Role of Information Communication Technologies in Violence Prevention

THE ROLE OF INFORMATION COMMUNICATIONS TECHNOLOGIES
IN VIOLENCE PREVENTION

Cathryn Meurn

Introduction

Violence is a global problem that exceeds cultural and socio-economic boundaries. From
collective to interpersonal and self-inflicted typologies, the impact of violence on health is
substantial. Overall violence is one of the leading causes of death worldwide for people between
15-44 years of age.1 However, the actual cost and extent to which violence occurs is difficult to
measure. Countless violent acts happen out of public view in offices, homes or even public
institutions.

Violence can be prevented and this assertion has been proven true within the field of
public health. Along with violence prevention, there have been numerous methods and programs
that have reduced the impact of violence itself. Action has been undertaken from the local and
community level up through to the international system. Methods have ranged from the level of
Defining Violence: primary prevention, aiming to prevent a violent act
before it occurs, to the tertiary level, which
“The intentional use of physical force encompasses approaches that focus on long-term care.
or power, threatened or actual,
against oneself, another person, or The goal of this background paper is to provide
against a group or community, that a brief introduction to the current and potential role that
either results in or has a high information and communication technologies (ICTs)
likelihood of resulting in injury, death, can play in the prevention and reduction of violence.
psychological harm, maldevelopment First and foremost this paper is by no means an
or deprivation” extensive study on the intersection of ICTs and violence
WHO 2002
prevention. There is a plethora of projects that exist and
a deeper landscape analysis is recommended. In addition, the use of ICTs in the field of public
health is in its early stages. Much of what is cited in this paper can be classified as pilot projects
and, to date, there is no in depth measurement of their impact. Therefore what has been written in
this paper is for the sole purpose of introducing the potential of the space and for encouraging
collective action forward.

The paper will begin with a brief introduction to ICTs and their rise in usage within
health programs, with reference to the debate that surrounds them. Then specific programs and
case examples, segregated by typology, will be discussed. Lastly we will look at some
overarching trends and examine gaps that will conclude with a series of proposed
recommendations.

The responsibility for the content of this article rests with the author and does not necessarily
represent the views of the Institute of Medicine or its committees and convening bodies.

The Technology and the Debate

Technologies such as the smartphone, crowd sourcing tools, remote diagnostics and other
technological innovations have proliferated over the past decade or so, and many have shifted
over to mainstream use. With this technological expansion, debate has also risen over the
positive and negative impacts these innovations have within communities and worldwide.
Information and communication technologies can be defined as a set of technological tools and
resources used to communicate, create, disseminate, store, and manage information. This can
include video, radio, television, Internet programs, social media platforms and mobile phones.
Distinctions are emerging between “old” and “new” forms of media and technology; that is,
between the use of television, radio and other forms of traditional media that have been
employed for decades and newer forms of media including social media and the use of the
mobile phone.

Particularly for the
developing world, adoption of the Mobile cellular subscriptions
mobile phone creates a new avenue by level of development
for combating against longstanding
problems. With currently over 5
billion mobile subscriptions
worldwide, phone ownership has
exploded. Two-thirds of these
subscriptions are in developing
countries and it is predicted that
soon 90 percent of the world’s
population will be within the ITU 2010
2
coverage of wireless networks.
Unique users active on social networks are also up nearly 30 percent globally, rising from 244.2
million to 314.5 million as reported by the Nielsen Company in 2010.3 There are over 800
million users on Facebook, Twitter is estimated to be beyond 200 million users, and more video
content is uploaded to YouTube in a 60-day period than what three major U.S. television
networks created in 60 years.4 Teens
are texting at monthly records and
areas such as eLearning, remote
diagnostics, and mServices are
growing steadily.

Still technology is not a
panacea for the problems we face
today. Despite the hype, these are
simply tools that can be used either
for social good or for harm. As with
the invention of paper, the printing
press, and the telephone – all
changed the way in which we interact

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with each other. These innovations have had a positive impact on society but these tools were
also conduits for yellow journalism and mass media campaigns against ethnic groups and certain
minorities. In addition, technology is only a small part of any solution. As seen in the diagram to
the left by Ushahidi, there is a lot of other “stuff” that goes along with making any project or
program successful.

In the case of today, these new forms of communication and new technologies have lead
to some fantastic outcomes, as discussed in the next section. Contrarily they have also elicited
new intricacies within the struggle to prevent and reduce violence. Trends in cyberbullying,
losses in privacy and security, and stories of perpetrators targeting victims through social media
sites, all weigh ominously when we speak of using these tools for social good.

