Evaluating digital intervention approaches for supporting immigrant women with intimate partner violence experiences: Findings from the It's weWomen plus sequential multiple assignment randomized trial (SMART).

Background: Intimate partner violence (IPV) disproportionately affects immigrant women, who often face barriers to accessing in-person services. Digital interventions offer a promising alternative by providing tailored, remote support.

Methods: In this SMART trial, 1265 foreign-born immigrant women across the U.S. were randomized to a personalized online ( = 660) or standard online safety information ( = 605) intervention. At 3 months, low responders ( = 366) were re-randomized to receive text-only ( = 183) or text + phone support ( = 183). Outcomes were assessed at 6 and 12 months.

Results: All groups showed reduced physical and sexual IPV over time, with no significant differences between first-stage conditions. Low responders in the text + phone group demonstrated significantly greater reductions in physical and sexual IPV ( = -0.25,  < 0.01), depression ( = -0.22,  < 0.01), and increased empowerment ( = 0.22,  < 0.01), from 3 to 12 months, compared to responders. These between-group effects were supported by significant within-group improvements, with the text + phone group narrowing or closing the gap with responders in most outcomes by 12 months. Among low responders initially assigned to the personalized online intervention, those re-randomized to text + phone support outperformed those receiving text-only support-showing significantly greater reductions in IPV ( = -0.32,  < 0.05), depression ( = -0.33,  < 0.05), and greater gains in empowerment ( = 0.27,  < 0.05). The text-only group also improved, particularly in depression and PTSD, with outcomes approaching those of responders by 12 months. Across conditions, low responders also showed substantial improvements in safety behaviors ( = 0.24-0.25;  < 0.05).

Conclusion: These findings highlight the value of stepped-care, adaptive approaches in addressing persistent IPV-related needs. Integrating personalized phone support into digital interventions can enhance outcomes for survivors who do not respond to brief, initial support alone.