 3 app-based safety planning interventions. Results: This review of the design suite of app-based interventions revealed challenges faced and lessons learned that may inform future efforts to design evidence-based mHealth and eHealth interventions. Conclusions: Following a user-centered approach can be helpful in designing mHealth and eHealth interventions for marginalized and vulnerable populations, and led to novel insights that improved the design of our interventions. %M 34931998 %R 10.2196/24114 %U https://www.jmir.org/2021/12/e24114 %U https://doi.org/10.2196/24114 %U http://www.ncbi.nlm.nih.gov/pubmed/34931998 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 4 %P e23713 %T Comparison Between Male and Female Survivors of Sexual Abuse and Assault in Relation to Age at Admission to Therapy, Age of Onset, and Age at Last Sexual Assault: Retrospective Observational Study %A AL-Asadi,Ali M %+ Department of Arts and Education, Grande Prairie Regional College, 10726 106 Avenue, Grande Prairie, AB, T8V 4C4, Canada, 1 780 539 2061, aalasadi@gprc.ab.ca %K sexual abuse %K sexual assault %K age of onset %K sex %K gender %K age %K therapy %K abuse %K assault %K mental health %K victim %K childhood %K children %K gender disparity %K violence %D 2021 %7 26.11.2021 %9 Original Paper %J JMIRx Med %G English %X Background: Sexual abuse and sexual assault are complex phenomena that involve many factors (or correlates) and have many health and financial implications for individuals, families, and society. Every correlate needs to be studied in detail, individually and in relation to other correlates. Only with a thorough understanding of these correlates can more efficient and targeted prevention and intervention programs be designed. Objective: The purpose of this study was to examine the differences between male and female survivors of sexual abuse and sexual assault regarding the correlates of the survivors’ age of onset of assault, age at the last assault, and age at which they entered therapy. Methods: Therapists at eight sexual assault centers in the province of Alberta, Canada, completed a questionnaire on each of their clients over a period of 7 years. A total of 3302 participants, of whom 2901 (87.86%) were female and 401 (12.1%) were male survivors of sexual abuse and assault, were included in this study. Mostly descriptive analyses were carried out on the 4 variables of concern in this study. Results: Regarding the number of survivors who sought therapy, female survivors outnumbered male survivors by a ratio of 7:1, with different ratios for different age groups. As children age, their risk of being sexually assaulted for the first time decreases. Male children are more likely to be sexually abused at a younger age, whereas female children are more vulnerable to being assaulted at all ages, particularly in adolescence. The mean age of onset of sexual abuse was found to be 6.71 (SD 2.86) years, and the odds of experiencing the first sexual assault during childhood, as opposed to adolescence, were 4:1 for females and 9:1 for males. Male survivors were two times more likely than female survivors to experience their first sexual assault in childhood. The vast majority of survivors sought help many years after being sexually assaulted, and male survivors waited an average of 3 years longer from the last sexual assault before seeking therapy. Conclusions: The majority of survivors of sexual abuse and sexual assault live with the consequences for many years before they seek help, and a large proportion of male survivors are not likely to seek help. %M 37725544 %R 10.2196/23713 %U https://med.jmirx.org/2021/4/e23713 %U https://doi.org/10.2196/23713 %U http://www.ncbi.nlm.nih.gov/pubmed/37725544 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e26252 %T mHealth for Anemia Reduction: Protocol for an Entertainment Education–Based Dual Intervention %A Pant,Ichhya %A Rimal,Rajiv %A Yilma,Hagere %A Bingenheimer,Jeffrey %A Sedlander,Erica %A Behera,Sibabrata %+ Department of Prevention and Community Health, School of Public Health, George Washington University, 950 New Hampshire Ave NW #2, Washington, DC, 20052, United States, 1 4044619851, ipant@gwu.edu %K mHealth %K interactive %K voice response %K entertainment %K education %K rural %K anemia %K bystander %K violence against women %D 2021 %7 22.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: More than half of the women of reproductive age (aged 15-49 years) are anemic in India. The uptake of and adherence to iron folic acid (IFA) supplements remain low despite sustained efforts to increase their use. With India’s burgeoning digital environment, mobile phones offer a potential medium for increasing their uptake, especially when combined with interactive voice messages that deliver entertaining stories infused with norms-based educational messages. Objective: This study aims to investigate whether a norms-based entertainment education mobile health intervention can increase self-efficacy for IFA adherence among women of reproductive age in Odisha, India. Methods: Mobile reduction in anemia through normative innovations (mRANI) is a randomized 2-arm study that includes assessments before and after the intervention. All study participants will be recruited from the intervention arm of the parent reduction in anemia through normative innovations trial only. Although the usual practice is to randomize participants either to a treatment arm or a usual care control arm, we will assign the mRANI control group to another entertainment education–based treatment group that is designed to improve bystander intervention to reduce violence against women. Data collection for the mRANI study is embedded in the parent trial and will include baseline and end line assessments. The primary outcomes are self-efficacy for IFA adherence and violence against women–related bystander intervention. The inclusion criteria for the mRANI study are participation in the parent trial and phone ownership. Women (approximately n=400) who meet the mRANI inclusion criteria will be randomly assigned to the IFA arm or the bystander arm. Ordinary least squares regression with robust SEs will be conducted to assess between-group comparisons at the end line. A mediation analysis will be conducted to examine whether social norms and interactivity mediate the relationship between intervention exposure and primary outcomes in both arms. Real-time monitoring data will offer insights into intervention receptivity and audience engagement. Results: Data collection for the mRANI study is integrated within the parent trial. Household surveys were conducted between February and March of 2021. Responses on the mRANI study’s primary and secondary outcomes were collected from 381 participants. The data analysis is expected to be completed by October 2021. Conclusions: This study will provide evidence on whether a mobile health norms–based entertainment education intervention can increase self-efficacy for IFA adherence and violence against women–related bystander intervention. International Registered Report Identifier (IRRID): PRR1-10.2196/26252 %M 34812735 %R 10.2196/26252 %U https://www.researchprotocols.org/2021/11/e26252 %U https://doi.org/10.2196/26252 %U http://www.ncbi.nlm.nih.gov/pubmed/34812735 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e28080 %T The Chicago Health and Life Experiences of Women Couples Study: Protocol for a Study of Stress, Hazardous Drinking, and Intimate Partner Aggression Among Sexual Minority Women and Their Partners %A Veldhuis,Cindy B %A Porsch,Lauren M %A Bochicchio,Lauren A %A Campbell,Jacquelyn %A Johnson,Timothy P %A LeBlanc,Allen J %A Leonard,Kenneth E %A Wall,Melanie %A Wilsnack,Sharon C %A Xu,Mariah %A Hughes,Tonda L %+ School of Nursing, Columbia University, 630 W. 168th St, New York, NY, 10032, United States, 1 312 307 0673, c.veldhuis@columbia.edu %K lesbian %K bisexual women %K intimate partner aggression %K partner violence %K same-sex couples %D 2021 %7 19.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Large gaps exist in research on alcohol use and intimate partner aggression (IPA) among sexual minority women (SMW; eg, lesbian, bisexual). Dyadic research with SMW and their partners can illuminate how couple-level factors operate in conjunction with individual-level factors to shape well-being in this understudied and vulnerable population. Given the traditionally gendered lens with which women are primarily viewed as victims and men as perpetrators, understanding the dynamics of IPA in same-sex female couples can also advance research and practice related to IPA more generally. Objective: Guided by a recent extension of the minority stress model that includes relational (couple-level) sexual minority stress and the I-cubed theoretical perspective on IPA, we will collect individual and dyadic data to better characterize the links between hazardous drinking and IPA among SMW and their partners. First, this study aims to examine the associations among minority stress, hazardous drinking, and IPA in SMW and their partners. Minority stressors will be assessed as both individual and couple-level constructs, thus further extending the minority stress model. Second, we aim to examine potential mediators and moderators of the associations among minority stress, hazardous drinking, and IPA. Finally, we aim to test models guided by the I-cubed theoretical perspective that includes instigating (eg, relationship conflict), impelling (eg, negative affect and trait anger), and inhibiting (eg, relationship commitment and emotion regulation) or disinhibiting (eg, hazardous drinking) influences on IPA perpetration. Methods: This United States National Institutes of Health–funded project will draw from a large and diverse cohort of SMW currently enrolled in the Chicago Health and Life Experiences of Women (CHLEW) study—a 21-year longitudinal study of risk factors and consequences associated with SMW hazardous drinking. SMW currently enrolled in the CHLEW and their partners will be invited to participate in the CHLEW Couples Study. By analyzing dyadic data using actor-partner interdependence models, we will examine how each partner’s minority stress, hazardous drinking, and IPA experiences are associated with both her own and her partner’s minority stress, hazardous drinking, and IPA perpetration. Results: Data collection began in February 2021 and will likely continue through 2023. Initial results should be available by mid-2024. Conclusions: The CHLEW Couples Study will fill important gaps in knowledge and provide the basis for future research aimed at clarifying the causal pathways linking hazardous drinking and IPA among SMW. This will support the development of culturally appropriate targeted individual and dyadic prevention and intervention strategies. International Registered Report Identifier (IRRID): DERR1-10.2196/28080 %M 34665154 %R 10.2196/28080 %U https://www.researchprotocols.org/2021/10/e28080 %U https://doi.org/10.2196/28080 %U http://www.ncbi.nlm.nih.gov/pubmed/34665154 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e32911 %T Female Genital Mutilation/Cutting Education for Midwives and Nurses as Informed by Women’s Experiences: Protocol for an Exploratory Sequential Mixed Methods Study %A Diaz,Monica Pilar %A Steen,Mary %A Brown,Angela %A Fleet,Julie-Anne %A Williams,Jan %+ UniSA Clinical and Health Sciences Unit, University of South Australia, City East Campus, GPO BOX 2471, Adelaide, 5001, Australia, 61 08 83021372, diamp001@mymail.unisa.edu.au %K education %K midwives %K nurses %K female genital mutilation/cutting %K maternity care %K women’s health care, knowledge %K attitude %K practice %D 2021 %7 15.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Female genital mutilation/cutting (FGM/C) is a complex and deeply rooted sociocultural custom that is innately entrenched in the lives of those who continue its practice despite the physical and psychological dangers it perpetrates. FGM/C is considered a significant independent risk factor for adverse maternal and fetal outcomes in pregnancy and childbirth. Several studies in high-income countries have explored the experiences and needs of women with FGM/C as well as the knowledge of the health professionals, particularly midwives and nurses, who care for them. However, to date, no studies have evaluated the implementation of education for health professionals in high-income countries to meet the specific needs of women with FGM/C. Objective: This study aims to explore the impact of an FGM/C education program for midwives and nurses as informed by the experiences of women with FGM/C accessing maternity, gynecological, and sexual health services in South Australia. Methods: This study will adopt a three-phase, exploratory sequential mixed methods design. Phase 1 will involve the exploration of women with FGM/C views and experiences accessing maternity and gynecological (including sexual health) services in South Australia. The findings from phase 1 will inform phase 2: the development of an educational program for midwives and nurses on the health and cultural needs of women with FGM/C. Phase 3 will involve the evaluation of the program by measuring midwives’ and nurses’ changes in knowledge, attitude, and practice immediately before and after the education as well as 4 months after completing the program. Phase 1 of this study has been approved by the Women’s and Children’s Health Network human research ethics committee (ID number 2021/HRE00156) and the University of South Australia human research ethics committee (ID number 204096). Results: Phase 1 will commence in August 2021, with the interpretation of findings being undertaken by November 2021. Phase 2 will be developed and facilitated by February 2022, and the final phase of this study will begin in March 2022. This study is expected to be completed by February 2023. Conclusions: The findings of this research will provide insight into the development and evaluation of education programs for midwives and nurses that includes collaboration with women from culturally and linguistically diverse backgrounds to address the specific cultural and health needs of communities. International Registered Report Identifier (IRRID): PRR1-10.2196/32911 %M 34652281 %R 10.2196/32911 %U https://www.researchprotocols.org/2021/10/e32911 %U https://doi.org/10.2196/32911 %U http://www.ncbi.nlm.nih.gov/pubmed/34652281 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e29025 %T Public Sentiment and Discourse on Domestic Violence During the COVID-19 Pandemic in Australia: Analysis of Social Media Posts %A Usher,Kim %A Durkin,Joanne %A Martin,Sam %A Vanderslott,Samantha %A Vindrola-Padros,Cecilia %A Usher,Luke %A Jackson,Debra %+ University of New England, Pat O’Shane Building, Armidale, 2350, Australia, 61 401096117, jdurkin3@myune.edu.au %K COVID-19 %K domestic violence %K social media %K Twitter %K sentiment analysis %K discourse analysis %K keyword analysis %K pandemic %K sentiment %K public health %K public expression %D 2021 %7 1.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Measuring public response during COVID-19 is an important way of ensuring the suitability and effectiveness of epidemic response efforts. An analysis of social media provides an approximation of public sentiment during an emergency like the current pandemic. The measures introduced across the globe to help curtail the spread of the coronavirus have led to the development of a situation labeled as a “perfect storm,” triggering a wave of domestic violence. As people use social media to communicate their experiences, analyzing public discourse and sentiment on social platforms offers a way to understand concerns and issues related to domestic violence during the COVID-19 pandemic. Objective: This study was based on an analysis of public discourse and sentiment related to domestic violence during the stay-at-home periods of the COVID-19 pandemic in Australia in 2020. It aimed to understand the more personal self-reported experiences, emotions, and reactions toward domestic violence that were not always classified or collected by official public bodies during the pandemic. Methods: We searched social media and news posts in Australia using key terms related to domestic violence and COVID-19 during 2020 via digital analytics tools to determine sentiments related to domestic violence during this period. Results: The study showed that the use of sentiment and discourse analysis to assess social media data is useful in measuring the public expression of feelings and sharing of resources in relation to the otherwise personal experience of domestic violence. There were a total of 63,800 posts across social media and news media. Within these posts, our analysis found that domestic violence was mentioned an average of 179 times a day. There were 30,100 tweets, 31,700 news reports, 1500 blog posts, 548 forum posts, and 7 comments (posted on news and blog websites). Negative or neutral sentiment centered on the sharp rise in domestic violence during different lockdown periods of the 2020 pandemic, and neutral and positive sentiments centered on praise for efforts that raised awareness of domestic violence as well as the positive actions of domestic violence charities and support groups in their campaigns. There were calls for a positive and proactive handling (rather than a mishandling) of the pandemic, and results indicated a high level of public discontent related to the rising rates of domestic violence and the lack of services during the pandemic. Conclusions: This study provided a timely understanding of public sentiment related to domestic violence during the COVID-19 lockdown periods in Australia using social media analysis. Social media represents an important avenue for the dissemination of information; posts can be widely dispersed and easily accessed by a range of different communities who are often difficult to reach. An improved understanding of these issues is important for future policy direction. Heightened awareness of this could help agencies tailor and target messaging to maximize impact. %M 34519659 %R 10.2196/29025 %U https://www.jmir.org/2021/10/e29025 %U https://doi.org/10.2196/29025 %U http://www.ncbi.nlm.nih.gov/pubmed/34519659 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e25782 %T Investigating Viewership of Season 3 of “13 Reasons Why” and the Mental Wellness of Adolescents: Partially Randomized Preference Trial %A Uhls,Yalda T %A Felt,Laurel %A Wartella,Ellen %A Sanders,Andrew %+ University of California, Los Angeles, Franz Hall, Los Angeles, CA, 90095, United States, 1 3102101244, yaldatuhls@gmail.com %K media %K adolescence %K mental health %K narrative %K 13 Reasons Why %K conversation %K television %K depression %K sexual assault %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: A conflicting body of research suggests that additional investigation is needed to understand how globally watched television shows featuring social and mental health issues, such as 13 Reasons Why, might affect adolescents’ mental wellness. Objective: This study aims to investigate adolescents’ viewership of the third season of the Netflix drama 13 Reasons Why (13RW-3) and their engagement with show-related content, paying special attention to mental health outcomes and conversational partners. Methods: A panel-based research platform operated by the National Opinion Research Center at the University of Chicago recruited 157 adolescents aged 13 to 17 years from its nationally representative pool of participants. Participants answered questions about how they discussed and learned about social and mental health issues portrayed in 13RW-3 (eg, masculine role pressure and sexual assault) and questions about mental wellness (eg, mental health self-efficacy and depression). After the participants completed the survey (T1), they were directed to either watch 13RW-3 as it aired for the first time (intervention group) or not watch 13RW-3 (control group). Approximately one month later (T2), all the participants were asked to complete the postsurvey. Additional survey questions about conversational partners, information seeking because of watching the show, and use of show-related content were included in the intervention postsurvey. Results: Our sample (N=157) was 52.2% (n=82) female and 54.8% (n=86) White, with a mean age of 14.99 (SD 1.4) years. At T2, viewers of 13RW-3 spoke about suicide significantly more frequently than nonviewers (P=.007). From T1 to T2, viewers increasingly discussed issues explored by 13RW-3 (P=.002), especially suicide, mental health, and bullying. Adolescent viewers were most likely to speak with friends, and parents were the second most commonly named. Two variables emerged as consistent moderators of conversational choices—having depressive symptoms and being impacted by sexual assault. There was no association between conversational frequency and information seeking around social and mental health issues, and neither mental health self-efficacy scores nor masculine role pressure scores significantly differed between viewers and nonviewers at T2. Conclusions: Viewing 13RW-3, a globally watched television show featuring social and mental health issues, led to adolescent conversations and information searches about topics explored by the show. Depressive symptoms and the impact of sexual assault moderated several relationships, guiding participants toward engaging with certain issues and seeking out specific conversational partners. As 13RW-3’s stories drove conversations—and story-driven conversations can raise awareness, reduce stigma, shift attitudes, normalize certain behaviors, and strengthen supportive relationships—potential wellness implications for television shows featuring social and mental health issues are considerable. %M 34524097 %R 10.2196/25782 %U https://mental.jmir.org/2021/9/e25782 %U https://doi.org/10.2196/25782 %U http://www.ncbi.nlm.nih.gov/pubmed/34524097 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e24624 %T Domestic Violence and Mental Health During the COVID-19 Pandemic in Bangladesh %A Rashid Soron,Tanjir %A Ashiq,Md Ashiqur Rahman %A Al-Hakeem,Marzia %A Chowdhury,Zaid Farzan %A Uddin Ahmed,Helal %A Afrooz Chowdhury,Chaman %+ Telepsychiatry Research and Innovation Network Ltd, 3D, 2nd Floor, Rupayan Trade Center, Bangla Motor, Dhaka, 1205, Bangladesh, 880 1718827138, tanjirsoron@gmail.com %K domestic violence %K COVID-19 %K mental health %K violence %K Bangladesh %K lockdown %K isolation %K anxiety %K stress %K telemental health %K telepsychiatry %K web-based survey %D 2021 %7 13.9.2021 %9 Viewpoint %J JMIR Form Res %G English %X Background: The COVID-19 lockdown, the advent of working from home, and other unprecedent events have resulted in multilayer and multidimensional impacts on our personal, social, and occupational lives. Mental health conditions are deteriorating, financial crises are increasing in prevalence, and the need to stay at home has resulted in the increased prevalence of domestic violence. In Bangladesh, where domestic violence is already prevalent, the lockdown period and stay-at-home orders could result in more opportunities and increased scope for perpetrators of domestic violence. Objective: In this study, we aimed to determine the prevalence and pattern of domestic violence during the initial COVID-19 lockdown period in Bangladesh and the perceptions of domestic violence survivors with regard to mental health care. Methods: We conducted this cross-sectional web-based study among the Bangladeshi population and used a semistructured self-reported questionnaire to understand the patterns of domestic violence and perceptions on mental health care from August to September 2020. The questionnaire was disseminated on different organizational websites and social media pages (ie, those of organizations that provide mental health and domestic violence services). Data were analyzed by using IBM SPSS (version 22.0; IBM Corporation). Results: We found that 36.8% (50/136) of respondents had faced domestic violence at some point in their lives; psychological abuse was the most common type of violence. However, the prevalence of the economical abuse domestic violence type increased after the COVID-19 lockdown was enforced. Although 96.3% (102/136) of the participants believed that domestic violence survivors need mental health support, only 25% (34/136) of the respondents had an idea about the mental health services that are available for domestic violence survivors in Bangladesh and how and where they could avail mental health services. Conclusions: Domestic violence is one of the most well-known stressors that have direct impacts on physical and mental health. However, the burden of domestic violence is often underreported, and its impact on mental health is neglected in Bangladesh. The burden of this problem has increased during the COVID-19 crisis, and the cry for mental health support is obvious in the country. However, it is necessary to provide information about available support services; telepsychiatry can be good option for providing immediate mental health support in a convenient and cost-effective manner. %M 34346893 %R 10.2196/24624 %U https://formative.jmir.org/2021/9/e24624 %U https://doi.org/10.2196/24624 %U http://www.ncbi.nlm.nih.gov/pubmed/34346893 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e27944 %T Psychological Violence Against Arab Women in the Context of Social Media: Web-Based Questionnaire Study %A Omar Bali,Ahmed %A Omer,Emad %A Abdulridha,Kawa %A Ahmad,Araz Ramazan %+ Diplomacy and Public Relations Department, University of Human Development, 15 Dania, Sulaimani, SD10A, Iraq, 964 7736990915, ahmed.bali@uhd.edu.iq %K psychological %K violence %K Arab women %K social media %K feminism %K sociology %K abuse %K oppression %K self-esteem %D 2021 %7 19.