Program and Intervention Designs

Collective Violence

Often receiving a high level of international, public and political attention, collective
violence is perhaps the most visible type of violence. Whether arising from violent intra-state
conflicts that account for the majority of conflicts today, the flow of displaced persons, acts of
terrorism or genocide, the associated affects can be immense. Impact from violent conflicts
affect the civilian society profoundly in regards to health via increased mortality, morbidity and
disability. The WHO has defined collective violence:

the instrumental use of violence by people who identify themselves as a member of a
group – whether this group is transitory or has a more permanent identity – against
another group or set of individuals, in order to achieve political, economic or social
objectives.5

However with the rise of new media, advances in technology and increased access,
opportunities exist in which violence can be further prevented. One of the most popular forms of
program implementation using mobile phones is through the utilization of short message service
(SMS) messaging, or better known as text messages. SMS has been used most frequently for
educational awareness via one-way messaging, such as Amnesty International’s SMS urgent-
action appeals campaign in The Netherlands. This campaign raised the awareness of torture
victims through text campaigns and in turn enabled the agency to collect “signatures” when
immediate action from supporters was necessary.6

One of the most cited cases, exemplifying the potential of SMS past simple awareness
campaigns, was during the Kenyan 2007 election. Although initial results indicated the
opposition candidate Raila Odinga was in the lead, incumbent President Mwai Kibaki was
announced as the official victor. Six weeks of violence ensued where the influential role of
mobiles became apparent. Through the Ushahidi platform, those with mobile phones were able
to send texts to a specific number to report on human rights abuses and incidents, which were
then mapped geographically on a website. This utilization of both texts and online tools not only
enabled the reporting of events in real time but also aided the mobilization of groups around the

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prevention of further violent outbreaks.7 Other instances using the Ushahidi platform have been
during the earthquake in Haiti, and more recently in the Egypt protests and the crisis in Libya.8
Nevertheless it is important to note that this mode of communication can also make it cheap and
easy for others to spread hateful messages to insight additional violence as it did in the case of
Kenya.

Outside of the recent trend of crowd sourcing information, traditional uses of information
communication technologies, such as phone networks, radio and television should not be
neglected. Radio and television have been used in many forms since their invention. With the
utilization of phone networks, one project of note is by Interaction Belfast, which created a
mobile phone network to prevent outbreaks of violence between warring neighborhoods in
Belfast. Volunteers in both Protestant and Catholic communities are given mobile phones to
enable communication with their counterparts when potentially violent crowds gathered or when
rumors of violence started to spread in order to resolve the issue.

Technologies provide not only increased communication but also increased
accountability and transparency.9 The organization Witness works to use the power of video
advocacy by documenting and sharing human rights abuses via cameras. By working with
constituents on the use of video as a medium to shed light on certain atrocities, they have helped
shed light on the repression of ethnic minorities in Burma and help prosecute recruiters of child
soldiers in the Democratic Republic of Congo.10 In addition, training includes information on
how to use video safely, which is important given the complexities this type of intervention can
give rise to.

Lastly, particularly in the developing world, a unique opportunity that deserves
highlighting is the increasing role of the health worker. As task shifting continues to progress in
these countries, community health workers can help to draw attention to indications of violence.
With multiple programs now using these health workers for community outreach, data collection
and reporting via the use of ICTs and mobile phones, opportunities exist to leverage.

Interpersonal Violence

Moving towards the category of interpersonal violence, opportunities for leveraging
technology still exist. Interpersonal violence is differentiated from collective violence as
violence that is inflicted by another individual or small group of individuals.11 Within this
category, this includes sexual violence, intimate partner violence, elder abuse, youth violence
and child abuse.

 Sexual violence

Sexual violence is defined as “any sexual act, attempt to obtain a sexual act, unwanted
sexual comments or advances, or acts to traffic, or otherwise directed, against a person’s
sexuality using coercion”.12 Research suggests that at least one in four women in the United
States have experienced sexual violence.13 Sexual violence is a universal problem and it can have
a deep impact on both physical and mental health including injury, stigmatization, and even
death. One continuously noted aspect of this type of violence is the lack of information

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surrounding the magnitude of the problem. Data tends to be limited as many women do not
report or seek medical services immediately in incidents of violence. To further complicate
matters, data comes from varying sectors, such as clinical settings, NGOs and the police.

Following upon the previous example of the Kenyan elections, the use of SMS and
geocoding can be applied to the prevention of interpersonal violence as well as collective
violence. In Egypt, Frontline SMS, a text messaging based system, in conjunction with the
Ushahidi platform have been used in a
project called Harassmap. In Egypt 83
percent of women are exposed to sexual
harassment.14 The basis of the program is
that if a woman is sexually harassed she
can send an SMS to the Harassmap
number with corresponding details of the
incident. This information will then be
mapped on the website, allowing for “hot-
spots” of harassment to become identified.
They also provide help and information for
victims.15 This program aims to help break
through the silence that surrounds this
issue.
Harassmap 2011

Another program aiming to break through some cultural barriers is the Mobile Cinema
Foundation. This program travels to various soldiers’ camps and exposes soldiers to the
consequences of rape through short films. These films seek to educate the soldiers of Congo’s
National Army through victim’s testimonies and discussions that are held after the viewing. This
form of digital storytelling can be a powerful tool both for empowering the victims and
educating offenders on the effects their actions can elicit.

