Development and testing of a smartphone-delivered IPV and related stress intervention for residents experiencing extreme weather in informal settlements in Kenya using ecological momentary approaches - Extreme weather (EW) is increasingly associated with intimate partner violence (IPV), psychological distress, and poor mental health, especially among women in low-resourced urban communities in the U.S. East Africa, a strategic U.S. partner and a region vulnerable to EW, provides an unparalleled opportunity to study these relationships in similar low-resourced urban areas. Lessons learned from highly exposed urban communities will directly inform U.S. strategies to prevent violence, strengthen mental health responses, and improve disaster preparedness for vulnerable populations. Despite growing evidence linking EW, IPV, and mental health, few interventions address women's safety during EW events. This exploratory study will develop and test a smartphone-based ecological momentary assessment (EMA) and ecological momentary intervention (EMI) application that delivers real-time safety planning, coping strategies, and support for women experiencing IPV in informal settlements in Kenya, generating scalable evidence to improve resilience, behavioral health, and public health preparedness. We will achieve this goal through the following aims: R21: Aim 1 is to develop and pilot a smartphone-based application to collect real-time EMA information about IPV experiences, emotional stress, IPV self-efficacy, receipt of IPV-related social support and services, safety, comfort with EW and ambient conditions, social and environmental context, and current behaviors from 320 IPV survivors in informal settlements. Participants will complete EMAs thrice daily for a two-week baseline period and for two-weeks following three common types of EW—a heatwave, a cold spell, and heavy rainfall. R21: Aim 2 is to use AIM 1 data to explore important, but understudied associations between EW and IPV. R33: Aim 1 is to adapt an evidence-based Wings of hope intervention (WINGS) for integration into the EMA application developed in the R21 study. R33: Aim 2 is to test the feasibility and preliminary efficacy of the event-triggered WINGS-based EMI adapted in R33: Aim 1 through a randomized control trial (RCT). Participants retained from the R21 phase (n=272), will be randomized to receive either a single-session, mobile version of WINGS (n=136) or the event-triggered, WINGS-based EMI adapted in R33: Aim 1 (n=136). For nine months, participants assigned to the event-triggered EMI will be prompted to participate in daily EMIs for two-weeks following EWEs. They will also be prompted to complete daily EMAs during these two-week periods. All participants, regardless of assignment, will be asked to complete digital assessments at baseline, immediately following receipt of the single-session of WINGS, and at 3-, 6-, and 12-months. The goals of this study are: to provide women with a low-cost, accessible, smartphone-based tool that empowers them to develop, utilize, and revise personal safety and harm reduction strategies that are specifically responsive to IPV and EW and to provide survivors with interventions in real-time. Findings will directly inform the development and adaptation of similar digital safety-planning tools for disaster-exposed, under-resourced communities in the United States facing increasing EW-related threats to women's safety.