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media provides women with varying platforms to express themselves, show their talents, communicate and expand their social relationships, and break the shackles imposed by their societies. Theoretically, social media can play a significant role in developing women’s freedom and decreasing social pressures; nonetheless, women continue to face violence during the social media era mainly in the form of psychological violence. Objective: This study aims to conduct an empirical in-depth analysis of how the digital space, particularly social media, provides men with new opportunities to surveil, restrict, harass, and intimidate feminists in Arab countries. Methods: This study includes an empirical survey to investigate what Arab women think are the causes and types of violence wielded against them and their perspectives on the impact of that violence. This study used a web-based questionnaire administered through Google Forms (n=1312) with responses from Arab women aged 15 years and above from all Arab countries. Results: We found that most Arab women feared posting an actual photograph of themselves on their social media accounts and only approximately one-third (490/1312, 37.3%) did so. Most women indicated that they encountered sexual harassment regardless of their age. Furthermore, most women were not aware of the legal aspects of this crime and even those who were aware indicated that they would not press charges for several reasons, including bringing dishonor upon their families, the time-consuming nature of litigation, and fear of revenge. Conclusions: This study shows that young and less educated women are more vulnerable to abuse from either social media users or being condemned by their families. This has several effects, including lower self-esteem and hesitancy in seeking a job, feelings of mistrust and fear, cynicism, anxiety, depression, and sleep disorders. These issues hold women back from using social media in positive ways and some consider leaving social media. %M 34420919 %R 10.2196/27944 %U https://www.jmir.org/2021/8/e27944 %U https://doi.org/10.2196/27944 %U http://www.ncbi.nlm.nih.gov/pubmed/34420919 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 3 %P e26062 %T A Therapeutic Game for Sexually Abused Children and Adolescents (Vil Du?!): Exploratory Mixed Methods Evaluation %A Endendijk,Joyce Johanna %A Tichelaar,Henny %A Deen,Menno %A Deković,Maja %+ Child and Adolescent Studies, Utrecht University, Heidelberglaan 1, Utrecht, 3548 CS, Netherlands, 31 30 253 4896, j.j.endendijk@uu.nl %K child sexual abuse %K psychotherapy %K serious games %K evaluation %K working elements %K acceptability %D 2021 %7 3.8.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Talking about experiences of sexual abuse in therapy is difficult for children and adolescents. Possible reasons for this difficulty are a lack of vocabulary to describe the situation or feelings of shame, fear, and self-blame associated with sexual abuse. The serious game Vil Du?! was developed to help children open up about their sexual abuse experiences. Vil Du?! is a nonverbal communication game that resembles a dress-up game in which children can show the therapist what happened to them. Objective: This exploratory evaluation study examines which working elements of the game could be identified in therapy with victims of sexual abuse (aim 1). In addition, this study examines how therapists evaluate the acceptability of the game (aim 2). Methods: The therapists completed 23 web-based surveys on the use of Vil Du?! In addition, semistructured interviews were conducted with 10 therapists. The data were analyzed in NVivo following previously reported stepwise guidelines. Results: Regarding aim 1, therapists mentioned various working elements of Vil Du?!; for instance, Vil Du?! puts the child in control of the situation. In addition, Vil Du?! reduces barriers to disclosure because there is no need to talk or have eye contact with the therapist. Regarding aim 2, Vil Du?! was generally evaluated more positively than negatively by the therapists. For instance, therapists indicated that using Vil Du?! is time efficient and might make the treatment process less confronting and difficult for the client. According to therapists, most clients indeed experienced less tension and more positive (or neutral) emotions than negative emotions when using Vil Du?! Conclusions: The most important working elements of Vil Du?!, according to therapists, are that it enables children to regain control over their sexual abuse experiences and reduces barriers to disclosing sexual abuse experiences. The more positive evaluation of Vil Du?! indicates the acceptability of the game for therapists as well as their clients. %M 34342592 %R 10.2196/26062 %U https://games.jmir.org/2021/3/e26062 %U https://doi.org/10.2196/26062 %U http://www.ncbi.nlm.nih.gov/pubmed/34342592 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e28680 %T Pregnant Women’s Attitudes Toward and Experiences With a Tablet Intervention to Promote Safety Behaviors in a Randomized Controlled Trial: Qualitative Study %A Walter,Bente %A Indreboe,Hege %A Lukasse,Mirjam %A Henriksen,Lena %A Garnweidner-Holme,Lisa %+ Department of Nursing and Health Promotion, Oslo Metropolitan University, St Olavs Plass, PO Box 4, Oslo, 0130, Norway, 47 +4748091956, lgarnwei@oslomet.no %K intimate partner violence %K eHealth %K pregnancy %K antenatal care, safety behaviors %K tablet intervention %D 2021 %7 20.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Intimate partner violence (IPV) is recognized as a global health problem. Women with low education and limited resources are more vulnerable, as are immigrant women. There is a lack of evidence on how health care professionals should communicate about and intervene against IPV during pregnancy. Earlier research has shown that when women manage digital questionnaires, they are more likely to disclose IPV. However, little is known about how women experience eHealth interventions with safety behaviors to prevent IPV. Objective: The aim of this study was to explore pregnant women’s attitudes toward and experiences with a tablet intervention to promote safety behaviors in a randomized controlled trial (RCT) in antenatal care. Methods: Individual semistructured interviews were conducted with 10 women who participated in the Safe Pregnancy Study. The Safe Pregnancy Study was a randomized controlled trial (RCT) using a tablet intervention containing IPV questions and a film to promote safety behaviors. Six women from the intervention group and four women from the control group were recruited. The content was available in Norwegian, Somali, and Urdu. Five of the women participating in the interviews spoke Norwegian at home and five spoke another language. The majority of the women who did not speak Norwegian at home perceived themselves as relatively well integrated. The interviews were conducted at different maternal and child health centers (MCHCs) in Norway between March 2020 and June 2020. The analysis was guided by thematic analysis. Results: Women who participated in the tablet intervention appreciated being asked questions about IPV on a tablet. However, it was important to supplement the tablet intervention with face-to-face communication with a midwife. The MCHC was regarded as a suitable place to answer questions and watch a film about safety behaviors. Women suggested making the tablet intervention available in other settings where women meet health care professionals. Some women expressed uncertainty about their anonymity regarding their answers in the questionnaire. We found no real differences between ethnic Norwegian and immigrant women’s attitudes toward and experiences with the tablet intervention. Conclusions: Questions about IPV and a film about safety behaviors on a tablet, as a supplement to face-to-face communication, might initiate and facilitate communication about IPV in antenatal care. Uncertainty regarding anonymity has to be addressed when questions about IPV are being asked on a tablet. Trial Registration: ClinicalTrials.gov NCT03397277; https://clinicaltrials.gov/ct2/show/NCT03397277 %M 34283023 %R 10.2196/28680 %U https://formative.jmir.org/2021/7/e28680 %U https://doi.org/10.2196/28680 %U http://www.ncbi.nlm.nih.gov/pubmed/34283023 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 3 %P e27974 %T Internet Searches for Terms Related to Child Maltreatment During COVID-19: Infodemiology Approach %A Riem,Madelon M E %A De Carli,Pietro %A Guo,Jing %A Bakermans-Kranenburg,Marian J %A van IJzendoorn,Marinus H %A Lodder,Paul %+ Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, Nijmegen, Netherlands, 31 0243612142, m.riem@psych.ru.nl %K child %K maltreatment %K COVID-19 %K pandemic %K internet searches %K information-seeking %K internet %K abuse %K trend %K Google trends %K infodemiology %D 2021 %7 13.7.2021 %9 Viewpoint %J JMIR Pediatr Parent %G English %X We examined internet searches indicative of abusive parental behaviors before and after the World Health Organization’s declaration of COVID-19 as a pandemic (March 11, 2020) and subsequent lockdown measures in many countries worldwide. Using Google Trends, we inferred search trends between December 28, 2018, and December 27, 2020, for queries consisting of “mother,” “father,” or “parents” combined with each of the 11 maltreatment-related verbs used in the Conflict Tactics Scales, Parent-Child version. Raw search counts from the Google Trends data were estimated using Comscore. Of all 33 search terms, 28 terms showed increases in counts after the lockdowns began. These findings indicate a strong increase in internet searches relating to occurrence, causes, or consequences of emotional and physical maltreatment since the lockdowns began and call for the use of maltreatment-related queries to direct parents or children to online information and support. %M 34174779 %R 10.2196/27974 %U https://pediatrics.jmir.org/2021/3/e27974 %U https://doi.org/10.2196/27974 %U http://www.ncbi.nlm.nih.gov/pubmed/34174779 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e24458 %T Receptiveness and Responsiveness Toward Using Social Media for Safe Firearm Storage Outreach: Mixed Methods Study %A Lam,Esther %A Moreno,Megan %A Bennett,Elizabeth %A Rowhani-Rahbar,Ali %+ Department of Epidemiology, School of Public Health, University of Washington, UW Box #351619, Seattle, WA, 98195, United States, 1 4088901256, estherwmlam@gmail.com %K firearm storage %K gun safety %K public health outreach %K social media %K mixed methods %K family %D 2021 %7 18.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Childhood and adolescent firearm injury and death rates have increased over the past decade and remain major public health concerns in the United States. Safe firearm storage has proven to be an effective measure to prevent firearm injury and death among youth. Social media has been used as an avenue to promote safe firearm storage, but perceptions of this tool remain unknown. Objective: The aim of this study was to determine receptiveness and responsiveness in promoting firearm lock box and trigger lock giveaway events on social media, and to describe the characteristics of participants who learned of these events through social media. Methods: We performed a mixed methods study combining a content analysis of Facebook event post comments, quantitative analysis of positive and negative feedback on social media, and a descriptive analysis of event participant characteristics. Through a qualitative content analysis approach, we thematically coded comments from each event’s social media page posting. Interrater reliability and κ statistics were calculated. We calculated the prevalence of positive and negative feedback data. Further, we calculated descriptive statistics for demographic characteristics gathered from day-of-event intake surveys. Differences between collected measures were analyzed with χ2 and t tests according to how the participant found out about the event (social media vs other means). Using concurrent analysis, we synthesized the results from both the qualitative and quantitative aims. Results: Through qualitative content analysis, 414 comments from 13 events were coded. Seven themes emerged through the comment coding process with the most common being “positive receptiveness” (294/414, 71.0%). From quantitative analysis of the social media content, we found higher levels of positive feedback compared to negative feedback. The average number of event post “likes” was 1271.3 per event, whereas the average count in which “hide post” was clicked was 72.3 times per event. Overall, 35.9% (1457/4054) of participants found out about the event through social media. The participants who learned about the event through social media were on average significantly younger than those who learned about the event through other means (–6.4 years, 95% CI –5.5 to –7.3). Among the group that learned of the event through social media, 43.9% (629/1433) identified as female, whereas 35.5% (860/2420) identified as female among the group that learned of the event through other means. Conclusions: There was overall positive receptiveness and responsiveness toward firearm lock box and trigger lock giveaway events when promoted on social media. Compared with other promotional tools, social media has the ability to reach those who are younger and those who identify as female. Future studies should extend this research to determine whether there is a difference between rural and urban settings, and consider other social media platforms in the analysis. %M 34142974 %R 10.2196/24458 %U https://www.jmir.org/2021/6/e24458 %U https://doi.org/10.2196/24458 %U http://www.ncbi.nlm.nih.gov/pubmed/34142974 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e18830 %T Implementation of iPads to Increase Compliance With Delivery of New Parent Education in the Mother–Baby Unit: Retrospective Study %A Pavuluri,Haritha %A Grant,Alicia %A Hartman,Alexander %A Fowler,Lauren %A Hudson,Jennifer %A Springhart,Patrick %A Kennedy,Ann Blair %+ University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, United States, 1 864 455 8374, kenneda5@greenvillemed.sc.edu %K technology %K handheld computers %K workflow %K education %K newborn %K head trauma %D 2021 %7 15.6.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Abusive head trauma (AHT) is a serious health problem affecting more than 3000 infants annually in the United States. The American Academy of Pediatrics and the Centers for Disease Control and Prevention (CDC) recommend that health care providers counsel new parents about the dangers of AHT. Previous studies demonstrate that parental education is effective at reducing AHT events. South Carolina law requires hospitals to offer all new parents with the opportunity to watch an educational video about AHT. This mandate is addressed in different ways at the several delivery centers within a large South Carolina health care system with a range of viewing methods utilized, from DVD players to mobile workstations to personal devices. Frequent technical barriers and workflow inefficiencies resulted in low rates of compliance with this mandate at several campuses. To improve compliance of parent viewing of this educational video, the health care system standardized video viewing protocol across all campuses by implementing the use of iPads for parental education. Existing literature suggests that patient education can be improved in the hospital setting by utilizing tablet computers, but our literature search identified a gap in research around the education of parents and caregivers during hospitalization for childbirth. We used the implementation of an iPad-based parental education delivery protocol to evaluate whether tablet computers can improve compliance with delivering new parent education in the hospital setting. Objective: The objective of this study was to evaluate whether the standardized use of iPads to deliver education in the mother–baby unit resulted in improved rates of parents’ acceptance of the opportunity to view an educational video about AHT. Methods: We interviewed physicians and nurses to determine what previous protocols were in place to educate new parents before a standardized iPad-based protocol was implemented across 6 campuses of a large South Carolina health care system. A retrospective study was conducted by review of 5231 records from across the 6 campuses to determine the pre- and postintervention compliance rates of viewing the AHT educational video by parents in the mother–baby unit. Results: Compliance increased overall (P<.001) across sites from an average of 41.93% (SD 46.24) to 99.73% (SD 0.26) (φ=0.510). As much as 4 of 6 locations saw a significant increase in compliance rates after introducing the iPad intervention (P<.001). The remaining 2 locations that showed no significant difference (P>.05) had very high rates of preintervention compliance. Conclusions: Following the implementation of a standardized iPad-based protocol to deliver new parent education, there was a significant improvement in the percentage of new parents who viewed an educational video about AHT in the mother–baby unit. Based on these results, other health care providers should consider iPads to be a feasible and effective method for delivering hospital-based education to families in the mother–baby unit. %M 34128809 %R 10.2196/18830 %U https://pediatrics.jmir.org/2021/2/e18830 %U https://doi.org/10.2196/18830 %U http://www.ncbi.nlm.nih.gov/pubmed/34128809 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e23976 %T A Rapid Assessment of the Impact of COVID-19 on Asian Americans: Cross-sectional Survey Study %A Quach,Thu %A Ðoàn,Lan N %A Liou,Julia %A Ponce,Ninez A %+ Asian Health Services, 101 8th Street, Suite 100, Oakland, CA, 94607, United States, 1 510 735 3179, tquach@ahschc.org %K COVID-19 %K Asian American %K testing %K mental health %K barrier %K behavior %K impact %K discrimination %K inequality %K disparity %K experience %K COVID %K violence %K culture %K stress %K anti-Asian violence %D 2021 %7 11.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The diverse Asian American population has been impacted by the COVID-19 pandemic, but due to limited data and other factors, disparities experienced by this population are hidden. Objective: This study aims to describe the Asian American community’s experiences during the COVID-19 pandemic, focusing on the Greater San Francisco Bay Area, California, and to better inform a Federally Qualified Health Center’s (FQHC) health care services and response to challenges faced by the community. Methods: We conducted a cross-sectional survey between May 20 and June 23, 2020, using a multipronged recruitment approach, including word-of-mouth, FQHC patient appointments, and social media posts. The survey was self-administered online or administered over the phone by FQHC staff in English, Cantonese, Mandarin, and Vietnamese. Survey question topics included COVID-19 testing and preventative behaviors, economic impacts of COVID-19, experience with perceived mistreatment due to their race/ethnicity, and mental health challenges. Results: Among 1297 Asian American respondents, only 3.1% (39/1273) had previously been tested for COVID-19, and 46.6% (392/841) stated that they could not find a place to get tested. In addition, about two-thirds of respondents (477/707) reported feeling stressed, and 22.6% (160/707) reported feeling depressed. Furthermore, 5.6% (72/1275) of respondents reported being treated unfairly because of their race/ethnicity. Among respondents who experienced economic impacts from COVID-19, 32.2% (246/763) had lost their regular jobs and 22.5% (172/763) had reduced hours or reduced income. Additionally, 70.1% (890/1269) of respondents shared that they avoid leaving their home to go to public places (eg, grocery stores, church, and school). Conclusions: We found that Asian Americans had lower levels of COVID-19 testing and limited access to testing, a high prevalence of mental health issues and economic impacts, and a high prevalence of risk-avoidant behaviors (eg, not leaving the house) in the early months of the COVID-19 pandemic. These findings provide preliminary insights into the impact of the COVID-19 pandemic on Asian American communities served by an FQHC and underscore the longstanding need for culturally and linguistically appropriate approaches to providing mental health, outreach, and education services. These findings led to the establishment of the first Asian multilingual and multicultural COVID-19 testing sites in the local area where the study was conducted, and laid the groundwork for subsequent COVID-19 programs, specifically contact tracing and vaccination programs. %M 34019478 %R 10.2196/23976 %U https://publichealth.jmir.org/2021/6/e23976 %U https://doi.org/10.2196/23976 %U http://www.ncbi.nlm.nih.gov/pubmed/34019478 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e26042 %T Impact of Firearm Surveillance on Gun Control Policy: Regression Discontinuity Analysis %A Post,Lori %A Mason,Maryann %A Singh,Lauren Nadya %A Wleklinski,Nicholas P %A Moss,Charles B %A Mohammad,Hassan %A Issa,Tariq Z %A Akhetuamhen,Adesuwa I %A Brandt,Cynthia A %A Welch,Sarah B %A Oehmke,James Francis %+ Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, 420 E Superior, Chicago, IL, 60611, United States, 1 203 980 7107, lori.post@northwestern.edu %K firearm surveillance %K assault weapons ban %K large-capacity magazines %K guns control policy %K mass shootings %K regression lines of discontinuity %D 2021 %7 22.