Department of General Practice, The University of Melbourne, Melbourne, VIC, Australia; The Royal Women's Hospital, Melbourne, VIC, Australia.
Department of General Practice, The University of Melbourne, Melbourne, VIC, Australia.
Lancet Public Health. 2019 Jun;4(6):e301-e310. doi: 10.1016/S2468-2667(19)30079-9.
Evidence for online interventions to help women experiencing intimate partner violence is scarce. We assessed whether an online interactive healthy relationship tool and safety decision aid (I-DECIDE) would increase women's self-efficacy and improve depressive symptoms compared with an intimate partner violence information website.
In this two-group pragmatic randomised controlled trial, we enrolled women who had screened positive for any form of intimate partner violence or fear of a partner in the 6 months before recruitment. Women aged 16-50 years currently residing in Australia, who had safe access to a computer and an internet connection, and who answered positively to one of the screening questions in English were eligible for inclusion. Participants were randomly assigned (1:1) by computer to receive either the intervention or control website. The intervention website consisted of modules on healthy relationships, abuse and safety, and relationship priority setting, and a tailored action plan. The control website was a static intimate partner violence information website. As the initial portion of the website containing the baseline questions was identical for both groups, there was no way for women to tell which group they had been allocated to, and the research team were also masked to participant allocation until after analysis of the 12-month data. Data were collected at baseline, immediately after completion of the website, at 6 months, and 12 months. Primary outcomes were mean general self-efficacy score (immediately after website completion, and at 6 months and 12 months) and mean depression score (at 6 months and 12 months). Data analyses were done according to intention-to-treat principles, accounting for missing data, and adjusted for outcome baseline scores. This trial was registered with the Australian New Zealand Clinical Trials Registry, ACTRN 12614001306606.
Between Jan 16, and Aug 28, 2015, 584 patients registered for the study and were assessed for eligibility. 422 eligible participants were randomly allocated to the intervention group (227 patients) or control group (195 patients). 179 (79%) participants in the intervention group and 156 (80%) participants in the control group completed 12-month follow-up. Mean self-efficacy at 6 months and 12 months was lower for participants in the intervention group than for participants in the control group, although this did not meet the prespecified mean difference (6 months: 27·5 [SD 5·1] vs 28·1 [4·4], imputed mean difference 1·3 [95% CI 0·3 to 2·3]; 12 months: 27·8 [SD 5·4] vs 29·0 [5·0], imputed mean difference 1·6 [95% CI 0·5 to 2·7]). We found no difference between groups in depressive symptoms at 6 months or 12 months (6 months: 22·5 [SD 17·1] vs 24·2 [17·2], imputed mean difference -0·3 [95% CI -3·5 to 3·0]; 12 months: 21·9 [SD 19·3] vs 21·5 [19·3], imputed mean difference -1·9 [95% CI -5·6 to 1·7]). Qualitative findings indicated that participants found the intervention supportive and a motivation for action.
Our findings highlight the need for further research, development, and refinement of online interventions for women experiencing intimate partner violence, particularly into the duration needed for interventions. Although we detected no meaningful differences between groups, our qualitative results indicated that some women find an online tool a helpful source of motivation and support.
Australian Research Council.
目前，有关在线干预措施帮助遭受亲密伴侣暴力的女性的证据还很少。我们评估了一种在线互动式健康关系工具和安全决策辅助工具（I-DECIDE）是否会比亲密伴侣暴力信息网站更能提高女性的自我效能感和改善抑郁症状。
这是一项两组成熟的随机对照试验，我们招募了在招募前 6 个月内筛查出任何形式的亲密伴侣暴力或对伴侣感到恐惧的女性。年龄在 16-50 岁之间、目前居住在澳大利亚、安全使用计算机和互联网的女性，以及对用英文回答的筛查问题之一回答为肯定的女性，有资格入选。参与者通过计算机随机分配（1:1）接受干预或对照网站。干预网站包括关于健康关系、虐待和安全以及关系优先事项设置的模块，以及量身定制的行动计划。对照网站是一个静态的亲密伴侣暴力信息网站。由于两个组的初始部分包含基线问题的网站是相同的，因此女性无法知道她们被分配到哪个组，并且研究团队在分析 12 个月的数据之前也不知道参与者的分配情况。数据在基线、完成网站后立即、6 个月和 12 个月时收集。主要结果是一般自我效能感评分的平均值（在完成网站后、6 个月和 12 个月时）和抑郁评分的平均值（在 6 个月和 12 个月时）。数据分析按照意向治疗原则进行，考虑了缺失数据，并根据结果基线评分进行了调整。该试验在澳大利亚和新西兰临床试验注册中心注册，注册号为 ACTRN 12614001306606。
在 2015 年 1 月 16 日至 8 月 28 日期间，有 584 名患者注册参加了该研究，并对其进行了资格评估。422 名合格的参与者被随机分配到干预组（227 名患者）或对照组（195 名患者）。179 名（79%）干预组参与者和 156 名（80%）对照组参与者完成了 12 个月的随访。与对照组参与者相比，干预组参与者在 6 个月和 12 个月时的自我效能感较低，尽管这并没有达到预设的平均差异（6 个月：27.5 [5.1] 与 28.1 [4.4]，估计平均差异 1.3 [95%CI 0.3-2.3]；12 个月：27.8 [5.4] 与 29.0 [5.0]，估计平均差异 1.6 [95%CI 0.5-2.7]）。我们没有发现两组在 6 个月或 12 个月时的抑郁症状有差异（6 个月：22.5 [17.1] 与 24.2 [17.2]，估计平均差异 0.3 [95%CI 3.5-3.0]；12 个月：21.9 [19.3] 与 21.5 [19.3]，估计平均差异 1.9 [95%CI 5.6-1.7]）。定性结果表明，参与者发现干预措施具有支持性，并为采取行动提供了动力。
我们的研究结果强调了需要进一步研究、开发和完善针对遭受亲密伴侣暴力的女性的在线干预措施，特别是需要研究干预措施需要多长时间。尽管我们没有发现两组之间有明显的差异，但我们的定性结果表明，一些女性发现在线工具是一个有帮助的动力和支持来源。
澳大利亚研究理事会。
