Across the four databases searched, a total of 389 studies were identified; 127 duplicates were removed, resulting in 262 studies screened. Screening at the title and abstract level resulted in the exclusion of 182 studies. There were 80 studies screened at the full-text stage, with 74 studies being excluded – the majority (60) for wrong study design. In total, 6 studies were included from the search of databases and 1 study was included from hand-searching, for a total of 7 included studies (see Fig. 1 for PRISMA diagram). Reference lists of systematic reviews, scoping reviews, and literature reviews that were found through the search of databases were also checked to ensure all relevant studies had been screened. This process did not identify any new studies.
Narrative Summary Of Themes
Using thematic analysis, three themes emerged that impacted women’s experiences of using sexualized violence safety apps: (1) security; (2) accessibility; and (3) knowledge. Recommendations and barriers found in relation to each theme are presented as subthemes. Table 4 offers a summary of each theme.
Table 3
Summary of Included Studies
Author, Year
|
Title
|
Country
|
Purpose
|
Participants
|
Research Method
|
Sexualized Violence Focus
|
Safety App
|
Key Findings
|
Alhusen et al., 2015
|
Development of the MyPlan safety decision app with friends of college women in abusive dating relationships
|
United States
|
To explore the perceptions of friends of dating violence survivors regarding the benefits of a safety decision aid, deployed through a smart phone application prototype, for friends of female survivors of dating violence.
|
Thirty-one college students who self-reported having a friend who had experienced dating violence while in college. Participants were English-speaking male and female college students, aged 18-24 (Mage = 20.84). The majority of participants were female (n = 25) and the remainder were male. Most of the participants were White (n = 16), followed by African American (n = 8); the remaining participants were from a variety of ethno-racial identities.
|
Qualitative - Focus groups/interview. Each of the focus group discussions lasted 60–90min and was cofacilitated by two trained research assistants. The individual in-depth interviews lasted approximately 60min. The procedures implemented were consistent across the focus groups and individual interviews. At the beginning of each focus group/interview, participants were instructed to progress through the app prototype preloaded onto an iPod touch. Participants also had access to the app throughout the focus group/interview. The emphasis of the interviews was on the friend’s assessment of the app. The audio-taped interviews were digitally recorded and then transcribed.
|
Dating violence (DV)
|
MyPlan – a prototype smart phone application (app) that is a safety decision aid designed to assist college women (age 18–24) experiencing dating violence/survivors of dating violence and their friends who wish to learn more about how to help them. A collaborative, multistate research team partnered with the One Love Foundation, a national relationship violence prevention advocacy organization, to develop the app.
|
Three themes were directly related to participants’ perceptions of the benefit of MyPlan in helping themselves as well as their friends in addressing DV: usefulness, understandability, and appropriateness. The findings support the acceptability and usefulness of an app to support peers of DV survivors on campus and thereby also strengthen the safety net for DV survivors.
|
Blayney et al., 2018
|
Enlisting friends to reduce sexual victimization risk: There's an app for that... but nobody uses it
|
United States
|
To collect feasibility and acceptability information on the Co6 app among college women who drink alcohol, a group at greater risk for sexualized violence, to shed light on the Co6 app and the challenges associated with app-based prevention in real-world contexts.
|
Forty-four college women. Women had to 18–24 years of age (Mage = 20.11, SD = 1.33), be enrolled in college, own a smart phone, and drink alcohol at least once per week in the last 6 months. A majority of participants were White (n = 23), followed by African American (n = 7), Asian (n = 6), Hispanic (n = 3), and other (n = 5). Almost all of the participants identified as heterosexual (n = 41)
|
Mixed Methods – Participants completed questionnaires, used the Co6 app for 2 months, and returned to report their experiences. For the qualitative component, participants were interviewed individually in a semi-structured format about what they liked and did not like about the app. Follow up interviews were approximately 1 hour long and were audio-recorded and transcribed verbatim.
|
Sexual victimization
|
Circle of Six (Co6 app) - centralizes both personal and community resources to reduce SV risk. Specifically, the app calls for users to program the con tact information of six trusted individuals, who are then identified as part of the user’s safety network (i.e., circle of six).
|
Findings were separated by what participants liked and what participants disliked. Themes related to what participants liked included that the app provided easy connection with friends, the app features, and believed the app was good in theory. Themes related to what participants disliked included that they thought the app was unnecessary, they were uncomfortable with group messaging, and there were limited contexts for use. Overall, the app may not meet the real-world needs of college women.