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Public mass shootings are a significant public health problem that require ongoing systematic surveillance to test and inform policies that combat gun injuries. Although there is widespread agreement that something needs to be done to stop public mass shootings, opinions on exactly which policies that entails vary, such as the prohibition of assault weapons and large-capacity magazines. Objective: The aim of this study was to determine if the Federal Assault Weapons Ban (FAWB) (1994-2004) reduced the number of public mass shootings while it was in place. Methods: We extracted public mass shooting surveillance data from the Violence Project that matched our inclusion criteria of 4 or more fatalities in a public space during a single event. We performed regression discontinuity analysis, taking advantage of the imposition of the FAWB, which included a prohibition on large-capacity magazines in addition to assault weapons. We estimated a regression model of the 5-year moving average number of public mass shootings per year for the period of 1966 to 2019 controlling for population growth and homicides in general, introduced regression discontinuities in the intercept and a time trend for years coincident with the federal legislation (ie, 1994-2004), and also allowed for a differential effect of the homicide rate during this period. We introduced a second set of trend and intercept discontinuities for post-FAWB years to capture the effects of termination of the policy. We used the regression results to predict what would have happened from 1995 to 2019 had there been no FAWB and also to project what would have happened from 2005 onward had it remained in place. Results: The FAWB resulted in a significant decrease in public mass shootings, number of gun deaths, and number of gun injuries. We estimate that the FAWB prevented 11 public mass shootings during the decade the ban was in place. A continuation of the FAWB would have prevented 30 public mass shootings that killed 339 people and injured an additional 1139 people. Conclusions: This study demonstrates the utility of public health surveillance on gun violence. Surveillance informs policy on whether a ban on assault weapons and large-capacity magazines reduces public mass shootings. As society searches for effective policies to prevent the next mass shooting, we must consider the overwhelming evidence that bans on assault weapons and/or large-capacity magazines work. %M 33783360 %R 10.2196/26042 %U https://publichealth.jmir.org/2021/4/e26042 %U https://doi.org/10.2196/26042 %U http://www.ncbi.nlm.nih.gov/pubmed/33783360 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e26554 %T Generating Intervention Concepts for Reducing Adolescent Relationship Abuse Inequities Among Sexual and Gender Minority Youth: Protocol for a Web-Based, Longitudinal, Human-Centered Design Study %A Coulter,Robert W S %A Mitchell,Shannon %A Prangley,Kelly %A Smallwood,Seth %A Bonanno,Leyna %A Foster,Elizabeth N %A Wilson,Abby %A Miller,Elizabeth %A Chugani,Carla D %+ Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto St, Pittsburgh, PA, 15261, United States, 1 4126240647, robert.ws.coulter@pitt.edu %K sexual and gender minorities %K adolescent %K psychosocial intervention %K internet-based intervention %K intimate partner violence %D 2021 %7 12.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sexual and gender minority youth (SGMY; eg, lesbian, gay, bisexual, and transgender youth) are at greater risk than their cisgender heterosexual peers for adolescent relationship abuse (ARA; physical, sexual, or psychological abuse in a romantic relationship). However, there is a dearth of efficacious interventions for reducing ARA among SGMY. To address this intervention gap, we designed a novel web-based methodology leveraging the field of human-centered design to generate multiple ARA intervention concepts with SGMY. Objective: This paper aims to describe study procedures for a pilot study to rigorously test the feasibility, acceptability, and appropriateness of using web-based human-centered design methods with SGMY to create novel, stakeholder-driven ARA intervention concepts. Methods: We are conducting a longitudinal, web-based human-centered design study with 45-60 SGMY (aged between 14 and 18 years) recruited via social media from across the United States. Using MURAL (a collaborative, visual web-based workspace) and Zoom (a videoconferencing platform), the SGMY will participate in four group-based sessions (1.5 hours each). In session 1, the SGMY will use rose-thorn-bud to individually document their ideas about healthy and unhealthy relationship characteristics and then use affinity clustering as a group to categorize their self-reported ideas based on similarities and differences. In session 2, the SGMY will use rose-thorn-bud to individually critique a universal evidence-based intervention to reduce ARA and affinity clustering to aggregate their ideas as a group. In session 3, the SGMY will use a creative matrix to generate intervention ideas for reducing ARA among them and force-rank the intervention ideas based on their potential ease of implementation and potential impact using an importance-difficulty matrix. In session 4, the SGMY will generate and refine intervention concepts (from session 3 ideations) to reduce ARA using round robin (for rapid iteration) and concept poster (for fleshing out ideas more fully). We will use content analyses to document the intervention concepts. In a follow-up survey, the SGMY will complete validated measures about the feasibility, acceptability, and appropriateness of the web-based human-centered design methods (a priori benchmarks for success: means >3.75 on each 5-point scale). Results: This study was funded in February 2020. Data collection began in August 2020 and will be completed by April 2021. Conclusions: Through rigorous testing of the feasibility of our web-based human-centered design methodology, our study may help demonstrate the use of human-centered design methods to engage harder-to-reach stakeholders and actively involve them in the co-creation of relevant interventions. Successful completion of this project also has the potential to catalyze intervention research to address ARA inequities for SGMY. Finally, our approach may be transferable to other populations and health topics, thereby advancing prevention science and health equity. International Registered Report Identifier (IRRID): DERR1-10.2196/26554 %M 33843601 %R 10.2196/26554 %U https://www.researchprotocols.org/2021/4/e26554 %U https://doi.org/10.2196/26554 %U http://www.ncbi.nlm.nih.gov/pubmed/33843601 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e22790 %T Mobile Remote Monitoring of Intimate Partner Violence Among Pregnant Patients During the COVID-19 Shelter-In-Place Order: Quality Improvement Pilot Study %A Krishnamurti,Tamar %A Davis,Alexander L %A Quinn,Beth %A Castillo,Anabel F %A Martin,Kelly L %A Simhan,Hyagriv N %+ Department of General Internal Medicine, University of Pittsburgh School of Medicine, 200 Meyran Avenue, Parkvale Building Suite 200, Pittsburgh, PA, 15213, United States, 1 4126924855, tamark@pitt.edu %K COVID-19 %K social isolation, sheltering-in-place %K intimate partner violence %K domestic violence %K pregnancy %K telemedicine %K telehealth %D 2021 %7 19.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Intimate partner violence (IPV) is one of the leading causes of pregnancy-related death. Prenatal health care providers can offer critical screening and support to pregnant people who experience IPV. During the COVID-19 shelter-in-place order, mobile apps may offer such people the opportunity to continue receiving screening and support services. Objective: We aimed to examine cases of IPV that were reported on a prenatal care app before and during the implementation of COVID-19 shelter-in-place mandates. Methods: The number of patients who underwent voluntary IPV screening and the incidence rate of IPV were determined by using a prenatal care app that was disseminated to patients from a single, large health care system. We compared the IPV screening frequencies and IPV incidence rates of patients who started using the app before the COVID-19 shelter-in-place order, to those of patients who started using the app during the shelter-in-place order. Results: We found 552 patients who started using the app within 60 days prior to the enforcement of the shelter-in-place order, and 407 patients who used the app at the start of shelter-in-place enforcement until the order was lifted. The incidence rates of voluntary IPV screening for new app users during the two time periods were similar (before sheltering in place: 252/552, 46%; during sheltering in place: 163/407, 40%). The overall use of the IPV screening tool increased during the shelter-in-place order. A slight, nonsignificant increase in the incidence of physical, sexual, and psychological violence during the shelter-in-place order was found across all app users (P=.56). Notably, none of the patients who screened positively for IPV had mentions of IPV in their medical charts. Conclusions: App-based screening for IPV is feasible during times when in-person access to health care providers is limited. Our results suggest that the incidence of IPV slightly increased during the shelter-in-place order. App-based screening may also address the needs of those who are unwilling or unable to share their IPV experiences with their health care provider. %M 33605898 %R 10.2196/22790 %U http://www.jmir.org/2021/2/e22790/ %U https://doi.org/10.2196/22790 %U http://www.ncbi.nlm.nih.gov/pubmed/33605898 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e22277 %T Characteristics of the Users of Troubled Desire, a Web-Based Self-management App for Individuals With Sexual Interest in Children: Descriptive Analysis of Self-assessment Data %A Schuler,Miriam %A Gieseler,Hannes %A Schweder,Katharina W %A von Heyden,Maximilian %A Beier,Klaus M %+ Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine, Charité-Universitätsmedizin Berlin, Charitépl 1, Berlin, 10117, Germany, 49 30 450 520 339, miriam.schuler@charite.de %K pedophilia %K hebephilia %K child sexual offenses %K child sexual abuse material %K web-based assessment %K web-based treatment %D 2021 %7 19.2.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Despite the high prevalence of child sexual offenses and the increasing amounts of available child sexual abuse material, there is a global shortage of preventive interventions focusing on individuals at risk of sexual offending. The web-based app Troubled Desire aims to address this shortage by offering self-assessments and self-management training modules in different languages to individuals with sexual interests in prepubescent and early pubescent children (ie, those with pedophilic and hebephiliac sexual interest, respectively). Objective: The aim of this study was to describe the characteristics of the users of the Troubled Desire app. Methods: The fully completed self-assessment data gathered within the first 30 months of this study from October 25, 2017 to April 25, 2020 were investigated. The main outcome measures were (1) sociodemographic information and (2) sexual interests and sexual behaviors of the users of Troubled Desire. Results: The self-assessment was completed by 4161 users. User accesses were mainly from Germany (2277/4161, 54.7%) and the United States (474/4161, 11.4%). Approximately 78.9% (3281/4161) of the users reported sexual interest in children; these users were significantly more likely to report distress and trouble owing to their sexual interest. Further, child sexual offenses and consumption of child sexual abuse material were significantly more common among users with sexual interest in children than among users with no sexual interest in children. Additionally, the majority of the offenses were not known to legal authorities. Conclusions: The Troubled Desire app is useful in reaching out to individuals with sexual interest in prepubescent and early pubescent children. However, future research is warranted to understand the prospective relevance of the Troubled Desire app in the prevention of child sexual offending. %M 33605895 %R 10.2196/22277 %U http://mental.jmir.org/2021/2/e22277/ %U https://doi.org/10.2196/22277 %U http://www.ncbi.nlm.nih.gov/pubmed/33605895 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23295 %T Remote Examination and Screening for Domestic Abuse. Comment on “Online Antenatal Care During the COVID-19 Pandemic: Opportunities and Challenges” %A Grimes,Hannah Lee %A Uppal,Ramnik %+ University of Cambridge Clinical School, Hills Road, Cambridge, United Kingdom, 44 01223 336700, hlg42@cam.ac.uk %K spouse abuse %K domestic abuse %K apps %K patient information %K antenatal care %K COVID-19 %D 2021 %7 17.2.2021 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 33595438 %R 10.2196/23295 %U https://www.jmir.org/2021/2/e23295 %U https://doi.org/10.2196/23295 %U http://www.ncbi.nlm.nih.gov/pubmed/33595438 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e19651 %T Measuring Public Reaction to Violence Against Doctors in China: Interrupted Time Series Analysis of Media Reports %A Yang,Qian %A Tai-Seale,Ming %A Liu,Stephanie %A Shen,Yi %A Zhang,Xiaobin %A Xiao,Xiaohua %A Zhang,Kejun %+ College of Computer Science and Technology, Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310058, China, 86 18758181126, zhangkejun@zju.edu.cn %K violence against doctors %K government intervention %K public opinion %K patient–physician relationship %D 2021 %7 16.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Violence against doctors in China is a serious problem that has attracted attention from both domestic and international media. Objective: This study investigates readers’ responses to media reports on violence against doctors to identify attitudes toward perpetrators and physicians and examine if such trends are influenced by national policies. Methods: We searched 17 Chinese violence against doctors reports in international media sources from 2011 to 2020. We then tracked back the original reports and web crawled the 19,220 comments in China. To ascertain the possible turning point of public opinion, we searched violence against doctors–related policies from Tsinghua University ipolicy database from 2011 to 2020, and found 19 policies enacted by the Chinese central government aimed at alleviating the intense patient–physician relationship. We then conducted a series of interrupted time series analyses to examine the influence of these policies on public sentiment toward violence against doctors over time. Results: The interrupted time series analysis (ITSA) showed that the change in public sentiment toward violence against doctors reports was temporally associated with government interventions. The declarations of 10 of the public policies were followed by increases in the proportion of online public opinion in support of doctors (average slope changes of 0.010, P<.05). A decline in the proportion of online public opinion that blamed doctors (average level change of –0.784, P<.05) followed the declaration of 3 policies. Conclusions: The government’s administrative interventions effectively shaped public opinion but only temporarily. Continued public policy interventions are needed to sustain the reduction of hostility toward medical doctors. %M 33591282 %R 10.2196/19651 %U http://www.jmir.org/2021/2/e19651/ %U https://doi.org/10.2196/19651 %U http://www.ncbi.nlm.nih.gov/pubmed/33591282 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25322 %T Virtual Reality or Augmented Reality as a Tool for Studying Bystander Behaviors in Interpersonal Violence: Scoping Review %A Xue,Jia %A Hu,Ran %A Zhang,Wenzhao %A Zhao,Yaxi %A Zhang,Bolun %A Liu,Nian %A Li,Sam-Chin %A Logan,Judith %+ Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada, 1 4169465429, jia.xue@utoronto.ca %K virtual reality %K augmented reality %K bystander behaviors %K interpersonal violence %K violent incidents %K people’s responses %K dating violence %K sexual violence %D 2021 %7 15.2.2021 %9 Review %J J Med Internet Res %G English %X Background: To provide participants with a more real and immersive intervening experience, virtual reality (VR) and/or augmented reality (AR) technologies have been integrated into some bystander intervention training programs and studies measuring bystander behaviors. Objective: We focused on whether VR or AR can be used as a tool to enhance training bystanders. We reviewed the evidence from empirical studies that used VR and/or AR as a tool for examining bystander behaviors in the domain of interpersonal violence research. Methods: Two librarians searched for articles in databases, including APA PsycInfo (Ovid), Criminal Justice Abstracts (EBSCO), Medline (Ovid), Applied Social Sciences Index & Abstracts (ProQuest), Sociological Abstracts (ProQuest), and Scopus till April 15, 2020. Studies focusing on bystander behaviors in conflict situations were included. All study types (except reviews) written in English in any discipline were included. Results: The search resulted in 12,972 articles from six databases, and the articles were imported into Covidence. Eleven studies met the inclusion and exclusion criteria. All 11 articles examined the use of VR as a tool for studying bystander behaviors. Most of the studies were conducted in US young adults. The types of interpersonal violence were school bullying, dating violence, sexual violence/assault, and soccer-associated violence. VR technology was used as an observational measure and bystander intervention program. We evaluated the different uses of VR for bystander behaviors and noted a lack of empirical evidence for AR as a tool. We also discuss the empirical evidence regarding the design, effectiveness, and limitations of implementing VR as a tool in the reviewed studies. Conclusions: The reviewed results have implications and recommendations for future research in designing and implementing VR/AR technology in the area of interpersonal violence. Future studies in this area may further contribute to the use of VR as an observational measure and explore the potential use of AR to study bystander behaviors. %M 33587044 %R 10.2196/25322 %U http://www.jmir.org/2021/2/e25322/ %U https://doi.org/10.2196/25322 %U http://www.ncbi.nlm.nih.gov/pubmed/33587044 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e25443 %T mHealth-Supported Delivery of an Evidence-Based Family Home-Visiting Intervention in Sierra Leone: Protocol for a Pilot Randomized Controlled Trial %A Desrosiers,Alethea %A Schafer,Carolyn %A Esliker,Rebecca %A Jambai,Musu %A Betancourt,Theresa S %+ Boston College, School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 01778, United States, 1 617 552 8398, alethea.desrosiers@bc.edu %K mHealth %K caregiver mental health %K family functioning %K early childhood development %K community health workers %D 2021 %7 2.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Past trauma and exposure to violence have been related to poor emotion regulation and household violence, which can have persistent mental health effects across generations. The Family Strengthening Intervention for Early Childhood Development (FSI-ECD/called Sugira Muryango in Rwanda) is an evidence-based behavioral home-visiting intervention to promote caregiver mental health, positive parenting practices, and early childhood development among families facing adversity. In Sierra Leone and other lower- and middle-income countries, mobile health (mHealth) technology has the potential to improve health care delivery and health outcomes. Objective: This study aims to (1) apply a user-centered design to develop and test mHealth tools to improve supervision and fidelity monitoring of community health workers (CHWs) delivering the FSI-ECD and (2) conduct a pilot randomized controlled trial of the FSI-ECD to assess feasibility, acceptability, and preliminary effects on caregiver mental health, emotion regulation, caregiving behaviors, and family violence in high-risk families with children aged 6-36 months in comparison with control families receiving standard care. Methods: We will recruit and enroll CHWs, supervisors, and families with a child aged 6-36 months from community health clinics in Sierra Leone. CHWs and supervisors will participate in 1 problem analysis focus group and 2 user interface/user experience cycles to provide feedback on mHealth tool prototypes. Families will be randomized to mHealth-supported FSI-ECD or standard maternal and child health services. We will collect quantitative data on caregiver mental health, emotion regulation, caregiving behaviors, and family functioning at baseline, postintervention, and 3-month follow up. We will use a mixed methods approach to explore feasibility and acceptability of mHealth tools and the FSI-ECD. Mixed effects linear modeling will assess FSI-ECD effects on caregiver outcomes. Cost-effectiveness analysis will estimate costs across FSI-ECD versus standard care. Results: Funding for this study was received from the National Institutes of Mental Health on August 17, 2020. Institutional Review Board approval was received on September 4, 2020. Data collection is projected to begin on December 15, 2020. Conclusions: This study will provide important data on the feasibility, acceptability, and preliminary efficacy of mHealth-supported delivery of an evidence-based family home-visiting intervention in a postconflict LMIC. Trial Registration: ClinicalTrials.gov NCT04481399; https://clinicaltrials.gov/ct2/show/NCT04481399. International Registered Report Identifier (IRRID): PRR1-10.2196/25443 %M 33528371 %R 10.2196/25443 %U https://www.researchprotocols.org/2021/2/e25443 %U https://doi.org/10.2196/25443 %U http://www.ncbi.nlm.nih.gov/pubmed/33528371 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e26130 %T A Couples-Based Intervention (Ghya Bharari Ekatra) for the Primary Prevention of Intimate Partner Violence in India: Pilot Feasibility and Acceptability Study %A Kalokhe,Ameeta Shivdas %A Iyer,Sandhya %A Gadhe,Keshav %A Katendra,Tuman %A Kolhe,Ambika %A Rahane,Girish %A Stephenson,Rob %A Sahay,Seema %+ Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 5003 CNR Building, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 404 712 1924, akalokh@emory.edu %K intimate partner violence %K prevention %K pilot study %K gender-based violence %K domestic violence %K violence %K India %K intervention %K prevalence %K mental health %K acceptance %K safety %K feasibility %K efficacy %D 2021 %7 1.