Sabri Bushra, Li Jian, Aryal Subhash, Mata Theresa, Murray Sarah M, Glass Nancy, Campbell Jacquelyn C
School of Nursing, Johns Hopkins University, Baltimore, MD, 21205, United States.
Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, United States.
Contemp Clin Trials Commun. 2025 Aug 17;47:101539. doi: 10.1016/j.conctc.2025.101539. eCollection 2025 Oct.
Intimate partner violence (IPV) disproportionately affects immigrant women, who often face barriers to accessing in-person services. Digital interventions offer a promising alternative by providing tailored, remote support.
In this SMART trial, 1265 foreign-born immigrant women across the U.S. were randomized to a personalized online ( = 660) or standard online safety information ( = 605) intervention. At 3 months, low responders ( = 366) were re-randomized to receive text-only ( = 183) or text + phone support ( = 183). Outcomes were assessed at 6 and 12 months.
All groups showed reduced physical and sexual IPV over time, with no significant differences between first-stage conditions. Low responders in the text + phone group demonstrated significantly greater reductions in physical and sexual IPV ( = -0.25, < 0.01), depression ( = -0.22, < 0.01), and increased empowerment ( = 0.22, < 0.01), from 3 to 12 months, compared to responders. These between-group effects were supported by significant within-group improvements, with the text + phone group narrowing or closing the gap with responders in most outcomes by 12 months. Among low responders initially assigned to the personalized online intervention, those re-randomized to text + phone support outperformed those receiving text-only support-showing significantly greater reductions in IPV ( = -0.32, < 0.05), depression ( = -0.33, < 0.05), and greater gains in empowerment ( = 0.27, < 0.05). The text-only group also improved, particularly in depression and PTSD, with outcomes approaching those of responders by 12 months. Across conditions, low responders also showed substantial improvements in safety behaviors ( = 0.24-0.25; < 0.05).
These findings highlight the value of stepped-care, adaptive approaches in addressing persistent IPV-related needs. Integrating personalized phone support into digital interventions can enhance outcomes for survivors who do not respond to brief, initial support alone.
亲密伴侣暴力（IPV）对移民女性的影响尤为严重，她们在获得面对面服务时往往面临障碍。数字干预通过提供量身定制的远程支持提供了一种有前景的替代方案。
在这项SMART试验中，美国1265名外国出生的移民女性被随机分为个性化在线干预组（n = 660）或标准在线安全信息干预组（n = 605）。在3个月时，低反应者（n = 366）被重新随机分组，接受纯文本支持（n = 183）或文本+电话支持（n = 183）。在6个月和12个月时评估结果。
随着时间的推移，所有组的身体和性方面的亲密伴侣暴力都有所减少，第一阶段的干预条件之间没有显著差异。与反应者相比，文本+电话组的低反应者在3至12个月期间，身体和性方面的亲密伴侣暴力显著减少（β = -0.25，p < 0.01），抑郁症状显著减轻（β = -0.22，p < 0.01），赋权增加（β = 0.22，p < 0.01）。这些组间效应得到了组内显著改善的支持，到12个月时，文本+电话组在大多数结果上与反应者的差距缩小或消除。在最初分配到个性化在线干预的低反应者中，重新随机分组接受文本+电话支持的人比接受纯文本支持的人表现更好——亲密伴侣暴力显著减少（β = -0.32，p < 0.05），抑郁症状显著减轻（β = -0.33，p < 0.05），赋权增加更多（β = 0.27，p < 0.05）。纯文本组也有改善，特别是在抑郁和创伤后应激障碍方面，到12个月时结果接近反应者。在所有干预条件下，低反应者在安全行为方面也有显著改善（β = 0.24 - 0.25；p < 0.05）。
这些发现凸显了逐步护理、适应性方法在满足持续的亲密伴侣暴力相关需求方面的价值。将个性化电话支持纳入数字干预可以改善那些仅对简短的初始支持无反应的幸存者的结局。
