Digital Screening and Supportive Intervention for Intimate Partner Violence Targeted Pregnant Women in Antenatal Care

Intimate Partner Violence (IPV) is a significant public health issue with extensive physical, psychological, and social consequences. Pregnancy is a vulnerableperiod, as IPV affects both the pregnant woman and the unborn child,increasing the risk of complications such as depression, post-traumatic stressdisorder (PTSD), preterm birth, intrauterine growth restriction (IUGR), and foetaldeath. Simultaneously, pregnancy presents a unique opportunity for earlydetection and support for women experiencing IPV, as nearly all pregnant women engage regularly with the healthcare system. However, there is also alack of knowledge about how to best identify and support pregnant womenexposed to IPV. Digital interventions are considered a promising approach to reaching women who might otherwise not access support, but further researchis needed to explore their potential.

This dissertation is based on the STOP study conducted in Denmark and Spain. The study developed and implemented a digital intervention that combineduniversal digital screening with a supportive intervention for pregnant women exposed to IPV, integrated into antenatal care. The supportive intervention included video counselling and access to a safety app. The dissertation comprised three studies, each addressing different aspects of the digitalintervention:

Study I described the implementation of STOP in antenatal care across two European settings and examined the feasibility of universal digital screening for IPV among pregnant women using validated tools (AAS and WAST). The results indicated that screening was feasible, with response rates exceeding 80% in both Denmark and Spain. Among the screened women, 9.6% reported IPV (Denmark: 8.5%; Spain: 17%). However, only 21.4% of women who screened positive accepted the subsequent supportive intervention. Acceptance was lower in Denmark than in Spain. These findings suggest that while digitalscreening is feasible, factors influencing the acceptance of digital interventions may differ across cultural and healthcare contexts.

Study II evaluated the effect of a digital supportive intervention among the 55 pregnant women who completed the intervention. The results demonstrated an average reduction in depressive symptoms, with a change in EPDS scores of 3.9 points from a baseline score of 11.3. Reductions in depressive symptoms were observed across countries, socio-demographic characteristics, and different intervention settings, with similar results achieved by midwives in Denmark and psychologists in Spain. Our findings could indicate that empowerment might have played a crucial role in reducing depressive symptoms. However, the lack of a control group limited the interpretation of the results. Furthermore, differences in intervention completion rates between Danish and Spanish participants should be explored, as factors such as the intervention’s integration into antenatal care and its flexible structure (e.g.,session numbers) likely influenced participation.

Study III explored Danish pregnant women’s experiences with the digitalsolutions through qualitative interviews. Participants highlighted privacy, flexibility, and trust in healthcare providers as important factors for engagement. However, the safety app was deemed less relevant, and technological challenges, as well as the need for an undisturbed space, were identified as barriers. To increase participation, these barriers must be addressed. 

Conclusion
This dissertation demonstrated that digital solutions had the potential to improve the identification and support of pregnant women experiencing IPV. Integrating digital tools into antenatal care could enhance access to support and complement existing services. Future research should focus on randomised trials to establish efficacy and refine implementation strategies in diverse contexts, ensuring that digital solutions become more accessible and applicable for pregnant women.