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The high global prevalence of intimate partner violence (IPV) and its association with poor physical and mental health underscore the need for effective primary prevention. We previously developed Ghya Bharari Ekatra (GBE), a couples-based primary prevention intervention for IPV among newly married couples residing in slum communities in Pune, India. Objective: Through this pilot study, we aimed to explore the acceptance, safety, feasibility, and preliminary efficacy of GBE. Methods: Between January and May 2018, we enrolled and assigned 20 couples to receive GBE plus information on IPV support services and 20 control couples to receive information on IPV support services alone. The GBE intervention was delivered over 6 weekly sessions to groups of 3 to 5 couples by lay peer educators in the communities in which the participants resided. Intervention components addressed relationship quality, resilience, communication and conflict negotiation, self-esteem, sexual communication and sexual health knowledge, and norms around IPV. Outcome evaluation included exit interviews with participants and peers to examine acceptance and feasibility challenges and baseline and 3-month follow-up interviews to examine change in IPV reporting and mental health (by women) and alcohol misuse (by men). The process evaluation examined dose delivered, dose received, fidelity, recruitment, participation rate, and context. Results: Half (40/83) of the eligible couples approached agreed to participate in the GBE intervention. Retention rates were high (17/20, 85% across all 6 sessions), feedback from exit interviews suggested the content and delivery methods were very well received, and the community was highly supportive of the intervention. The principal feasibility challenge involved recruiting men with the lowest income who were dependent on daily wages. No safety concerns were reported by female participants over the course of the intervention or at the 3-month follow-up. There were no reported physical or sexual IPV events in either group, but there were fewer incidents of psychological abuse in GBE participants (3/17, 18%) versus control participants (4/16, 25%) at 3-month follow-up. There was also significant improvement in the overall mental health of female intervention participants and declines in the control participants (change in mean General Health Questionnaire-12 score: –0.13 in intervention vs 0.13 in controls; P=.10). Conclusions: GBE has high acceptance, feasibility, and preliminary efficacy in preventing IPV and improving mental health among women. Next steps include refining the intervention content based on pilot findings and examining intervention efficacy through a large-scale randomized trial with longer follow-up. Trial Registration: ClinicalTrials.gov NCT03332134; https://clinicaltrials.gov/ct2/show/NCT03332134. Clinical Trials Registry of India CTRI/2018/01/011596; http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=21443 International Registered Report Identifier (IRRID): RR2-10.2196/11533 %M 33459278 %R 10.2196/26130 %U https://formative.jmir.org/2021/2/e26130 %U https://doi.org/10.2196/26130 %U http://www.ncbi.nlm.nih.gov/pubmed/33459278 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e24269 %T A Moderated Mediation Analysis of Condom Negotiation and Sexual Orientation on the Relationship Between Sexual Coercion and Condom Use in Chinese Young Women: Cross-Sectional Study %A Zhang,Wen %A Choi,Edmond Pui Hang %A Fong,Daniel Yee-Tak %A Wong,Janet Yuen-Ha %+ School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, Hong Kong, 852 3917 6641, janetyh@hku.hk %K sex offenses %K sex orientation %K unprotected sex %K online research %K women’s health %D 2021 %7 19.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The high prevalence of sexual coercion against young women has become a significant public health issue in China and other regions around the world. Young women are also especially vulnerable to engage in inconsistent condom use because of low sexual control. Although the relationship between sexual coercion and condom use has been widely demonstrated, the mechanism of this relationship is still unclear. Objective: The objective of this study was to test condom negotiation as a mediator of the relationship between sexual coercion and condom use in young Chinese women and to investigate whether sexual orientation is a moderator. Methods: Data were collected using web-based questionnaires and a total of 402 young Chinese women were included in the analysis. Sexual coercion was measured using a subscale of the Revised Conflict Tactics Scales and condom negotiation was measured using a subscale of the UCLA Multidimensional Condom Attitudes Scale. Sexual orientation was assessed using an item adopted from a previous study and condom use was calculated by the total number of times condoms were used divided by the total number of times sexual intercourse was engaged in during the past 3 months. Moderated mediation analyses were conducted with sexual coercion as the independent variable, condom use consistency as the dependent variable, condom negotiation as the mediator variable, and sexual orientation as a moderator. Results: The moderated mediation analysis indicated that the relationship between sexual coercion and condom use was significantly mediated by condom negotiation and moderated by sexual orientation. The indirect effect of condom negotiation was significant in heterosexual women (indirect effect: –0.80, 95% boot CI –1.67 to –0.36) but not in sexual minority women (indirect effect: –0.33, 95% boot CI –0.86 to 0.31). Conclusions: The results showed that sexual orientation meaningfully affects the relationship between sexual coercion and condom negotiation. The difference in the mechanism of the relation between sexual coercion and sexual behaviors in heterosexual and sexual minority women should be considered for future research and interventions aimed at mitigating the adverse effects of sexual coercion. %M 33464220 %R 10.2196/24269 %U http://publichealth.jmir.org/2021/1/e24269/ %U https://doi.org/10.2196/24269 %U http://www.ncbi.nlm.nih.gov/pubmed/33464220 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e24562 %T How Health Care Workers Wield Influence Through Twitter Hashtags: Retrospective Cross-sectional Study of the Gun Violence and COVID-19 Public Health Crises %A Ojo,Ayotomiwa %A Guntuku,Sharath Chandra %A Zheng,Margaret %A Beidas,Rinad S %A Ranney,Megan L %+ Brown-Lifespan Center for Digital Health, Brown University, 139 Point St, Providence, RI, 02903, United States, 1 646 644 3053, megan_ranney@brown.edu %K COVID-19 %K firearm injury %K social media %K online advocacy %K Twitter %K infodemiology %K infoveillance %K tweet %K campaign %K health care worker %K influence %K public health %K crisis %K policy %D 2021 %7 6.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Twitter has emerged as a novel way for physicians to share ideas and advocate for policy change. #ThisIsOurLane (firearm injury) and #GetUsPPE (COVID-19) are examples of nationwide health care–led Twitter campaigns that went viral. Health care–initiated Twitter hashtags regarding major public health topics have gained national attention, but their content has not been systematically examined. Objective: We hypothesized that Twitter discourse on two epidemics (firearm injury and COVID-19) would differ between tweets with health care–initiated hashtags (#ThisIsOurLane and #GetUsPPE) versus those with non–health care–initiated hashtags (#GunViolence and #COVID19). Methods: Using natural language processing, we compared content, affect, and authorship of a random 1% of tweets using #ThisIsOurLane (Nov 2018-Oct 2019) and #GetUsPPE (March-May 2020), compared to #GunViolence and #COVID19 tweets, respectively. We extracted the relative frequency of single words and phrases and created two sets of features: (1) an open-vocabulary feature set to create 50 data-driven–determined word clusters to evaluate the content of tweets; and (2) a closed-vocabulary feature for psycholinguistic categorization among case and comparator tweets. In accordance with conventional linguistic analysis, we used a P<.001, after adjusting for multiple comparisons using the Bonferroni correction, to identify potentially meaningful correlations between language features and outcomes. Results: In total, 67% (n=4828) of #ThisIsOurLane tweets and 36.6% (n=7907) of #GetUsPPE tweets were authored by health care professionals, compared to 16% (n=1152) of #GunViolence and 9.8% (n=2117) of #COVID19 tweets. Tweets using #ThisIsOurLane and #GetUsPPE were more likely to contain health care–specific language; more language denoting positive emotions, affiliation, and group identity; and more action-oriented content compared to tweets with #GunViolence or #COVID19, respectively. Conclusions: Tweets with health care–led hashtags expressed more positivity and more action-oriented language than the comparison hashtags. As social media is increasingly used for news discourse, public education, and grassroots organizing, the public health community can take advantage of social media’s broad reach to amplify truthful, actionable messages around public health issues. %M 33315578 %R 10.2196/24562 %U https://publichealth.jmir.org/2021/1/e24562 %U https://doi.org/10.2196/24562 %U http://www.ncbi.nlm.nih.gov/pubmed/33315578 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 9 %N 4 %P e19023 %T Using Friendship Ties to Understand the Prevalence of, and Factors Associated With, Intimate Partner Violence Among Adolescents and Young Adults in Kenya: Cross-Sectional, Respondent-Driven Survey Study %A Memiah,Peter %A Kamau,Anne %A Opanga,Yvonne %A Muhula,Samuel %A Nyakeriga,Emmanuel %A Humwa,Felix %A Cook,Courtney %A Kingori,Caroline %A Muriithi,Job %+ University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, MD, 21201, United States, 1 4107966283, pmemiah@ihv.umaryland.edu %K intimate partner violence %K adolescents %K young adults %K bullying %K physical abuse %K abuse %K Africa %K prevalence %K risk %D 2020 %7 31.12.2020 %9 Original Paper %J Interact J Med Res %G English %X Background: Optimization of innovative approaches is required for estimating the intimate partner violence (IPV) burden among adolescents and young adults (AYA). Further investigation is required to identify risk and protective factors associated with IPV among AYA. There remain significant gaps in understanding these factors among this vulnerable population. Objective: The goal of our study was to determine the prevalence of IPV among an urban population of AYA and to identify factors associated with IPV among AYA. Methods: A cross-sectional study design utilizing respondent-driven sampling was adopted. The study was conducted among 887 AYA, aged 15 to 24 years, residing in Nairobi, Kenya. Data were collected through a phone-based survey using the REACH (Reaching, Engaging Adolescents and Young Adults for Care Continuum in Health)-AYA app. Questions on behavioral and psychosocial factors were adopted from different standardized questionnaires. Descriptive, bivariate, and multivariable statistics were used to describe the characteristics of the study sample. Results: Of the 887 participants, a higher proportion were male (540/887, 60.9%) compared to female (347/887, 39.1%). The prevalence of IPV was 22.3% (124/556). IPV was associated with being unsure if it was okay for a boy to hit his girlfriend, living in a home with physical violence or abuse, and being bullied (P=.005). The likelihood of experiencing IPV was higher among respondents whose friends and family members used alcohol (odds ratio [OR] 1.80, 95% CI 1.09-2.98) and among those who had repeated a class at school in the past two years (OR 1.90, 95% CI 1.11-3.23). Respondents who visited a health facility or doctor for reproductive health services were 2 times more likely to experience IPV (OR 2.23, 95% CI 1.40-3.70). Respondents who had used illicit drugs were 2 times more likely to experience IPV (OR 4.31, 95% CI 2.64-7.04). The probability of experiencing IPV decreased by 63% (OR 0.37, 95% CI 0.16-0.85) among respondents who refused to have sex with someone who was not prepared to use a condom. Conclusions: IPV remains a significant public health priority because of its impact to society. Our results are in congruence with other similar studies. Efforts toward incorporating appropriate IPV core measures into the comprehensive care package for every AYA seeking health services should be explored. Programs need to address constellations of risk and protective factors linked to IPV in an effort to prevent its occurrence. %M 33382380 %R 10.2196/19023 %U http://www.i-jmr.org/2020/4/e19023/ %U https://doi.org/10.2196/19023 %U http://www.ncbi.nlm.nih.gov/pubmed/33382380 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e23725 %T Prevalence of Mental Illnesses in Domestic Violence Police Records: Text Mining Study %A Karystianis,George %A Simpson,Annabeth %A Adily,Armita %A Schofield,Peter %A Greenberg,David %A Wand,Handan %A Nenadic,Goran %A Butler,Tony %+ School of Population Health, University of New South Wales, Level 3, Samuels Building, Gate 11, Botany Street, UNSW Kensington Campus, Sydney, 2052, Australia, 61 (2) 9385 3811, g.karystianis@unsw.edu.au %K text mining %K mental illnesses %K domestic violence %K police data %K trend analysis %D 2020 %7 24.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The New South Wales Police Force (NSWPF) records details of significant numbers of domestic violence (DV) events they attend each year as both structured quantitative data and unstructured free text. Accessing information contained in the free text such as the victim’s and persons of interest (POI's) mental health status could be useful in the better management of DV events attended by the police and thus improve health, justice, and social outcomes. Objective: The aim of this study is to present the prevalence of extracted mental illness mentions for POIs and victims in police-recorded DV events. Methods: We applied a knowledge-driven text mining method to recognize mental illness mentions for victims and POIs from police-recorded DV events. Results: In 416,441 police-recorded DV events with single POIs and single victims, we identified 64,587 events (15.51%) with at least one mental illness mention versus 4295 (1.03%) recorded in the structured fixed fields. Two-thirds (67,582/85,880, 78.69%) of mental illnesses were associated with POIs versus 21.30% (18,298/85,880) with victims; depression was the most common condition in both victims (2822/12,589, 22.42%) and POIs (7496/39,269, 19.01%). Mental illnesses were most common among POIs aged 0-14 years (623/1612, 38.65%) and in victims aged over 65 years (1227/22,873, 5.36%). Conclusions: A wealth of mental illness information exists within police-recorded DV events that can be extracted using text mining. The results showed mood-related illnesses were the most common in both victims and POIs. Further investigation is required to determine the reliability of the mental illness mentions against sources of diagnostic information. %M 33361056 %R 10.2196/23725 %U http://www.jmir.org/2020/12/e23725/ %U https://doi.org/10.2196/23725 %U http://www.ncbi.nlm.nih.gov/pubmed/33361056 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e22361 %T Intimate Partner Violence and Electronic Health Interventions: Systematic Review and Meta-Analysis of Randomized Trials %A Linde,Ditte S %A Bakiewicz,Aleksandra %A Normann,Anne Katrine %A Hansen,Nina Beck %A Lundh,Andreas %A Rasch,Vibeke %+ Department of Clinical Research, University of Southern Denmark, Kløvervænget 10, 10, Odense, Denmark, 45 61666564, dsondergaard@health.sdu.dk %K eHealth %K randomized trials %K intimate partner violence %K domestic violence %K abuse %K depression %K PTSD %D 2020 %7 11.12.2020 %9 Review %J J Med Internet Res %G English %X Background: Intimate partner violence (IPV) is a major public health concern. eHealth interventions may reduce exposure to violence and health-related consequences as the technology provides a safe and flexible space for the target population. However, the evidence is unclear. Objective: The goal of the review is to examine the effect of eHealth interventions compared with standard care on reducing IPV, depression, and posttraumatic stress disorder (PTSD) among women exposed to IPV. Methods: We searched EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, PsycInfo, Scopus, Global Health Library, ClinicalTrials.gov, and International Clinical Trials Registry Platform for published and unpublished trials from inception until April 2019. Trials with an eHealth intervention targeting women exposed to violence were included. We assessed risk of bias using the Cochrane Risk of Bias Tool. Trials that reported effect estimates on overall IPV; physical, sexual, and psychological violence; depression; or posttraumatic stress disorder were included in meta-analyses. Results: A total of 14 trials were included in the review; 8 published trials, 3 unpublished trials and 3 ongoing trials. Of the 8 published trials, 2 were judged as overall low risk of bias trials. The trials reported 23 types of outcomes, and 7 of the trials had outcomes that were eligible for meta-analyses. Our pooled analyses found no effect of eHealth interventions on any of our prespecified outcomes: overall IPV (SMD –0.01; 95% CI –0.11 to 0.08; I2=0%; 5 trials, 1668 women); physical violence (SMD 0.01; 95% CI –0.22 to 0.24; I2=58%; 4 trials, 1128 women); psychological violence (SMD 0.07; 95% CI –0.12 to 0.25; I2=40%; 4 trials, 1129 women); sexual violence (MD 0.36; 95% CI –0.18 to 0.91; I2=0%; 2 trials, 1029 women); depression (SMD –0.13; 95% CI –0.37 to 0.11; I2=78%; 5 trials, 1600 women); and PTSD (MD –0.11; 95% CI –1.04 to 0.82; I2=0%; 5 trials, 1267 women). Conclusions: There is no evidence from randomized trials of a beneficial effect of eHealth interventions on IPV. More high-quality trials are needed, and we recommend harmonizing outcome reporting in IPV trials by establishing core outcome sets. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019130124; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=130124 %M 33306030 %R 10.2196/22361 %U http://www.jmir.org/2020/12/e22361/ %U https://doi.org/10.2196/22361 %U http://www.ncbi.nlm.nih.gov/pubmed/33306030 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e20940 %T Long-Term Outcomes of the Good School Toolkit Primary School Violence Prevention Intervention Among Adolescents: Protocol for a Nonrandomized Quasi-Experimental Study %A Knight,Louise %A Atuhaire,Lydia %A Allen,Elizabeth %A Namy,Sophie %A Anton-Erxleben,Katharina %A Nakuti,Janet %A Mirembe,Angel Faridah %A Nakiboneka,Mastula %A Seeley,Janet %A Weiss,Helen A %A Parkes,Jenny %A Bonell,Chris %A Naker,Dipak %A Devries,Karen %+ London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom, 44 020 7636 8636, Louise.Knight@lshtm.ac.uk %K violence %K long-term follow-up %K whole-school %K intervention %K adolescents %K Uganda %K resilience %K non-randomised %D 2020 %7 7.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Violence against children in schools is a global public health problem. There is growing evidence that school-based interventions can be effective in reducing violence against children in schools. However, there is little evidence on the long-term impact of such interventions. The Good School Toolkit, developed by Raising Voices, a Uganda-based nonprofit organization, is a whole-school violence prevention intervention that aims to change the operational culture of primary schools. In 2014, the Good School Toolkit was evaluated through a cluster randomized controlled trial (Good Schools Study) and found to reduce teacher-to-student and student-to-student violence. Objective: This protocol describes quantitative analyses to explore long-term outcomes of the Good School Toolkit intervention among adolescents in Uganda, including the extent to which it is associated with peer-violence victimization (primary outcome) and peer-violence perpetration, intimate-partner violence, acceptance of teacher-violence, equitable gender attitudes, agency, self-regulation, peer connectedness, social assets, psychological assets, and retention in school (secondary outcomes). Methods: This is a nonrandomized quasi-experimental 4-year follow-up study of adolescents who attended the 42 Good Schools Study primary schools in 2014; 21 schools initiated the Good School Toolkit intervention during the trial from 2012, and 19 schools initiated the intervention after the trial (during the later delivery phase) from 2015; 2 schools did not implement the intervention. Students in the final school grade (Primary 7) during 2014 of the 19 primary schools in the later delivery phase are expected to have left school prior to toolkit delivery in 2015. Wave 1 data were collected in 2014 from 3431 grade Primary 5 to Primary 7 school students aged 11-14 years; these students were followed up in 2018-2019 when aged 16-19 years and invited to participate in the Wave 2 survey. Data were collected in face-to-face interviews by trained Ugandan field researchers. Toolkit exposure groups are defined as exposed during the Good Schools Study trial (from 2012), as exposed during later delivery (from 2015), or not exposed including those expected to have completed Primary 7 prior to later delivery or from the 2 schools that did not implement the toolkit. Associations between outcomes at Wave 2 and toolkit exposure groups will be analyzed using mixed-effect multivariable logistic and linear regression models for binary and continuous outcomes, respectively. This analysis is exploratory and aims to generate hypotheses on if, and under what circumstances, the toolkit influences later adolescent outcomes. Results: Data collection was completed in August 2019. Conclusions: To our knowledge, this is the first long-term follow-up study of adolescents exposed to a school-based violence-prevention intervention in sub-Saharan Africa. If the intervention reduces violence and improves other outcomes in later adolescence, then this study supports primary school interventions as key to achieving long-term population impacts. The pattern of effects will inform where reinforced or additional interventions are needed. International Registered Report Identifier (IRRID): DERR1-10.2196/20940 %M 33283762 %R 10.2196/20940 %U https://www.researchprotocols.org/2020/12/e20940 %U https://doi.org/10.2196/20940 %U http://www.ncbi.nlm.nih.gov/pubmed/33283762 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e18190 %T The Role of Stress and Genital Immunity in Sexual Trauma and HIV Susceptibility Among Adolescent Girls and Adult Women (The THRIVE Study): Protocol for a Longitudinal Case-Control Study %A Stockman,Jamila K %A Anderson,Katherine M %A Karris,Maile Y %A Benson,Constance A %A Tsuyuki,Kiyomi %A Granger,Douglas A %A Weber,Akilah %A Ghosh,Mimi %+ Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, , United States, 1 92093 0507, jstockman@health.ucsd.edu %K sexual trauma %K sexual violence %K forced sex %K HIV risk %K stress %K genital immunity %K adolescent girls %K adult women %K United States %K case-control %K longitudinal %D 2020 %7 7.