|
Bloom et al., 2016
|
Developing an App for College Women in Abusive Same-Sex Relationships and Their Friends
|
United States
|
To establish initial content validity, feasibility, appropriateness, understandability, and usability of a smartphone-based safety decision aid app for college women in same-sex relationships and their friends.
|
Thirteen participants participated in interviews. These included eight college students (four female survivors, three female friends, and one male friend), five of whom were White and three African American, with a mean age 22.0 years, SD 1.9. Five college staff who worked directly with LGBT survivors on campus also participated (four female, one male; all White, mean age 28.2, SD 3.6) in the study.
|
Qualitative - Interviews using a semi-structured interview guide with questions regarding understandability, appropriateness, comprehensiveness, and usefulness of the app for women in same-sex relationships and their friends. Interviews were audio-recorded.
|
Same-sex dating violence
|
An interactive, personalized safety decision aid smartphone application (app) developed by a collaborative, multistate team. The app was intended to allow abused college-aged women and their friends to privately and safely assess violence severity in an abusive relationship, clarify their areas of decisional conflict, (e.g., advantages/disadvantages of the relation- ship) and identify their safety priorities and link to national resources (e.g., national hotline).
|
Findings focused on barriers to recognizing abuse and accessing help (three themes emerged: isolation, lack of awareness of abuse/violence and resources for support, and fear of or actual experiences of discrimination); and feasibility of an app-based safety planning resource (three themes emerged: appropriateness and inclusivity of app content for same-sex survivors and friends, appropriateness and acceptability of a smartphone-based approach for same-sex survivors and friends, and potential safety issues with the app). Overall, findings support the use of the app to assist college women experiencing same-sex dating violence and peers to connect with resources and develop tailored safety plans to reduce violence and increase their safety.
|
Gilmore et al., 2019
|
Usability testing of a mobile health intervention to address acute care needs after sexual assault
|
United States
|
To test the usability of a mobile health intervention targeting alcohol and drug misuse, suicide prevention, posttraumatic stress symptoms, coping skills, and referral to formal assistance for individuals who have experienced sexual assault.
|
Thirteen participants (Mage = 28.00) who experienced sexual assault and received a sexual assault medical forensic examination. Most participants identified as white (n = 13), female (n = 11), and were single (n = 7). One person identified as male and another as “other”. Approximately two-thirds of participants were not in college (n = 10) and had medical insurance (n = 10). The average length of time since the sexual assault was 12.09 months. The assaults were perpetrated by an acquaintance (n = 7), stranger (n = 5), and partner (n = 1).
|
Mixed Methods- The qualitative component consisted of individual interviews that were conducted in-person or through teleconferencing, according to participant preference, and lasted 45 to 60 minutes.
|
Sexual Assault
|
SC-Safe - a resource designed for individuals over the age of 18 residing in South Carolina who have experienced sexual assault. It was designed by the first and second authors to address a gap in clinical services after recent sexual assault.
|
Core themes included aesthetics and usability (app is simple and not overwhelming, layout allows for privacy, increase colour brightness and font size, make navigation functions clear and uniform across app); barriers to resources (logistical barriers, attitudinal barriers); and opinions about SC-Safe (education module was informative and helpful, feedback on emotion and behavioural health module, feedback on general coping skills). Overall, participants found the app to be user friendly and liked it more than they disliked it.
|
Lindsay et al., 2013
|
Survivor feedback on a safety decision aid smartphone application for college-age women in abusive relationships
|
United States
|
For young women who had previously experienced dating violence to evaluate a mobile phone application safety decision aid prototype, which was designed for use by college-age women experiencing dating violence.
|
Thirty-four English-speaking female college students, ages 18–25 (Mage = 21.26, SD = 1.86), who reported that they experienced dating violence while in college. Self-identified ethno-racial background were 52.6% White, 23.7% Hispanic, 7.9% African America, 13.2% Multiracial, and 2.6% other. Nearly 16% of participants reported being in a previous relationship with an abusive female partner.
|
Qualitative- Ten focus group (ranging from 2 to 7 participants) discussions, each lasting approximately 90 min, were cofacilitated by two trained research assistants in a campus or community location. Individual interviews took place in a setting of the participant’s choosing, were approximately 60 min, and were conducted by one trained research assistant. Procedures were consistent across the focus group sessions and individual interviews and a semi-structured interview guide was utilized.
|
Dating Violence/Intimate Partner Violence
|
A prototype smart phone application (app) that is a safety decision aid designed to assist college women (age 18–24) experiencing dating violence/survivors of dating violence and their friends who wish to learn more about how to help them. A collaborative, multistate research team partnered with the One Love Foundation, a national relationship violence prevention advocacy organization, to develop the app.
