PRB

A new program is training nurses in Indian hospitals to use a mobile device to identify women at risk of violence and promote disclosure. The program, Mobilise!, is based on research led by Suneeta Krishnan, a social epidemiologist who presented her findings during PRB’s 16 Days of Activism Against Gender Violence.

Mobile health, or mHealth, the use of mobile technology for public health programs, holds promise for the future of health information and services, especially in developing countries. Today there are over 100,000 mHealth applications for mobile communications across a range of uses—from creating educational text messages for pregnant women to tracking immunizations to combating counterfeit drug use.¹

But using mHealth to combat gender-based violence is relatively new, mostly because of the sensitivity of the issue. On college campuses across the United States, the response to violence against women has sparked some creative mHealth responses, such as NightOwl, a social mobile application that provides users with an anonymous way to report dangerous situations at social events, or the Circle of 6 application that allows users to quickly text a trusted friend if they sense a risky situation.²

Gender-Based Violence Is Widespread in India

Violence against women in India has gotten worse, with an increase of 70 percent in the last decade.³ Krishnan’s research in urban poor neighborhoods of Bangalore, India, found that among women ages 16 to 25, nearly 80 percent had experienced physical, psychological, or sexual domestic violence by their husband or member of their extended family.⁴ Triggers for domestic violence were challenging the husband, health-related issues such as discussing contraception or sex, conflicts over finances, and the husband being under in the influence of alcohol. According to Krishnan, women who gained employment during the course of the study were significantly more likely to report domestic violence, making economic agency for women a risk factor.⁵

Across India, of the nearly 25,000 rapes in 2012, 98 percent of offenders were known to the victim, yet only 1 percent reported sexual violence to the police.⁶ “The crisis of violence against women in India requires urgent, multisectoral responses,” according to Krishnan, who sees the health system as a “key entry point” for interventions that aim to address the problem. “We are leveraging the power of mobile technology to replicate and scale interventions with quality and rigor.”

Krishnan also conducted research with health care providers and found strong support for the idea of identifying domestic violence within the hospital setting, especially among nurses and community health workers. With support from the municipality and funding from the Indian Council for Medical Research, Krishnan and her team began training health care workers to identify the signs of violence and provide support to women through the Soukhya Project. Krishnan’s ongoing advocacy resulted in the development of a municipal policy on domestic violence.

mHealth Innovations Offer Solutions

However, though the training improved both awareness of and action to address domestic violence, challenges remained: capturing data on service provision, inconsistent adherence to the case identification and response protocol, and expanding the training to additional workers. To address these challenges, Krishnan partnered with Dimagi, Inc., a technology firm committed to helping underserved communities.⁷ Dimagi develops mHealth products that guide frontline workers and captures data on health services.

With funding from USAID, Dimagi is using its flagship product, CommCare, a health data collection and case management tool, as the basis for three mHealth products: mTrainer, mSoukhya, and mShakti. The first tool is a mobile technology-supported interactive training to increase knowledge and skills to address domestic violence for health care providers. The second, mSoukhya, provides standardized guidelines, protocols, and job aids based on the original training Krishnan and her team had developed. And mShakti is a new tool that provides education to women about the unacceptability of domestic violence and the availability of services.⁸

These mHealth tools are now being tested through Mobilise! in 30 primary health care centers in Bangalore. As her program takes off, Krishnan plans a rigorous evaluation to determine whether it can be replicated in other parts of India where the problem of domestic violence is also pervasive.

References

1. Firdaus Kharas, “Mobile Phones, Animation, and a Healthcare Revolution,” Oct. 1, 2012, accessed at http://cultureshift.tv/2012/10/01/mobile-phones-animation-and-a-health-care-revolution, on Aug. 12, 2014.
2. Carnegie Mellon Integrated Innovation Institute, “Students at Carnegie Mellon’s Integrated Institute Tackle Acquaintance/Date-Rape Crisis with Marketable Solutions,” press release, accessed at www.cmu.edu/news/stories/archives/2014/july/july30_tacklingsexualassault.html, on Aug. 12, 2014; and Circle of 6, accessed at www.circleof6app.com, on Aug. 13, 2014.
3. Suneeta Krishnan, “Moving From Research to Practice: Responses to Domestic Violence In Urban India,” presentation to IGWG, PRB’s Sixteen Days of Violence, March 10, 2014.
4. Krishnan, “Moving From Research to Practice.”
5. Suneeta Krishnan et al., “Do Changes in Spousal Employment Status Lead to Domestic Violence? Insights From a Prospective Study in Bangalore, India,” Social Science & Medicine 70, no. 1 (2010): 136-43.
6. Krishnan, “Moving From Research to Practice.”
7. Partners in the project also include RTI International and St. John’s Research Institute.
8. Suneeta Krishnan, “Evaluation of the Mobile Supported Linkages to Support Services for Domestic Violence Prevention and Response (Mobilise!) Project, India,” evaluation plan June 2014, sent by personal communication with the author on July 31, 2014.