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: The relationship between sexual violence and HIV risk has been extensively documented through social and behavioral research; however, the underlying biological mechanisms are poorly understood. Objective: The purpose of the THRIVE (Trauma and HIV Risk: Investigating Stress and the Immune Disruption of the Vaginal Environment) Study is to examine the impact of sexual trauma due to sexual violence on HIV susceptibility through dysregulation of soluble inflammatory and anti-inflammatory and anti-HIV biomarkers in the female genital tract and dysregulation of the hypothalamic-pituitary-adrenal axis among adolescent girls and adult women. Methods: The THRIVE Study is a longitudinal case-control study conducted in San Diego, CA, among a racially diverse sample. Cases are adolescent girls (aged 14-19 years) or adult women (aged 20-45 years) who have experienced forced vaginal penetration by a phallus perpetrated by a man within the past 15 days. Controls are adolescent girls or adult women who have engaged in consensual vaginal sex with a man within the past 15 days. At baseline and 1- and 3-month follow-up study visits, participants undergo a urine-based pregnancy test; venipuncture blood draw for HIV, C-reactive protein, adrenocorticotropic hormone, and progesterone testing; a 45-min interviewer-administered computer survey; and cervicovaginal lavage to measure proinflammatory and anti-inflammatory and anti-HIV soluble immune biomarkers. After each study visit, participants self-collect saliva specimens (upon waking, 30 min after waking, and 45 min after waking) at home for 3 consecutive days, which are later assayed for cortisol and dehydroepiandrosterone sulfate. Participants receive compensation at each study visit and for the return of saliva specimens, and a list of local medical and support services. Study procedures use trauma-informed care methods, given the sensitive nature of the study and enrollment of women in the acute phase after sexual trauma. All research staff and investigators adhere to ethical principles and guidelines in the conduct of research activities. Data will be analyzed for descriptive and inferential analyses. Results: The recruitment of participants is ongoing. The publication of the first results is expected by late 2021. Conclusions: The THRIVE Study will provide foundational knowledge on how sexual trauma due to sexual violence increases susceptibility to HIV acquisition via alterations in cervicovaginal immune regulation and the psychobiology of the stress responses. These findings will inform future research on mechanistic models of in vitro and in vivo injury and cervicovaginal wound healing processes, which may lead to the development of nonvaccine biomedical HIV prevention products for girls and women. International Registered Report Identifier (IRRID): DERR1-10.2196/18190 %M 32903198 %R 10.2196/18190 %U https://www.researchprotocols.org/2020/12/e18190 %U https://doi.org/10.2196/18190 %U http://www.ncbi.nlm.nih.gov/pubmed/32903198 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e23579 %T How Internet Contracts Impact Research: Content Analysis of Terms of Service on Consumer Product Websites %A Weiger,Caitlin %A Smith,Katherine C %A Cohen,Joanna E %A Dredze,Mark %A Moran,Meghan Bridgid %+ Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States, 1 (410) 955 3543, cweiger2@jhmi.edu %K marketing %K contracts %K internet %K jurisprudence %K ethics %D 2020 %7 2.12.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Companies use brand websites as a promotional tool to engage consumers on the web, which can increase product use. Given that some products are harmful to the health of consumers, it is important for marketing associated with these products to be subject to public health surveillance. However, terms of service (TOS) governing the use of brand website content may impede such important research. Objective: The aim of this study is to explore the TOS for brand websites with public health significance to assess possible legal and ethical challenges for conducting research on consumer product websites. Methods: Using Statista, we purposefully constructed a sample of 15 leading American tobacco, alcohol, psychiatric pharmaceutical, fast-food, and gun brands that have associated websites. We developed and implemented a structured coding system for the TOS on these websites and coded for the presence versus absence of different types of restriction that might impact the ability to conduct research. Results: All TOS stated that by accessing the website, users agreed to abide by the TOS (15/15, 100%). A total of 11 out of 15 (73%) websites had age restrictions in their TOS. All alcohol brand websites (5/15, 33%) required users to enter their age or date of birth before viewing website content. Both websites for tobacco brands (2/15, 13%) further required that users register and verify their age and identity to access any website content and agree that they use tobacco products. Only one website (1/15, 7%) allowed users to display, download, copy, distribute, and translate the website content as long as it was for personal and not commercial use. A total of 33% (5/15) of TOS unconditionally prohibited or put substantial restrictions on all of these activities and/or failed to specify if they were allowed or prohibited. Moreover, 87% (13/15) of TOS indicated that website access could be restricted at any time. A total of 73% (11/15) of websites specified that violating TOS could result in deleting user content from the website, revoking access by having the user’s Internet Protocol address blocked, terminating log-in credentials, or enforcing legal action resulting in civil or criminal penalties. Conclusions: TOS create complications for public health surveillance related to e-marketing on brand websites. Recent court opinions have reduced the risk of federal criminal charges for violating TOS on public websites, but this risk remains unclear for private websites. The public health community needs to establish standards to guide and protect researchers from the possibility of legal repercussions related to such efforts. %M 33263555 %R 10.2196/23579 %U http://publichealth.jmir.org/2020/4/e23579/ %U https://doi.org/10.2196/23579 %U http://www.ncbi.nlm.nih.gov/pubmed/33263555 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 11 %P e23819 %T Development and Validation of a Scale to Measure Intimate Partner Violence Among Transgender and Gender Diverse Populations: Protocol for a Linear Three-Phase Study (Project Empower) %A Stephenson,Rob %A Todd,Kieran %A Gamarel,Kristi E %A Bonar,Erin E %A Peitzmeier,Sarah %+ Center for Sexuality and Health Disparities and The School of Nursing, University of Michigan, 400 North Ingalls, Ann Arbor, MI, 48109, United States, 1 7346150149, rbsteph@umich.edu %K intimate partner violence %K transgender %K scale %D 2020 %7 26.11.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Intimate partner violence (IPV) is approximately twice as prevalent among transgender and gender diverse individuals (those whose current gender identity does not match their sex assigned at birth) than among cisgender individuals (those whose gender aligns with their sex assigned at birth). However, most existing scales measuring IPV are not validated among transgender and gender diverse populations and do not consider the unique forms of IPV experienced by transgender and gender diverse individuals. Objective: This paper describes the protocol for Project Empower, a study that seeks to develop and validate a new scale to measure IPV as experienced by transgender and gender diverse adults. A new scale is necessary to improve the accuracy of IPV measurement among transgender and gender diverse populations and may inform the current tools used to screen and link to services for transgender and gender diverse people who experience or perpetrate IPV. Methods: The proposed new scale will be developed by a linear three-phase process. In Phase I, we will recruit a maximum of 110 transgender and gender diverse participants to participate in in-depth interviews and focus groups. Phase I will collect qualitative data on the experiences of IPV among transgender and gender individuals. After generating scale items from the qualitative data in Phase I, Phase II will conduct up to 10 cognitive interviews to examine understanding of scale items and refine wording. Phase III will then conduct a survey with an online recruited sample of 700 transgender and gender diverse individuals to validate the scale using factor analysis and examine the prevalence, antecedents, and linked health outcomes of IPV. This study will generate the first comprehensive IPV scale including trans-specific IPV tactics that has undergone robust mixed-methods validation for use in transgender and gender diverse populations, regardless of sex assigned at birth. Results: Project Empower launched in August 2019, with Phases I and II expected to be complete by late 2020. Phase III (survey of 700 transgender individuals) is expected to be launched in January 2021. Conclusions: A scale that more accurately captures the forms of IPV experienced by transgender and gender diverse people not only has the potential to lead to more accurate measurements of prevalence but also can identify unique forms of violence that may form the basis of IPV prevention interventions. Additionally, identifying the forms of IPV experienced by transgender and gender diverse people has the potential to lead to the refinement of clinical screening tools used to identify and refer those who experience and perpetrate violence in clinical settings. International Registered Report Identifier (IRRID): DERR1-10.2196/23819 %M 33242022 %R 10.2196/23819 %U http://www.researchprotocols.org/2020/11/e23819/ %U https://doi.org/10.2196/23819 %U http://www.ncbi.nlm.nih.gov/pubmed/33242022 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e15347 %T Quantitative Methods for Analyzing Intimate Partner Violence in Microblogs: Observational Study %A Homan,Christopher Michael %A Schrading,J Nicolas %A Ptucha,Raymond W %A Cerulli,Catherine %A Ovesdotter Alm,Cecilia %+ Rochester Institute of Technology, 102 Lomb Memorial Dr, Rochester, NY, 14623-5608, United States, 1 5857196835, cmh@cs.rit.edu %K intimate partner violence %K social media %K natural language processing %D 2020 %7 19.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media is a rich, virtually untapped source of data on the dynamics of intimate partner violence, one that is both global in scale and intimate in detail. Objective: The aim of this study is to use machine learning and other computational methods to analyze social media data for the reasons victims give for staying in or leaving abusive relationships. Methods: Human annotation, part-of-speech tagging, and machine learning predictive models, including support vector machines, were used on a Twitter data set of 8767 #WhyIStayed and #WhyILeft tweets each. Results: Our methods explored whether we can analyze micronarratives that include details about victims, abusers, and other stakeholders, the actions that constitute abuse, and how the stakeholders respond. Conclusions: Our findings are consistent across various machine learning methods, which correspond to observations in the clinical literature, and affirm the relevance of natural language processing and machine learning for exploring issues of societal importance in social media. %M 33211021 %R 10.2196/15347 %U http://www.jmir.org/2020/11/e15347/ %U https://doi.org/10.2196/15347 %U http://www.ncbi.nlm.nih.gov/pubmed/33211021 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 11 %P e19162 %T Posttraumatic Stress Disorder and Neuroprogression in Women Following Sexual Assault: Protocol for a Randomized Clinical Trial Evaluating Allostatic Load and Aging Process Acceleration %A Coimbra,Bruno Messina %A Yeh,Mary %A D'Elia,Ana Teresa %A Maciel,Mariana Rangel %A Carvalho,Carolina Muniz %A Milani,Ana Carolina %A Mozzambani,Adriana %A Juruena,Mario %A Belangero,Sintia Iole %A Jackowski,Andrea Parolin %A Poyares,Dalva %A Mello,Andrea Feijo %A Mello,Marcelo Feijo %+ Program for Research and Care on Violence and PTSD, Universidade Federal de São Paulo, Rua Major Maragliano 241, São Paulo, 04017030, Brazil, 55 1155764990 ext 1064, feijomellom@me.com %K PTSD %K neuroprogression %K allostatic load %K sexual assault %K trauma %K thematic research %K randomized clinical trial %K aging %D 2020 %7 18.11.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Posttraumatic stress disorder (PTSD) is a prevalent, chronic, and severe disorder related to traumatic events. Women are disproportionately affected by PTSD than men and are more at risk in the occurrence of sexual assault victimization. Estimates suggest that 50% of women develop PTSD following sexual assault and successful clinical management can be challenging. Growing evidence has implicated neural, immune, and endocrine alterations underpinning PTSD, but only few studies have assessed the evolution of acute PTSD in women. Objective: This study aims to measure whether the onset of PTSD is associated with accelerated aging in women following sexual assault. We hypothesize that the increase of allostatic load caused by PTSD leads to neuroprogression. We will implement a randomized clinical trial to compare responses to treatment with either interpersonal psychotherapy adapted for PTSD (IPT-PTSD) or the selective serotonin reuptake inhibitor sertraline. Methods: We will include women between 18 and 45 years of age, who experienced sexual assault from 1 to 6 months before the initial evaluation, and present with a Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnosis of PTSD. Baseline evaluation will comprise clinical and psychometric assessments, structural and functional magnetic resonance imaging, neuropsychological testing, polysomnography, evaluation of immune and endocrine parameters, and genetic analyses. Age-matched female healthy controls will be included and subjected to the same evaluation. Patients will be randomized for treatment in 1 of the 2 arms of the study for 14 weeks; follow-up will continue until 1 year after inclusion via treatment as usual. The researchers will collect clinical and laboratory data during periodic clinical assessments up to 1-year follow-up. Results: Data collection started in early 2016 and will be completed by the end of the first semester of 2020. Analyses will be performed soon afterward, followed by the elaboration of several articles. Articles will be submitted in early 2021. This research project has obtained a grant from the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP 2014/12559-5). Conclusions: We expect to provide insight into the consequences of recent sexual assault exposure in women by investigating the degree of neuroprogression developing from an early stage of PTSD. We also expect to provide important evidence on the efficacy of a non-exposure psychotherapy (IPT-PTSD) to mitigate PTSD symptoms in recently sexually assaulted women. Further, we aim to obtain evidence on how treatment outcomes are associated with neuroprogression measures. Trial Registration: Brazilian Clinical Trials Registry RBR-3z474z; http://www.ensaiosclinicos.gov.br/rg/RBR-3z474z/ International Registered Report Identifier (IRRID): DERR1-10.2196/19162 %M 33206061 %R 10.2196/19162 %U http://www.researchprotocols.org/2020/11/e19162/ %U https://doi.org/10.2196/19162 %U http://www.ncbi.nlm.nih.gov/pubmed/33206061 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e24361 %T The Hidden Pandemic of Family Violence During COVID-19: Unsupervised Learning of Tweets %A Xue,Jia %A Chen,Junxiang %A Chen,Chen %A Hu,Ran %A Zhu,Tingshao %+ Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St W, Toronto, ON, M5S 1V4, Canada, 1 416 946 5429, jia.xue@utoronto.ca %K Twitter %K family violence %K COVID-19 %K machine learning %K big data %K infodemiology %K infoveillance %D 2020 %7 6.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Family violence (including intimate partner violence/domestic violence, child abuse, and elder abuse) is a hidden pandemic happening alongside COVID-19. The rates of family violence are rising fast, and women and children are disproportionately affected and vulnerable during this time. Objective: This study aims to provide a large-scale analysis of public discourse on family violence and the COVID-19 pandemic on Twitter. Methods: We analyzed over 1 million tweets related to family violence and COVID-19 from April 12 to July 16, 2020. We used the machine learning approach Latent Dirichlet Allocation and identified salient themes, topics, and representative tweets. Results: We extracted 9 themes from 1,015,874 tweets on family violence and the COVID-19 pandemic: (1) increased vulnerability: COVID-19 and family violence (eg, rising rates, increases in hotline calls, homicide); (2) types of family violence (eg, child abuse, domestic violence, sexual abuse); (3) forms of family violence (eg, physical aggression, coercive control); (4) risk factors linked to family violence (eg, alcohol abuse, financial constraints, guns, quarantine); (5) victims of family violence (eg, the LGBTQ [lesbian, gay, bisexual, transgender, and queer or questioning] community, women, women of color, children); (6) social services for family violence (eg, hotlines, social workers, confidential services, shelters, funding); (7) law enforcement response (eg, 911 calls, police arrest, protective orders, abuse reports); (8) social movements and awareness (eg, support victims, raise awareness); and (9) domestic violence–related news (eg, Tara Reade, Melissa DeRosa). Conclusions: This study overcomes limitations in the existing scholarship where data on the consequences of COVID-19 on family violence are lacking. We contribute to understanding family violence during the pandemic by providing surveillance via tweets. This is essential for identifying potentially useful policy programs that can offer targeted support for victims and survivors as we prepare for future outbreaks. %M 33108315 %R 10.2196/24361 %U http://www.jmir.org/2020/11/e24361/ %U https://doi.org/10.2196/24361 %U http://www.ncbi.nlm.nih.gov/pubmed/33108315 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e17424 %T Natural Language Processing Tools for Assessing Progress and Outcome of Two Veteran Populations: Cohort Study From a Novel Online Intervention for Posttraumatic Growth %A Norman,Kim P %A Govindjee,Anita %A Norman,Seth R %A Godoy,Michael %A Cerrone,Kimberlie L %A Kieschnick,Dustin W %A Kassler,William %+ Young Adult and Family Center, UCSF Weill Institute for Neurosciences, University of California, 401 Parnassus Ave, San Francisco, CA, 94143, United States, 1 415 476 7402, kim.norman@ucsf.edu %K natural language analysis %K emotional tone %K personality %K values %K PTSD %K military sexual trauma %K online interventions %K internet-based cognitive behavioral therapy %K narrative therapy %K mindfulness %D 2020 %7 23.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Over 100 million Americans lack affordable access to behavioral health care. Among these, military veterans are an especially vulnerable population. Military veterans require unique behavioral health services that can address military experiences and challenges transitioning to the civilian sector. Real-world programs to help veterans successfully transition to civilian life must build a sense of community, have the ability to scale, and be able to reach the many veterans who cannot or will not access care. Digitally based behavioral health initiatives have emerged within the past few years to improve this access to care. Our novel behavioral health intervention teaches mindfulness-based cognitive behavioral therapy and narrative therapy using peer support groups as guides, with human-facilitated asynchronous online discussions. Our study applies natural language processing (NLP) analytics to assess effectiveness of our online intervention in order to test whether NLP may provide insights and detect nuances of personal change and growth that are not currently captured by subjective symptom measures. Objective: This paper aims to study the value of NLP analytics in assessing progress and outcomes among combat veterans and military sexual assault survivors participating in novel online interventions for posttraumatic growth. Methods: IBM Watson and Linguistic Inquiry and Word Count tools were applied to the narrative writings of combat veterans and survivors of military sexual trauma who participated in novel online peer-supported group therapies for posttraumatic growth. Participants watched videos, practiced skills such as mindfulness meditation, told their stories through narrative writing, and participated in asynchronous, facilitated online discussions with peers. The writings, including online postings, by the 16 participants who completed the program were analyzed after completion of the program. Results: Our results suggest that NLP can provide valuable insights on shifts in personality traits, personal values, needs, and emotional tone in an evaluation of our novel online behavioral health interventions. Emotional tone analysis demonstrated significant decreases in fear and anxiety, sadness, and disgust, as well as increases in joy. Significant effects were found for personal values and needs, such as needing or desiring closeness and helping others, and for personality traits of openness, conscientiousness, extroversion, agreeableness, and neuroticism (ie, emotional range). Participants also demonstrated increases in authenticity and clout (confidence) of expression. NLP results were generally supported by qualitative observations and analysis, structured data, and course feedback. Conclusions: The aggregate of results in our study suggest that our behavioral health intervention was effective and that NLP can provide valuable insights on shifts in personality traits, personal values, and needs, as well as measure changes in emotional tone. NLP’s sensitivity to changes in emotional tone, values, and personality strengths suggests the efficacy of NLP as a leading indicator of treatment progress. %M 32769074 %R 10.2196/17424 %U https://formative.jmir.org/2020/9/e17424 %U https://doi.org/10.2196/17424 %U http://www.ncbi.nlm.nih.gov/pubmed/32769074 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 9 %P e19881 %T Game-Based Meditation Therapy to Improve Posttraumatic Stress and Neurobiological Stress Systems in Traumatized Adolescents: Protocol for a Randomized Controlled Trial %A Schuurmans,Angela A T %A Nijhof,Karin S %A Scholte,Ron %A Popma,Arne %A Otten,Roy %+ Behavioural Science Institute, Radboud University, Montessorilaan 3, Nijmegen, 6525 HR, Netherlands, 31 24 361 61 61, angela.anna.schuurmans@gmail.com %K Adolescents %K Autonomic nervous system %K Cortisol %K Meditation %K Neurofeedback %K Posttraumatic stress %K Randomized controlled trial %K Trauma %D 2020 %7 23.9.