|
Participants reviewed and provided feedback on the app and four themes emerged: usefulness, understandability, appropriateness, and comprehensiveness of the app. Participants were positive about the potential of the app to provide personalized information about abusive dating relationships and appropriate resources in a private, safe, and nonjudgmental manner. Participants also provided recommendations for further development of the app.
|
Ragavan et al., 2019
|
Thrive: A Novel Health Education Mobile Application for Mothers Who Have Experienced Intimate Partner Violence
|
United States
|
Describe the development and formative evaluation of a trauma-informed, user-friendly Smartphone- based mobile application to address the unmet health needs and improve the well-being of mothers who have experienced intimate partner violence (IPV).
|
Eight IPV survivors and 16 hospital-based staff (nine health care providers, four social workers, one mental health provider, and three IPV advocates; hereafter called providers).
|
Formative Evaluation - Participants were instructed to use Thrive on a study Smartphone for 10 to 20 minutes and then provide feedback about its content, design, safety features, and applicability via a structured interview.
|
Intimate Partner Violence
|
Thrive - a trauma-informed, user-friendly Smartphone based mobile application (app) to address the unmet health needs and improve the well-being of mothers who have experienced IPV. A multidisciplinary team of IPV experts developed the app in partnership with software developers.
|
Participants found Thrive to be user-friendly, informative, trauma- informed, and easier and more relevant than other forms of health education. Participants had several recommendations including making the app more interactive and personalized by allowing users to add their own content, having a password to increase security, and providing social support mechanisms. Initial feedback sessions have demonstrated preliminary acceptability of the app.
|
Tarzia et al., 2017
|
“Technology Doesn’t Judge You”: Young Australian Women’s Views on Using the Internet and Smartphones to Address Intimate Partner Violence
|
Australia
|
To confirm the hypothesis that technology has a potential role in responding to IPV, and to ascertain what factors might encourage or discourage women from using an IPV website or app.
|
Nineteen women between 20 and 25 years of age. All participants were residing in Victoria, Australia at the time of the study, and all had self-reported experiencing fear of a partner in the previous 6 months. None of the women were married at the time of participation, and most were tertiary educated.
|
Qualitative- Four focus groups were held at The University of Melbourne between April and August 2014. The sessions were informal and semi structured in nature, and facilitated by a trained researcher. An additional note taker was present but did not take part in the conversation. The discussions lasted approximately 60 min each and were audio recorded and later transcribed verbatim by members of the research team.
|
Intimate Partner Violence
|
Not specified – general exploration of safety apps
|
Young women’s views around responding to IPV using web-based applications can be grouped into three main themes: behavioral beliefs and attitudes (it’s easier than telling someone, it’s not “normal” to be in an abusive relationship, an app can raise awareness, an app should do more than provide information, an app needs to strike a balance); normative beliefs and subjective norms (for young people technology is a way of life, it needs to be endorsed by someone who counts); and control beliefs and perceived behavioral control (access anywhere/anytime, protecting safety and privacy). Findings highlight the potential for technological interventions to become a valuable addition to the resources available to young women.
|
Table 4
Themes
|
Specific Aspects
|
Sources
|
Sample Quotations
|
Security
|
Privacy, judgement, stigma
|
Blayney et al. (2018); Bloom et al. (2016); Gilmore et al. (2019); Lindsay et al. (2013); Ragavan et al. (2019); Tarzia et al. (2017)
|
The option of ... being able to maybe correspond with people anonymously, especially if you’re scared of being judged or found out ... that’d be really good. (Tarzia et al., 2017: p. 205)
|
Accessibility
|
Ease and usefulness
|
Alhusen et al. (2015); Blayney et al. (2018); Bloom et al. (2016); Gilmore et al. (2019); Lindsay et al. (2013); Ragavan et al. (2019); Tarzia et al. (2017)
|
It helps you organize your mind because when you’re in the situation, you don’t really know how to feel ... there’s so much going on, you don’t really know how to categorize things. When [the app does] it for you, it just helps you put yourself in order, and have more control on your life. When something’s happening to you like that, you feel like you’re out of control and you can’t—you don’t know where to go. You don’t know what to do. You’re just so confused, so I think it helps. (Lindsay et al., 2013; p. 378)
|
Knowledge
|
Information, awareness, validation, myth debunking
|
Alhusen et al. (2015); Bloom et al. (2016); Gilmore et al. (2018); Lindsay et al. (2013); Ragavan et al. (2019); Tarzia et al. (2017)
|
I liked the concrete advice...it didn’t just say ‘‘talk to your friend’’— rather ‘‘here are five different things you can say.’’ I feel like everyone knows you have to talk to the person but people don’t know what to say and how to say it, and that was very, very useful. (Alhusen et al., 2015; p. 274)
|
Security
Security was found to be a prevalent theme across studies that influenced women’s experiences of using safety apps (46–52). Specific aspects of security that were discussed included privacy, judgement, and stigma. All of the studies identified that using safety apps to obtain information provided more privacy or anonymity than obtaining information from in-person health services (46–52). Using a safety app was also found to provide additional privacy because individuals could access them discreetly and apps were designed to be ambiguous to others (49, 51, 52). For example, using basic colours for the app’s design so that it would not be recognized as a sexualized violence related app by another person who might see the individual’s phone.
