Being Safe, Healthy, and Positively Empowered (BSHAPE): A Digital Multicomponent Intervention to Improve Health and Safety Outcomes Among Women with Cumulative Exposures to Violence

PROJECT SUMMARY Pre-and post-migration exposures to interpersonal violence can have a significant negative impact on the health of immigrant women in the United States. Those with cumulative exposures to interpersonal violence often face substantial mental and physical health challenges, including conditions such as PTSD and HIV/STIs, alongside ongoing safety risks. Despite these needs, many do not seek support from formal support services due to barriers such as isolation, mistrust, or limited awareness of available resources. Thus, there is a critical need for accessible, evidence-based digital interventions that address the care needs of immigrant women with cumulative exposures to violence and mental health symptoms, and can be accessed outside traditional service settings. A trauma-informed digital intervention (Being Safe, Healthy, and Positively Empowered (BSHAPE) was designed to improve health and safety outcomes for immigrant women with cumulative exposures to violence and mental health symptoms. The findings from the BSHAPE pilot study found that the BSHAPE intervention was feasible and acceptable. Women who participated in BSHAPE demonstrated improvements in outcomes, including reduced stress, enhanced self-efficacy, improved mental health, and increased safety-related empowerment. The proposed study will use a sequential, mixed-methods longitudinal design to evaluate the efficacy of BSHAPE in a large-scale trial. In the first phase, the study will further refine BSHAPE to make it more user-friendly, engaging, accessible, and adaptive to immigrant women from diverse backgrounds. This refinement will be guided by user feedback from the BSHAPE pilot trial, as well as qualitative input from cultural consultants and participants. The goal is to ensure that the intervention is responsive to users’ needs, preferences, and lived experiences, laying a strong foundation for subsequent testing in a larger trial. In the second phase, the study will employ a longitudinal, randomized controlled trial design to randomly assign 676 women to either the BSHAPE arm (n = 338) or the control arm (n = 338). The health and safety-related outcomes will be assessed at 3-, 6-, and 12-month follow-up. It is hypothesized that BSHAPE participants will show improvements in mental health, reduced stress, enhanced self-care, and increased safety. Additionally, the study will investigate potential mediators and moderators of the intervention's effect on key outcomes. The study will result in an evidence-based digital BSHAPE intervention designed to provide flexible, remote support for immigrant women with trauma histories and mental health symptoms. Its digital format offers a scalable, potentially cost-efficient model for addressing health and safety needs, particularly in contexts where traditional services are difficult to access due to logistical, geographic, or personal barriers. By providing early and accessible support, BSHAPE may help reduce reliance on high-intensity or crisis-based services, such as long-term behavioral health treatment.