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Many adolescents in residential care have been exposed to prolonged traumatic experiences such as violence, neglect, or abuse. Consequently, they suffer from posttraumatic stress. This not only negatively affects psychological and behavioral outcomes (eg, increased anxiety, depression, and aggression) but also has adverse effects on physiological outcomes, in particular on their neurobiological stress systems. Although current evidence-based treatment options are effective, they have their limitations. An alternative to traditional trauma treatment is meditation-based treatment that focuses on stress regulation and relaxation. Muse is a game-based meditation intervention that makes use of adolescents’ intrinsic motivation. The neurofeedback element reinforces relaxation abilities. Objective: This paper describes the protocol for a randomized controlled trial in which the goal is to examine the effectiveness of Muse (InteraXon Inc) in reducing posttraumatic stress and normalizing neurobiological stress systems in a sample of traumatized adolescents in residential care. Methods: This will be a multicenter, multi-informant, and multimethod randomized controlled trial. Participants will be adolescents (N=80), aged 10 to 18 years, with clinical levels of posttraumatic symptoms, who are randomized to receive either the Muse therapy sessions and treatment as usual (intervention) or treatment as usual alone (control). Data will be collected at 3 measurement instances: pretest (T1), posttest (T2), and at 2-month follow-up. Primary outcomes will be posttraumatic symptoms (self-report and mentor report) and stress (self-report) at posttest. Secondary outcomes will be neurobiological stress parameters under both resting and acute stress conditions, and anxiety, depression, and aggression at posttest. Secondary outcomes also include all measures at 2-month follow-up: posttraumatic symptoms, stress, anxiety, depression aggression, and neurobiological resting parameters. Results: The medical-ethical committee Arnhem-Nijmegen (NL58674.091.16) approved the trial on November 15, 2017. The study was registered on December 2, 2017. Participant enrollment started in January 2018, and the results of the study are expected to be published in spring or summer 2021. Conclusions: Study results will demonstrate whether game-based meditation therapy improves posttraumatic stress and neurobiological stress systems, and whether it is more effective than treatment as usual alone for traumatized adolescents. Trial Registration: Netherlands Trial Register NL6689 (NTR6859); https://www.trialregister.nl/trial/6689 International Registered Report Identifier (IRRID): DERR1-10.2196/19881 %M 32965226 %R 10.2196/19881 %U http://www.researchprotocols.org/2020/9/e19881/ %U https://doi.org/10.2196/19881 %U http://www.ncbi.nlm.nih.gov/pubmed/32965226 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e15866 %T Designing an Information and Communications Technology Tool With and for Victims of Violence and Their Case Managers in San Francisco: Human-Centered Design Study %A Patel,Devika %A Sarlati,Siavash %A Martin-Tuite,Patrick %A Feler,Joshua %A Chehab,Lara %A Texada,Michael %A Marquez,Ruben %A Orellana,F Julia %A Henderson,Terrell L %A Nwabuo,Adaobi %A Plevin,Rebecca %A Dicker,Rochelle Ami %A Juillard,Catherine %A Sammann,Amanda %+ Department of Surgery, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, United States, 1 (628) 206 3764, devika.patel@ucsf.edu %K human-centered design %K violence intervention %K information and communications technology %D 2020 %7 24.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Violence is a public health problem. Hospital-based violence intervention programs such as the San Francisco Wraparound Project (WAP) have been shown to reduce future violent injury. The WAP model employs culturally competent case managers who recruit and enroll violently injured patients as clients. Client acceptance of the WAP intervention is variable, and program success depends on streamlined, timely communication and access to resources. High rates of smartphone usage in populations who are at risk for violent reinjury create an opportunity to design a tailored information and communications technology (ICT) tool to support hospital-based violence intervention programs. Objective: Current evidence shows that ICT tools developed in the health care space may not be successful in engaging vulnerable populations. The goal of this study was to use human-centered design methodology to identify the unique communication needs of the clients and case managers at WAP to design a mobile ICT. Methods: We conducted 15 semi-structured interviews with users: clients, their friends and families, case managers, and other stakeholders in violence intervention and prevention. We used a human-centered design and general inductive approach to thematic analysis to identify themes in the qualitative data, which were extrapolated to insight statements and then reframed into design opportunities. Wireframes of potential mobile ICT app screens were developed to depict these opportunities. Results: Thematic analysis revealed four main insights that were characterized by the opposing needs of our users. (1) A successful relationship is both professional and personal. Clients need this around the clock, but case managers can only support this while on the clock. (2) Communications need to feel personal, but they do not always need to be personalized. (3) Healing is a journey of skill development and lifestyle changes that must be acknowledged, monitored, and rewarded. (4) Social networks need to provide peer support for healing rather than peer pressure to propagate violence. These insights resulted in the following associated design opportunities: (1) Maximize personal connection while controlling access, (2) allow case managers to personalize automated client interactions, (3) hold clients accountable to progress and reward achievements, and (4) build a connected, yet confidential community. Conclusions: Human-centered design enabled us to identify unique insights and design opportunities that may inform the design of a novel and tailored mobile ICT tool for the WAP community. %M 32831179 %R 10.2196/15866 %U http://mhealth.jmir.org/2020/8/e15866/ %U https://doi.org/10.2196/15866 %U http://www.ncbi.nlm.nih.gov/pubmed/32831179 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e19831 %T Digital or Digitally Delivered Responses to Domestic and Intimate Partner Violence During COVID-19 %A Emezue,Chuka %+ Sinclair School of Nursing, University of Missouri-Columbia, S235 School of Nursing, Columbia, MO, 65211, United States, 1 573 999 2594, chukanestor@gmail.com %K COVID-19 %K pandemic %K mental health %K digital interventions %K technology %K coronavirus %K domestic violence %K prevention %K abuse %K intimate partner violence %D 2020 %7 30.7.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Before the coronavirus disease (COVID-19), 1 in 3 women and girls, globally, were victimized by an abusive partner in intimate relationships. However, the current pandemic has amplified cases of domestic violence (DV) against women and girls, with up to thrice the prevalence in DV cases compared to the same time last year. Evidence of the adverse effects of the pandemic on DV is still emerging, even as violence prevention strategies are iteratively being refined by service providers, advocacy agencies, and survivors to meet stay-at-home mandates. Emotional and material support for survivors is a critical resource increasingly delivered using digital and technology-based modalities, which offer several advantages and challenges. This paper rapidly describes current DV mitigation approaches using digital solutions, signaling emerging best practices to support survivors, their children, and abusers during stay-at-home advisories. Some examples of technology-based strategies and solutions are presented. An immediate priority is mapping out current digital solutions in response to COVID-19–related DV and outlining issues with uptake, coverage, and meaningful use of digital solutions. %M 32678797 %R 10.2196/19831 %U http://publichealth.jmir.org/2020/3/e19831/ %U https://doi.org/10.2196/19831 %U http://www.ncbi.nlm.nih.gov/pubmed/32678797 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e13294 %T Classification and Prediction of Violence Against Chinese Medical Staff on the Sina Microblog Based on a Self-Organizing Map: Quantitative Study %A Duan,Guimin %A Liao,Xin %A Yu,Weiping %A Li,Guihua %+ School of Public Affairs and Law, Southwest Jiaotong University, No 111, First Section, North of Second Ring Road, Chengdu, Sichuan, 610031, China, 86 17761305794, liao_shane@163.com %K workplace violence %K medical staff %K social media %D 2020 %7 26.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: For the last decade, doctor-patient contradiction in China has remained prominent, and workplace violence toward medical staff still occurs frequently. However, little is known about the types and laws of propagation of violence against medical staff online. Objective: By using a self-organizing map (SOM), we aimed to explore the microblog propagation law for violent incidents in China that involve medical staff, to classify the types of incidents and provide a basis for rapidly and accurately predicting trends in public opinion and developing corresponding measures to improve the relationship between doctors and patients. Methods: For this study, we selected 60 cases of violent incidents in China involving medical staff that led to heated discussions on the Sina microblog from 2011 to 2018, searched the web data of the microblog using crawler software, recorded the amount of new tweets every 2 hours, and used the SOM neural network to cluster the number of tweets. Polynomial and exponential functions in MATLAB software were applied to predict and analyze the data. Results: Trends in the propagation of online public opinion regarding the violent incidents were categorized into 8 types: bluff, waterfall, zigzag, steep, abrupt, wave, steep slope, and long slope. The communications exhibited different characteristics. The prediction effect of 4 types of incidents (ie, bluff, waterfall, zigzag, and steep slope) was good and accorded with actual spreading trends. Conclusions: Our study found that the more serious the consequences of a violent incident, such as a serious injury or death, the more attention it drew on the microblog, the faster was its propagation speed, and the longer was its duration. In these cases, the propagation types were mostly steep slope, long slope, and zigzag. In addition, the more serious the consequences of a violent incident, the higher popularity it exhibited on the microblog. The popularity within a week was significantly higher for acts resulting from patients’ dissatisfaction with treatments than for acts resulting from nontherapeutic incidents. %M 32348253 %R 10.2196/13294 %U http://www.jmir.org/2020/5/e13294/ %U https://doi.org/10.2196/13294 %U http://www.ncbi.nlm.nih.gov/pubmed/32348253 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e16828 %T Midwives’ Attitudes Toward and Experience With a Tablet Intervention to Promote Safety Behaviors for Pregnant Women Reporting Intimate Partner Violence: Qualitative Study %A Garnweidner-Holme,Lisa %A Henriksen,Lena %A Flaathen,Eva Marie %A Klette Bøhler,Tone %A Lukasse,Mirjam %+ Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, PB 4 St. Olavs plass, Oslo, 0130, Norway, 47 48091956, lgarnwei@oslomet.no %K intimate partner violence %K mHealth %K attitudes %K midwives %K prenatal care %D 2020 %7 20.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Violence against women is considered a global health problem, and intimate partner violence (IPV) around the time of childbirth can have severe consequences for mother and child. Prenatal care is considered a window of opportunity to address IPV and ask women about exposure to violence since women are in regular contact with health care providers. Mobile health (mHealth) interventions might overcome the barriers to talking about IPV face-to-face. Objective: Our objective was to explore midwives’ attitudes toward a tablet intervention consisting of information about IPV and safety behaviors as well as their experiences with recruiting pregnant women of different ethnic backgrounds in a randomized controlled trial (RCT). Methods: Individual interviews were conducted with 9 midwives who recruited participants for an RCT to test a video to promote safety behaviors delivered on a tablet during prenatal care. Analysis was guided by thematic analysis. Results: Midwives perceived the tablet intervention as an appropriate supplement during prenatal care to provide information about IPV and promote safety behaviors. They participated in the RCT primarily to obtain more knowledge regarding how to communicate about IPV. The intervention was perceived as an anonymous door-opener to talk about IPV and a good solution to ensure that every woman gets the same information. However, the content of the intervention had to be trustworthy and align with the information the midwives provide to women. Given the sensitivity of IPV, midwives outlined the importance of following the intervention with face-to-face communication. Midwives reported technical problems and a high demand on their time as the main challenges to recruiting women. They experienced challenges recruiting women of different ethnic backgrounds due to linguistic barriers and the women’s skepticism about scientific research. Conclusions: The tablet intervention might help midwives communicate about IPV. Although the video was considered as an anonymous door-opener to talk about IPV, midwives outlined the importance of following the intervention with face-to-face communication. The scarcity of midwives’ time during consultations has to be considered when implementing the intervention. Further research is needed to overcome barriers that limit inclusion of women from different ethnic backgrounds. Trial Registration: ClinicalTrials.gov NCT03397277; https://clinicaltrials.gov/ct2/show/NCT03397277 %M 32432553 %R 10.2196/16828 %U http://mhealth.jmir.org/2020/5/e16828/ %U https://doi.org/10.2196/16828 %U http://www.ncbi.nlm.nih.gov/pubmed/32432553 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e15736 %T Characteristics of Gun Advertisements on Social Media: Systematic Search and Content Analysis of Twitter and YouTube Posts %A Jordan,Lisa %A Kalin,James %A Dabrowski,Colleen %+ Drew University, 36 Madison Ave, Madison, NJ, 07940 1434, United States, 1 9734083740, ljordan@drew.edu %K firearms %K advertising %K social media %K internet %K gender identity %D 2020 %7 27.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Although gun violence has been identified as a major public health concern, the scope and significance of internet gun advertising is not known. Objective: This study aimed to quantify the characteristics of gun advertising on social media and to compare the reach of posts by manufacturers with those of influencers. Methods: Using a systematic search, we created a database of recent and popular Twitter and YouTube posts made public by major firearm manufacturers and influencers. From our sample of social media posts, we reviewed the content of the posts on the basis of 19 different characteristics, such as type of gun, presence of women, and military or police references. Our content analysis summarized statistical differences in the information conveyed in posts to compare advertising approaches across social media platforms. Results: Sample posts revealed that firearm manufacturers use social media to attract audiences to websites that sell firearms: 14.1% (131/928; ±2.9) of Twitter posts, 53.6% (228/425; ±6.2) of YouTube videos, and 89.5% (214/239; ±5.1) of YouTube influencer videos link to websites that facilitate sales. Advertisements included women in efforts to market handguns and pistols for the purpose of protection: videos with women included protection themes 2.5 times more often than videos without women. Top manufacturers of domestic firearms received 98 million channel views, compared with 6.1 billion channel views received by the top 12 YouTube influencers. Conclusions: Firearm companies use social media as an advertising platform to connect viewers to websites that sell guns. Gun manufacturers appropriate YouTube servers, video streaming services, and the work of YouTube influencers to reach large audiences to promote the widespread sale of consumer firearms. YouTube and Twitter subsidize gun advertising by offering server and streaming services at no cost to gun manufacturers, to the commercial benefit of Google and Twitter’s corporate ownership. %M 32217496 %R 10.2196/15736 %U http://www.jmir.org/2020/3/e15736/ %U https://doi.org/10.2196/15736 %U http://www.ncbi.nlm.nih.gov/pubmed/32217496 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e15828 %T The mPOWERED Electronic Learning System for Intimate Partner Violence Education: Mixed Methods Usability Study %A Hughes,Charmayne %A Musselman,Elaine A %A Walsh,Lilia %A Mariscal,Tatiana %A Warner,Sam %A Hintze,Amy %A Rashidi,Neela %A Gordon-Murer,Chloe %A Tanha,Tiana %A Licudo,Fahrial %A Ng,Rachel %A Tran,Jenna %+ Health Equity Institute, San Francisco State University, 1600 Holloway Ave, Department of Kinesiology, San Francisco, CA, 94132, United States, 1 4157708121, cmhughes@sfsu.edu %K intimate partner violence %K domestic violence %K nursing education %K learning %D 2020 %7 3.1.2020 %9 Original Paper %J JMIR Nursing %G English %X Background: Nurse practitioners are a common resource for victims of intimate partner violence (IPV) presenting to health care settings. However, they often have inadequate knowledge about IPV and lack self-efficacy and confidence to be able to screen for IPV and communicate effectively with patients. Objective: The aim of this study was to develop and test the usability of a blended learning system aimed at educating nurse practitioner students on topics related to IPV (ie, the mPOWERED system [Health Equity Institute]). Methods: Development of the mPOWERED system involved usability testing with 7 nurse educators (NEs) and 18 nurse practitioner students. Users were asked to complete usability testing using a speak-aloud procedure and then complete a satisfaction and usability questionnaire. Results: Overall, the mPOWERED system was deemed to have high usability and was positively evaluated by both NEs and nurse practitioner students. Respondents provided critical feedback that will be used to improve the system. Conclusions: By including target end users in the design and evaluation of the mPOWERED system, we have developed a blended IPV learning system that can easily be integrated into health care education. Larger-scale evaluation of the pedagogical impact of this system is underway. %M 34345778 %R 10.2196/15828 %U https://nursing.jmir.org/2020/1/e15828 %U https://doi.org/10.2196/15828 %U http://www.ncbi.nlm.nih.gov/pubmed/34345778 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 9 %P e13837 %T The #MeToo Movement in the United States: Text Analysis of Early Twitter Conversations %A Modrek,Sepideh %A Chakalov,Bozhidar %+ Health Equity Institute, San Francisco State University, 1600 Hollaway Avenue HSS 386, San Francisco, CA, 94132, United States, 1 415 405 7556, smodrek@sfsu.edu %K social media %K sexual abuse %K sexual assault %K machine learning %K infodemiology %K infoveillance %D 2019 %7 03.09.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The #MeToo movement sparked an international debate on the sexual harassment, abuse, and assault and has taken many directions since its inception in October of 2017. Much of the early conversation took place on public social media sites such as Twitter, where the hashtag movement began. Objective: The aim of this study is to document, characterize, and quantify early public discourse and conversation of the #MeToo movement from Twitter data in the United States. We focus on posts with public first-person revelations of sexual assault/abuse and early life experiences of such events. Methods: We purchased full tweets and associated metadata from the Twitter Premium application programming interface between October 14 and 21, 2017 (ie, the first week of the movement). We examined the content of novel English language tweets with the phrase “MeToo” from within the United States (N=11,935). We used machine learning methods, least absolute shrinkage and selection operator regression, and support vector machine models to summarize and classify the content of individual tweets with revelations of sexual assault and abuse and early life experiences of sexual assault and abuse. Results: We found that the most predictive words created a vivid archetype of the revelations of sexual assault and abuse. We then estimated that in the first week of the movement, 11% of novel English language tweets with the words “MeToo” revealed details about the poster’s experience of sexual assault or abuse and 5.8% revealed early life experiences of such events. We examined the demographic composition of posters of sexual assault and abuse and found that white women aged 25-50 years were overrepresented in terms of their representation on Twitter. Furthermore, we found that the mass sharing of personal experiences of sexual assault and abuse had a large reach, where 6 to 34 million Twitter users may have seen such first-person revelations from someone they followed in the first week of the movement. Conclusions: These data illustrate that revelations shared went beyond acknowledgement of having experienced sexual harassment and often included vivid and traumatic descriptions of early life experiences of assault and abuse. These findings and methods underscore the value of content analysis, supported by novel machine learning methods, to improve our understanding of how widespread the revelations were, which likely amplified the spread and saliency of the #MeToo movement. %M 31482849 %R 10.2196/13837 %U https://www.jmir.org/2019/9/e13837/ %U https://doi.org/10.2196/13837 %U http://www.ncbi.nlm.nih.gov/pubmed/31482849 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e13868 %T Digital Education of Health Professionals on the Management of Domestic Violence: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration %A Divakar,Ushashree %A Nazeha,Nuraini %A Posadzki,Pawel %A Jarbrink,Krister %A Bajpai,Ram %A Ho,Andy Hau Yan %A Campbell,James %A Feder,Gene %A Car,Josip %+ Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road, Singapore,, Singapore, 65 6340 2480, josip.car@ntu.edu.sg %K systematic reviews %K evidence-based %K health workforce %K domestic violence %D 2019 %7 23.05.2019 %9 Review %J J Med Internet Res %G English %X Background: The World Health Organization states that 35% of women experience domestic violence at least once during their lifetimes. However, approximately 80% of health professionals have never received any training on management of this major public health concern. Objective: The objective of this study was to evaluate the effectiveness of health professions digital education on domestic violence compared to that of traditional ways or no intervention. Methods: Seven electronic databases were searched for randomized controlled trials from January 1990 to August 2017. The Cochrane Handbook guideline was followed, and studies reporting the use of digital education interventions to educate health professionals on domestic violence management were included. Results: Six studies with 631 participants met our inclusion criteria. Meta-analysis of 5 studies showed that as compared to control conditions, digital education may improve knowledge (510 participants and 5 studies; standardized mean difference [SMD] 0.67, 95% CI 0.38-0.95; I2=59%; low certainty evidence), attitudes (339 participants and 3 studies; SMD 0.67, 95% CI 0.25-1.09; I2=68%; low certainty evidence), and self-efficacy (174 participants and 3 studies; SMD 0.47, 95% CI 0.16-0.77; I2=0%; moderate certainty evidence). Conclusions: Evidence of the effectiveness of digital education on health professionals’ understanding of domestic violence is promising. However, the certainty of the evidence is predominantly low and merits further research. Given the opportunity of scaled transformative digital education, both further research and implementation within an evaluative context should be prioritized. %M 31124462 %R 10.2196/13868 %U http://www.jmir.org/2019/5/e13868/ %U https://doi.org/10.2196/13868 %U http://www.ncbi.nlm.nih.gov/pubmed/31124462 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e11306 %T Child Maltreatment Disclosure to a Text Messaging–Based Crisis Service: Content Analysis %A Schwab-Reese,Laura %A Kanuri,Nitya %A Cash,Scottye %+ Department of Health and Kinesiology, Purdue University, Lambert Fieldhouse 106B, 800 W Stadium Ave, West Lafayette, IN, 47907, United States, 1 7654966723, lschwabr@purdue.edu %K child maltreatment %K disclosure %K SMS %K text message %D 2019 %7 25.