Four studies noted that participants experienced a greater sense of security because they faced less judgment regarding being a victim of sexualized violence and, therefore, avoided stigma when using a safety app (47–49, 51). Using a safety app was found to be more objective and unbiased than accessing traditional health services or speaking with friends and family (48, 49, 51). Five of the seven studies also acknowledged that individuals found it was easier to interact with an app than having to discuss their situation with health professionals or their social network (46–49, 51). Women perceived less stigma about having experienced sexualized violence as a result of using these apps (47–49, 51). One participant stated:
With suicide already being stigmatized the way it is, and communication about suicide being the way it is, I would want to know that like, it’s okay to talk about this and it’s okay if this is what you’re feeling like (Gilmore et al., 2019, p. 10). (51)
Many participants mentioned the option of not having to discuss sexualized violence in a traditional way such as ‘‘face-to-face’’ as a benefit (46–49, 51). One participant noted, ‘‘it [app] gives you a privacy and accessibility. .. the fact that I don’t have to go to Student Health Center to get help and not have to worry about being judged’’ (Alhusen et al., 2015, p. 276) (46). Another participant discussed the benefit of accessing help via an app instead of going to a counseling center on campus, noting: ‘‘I feel judged to go. .. just knowing that I’m going to see them every day since I live there [on campus] I would feel a little uncomfortable’’ (Alhusen et al., 2015, p. 276) (46). Interestingly, several studies identified that it would be beneficial to be able to engage with others through the app (48, 49, 52), stating that “the option of ... being able to maybe correspond with people anonymously, especially if you’re scared of being judged or found out ... that’d be really good” (Tarzia, Iyer, et al., 2017, p. 205) (49).
Barriers and recommendations. The greatest barrier that emerged in relation to security was privacy, including the potential for partner monitoring or surveillance which may limit use of the app (47–49, 51). For example, one participant commented: “If somebody’s in a relationship that is abusive, and someone’s already checking their phone and checking everything they’re doing, and they have an app about this on their phone, it might cause issues” (Lindsay et al., 2013, p. 382) (48). Recommendations to address privacy concerns, some of which were already part of the apps studied, included providing password protection for the app (46, 48, 49, 52), an emergency exit on each screen (47, 52), use of an innocuous name for the app that does not refer to relationships or safety (46–49, 52), and even allowing the user to rename the program or change the icon themselves (47).
Bloom et al. (2016) suggested the ability for users to print or e-mail the contents of the app to themselves or another person and then delete the app or the answers as a useful alternative(47). This would circumvent the need for the resources on the app to be exclusively on a computer or smartphone(47). Other studies specifically recommended educating users about healthy relationship boundaries regarding technology and sharing passwords with partners and friends to better instruct users how to hide the app (e.g., bury the app in smartphone folders), and how to safely use the app if a partner monitors their phone (47, 48). Women who reviewed the Circle of 6 (Co6) app specifically identified being uncomfortable with the group messaging feature, which is customized to send messages to only select individuals that you identify as your “circle of 6” (50).
