Novel doula intervention to leverage clinic-community connections to support perinatal intimate partner violence survivors

University Of Pittsburgh At Pittsburgh, Pittsburgh PA

Investigators

Linked publications, trials & patents

Abstract

Intimate partner violence (IPV) during the perinatal period is a pervasive and devastating public health epidemic. Healthcare settings offer a unique opportunity to support perinatal IPV patients and connect them with resources, as they come for regularly scheduled prenatal and postpartum visits. Universal empowerment is a promising healthcare-based IPV intervention, where IPV related education and resources are provided to all perinatal patients, avoiding some of the challenges of the traditional screen and refer approach. Universal empowerment has been tested and shown to be effective and feasible in other settings such as family planning clinics and school-based health centers, but has not been rigorously evaluated during prenatal visits. Universal empowerment may be further optimized by doula-based support, as doulas have been shown to improve other health outcomes (e.g., preterm birth, access to perinatal visits) although less is known about their effect on reducing IPV. Doulas may be particularly effective in helping bolster social support and connection for perinatal patients. The objective of this application is to conduct a 2-arm type 1 hybrid trial with 250 perinatal participants (125 per group) to test the effectiveness of an enhanced universal empowerment intervention delivered during 28–32 week prenatal visits (Thrive) compared with universal empowerment plus pairing with an IPV-trained doula (Doula Thrive). In Aim 1, we will assess the effectiveness of both Thrive and Doula Thrive in reducing IPV (primary outcome; defined as a range of coercive and controlling behaviors), as well as perinatal cannabis use, tobacco use, and depression (secondary outcomes). We hypothesize that while both interventions will reduce IPV, we will find a greater effect for Doula Thrive. In Aim 2, we will conduct mediation and moderation analyses to test mechanisms through which the intervention is effective and to elucidate participant profiles moderating intervention effectiveness. Through interviews, surveys, and tracking data, in Aim 3 we will collect data on implementation factors aligned with the PRISM framework. We have convened a community-academic team with expertise in IPV, perinatal health, doula care, stakeholder partnerships, clinical trial design and analysis, and implementation science; patients will be core partners in this work. Results will inform the design of a future implementation trial to test further implementation, dissemination, and scalability. This intervention has the potential to be instrumental in supporting perinatal IPV patients, ultimately reducing IPV and promoting health outcomes.