Using Implementation Science to Inform the Adaptation of an Intimate Partner Violence Prevention Program for Forcibly Displaced Couples in the United States

Background and Purpose

While growing evidence points to the effectiveness of social and economic empowerment programs in reducing intimate partner violence (IPV) globally, IPV prevention among forcibly displaced populations (FDPs) in the US is a notable gap in both research and practice. The International Rescue Committee (IRC) developed an eight-session intervention, EA$E (Economic And Social Empowerment), for war-affected populations in humanitarian settings. Using rigorous methods, EA$E was shown to be effective in reducing IPV experience and PTSD symptoms among war-affected women in Côte d’Ivoire. Drawing from implementation science, the purpose of this mixed-method study was to inform the adaptation of EA$E to account for salient social and financial stressors that exacerbate risks of IPV among FDPs in the US. Our research questions were: How do resettlement clients and providers perceive the acceptability, appropriateness, and feasibility of EA$E? What are barriers and facilitators to implementing EA$E in the US?

Methods

We employed a novel theater-testing method, which allowed participants to view original EA$E sessions via immersive videos created specifically for the project. With IRB approval, we conducted in-depth focus group discussions with IRC staff (n=18) and FDP clients (n=44) from Middle East and Central Africa. Participants discussed the acceptability, appropriateness, and feasibility of intervention components; what they would add or remove; and, broad recommendations for adaptation. Each focus group spanned two days (8 hours in total). Surveys were administered to collect quantitative data on participant demographics, and acceptability, feasibility, and appropriateness per session.

Results

Overall, participants strongly endorsed the acceptability of EA$E, with staff expressing some apprehension. Participants emphasized the importance of programs focused on household wellbeing as integral to successful resettlement. Clients recommended that EA$E be offered immediately post-arrival, while staff considered other resettlement requirements. Participants discussed variations in client education levels and recommended designing a menu of activities to respond accordingly. Regarding feasibility, participants highlighted the importance of offering childcare and transportation support, addressing scheduling challenges, and providing incentives. While participants endorsed the group-based format, privacy concerns were noted. For EA$E facilitators, participants emphasized the importance of cultural humility, technical knowledge, and trauma informed perspectives.

Conclusions and Implications

This research has implications for re-imagining how the US resettlement moves towards centering women, gender equity, and IPV prevention in the delivery of core services. Funding and resources for organizational capacity-building are necessary to support the implementation and evaluation of IPV prevention programs. Given the dearth of research on IPV prevention among FDPs in the US, this project highlights the importance of fostering collaborative partnerships between communities, practitioners, and researchers to generate meaningful, actionable, and culturally-responsive IPV prevention research and practice with FDPs in the US.