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Disclosure is a difficult but important process for victims of child maltreatment. There is limited research on child maltreatment disclosure. Young people have been reluctant to disclose victimization to adults, but short message service (SMS) crisis services may represent one novel method of engaging young people around sensitive topics. Objective: The purpose of this study was to determine characteristics of child maltreatment disclosure to an SMS-based crisis service. Methods: We conducted a content analysis of all conversations (N=244) that resulted in a mandatory report by an SMS-based crisis service between October 2015 and July 2017. We coded characteristics of the disclosure process, including the reason for initial contact, phrase used to disclose abuse, perpetrator, type of abuse, and length of victimization. After identifying terms used by young people to disclose child abuse, we randomly selected and analyzed 50 conversations using those terms to determine if use of the terms differed between conversations that did and did not result in mandatory report. Results: Parents were the most common perpetrator. Physical abuse was the most common form of abuse discussed in the initial abuse disclosure (106/244, 43.4%), followed by psychological abuse (83/244, 34.0%), sexual abuse (38/244, 15.6%), and neglect (15/244, 6.1%). More than half of the texters discussed abuse or other significant family issues in the first message. An explicit description of the experience or definite language, such as abuse, rape, and molested, was common in disclosures. Conclusions: Early disclosure, combined with explicit language, may suggest at least a portion of young victims are actively seeking safe ways to talk about their experiences with abuse, rather than incidentally sharing experiences while seeking support for other issues. SMS text messaging may be a valuable way to engage with young people around sensitive topics, but these approaches will require careful consideration in their development, implementation, and evaluation to ensure a positive experience for young people. %M 30907745 %R 10.2196/11306 %U http://mhealth.jmir.org/2019/3/e11306/ %U https://doi.org/10.2196/11306 %U http://www.ncbi.nlm.nih.gov/pubmed/30907745 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e13067 %T Automated Analysis of Domestic Violence Police Reports to Explore Abuse Types and Victim Injuries: Text Mining Study %A Karystianis,George %A Adily,Armita %A Schofield,Peter W %A Greenberg,David %A Jorm,Louisa %A Nenadic,Goran %A Butler,Tony %+ The Kirby Institute, Faculty of Medicine, The University of New South Wales, Level 6, Wallace Wurth Building, High Street, Kensington NSW, Sydney, 2052, Australia, 61 (2) 9385 0900, gkarystianis@kirby.unsw.edu.au %K domestic violence %K injuries %K abuse types %K text mining %K rule-based approach %K police narratives %D 2019 %7 12.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The police attend numerous domestic violence events each year, recording details of these events as both structured (coded) data and unstructured free-text narratives. Abuse types (including physical, psychological, emotional, and financial) conducted by persons of interest (POIs) along with any injuries sustained by victims are typically recorded in long descriptive narratives. Objective: We aimed to determine if an automated text mining method could identify abuse types and any injuries sustained by domestic violence victims in narratives contained in a large police dataset from the New South Wales Police Force. Methods: We used a training set of 200 recorded domestic violence events to design a knowledge-driven approach based on syntactical patterns in the text and then applied this approach to a large set of police reports. Results: Testing our approach on an evaluation set of 100 domestic violence events provided precision values of 90.2% and 85.0% for abuse type and victim injuries, respectively. In a set of 492,393 domestic violence reports, we found 71.32% (351,178) of events with mentions of the abuse type(s) and more than one-third (177,117 events; 35.97%) contained victim injuries. “Emotional/verbal abuse” (33.46%; 117,488) was the most common abuse type, followed by “punching” (86,322 events; 24.58%) and “property damage” (22.27%; 78,203 events). “Bruising” was the most common form of injury sustained (51,455 events; 29.03%), with “cut/abrasion” (28.93%; 51,284 events) and “red marks/signs” (23.71%; 42,038 events) ranking second and third, respectively. Conclusions: The results suggest that text mining can automatically extract information from police-recorded domestic violence events that can support further public health research into domestic violence, such as examining the relationship of abuse types with victim injuries and of gender and abuse types with risk escalation for victims of domestic violence. Potential also exists for this extracted information to be linked to information on the mental health status. %M 30860490 %R 10.2196/13067 %U http://www.jmir.org/2019/3/e13067/ %U https://doi.org/10.2196/13067 %U http://www.ncbi.nlm.nih.gov/pubmed/30860490 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 1 %P e11533 %T Primary Prevention of Intimate Partner Violence Among Recently Married Dyads Residing in the Slums of Pune, India: Development and Rationale for a Dyadic Intervention %A Kalokhe,Ameeta Shivdas %A Iyer,Sandhya %A Katendra,Tuman %A Gadhe,Keshav %A Kolhe,Ambika R %A Paranjape,Anuradha %A del Rio,Carlos %A Stephenson,Rob %A Sahay,Seema %+ Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 1518 Clifton Road Office 6009, Atlanta, GA, 30322, United States, 1 4047121924, akalokh@emory.edu %K intimate partner violence %K prevention %K gender-based violence %K domestic violence %K intervention %D 2019 %7 18.01.2019 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Intimate partner violence (IPV) is frequently experienced by women of low socioeconomic status in India. It is a human rights violation and associated with negative effects on physical and mental well-being, underscoring the need for effective prevention strategies. Objective: This study aimed to develop a dyadic intervention for the primary prevention of IPV among newly married couples residing in slum communities in India. Methods: The intervention was developed using a community-based, mixed-methods design rooted in couple-interdependence theory and guided by the intervention mapping (IM) framework. It used the six critical IM steps to inform the content and delivery of the intervention: (1) needs assessment, (2) preparation of matrices of change objectives, (3) selection of theory-based methods and practical applications, (4) production of intervention components and materials, (5) intervention adoption and implementation, and (6) evaluation planning. Results: The resulting Ghya Bharari Ekatra (Take a Flight Together) intervention is intended to be delivered in 6 weekly sessions by a trained pair of male and female lay community educators to groups of 3 to 5 newly married couples in the community in which they reside. It uses games, discussions, self-reflections, and skill-building exercises to cover the following topics: enhancing relationship quality time, self-esteem and resilience, communication and conflict management, goal setting and implementation, sexual communication and sexual health and reproductive health knowledge, and redefining and challenging norms surrounding IPV occurrence. The formative work guided the protocol, including module duration and timing (2-hour sessions of convenience to participants), ordering of modules (based on potential level of interest and sensitivity of the topics), content (ie, informed scripts of role plays and films), intervention delivery methods (ie, interactive activities), and selection of the interventionists (based on capacity to connect with participants) and venue (community-based, convenient, and safe spaces). Ghya Bharari Ekatra was piloted between January and May 2018, and evaluation is presently underway. Conclusions: Ghya Bharari Ekatra is evidence-based, grounded in intervention-mapping, and developed and iteratively refined using a community-based participatory research approach, suggesting it has great potential to be an acceptable and effective solution to preventing IPV among newly married couples. Trial Registration: ClinicalTrials.gov NCT03332134; https://clinicaltrials.gov/ct2/show/NCT03332134 %M 30664483 %R 10.2196/11533 %U http://www.researchprotocols.org/2019/1/e11533/ %U https://doi.org/10.2196/11533 %U http://www.ncbi.nlm.nih.gov/pubmed/30664483 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 4 %P e10845 %T Effects of a Theta/Sensorimotor Rhythm Neurofeedback Training Protocol on Measures of Impulsivity, Drug Craving, and Substance Abuse in Forensic Psychiatric Patients With Substance Abuse: Randomized Controlled Trial %A Fielenbach,Sandra %A Donkers,Franc CL %A Spreen,Marinus %A Bogaerts,Stefan %+ Research Department, Forensic Psychiatric Centre Dr S van Mesdag, Helperlinie 2, Groningen, 9722AZ, Netherlands, 31 505221221, s.fielenbach@fpcvanmesdag.nl %K neurofeedback %K impulsivity %K substance use disorder %K offenders %K drug craving %D 2018 %7 11.12.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Forensic psychiatric patients are often diagnosed with psychiatric disorders characterized by high levels of impulsivity as well as comorbid substance use disorders (SUD). The combination of psychiatric disorders and SUD increases the risk of future violence. Chronic substance abuse can lead to a structural state of disinhibition, resulting in more drug taking and eventually loss of control over drug intake. When treating SUD, it is crucial to address high levels of impulsivity and lack of inhibitory control. Objective: This study set out to investigate the effects of a theta/sensorimotor rhythm (SMR) neurofeedback training protocol on levels of impulsivity, levels of drug craving, and actual drug intake in a population of forensic psychiatric patients with a diagnosis of SUD. Methods: A total of 21 participants received 20 sessions of theta/SMR neurofeedback training in combination with treatment-as-usual (TAU). Results of the intervention were compared with results from 21 participants who received TAU only. Results: SMR magnitude showed a significant (P=.02) increase post training for patients in the neurofeedback training group, whereas theta magnitude did not change (P=.71). Levels of drug craving as well as scores on the motor subscale of the Barratt Impulsivity Scale-11 decreased equally for patients in the neurofeedback training group and the TAU group. Other measures of impulsivity as well as drug intake did not change posttreatment (P>.05). Therefore, neurofeedback+TAU was not more effective than TAU only. Conclusions: This study demonstrated evidence that forensic psychiatric patients are able to increase SMR magnitude over the course of neurofeedback training. However, at the group level, the increase in SMR activity was not related to any of the included impulsivity or drug craving measures. Further research should focus on which patients will be able to benefit from neurofeedback training at an early stage of the employed training sessions. Trial Registration: Dutch National Trial Register: NTR5386; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5386 (Archived by WebCite at http://www.webcitation.org/6nXLQuoLl). %M 30538087 %R 10.2196/10845 %U http://mental.jmir.org/2018/4/e10845/ %U https://doi.org/10.2196/10845 %U http://www.ncbi.nlm.nih.gov/pubmed/30538087 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 9 %P e11548 %T Automatic Extraction of Mental Health Disorders From Domestic Violence Police Narratives: Text Mining Study %A Karystianis,George %A Adily,Armita %A Schofield,Peter %A Knight,Lee %A Galdon,Clara %A Greenberg,David %A Jorm,Louisa %A Nenadic,Goran %A Butler,Tony %+ Kirby Institute, Faculty of Medicine, University of New South Wales, Level 6, Wallace Wurth Building High Street, Kensington NSW, Sydney, 2052, Australia, 61 (2) 9385 0900, gkarystianis@kirby.unsw.edu.au %K text mining %K rule-based approach %K police narratives %K mental health disorders %K domestic violence %D 2018 %7 13.09.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Vast numbers of domestic violence (DV) incidents are attended by the New South Wales Police Force each year in New South Wales and recorded as both structured quantitative data and unstructured free text in the WebCOPS (Web-based interface for the Computerised Operational Policing System) database regarding the details of the incident, the victim, and person of interest (POI). Although the structured data are used for reporting purposes, the free text remains untapped for DV reporting and surveillance purposes. Objective: In this paper, we explore whether text mining can automatically identify mental health disorders from this unstructured text. Methods: We used a training set of 200 DV recorded events to design a knowledge-driven approach based on lexical patterns in text suggesting mental health disorders for POIs and victims. Results: The precision returned from an evaluation set of 100 DV events was 97.5% and 87.1% for mental health disorders related to POIs and victims, respectively. After applying our approach to a large-scale corpus of almost a half million DV events, we identified 77,995 events (15.83%) that mentioned mental health disorders, with 76.96% (60,032/77,995) of those linked to POIs versus 16.47% (12,852/77,995) for the victims and 6.55% (5111/77,995) for both. Depression was the most common mental health disorder mentioned in both victims (22.25%, 3269) and POIs (18.70%, 8944), followed by alcohol abuse for POIs (12.19%, 5829) and various anxiety disorders (eg, panic disorder, generalized anxiety disorder) for victims (11.66%, 1714). Conclusions: The results suggest that text mining can automatically extract targeted information from police-recorded DV events to support further public health research into the nexus between mental health disorders and DV. %M 30213778 %R 10.2196/11548 %U http://www.jmir.org/2018/9/e11548/ %U https://doi.org/10.2196/11548 %U http://www.ncbi.nlm.nih.gov/pubmed/30213778 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 5 %P e134 %T Examining the Impact of Trauma-Informed Cognitive Behavioral Therapy on Perinatal Mental Health Outcomes Among Survivors of Intimate Partner Violence (The PATH Study): Protocol for a Feasibility Study %A Jackson,Kimberley T %A Parkinson,Sarah %A Jackson,Brianna %A Mantler,Tara %+ School of Health Studies, Faculty of Health Sciences, The University of Western Ontario, 1151 Richmond Street, London, ON, N6A3K7, Canada, 1 5196612111 ext 85541, tscott32@uwo.ca %K intimate partner violence %K cognitive behavioral therapy %K perinatal %K mental health %K women %K nurse %D 2018 %7 25.05.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Intimate partner violence (IPV) is a pervasive public health problem, impacting the health and quality of life of survivors worldwide. The trauma of IPV is associated with a high incidence of mental illness, namely depressive and anxiety disorders, and posttraumatic stress disorder (PTSD). Moreover, literature endorses cognitive behavioral therapy (CBT) interventions as a gold standard for those with symptomatology consistent with anxiety disorders, mood disorders, and PTSD. However, efficacy has not been evaluated among a population of pregnant survivors of IPV. Objective: We present the protocol that will be used to explore the efficacy of trauma-informed cognitive behavioral therapy on maternal and child health outcomes for pregnant women with PTSD, depression, or anxiety symptomatology resulting from IPV. A secondary aim will be to test the validity and feasibility of study methodology to support the successful implementation of a full-scale randomized controlled trial. Methods: The Promoting Attachment Through Healing (PATH) study will use a mixed-methods approach grounded in an intersectional feminist framework to explore the effectiveness of trauma-informed CBT for pregnant survivors of IPV. Study participants will be recruited through the hospital-based Perinatal Mental Health Clinic (London, Ontario, Canada). A feasibility sample of 20 pregnant women (cohort 1) will be selected to engage in an eight-session antenatal CBT intervention facilitated by the program’s perinatal clinical nurse specialist, with evaluation at baseline, at two months postpartum (intervention and online questionnaire), and at six and twelve months postpartum (online questionnaire only). Concurrently, we will conduct a retrospective audit of 100 medical charts (cohort 2; 50 charts of perinatal women who received CBT and 50 charts of women who did not receive perinatal CBT) from the past five years. The efficacy of the intervention will be based on a reduction of mental illness symptomatology, improved maternal-infant attachment, maternal coping, and maternal quality of life. Additionally, the feasibility of the protocol and acceptability of the intervention from the women’s perspective will be examined. Inductive content analysis of all qualitative data will be used to determine common themes. Additionally, descriptive statistics, including measures of central tendency and dispersion, will be computed for all continuous variables. Alternatively, frequency tables will be constructed for all categorical variables. Results: The work reported here is in the proposal phase. Once the protocol is implemented, we will report the results in a follow-up paper. Participant recruitment for cohort 1 has started and we have finished data collection for cohort 2. It is anticipated that the results will be available by the end of 2018. Conclusions: Findings will assess the acceptability of the study methodology and protocol for a full-scale randomized controlled trial. Furthermore, if CBT is proven effective for pregnant survivors of IPV, this intervention could be readily adopted by health care and social support services, thereby contributing to an improved standard of care for this unique population. Trial Registration: ClinicalTrials.gov NCT03536442; https://www.clinicaltrials.gov/ct2/show/NCT03536442 (Archived by WebCite at http://www.webcitation.org/6zeurv1ay) Registered Report Identifier: RR1-10.2196/9820 %M 29802091 %R 10.2196/resprot.9820 %U http://www.researchprotocols.org/2018/5/e134/ %U https://doi.org/10.2196/resprot.9820 %U http://www.ncbi.nlm.nih.gov/pubmed/29802091 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 4 %N 1 %P e10556 %T Prevalence and Factors Associated with Domestic Violence During Pregnancy in Arua District, Uganda, 2015 %A Namugamba,Alice %A Mangwi,R %D 2018 %7 29.03.2018 %9 Abstract %J iproc %G English %X Background: Domestic violence during pregnancy is a serious public health challenge threatening maternal and fetal health outcomes. In Uganda, 16% of women experienced domestic abuse during pregnancy (UDHS 2011). Objective: To investigate the prevalence and factors associated with domestic violence during pregnancy in Arua district so as to identify the magnitude of the problem, inform policy so as to protect pregnant women. Methods: A cross-sectional study was conducted. Multi stage sampling technique was applied. Interviewer administered questionnaires were used. Binary and multi variable logistic regression analyses were carried out to identify strongest factors associated with domestic violence. Results: A total of 459 pregnant women were sampled. Prevalence of domestic violence during pregnancy was 48%. Emotional violence was the most prevalent form of violence (40%) followed by physical abuse contributing 29% and sexual violence 28%. Pregnant women reported husbands as their most perpetrators. Partner’s alcohol consumption was the strongest risk factor associated with domestic violence during pregnancy (AOR 12.20 CI 2.25-65.92) followed by number of wives (AOR 2.16 C.I 1.08-4.32), wanting to be pregnant (AOR 0.26 C.I 0.14-0.48) and occupation too (AOR 2.22 C.I 1.12-4.42). Conclusions: Domestic violence against pregnant women was quite high. Almost five in ten women experienced domestic violence. Partner’s alcohol consumption and number of wives were the strongest factors. Partner involvement during antenatal period is important. Increased attention to this vulnerable group is needed to improve maternal and child health. Antenatal care is known to be an important window of opportunity in providing support. %R 10.2196/10556 %U http://www.iproc.org/2018/1/e10556/ %U https://doi.org/10.2196/10556 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 12 %P e426 %T Efficacy of a Web-Based Safety Decision Aid for Women Experiencing Intimate Partner Violence: Randomized Controlled Trial %A Koziol-McLain,Jane %A Vandal,Alain C %A Wilson,Denise %A Nada-Raja,Shyamala %A Dobbs,Terry %A McLean,Christine %A Sisk,Rose %A Eden,Karen B %A Glass,Nancy E %+ Centre for Interdisciplinary Trauma Research, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand, 64 9 921 9670, jane.koziol-mclain@aut.ac.nz %K eHealth %K intimate partner violence %K randomized controlled trial %K New Zealand %K depression %K population groups %D 2018 %7 10.