Accessibility
The importance of accessibility emerged as a key theme that influenced experiences that women had when using sexualized violence safety apps. Accessibility included the ease and usefulness of the safety apps (46–52). Women in all studies reported that they found the safety apps to be user friendly, easy to use, and easily accessible (46–52). In six studies, the usefulness of the app was directly related to the fact that it could be used anywhere, was comprehensive in content, and all the information needed was in one place (46–49, 51, 52). For example, one participant commented:
It helps you organize your mind because when you’re in the situation, you don’t really know how to feel ... there’s so much going on, you don’t really know how to categorize things. When [the app does] it for you, it just helps you put yourself in order, and have more control on your life. When something’s happening to you like that, you feel like you’re out of control and you can’t—you don’t know where to go. You don’t know what to do. You’re just so confused, so I think it helps (Lindsay et al., 2013, p. 378). (48)
In many studies, participants found that the app could be customized or personalized to the specific user, which improved its accessibility and overall usability (46, 48, 50). Examples of personalized or customized content included safety planning suggestions (46), messages that will be sent to friends (50), and what information is presented, such as a specific risk assessment and safety plan for the user (48). Overall, most (n = 6) studies found that the accessibility of safety apps had the potential to improve safety and decrease risk (47–52).
Barriers and recommendations. Several studies noted suggestions to improve the accessibility of sexualized violence safety apps. Making the apps more personalized and interactive was recommended by women in five studies (47–50, 52). Examples included providing written scripts to choose from (47, 50, 51) or the ability to connect directly with a counsellor through the app (48, 49, 52). Other recommendations included making the navigation functions standard across the app and clearly indicating the purpose of each icon (51). Celebrity endorsement was also suggested as a way to promote sexualized violence safety apps, which in turn would increase a sense of accessibility for more women (49).
Alhusen et al. (2015) noted that if individuals are not ready to address the violence, then the app may be unnecessary and useless (46). One participant noted “If they’re not ready they’re not ready… don’t talk about them behind their back and don’t talk about them with others [on an app] (Alhusen et al., 2015, p. 276)” (46). Further, women in the Blayney et al. (2018) study noted the app had limited contexts for use and did not provide anything more than a mobile phone could offer, seeing the app as unnecessary(50). Feedback included:
It just generally seemed like you could do the same things without the app, because iPhones nowadays are so intricate. Like, you could click details on your messages and press ‘send location’ and type a short message. I feel like that wouldn’t take nearly as long as opening the app, clicking the button, sending the messages… It’s not really an easy way to contact friends, I think personally for me, it would just be easier to call or text them. Like it wasn’t any easier to do that [use the app] (Blayney et al., 2018, p. 771). (50)
Knowledge
Six studies discussed the importance of knowledge in the experiences of women when using sexualized violence safety apps (46–49, 51, 52). How women experienced the knowledge provided on the safety apps was dependent on the information provided, and if the information increased awareness, validation, and myth debunking. In all six studies, participants found the safety apps to be helpful in raising awareness of sexualized violence and recognizing violent behaviour through various ways such as myth debunking (46–49, 51, 52). Additionally, six studies found the apps to be an easy way to acquire information that validated women’s experiences of violence and indicated that participants found the app provided assurance that they are not alone (47–52).
Further, six studies found that women believed the apps to contain relevant information that was credible, evidence based, and/or trauma informed (46–49, 51, 52). In relation to providing knowledgeable and credible information, one participant commented:
I liked the concrete advice...it didn’t just say ‘‘talk to your friend’’— rather ‘‘here are five different things you can say.’’ I feel like everyone knows you have to talk to the person, but people don’t know what to say and how to say it (Alhusen et al., 2015, p. 274). (46)
Similarly, another participant commented that the app “arms you with ideas as to how to go about it [conversations] properly” (Alhusen et al., 2015; p. 276) (46).
The information, options, choices, and safety planning strategies provided on the safety apps were also found to increase a feeling of empowerment (46–49). For example, one participant commented: “[A young woman] should feel relieved. Like she is equipped to know what to do, and not lost and drowning her sorrows and burden by herself. Like someone is there to help her” (Tarzia, Iyer, et al., 2017 p. 209) (49).
Barriers and recommendations. Several studies noted recommendations for improving the knowledge provided on sexualized violence safety apps. Several women thought that personal anecdotes, rather than statistics about dating violence, might better help young women recognize the violence in their own relationships (47, 52). Gilmore et al. (2019) (51) and Lindsay et al. (2013) (48) found that some young women noted the desire for more information throughout the app about emotional abuse, as illustrated by the following participant: “It would be really cool if there was more stuff about emotional abuse and control because I think that is also really important” (Lindsay et al., 2013, p. 383) (48). Survivors thought information about what the police can and cannot do to assist the survivor would also be helpful because “talking to police can be kinda scary” (Lindsay et al., 2013, p. 383) (48). Last, several studies believed that sexualized violence safety apps should do more than just provide information (47–49, 51). In addition to providing information, the safety apps need to expand the ability to gain knowledge by including information for appropriate resources (47, 49, 51) and incorporating further educational modules and learning opportunities (47, 51).