Preparing for the worst - promoting safety behaviors among Norwegian, Pakistani, and Somali pregnant women - a randomised controlled trial

Guidelines for antenatal care encourage health professionals to ask pregnant women about their experience of violence. Studies show that around 4 percent of pregnant women experience violence during pregnancy and many more have previous experiences of violence. The experience of violence can have detrimental consequences for the health of both mother and child. In Norway, the guidelines recommending routine inquiry about violence among all pregnant women came in 2014. However, many midwives and other healthcare staff feel unprepared for this task. The aim of our study was to reduce intimate partner violence (IPV) through a video showing women what violence is and how to act to get away from it. The study has found place at 19 community health centers in Oslo and the surrounding area. We estimated the proportion of current and previous violence among pregnant women, using an online questionnaire on a tablet, Q1 prior to randomization. Women reporting having experienced violence were randomized to either the intervention video informing women about violence and which safety measures they can take, or a control video on how to stays safe in regards to food, medication and physical activity. All materials were developed in Norwegian, Urdu, English and Somali. We involved users in the development through 16 in-depth interviews with Norwegian, Pakistani and Somali women from the target group. Participating women were shown the questionnaires and asked for their comments. Next women were asked their opinion on the concept of a video to inform about violence and safety measures and which safety measures they felt should be included. They were so shown the video and asked for comments. Two focus group interviews were done with staff at two crisis-shelters to gain their thoughts and input on the intervention video. The results of this work has been accepted as an article for publication. We performed a pilot study January/February 2017 at all participating health centers. This allowed us to fix technical and practical issues. Recruitment started March 2017. Autumn of 2017 we finalized the analyses strategy for the RCT and registered our study in clinical.trials.org. The protocol of our study was published BMC Public Health spring 2019. After the initial kick-off meeting, we have had regular meetings with recruiting midwives and other health personal. In March due to Covid-19 physical meetings stopped. Inclusion criteria were as follows: age 18 or more, being able to understand one of the languages of the study, being allowed to answer the questionnaire in private. All participating women filled out Q1 and gave us consent to collect data from their hospital discharge note. This includes mode of delivery, breastfeeding etc? We stopped including new women in our study August 2019. We finished collected outcome data September 2020. All women who were randomized are asked to fill out a questionnaire at approx. 3 months post-partum (Q2). In all 1945 women have completed Q1, 320 were randomized and approx. 250 women filled out Q2 3 months postpartum. No serious events have been reported in relation to the study. As part of the evaluation of our project we interviewed 19 midwives during the summer of 2019 about their experience of participating in this study and their opinion of using an electronic questionnaire to ask about violence and a video to provide information. The results of these interviews were published May 2020. During the summer of 2020 we interviewed women who had participated in our study about their experience of the online questionnaire and video. This study was published in 2021. The publication of the main outcome of the RCT is expected to come spring 2022. A final seminar was held in November 2021 where we presented the findings from the study to our collaborators in the community antenatal care among others.

Som intervensjon lagde vi en kort video som informerer kvinner om hva vold er, hvilke mulige tiltak de kan gjøre for å trygge seg selv og hvor de kan få hjelp. Flere jordmødre ved de 19 helsestasjoner der studien fant sted ønsker å bruke videoen i praksis. Videoen kan brukes til å starte en samtale.

Intimate partner violence (IPV) is common and has a detrimental effect on women's health, and the health of their children. It has short- and long-term consequences for individuals, families and society. Women experiencing violence are likely to keep this hidden and may hesitate to seek help. Immigrant women are especially vulnerable as they may be unaware of their rights, and how to access help. We included therefor two immigrant groups with a high first generation fertility rate, Pakistani and Somali women. Almost all women attend antenatal care, meeting community health care workers such as midwives and general practitioners. December 2014 new Norwegian guidelines were introduced suggesting all pregnant women are asked routinely about violence. Midwives have been reluctant to do so as they feel unprepared for the task. Our project will provide community midwives with a screening tool developed in collaboration with them, pregnant women from three target groups and experts in the field. They will also have the opportunity to test out a video promoting safety behaviors. Our project will promote better collaboration between the different professionals involved in the care of women experiencing IPV such as family doctors, social workers, the police,legal advisers. For the development of the screening tool we will document the involvement of pregnant women,community midwives,experts in the field and systematic review of guidelines and research. For the development of the video we will use focus group interviews with pregnant women from the target groups to find out which behaviors promote safety. To test the effectiveness of the screening and video we will perform a cluster RCT. To evaluate midwives' and women's experience of the screening and video we will have in depth interviews with a purposefully selected sample for the different groups.Developing an intervention for pregnant women, also with an immigrant background contributes to reducing social differences.