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Intimate partner violence (IPV) is a human rights violation and leading health burden for women. Safety planning is a hallmark of specialist family violence intervention, yet only a small proportion of women access formal services. A Web-based safety decision aid may reach a wide audience of women experiencing IPV and offer the opportunity to prioritize and plan for safety for themselves and their families. Objective: The aim of this study was to test the efficacy of a Web-based safety decision aid (isafe) for women experiencing IPV. Methods: We conducted a fully automated Web-based two-arm parallel randomized controlled trial (RCT) in a general population of New Zealand women who had experienced IPV in the past 6 months. Computer-generated randomization was based on a minimization scheme with stratification by severity of violence and children. Women were randomly assigned to the password-protected intervention website (safety priority setting, danger assessment, and tailored action plan components) or control website (standard, nonindividualized information). Primary endpoints were self-reported mental health (Center for Epidemiologic Studies Depression Scale-Revised, CESD-R) and IPV exposure (Severity of Violence Against Women Scale, SVAWS) at 12-month follow-up. Analyses were by intention to treat. Results: Women were recruited from September 2012 to September 2014. Participants were aged between 16 and 60 years, 27% (111/412) self-identified as Māori (indigenous New Zealand), and 51% (210/412) reported at baseline that they were unsure of their future plans for their partner relationship. Among the 412 women recruited, retention at 12 months was 87%. The adjusted estimated intervention effect for SVAWS was −12.44 (95% CI −23.35 to −1.54) for Māori and 0.76 (95% CI −5.57 to 7.09) for non-Māori. The adjusted intervention effect for CESD-R was −7.75 (95% CI −15.57 to 0.07) for Māori and 1.36 (−3.16 to 5.88) for non-Māori. No study-related adverse events were reported. Conclusions: The interactive, individualized Web-based isafe decision aid was effective in reducing IPV exposure limited to indigenous Māori women. Discovery of a treatment effect in a population group that experiences significant health disparities is a welcome, important finding. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12612000708853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12612000708853 (Archived by Webcite at http://www.webcitation/61MGuVXdK) %M 29321125 %R 10.2196/jmir.8617 %U http://www.jmir.org/2017/12/e426/ %U https://doi.org/10.2196/jmir.8617 %U http://www.ncbi.nlm.nih.gov/pubmed/29321125 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 3 %N 1 %P e37 %T Feasibility of an Automated System Counselor for Survivors of Sexual Assault %A Howe,Esther %A Pedrelli,Paola %A Morris,Robert %A Nyer,Maren %A Mischoulon,David %A Picard,Rosalind %+ Department of Psychiatry, Massachusetts General Hospital, 6th Floor, 1 Bowdoin Square, Boston, MA,, United States, 1 6176437690, ehowe3@mgh.harvard.edu %K CBT %K web chat %D 2017 %7 22.09.2017 %9 Abstract %J iproc %G English %X Background: Sexual assault (SA) is common and costly to individuals and society, and increases risk of mental health disorders. Stigma and cost of care discourage survivors from seeking help. Norms profiling survivors as heterosexual, cisgendered women dissuade LGBTQIA+ individuals and men from accessing care. Because individuals prefer disclosing sensitive information online rather than in-person, online systems—like instant messaging and chatbots—for counseling may bypass concerns about stigma. These systems’ anonymity may increase disclosure and decrease impression management, the process by which individuals attempt to influence others’ perceptions. Their low cost may expand reach of care. There are no known evidence-based chat platforms for SA survivors. Objective: To examine feasibility of a chat platform with peer and automated system (chatbot) counseling interfaces to provide cognitive reappraisals (a cognitive behavioral therapy technique) to survivors. Methods: Participants are English-speaking, US-based survivors, 18+ years old. Participants are told they will be randomized to chat with a peer or automated system counselor 5 times over 2 weeks. In reality, all participants chat with a peer counselor. Chats employ a modified-for-context evidence-based cognitive reappraisal script developed by Koko, a company offering support services for emotional distress via social networks. At baseline, participants indicate counselor type preference and complete a basic demographic form, the Brief Fear of Negative Evaluation Scale, and self-disclosure items from the International Personality Item Pool. After 5 chats, participants complete questions from the Client Satisfaction Questionnaire (CSQ), Self-Reported Attitudes Toward Agent, and the Working Alliance Inventory. Hypotheses: 1) Online chatting and automated systems will be acceptable and feasible means of delivering cognitive reappraisals to survivors. 2) High impression management (IM≥25) and low self-disclosure (SD≤45) will be associated with preference for an automated system. 3) IM and SD will separately moderate the relationship between counselor assignment and participant satisfaction. Results: Ten participants have completed the study. Recruitment is ongoing. We will enroll 50+ participants by 10/2017 and outline findings at the Connected Health Conference. To date, 70% of participants completed all chats within 24 hours of enrollment, and 60% indicated a pre-chat preference for an automated system, suggesting acceptability of the concept. The post-chat CSQ mean total score of 3.98 on a 5-point Likert scale (1=Poor; 5=Excellent) suggests platform acceptability. Of the 50% reporting high IM, 60% indicated preference for an automated system. Of the 30% reporting low SD, 33% reported preference for an automated system. At recruitment completion, ANOVA analyses will elucidate relationships between IM, SD, and counselor assignment. Correlation and linear regression analyses will show any moderating effect of IM and SD on the relationship between counselor assignment and participant satisfaction. Conclusions: Preliminary results suggest acceptability and feasibility of cognitive reappraisals via chat for survivors, and of the automated system counselor concept. Final results will explore relationships between SD, IM, counselor type, and participant satisfaction to inform the development of new platforms for survivors. %R 10.2196/iproc.8585 %U http://www.iproc.org/2017/1/e37/ %U https://doi.org/10.2196/iproc.8585 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e204 %T Young People, Adult Worries: Randomized Controlled Trial and Feasibility Study of the Internet-Based Self-Support Method “Feel the ViBe” for Adolescents and Young Adults Exposed to Family Violence %A van Rosmalen-Nooijens,Karin %A Lo Fo Wong,Sylvie %A Prins,Judith %A Lagro-Janssen,Toine %+ Gender & Women’s Health, Department of Primary and Community Care, Radboud university medical center, Internal post 117, P.O. Box 9101, Nijmegen, 6500HB, Netherlands, 31 0 243613110, karin.vanrosmalen-nooijens@radboudumc.nl %K domestic violence %K child abuse %K exposure to violence %K adolescent %K young adult %K telemedicine %K peer group %K peer influence %K Internet %K feasibility studies %K randomized controlled trial %K delivery of health care %D 2017 %7 12.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Adolescents and young adults (AYAs) are of special interest in a group of children exposed to family violence (FV). Past-year prevalence of exposure to FV is known to be highest in AYAs and has severe consequences. Peer support is an effective approach to behavior change and the Internet is considered suitable as a mode of delivery. Objective: The study aimed to evaluate both effectiveness and feasibility of a randomized controlled trial (RCT) and feasibility study of the Internet-based self-support method “Feel the ViBe” (FtV) using mixed-methods approach to fully understand the strengths and weaknesses of a new intervention. Methods: AYAs aged 12-25 years and exposed to FV were randomized in an intervention group (access to FtV + usual care) and a control group (minimally enhanced usual care) after they self-registered themselves. From June 2012 to July 2014, participants completed the Impact of Event Scale (IES) and Depression (DEP) and Anxiety (ANX) subscales of the Symptom CheckList-90-R (SCL-90) every 6 weeks. The Web Evaluation Questionnaire was completed after 12 weeks. Quantitative usage data were collected using Google analytics and content management system (CMS) logs and data files. A univariate analysis of variance (UNIANOVA) and mixed model analysis (intention-to-treat [ITT], complete case) were used to compare groups. Pre-post t tests were used to find within-group effects. Feasibility measures structurally address the findings. The CONsolidated Standards Of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth (CONSORT-EHEALTH) checklist was closely followed. Results: In total, 31 out of 46 participants in the intervention group and 26 out of 47 participants in the control group started FtV. Seventeen participants (intervention: n=8, control: n=9) completed all questionnaires. Mixed model analysis showed significant differences between groups on the SCL-90 DEP (P=.04) and ANX (P=.049) subscales between 6 and 12 weeks after participation started. UNIANOVA showed no significant differences. Pre-post paired sample t tests showed significant improvements after 12 weeks for the SCL-90 DEP (P=.03) and ANX (P=.046) subscales. Reported mean Web-based time per week was 2.83 with a session time of 36 min. FtV was rated a mean 7.47 (1-10 Likert scale) with a helpfulness score of 3.16 (1-5 Likert scale). All participants felt safe. Two-thirds of the intervention participants started regular health care. Conclusions: No changes on the IES were found. SCL-90 DEP and ANX showed promising results; however, the calculated sample size was not reached (n=18). FtV functions best as a first step for adolescents and young adults in an early stage of change. FtV can be easily implemented without extensive resources and fits best in the field of public health care or national governmental care. Trial Registration: Netherlands National Trial Register (NTR): NTR3692; http://www.trialregister.nl/trialreg/admin/ rctview.asp?TC=3692 (Archived by WebCite at http://www.webcitation.org/6qIeKyjA4) %M 28606893 %R 10.2196/jmir.6004 %U http://www.jmir.org/2017/6/e204/ %U https://doi.org/10.2196/jmir.6004 %U http://www.ncbi.nlm.nih.gov/pubmed/28606893 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 3 %P e94 %T Methodological and Ethical Challenges in a Web-Based Randomized Controlled Trial of a Domestic Violence Intervention %A Tarzia,Laura %A Valpied,Jodie %A Koziol-McLain,Jane %A Glass,Nancy %A Hegarty,Kelsey %+ Department of General Practice, The University of Melbourne, 200 Berkeley St, Carlton, 3053, Australia, 61 390358604, laura.tarzia@unimelb.edu.au %K eHealth %K domestic violence %K web-based trials %K research design %K ethics, research %D 2017 %7 28.03.2017 %9 Viewpoint %J J Med Internet Res %G English %X The use of Web-based methods to deliver and evaluate interventions is growing in popularity, particularly in a health care context. They have shown particular promise in responding to sensitive or stigmatized issues such as mental health and sexually transmitted infections. In the field of domestic violence (DV), however, the idea of delivering and evaluating interventions via the Web is still relatively new. Little is known about how to successfully navigate several challenges encountered by the researchers while working in this area. This paper uses the case study of I-DECIDE, a Web-based healthy relationship tool and safety decision aid for women experiencing DV, developed in Australia. The I-DECIDE website has recently been evaluated through a randomized controlled trial, and we outline some of the methodological and ethical challenges encountered during recruitment, retention, and evaluation. We suggest that with careful consideration of these issues, randomized controlled trials can be safely conducted via the Web in this sensitive area. %M 28351830 %R 10.2196/jmir.7039 %U http://www.jmir.org/2017/3/e94/ %U https://doi.org/10.2196/jmir.7039 %U http://www.ncbi.nlm.nih.gov/pubmed/28351830 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 11 %P e302 %T Infusing Technology Into Perinatal Home Visitation in the United States for Women Experiencing Intimate Partner Violence: Exploring the Interpretive Flexibility of an mHealth Intervention %A Bacchus,Loraine J %A Bullock,Linda %A Sharps,Phyllis %A Burnett,Camille %A Schminkey,Donna L %A Buller,Ana Maria %A Campbell,Jacquelyn %+ Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom, 44 +442079588244, Loraine.Bacchus@lshtm.ac.uk %K intimate partner violence %K screening %K home visitation %K nurses %K mhealth %K intervention %K technology %K interpretive flexibility %D 2016 %7 17.11.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusions: 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. ClinicalTrial: Clinicaltrials.gov NCT01688427; https://clinicaltrials.gov/ct2/show/NCT01688427 (Archived by WebCite at http://www.webcitation.org/6limSWdZP) %M 27856405 %R 10.2196/jmir.6251 %U http://www.jmir.org/2016/11/e302/ %U https://doi.org/10.2196/jmir.6251 %U http://www.ncbi.nlm.nih.gov/pubmed/27856405 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 10 %P e281 %T Participant Recruitment and Engagement in Automated eHealth Trial Registration: Challenges and Opportunities for Recruiting Women Who Experience Violence %A Koziol-McLain,Jane %A McLean,Christine %A Rohan,Maheswaran %A Sisk,Rose %A Dobbs,Terry %A Nada-Raja,Shyamala %A Wilson,Denise %A Vandal,Alain C %+ Centre for Interdisciplinary Trauma Research, Faculty of Health and Environmental Sciences, Auckland University of Technology, A-9, Private Bag 92006, Auckland, 1142, New Zealand, 64 9 921 9670, jane.koziol-mclain@aut.ac.nz %K eHealth %K recruitment %K dropout %K intimate partner violence %K Web-based trials %D 2016 %7 25.10.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Automated eHealth Web-based research trials offer people an accessible, confidential opportunity to engage in research that matters to them. eHealth trials may be particularly useful for sensitive issues when seeking health care may be accompanied by shame and mistrust. Yet little is known about people’s early engagement with eHealth trials, from recruitment to preintervention autoregistration processes. A recent randomized controlled trial that tested the effectiveness of an eHealth safety decision aid for New Zealand women in the general population who experienced intimate partner violence (isafe) provided the opportunity to examine recruitment and preintervention participant engagement with a fully automated Web-based registration process. The trial aimed to recruit 340 women within 24 months. Objective: The objective of our study was to examine participant preintervention engagement and recruitment efficiency for the isafe trial, and to analyze dropout through the registration pathway, from recruitment to eligibility screening and consent, to completion of baseline measures. Methods: In this case study, data collection sources included the trial recruitment log, Google Analytics reports, registration and program metadata, and costs. Analysis included a qualitative narrative of the recruitment experience and descriptive statistics of preintervention participant engagement and dropout rates. A Koyck model investigated the relationship between Web-based online marketing website advertisements (ads) and participant accrual. Results: The isafe trial was launched on September 17, 2012. Placement of ads in an online classified advertising platform increased the average number of recruited participants per month from 2 to 25. Over the 23-month recruitment period, the registration website recorded 4176 unique visitors. Among 1003 women meeting eligibility criteria, 51.55% (517) consented to participate; among the 501 women who enrolled (consented, validated, and randomized), 412 (82.2%) were accrued (completed baseline assessments). The majority (n=52, 58%) of the 89 women who dropped out between enrollment and accrual never logged in to the allocated isafe website. Of every 4 accrued women, 3 (314/412, 76.2%) identified the classified ad as their referral source, followed by friends and family (52/412, 12.6%). Women recruited through a friend or relative were more likely to self-identify as indigenous Māori and live in the highest-deprivation areas. Ads increased the accrual rate by a factor of 74 (95% CI 49–112). Conclusions: Print advertisements, website links, and networking were costly and inefficient methods for recruiting participants to a Web-based eHealth trial. Researchers are advised to limit their recruitment efforts to Web-based online marketplace and classified advertising platforms, as in the isafe case, or to social media. Online classified advertising in “Jobs–Other–volunteers” successfully recruited a diverse sample of women experiencing intimate partner violence. Preintervention recruitment data provide critical information to inform future research and critical analysis of Web-based eHealth trials. ClinicalTrial: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12612000708853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12612000708853 (Archived by WebCite at http://www.webcitation/6lMGuVXdK) %M 27780796 %R 10.2196/jmir.6515 %U https://www.jmir.org/2016/10/e281/ %U https://doi.org/10.2196/jmir.6515 %U http://www.ncbi.nlm.nih.gov/pubmed/27780796 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 3 %N 4 %P e64 %T A Formative Evaluation of a Social Media Campaign to Reduce Adolescent Dating Violence %A Lambert,Danielle N %A Bishop,Lauren E %A Guetig,Stephanie %A Frew,Paula M %+ Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, 500 Irvin Court, Suite 200, Decatur, GA, 30030, United States, 1 404 712 8546, pfrew@emory.edu %K adolescents %K dating violence %K social media %K formative evaluation %D 2014 %7 12.11.2014 %9 Protocol %J JMIR Res Protoc %G English %X Background: The Emory Jane Fonda Center implemented the Start Strong Atlanta social marketing campaign, “Keep It Strong ATL”, in 2007 to promote the development of healthy adolescent relationships and to foster the prevention of adolescent dating abuse among 11-14 year olds. Objective: A formative evaluation was conducted to understand whether messages directed at the target audience were relevant to the program’s relationship promotion and violence prevention goals, and whether the “Web 2.0” social media channels of communication (Facebook, Twitter, YouTube, Flickr, Tumblr, and Pinterest) were reaching the intended audience. Methods: Mixed methodologies included qualitative interviews and a key informant focus group, a cross-sectional survey, and web analytics. Qualitative data were analyzed using constant comparative methodology informed by grounded theory. Descriptive statistics were generated from survey data, and web analytics provided user information and traffic patterns. Results: Results indicated that the Keep It Strong ATL social marketing campaign was a valuable community resource that had potential for broader scope and greater reach. The evaluation team learned the importance of reaching adolescents through Web 2.0 platforms, and the need for message dissemination via peers. Survey results indicated that Facebook (ranked 6.5 out of 8) was the highest rated social media outlet overall, and exhibited greatest appeal and most frequent visits, yet analytics revealed that only 3.5% of “likes” were from the target audience. These results indicate that the social media campaign is reaching predominantly women (76.5% of viewership) who are outside of the target age range of 11-14 years. Conclusions: While the social media campaign was successfully launched, the findings indicate the need for a more focused selection of communication channels, timing of media updates to maximize visibility, balancing message tone and delivery, and incorporating differentiated messaging for the target audiences. Collaboration with parents and community partners is also emphasized in order to expand the campaign’s reach and create more channels to disseminate relationship promotion and dating violence prevention messaging to the intended audience. %M 25405494 %R 10.2196/resprot.3546 %U http://www.researchprotocols.org/2014/4/e64/ %U https://doi.org/10.2196/resprot.3546 %U http://www.ncbi.nlm.nih.gov/pubmed/25405494 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e203 %T A Web-Based Sexual Violence Bystander Intervention for Male College Students: Randomized Controlled Trial %A Salazar,Laura F %A Vivolo-Kantor,Alana %A Hardin,James %A Berkowitz,Alan %+ Georgia State University, School of Public Health, PO Box 3984, Atlanta, GA, 30302-3984, United States, 1 404 413 1396, lsalazar1@gsu.edu %K Internet %K sex offenses %K rape %K universities %K students %K public health %D 2014 %7 05.09.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Bystander intervention approaches offer promise for reducing rates of sexual violence on college campuses. Most interventions are in-person small-group formats, which limit their reach and reduce their overall public health impact. Objective: This study evaluated the efficacy of RealConsent, a Web-based bystander approach to sexual violence prevention, in enhancing prosocial intervening behaviors and preventing sexual violence perpetration. Methods: A random probability sample of 743 male undergraduate students (aged 18 to 24 years) attending a large, urban university located in the southeastern United States was recruited online and randomized to either RealConsent (n=376) or a Web-based general health promotion program (n=367). Participants were surveyed online at baseline, postintervention, and 6-months postintervention. RealConsent was delivered via a password-protected Web portal that contained six 30-minute media-based and interactive modules covering knowledge of informed consent, communication skills regarding sex, the role of alcohol and male socialization in sexual violence, empathy for rape victims, and bystander education. Primary outcomes were self-reported prosocial intervening behaviors and sexual violence perpetration. Secondary outcomes were theoretical mediators (eg, knowledge, attitudes). Results: At 6-month follow-up RealConsent participants intervened more often (P=.04) and engaged in less sexual violence perpetration (P=.04) compared to controls. In addition, RealConsent participants reported greater legal knowledge of sexual assault (P<.001), greater knowledge of effective consent (P<.001), less rape myths (P<.001), greater empathy for rape victims (P<.001), less negative date rape attitudes (P<.001), less hostility toward women (P=.01), greater intentions to intervene (P=.04), less hyper-gender ideology (P<.001), less positive outcome expectancies for nonconsensual sex (P=.03), more positive outcome expectancies for intervening (P<.001), and less comfort with other men’s inappropriate behaviors (P<.001). Conclusions: Our results support the efficacy of RealConsent. Due to its Web-based format, RealConsent has potential for broad-based dissemination thereby increasing its overall public health impact on sexual violence. Trial Registration: Clinicaltrials.gov: NCT01903876; http://clinicaltrials.gov/show/NCT01903876 (Archived by WebCite at http://www.webcitation.org/6S1PXxWKt). %M 25198417 %R 10.2196/jmir.3426 %U http://www.jmir.org/2014/9/e203/ %U https://doi.org/10.2196/jmir.3426 %U http://www.ncbi.nlm.nih.gov/pubmed/25198417