Other programs center on confidential hotlines, such as the National Sexual Assault
Hotline in the United States where victims can call in for help. Relating this method to sex
trafficking we can point towards the International Organization for Migration who partnered with
Ukrainian mobile phone service providers in 2007, allowing victims to dial a certain number to
receive information and advice on migration and trafficking issues.16

Often it is an intimate partner that commits sexual violence, making sexual violence
dovetail closely with intimate partner violence. Many interventions then can relate to both areas
including programs that promote gender equality, additional awareness campaigns, and
microfinance programs for women and support networks.

 Intimate Partner Violence

Intimate partner violence is one of the most common forms of violence against women.
This categorization refers to any “behavior within an intimate relationship that causes physical,
psychological or sexual harm to those in the relationship”.17 Intimate partner violence occurs

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throughout the world regardless of social, economic or religious divisions. In looking at specific
risk factors women who tend to be uneducated, of low income and lack support often fall victim
to this behavior.18

Again conventional forms of technology and media can play a role in the prevention of
intimate partner violence. This includes hotlines and awareness campaigns through both
traditional and new media. Bell Bajao, or Ring the Bell, campaign is a series of public service
announcements urging men and boys to stand against domestic violence. The idea is that if one is
hearing violence in progress to ring the bell and ask a simple question, such as “Can I borrow a
cup of sugar?” It is likely the perpetrator recognizes the person has heard the violence and this
will interrupt the action. The organization also hosts a blog for victims to voice their experiences
and offers information and guidance.19

Domestically, the company Liz Claiborne initiated a Love Is Not Abuse program, which
provides information and tools for men, women, and children including teens to learn more about
the issue of domestic violence. In August of 2011 they launched the Love Is Not Abuse iPhone
application that helps teach parents about teen dating abuse and demonstrates how technology,
such as text messages, emails and phone calls, can be conduits for committing abuse. Parents
receive real-time communication mimicking the abusive and controlling behaviors teens might
face in their relationships.20 This program illuminates the negative role technology can take on.

However, texting also can be used as a cheap and effective way to prevent intimate
partner violence, as demonstrated by a case in Ohio where a texting service allowed victims to
report incidents silently via a simple SMS message and make contact with a crisis intervention
worker or police without making an actual phone call. The total cost of the program set-up,
which used the FrontlineSMS platform, was about $380.00. FamilyFirst, as it was termed,
processed between 6,000 to 8,000 texts per month during the first year and helped convict 18
abusers which victims were able to report confidentially.21

Outside of these programs, technology can play a role in helping to transform some of the
underlying causes of intimate partner violence. Enabling access for women to both economic and
societal support such as through the Village Phone project by Grameen Phone Foundation can
lead to positive outcomes. The Village Phone model was based on providing a small loan and a
“business in a box” enabling the aspiring entrepreneur to provide customers with access to a
mobile phone and sell mobile airtime. By March 2011, the program claims that 85% of the 6,876
entrepreneurs who had been recruited into the network are women.22 This notion of women
having access to a mobile device is further echoed by the report Women & Mobile: A Global
Opportunity published in 2010. This report states 9 out of 10 women surveyed felt safer, and
85% of women felt more independent, because of their mobile phone.23 With the rise of mobile
payments and mobile money, or mFinance, and increasing access to mobile devices – women are
beginning tap into economic independence in places they traditionally have not been able to.

Lastly, social support for women in domestic violence situations is an important factor. In
the developed world, this may be derived from in-person working groups or community groups
and can extend through social media platforms and the Internet, allowing women to connect and
share their experiences. However in the developing world, mobile phones can play a unique role

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in garnering this type of support. In Senegal, the organizations Tostan and UNICEF launched
the Jokko Initiative. By way of SMS technology the program allows community members to
send out messages on topics including information on vital events, service announcements and
income-generating activities.24 It allows women the opportunity to promote their goods and get
information out about events they organize. Not only does this provide a chance for women to
connect with each other and provide support, but the program is also tied into Tostan’s literacy
and math program.

 Elder Abuse

Elder abuse has received the least public attention, having historically been defined as a
“private matter.” Today it is seen as an important problem likely to grow due to the rise in aging
populations in many countries. It is agreed that elder abuse is defined as “either an act of
commission or of
omission”, and that it may
be either intentional or
unintentional.25 The
elderly can experience
violence physically,
sexually or
psychologically and they
are also susceptible to
economic abuse.

Again we see the
use of hotlines and the
Department of Economic and Social Affairs Population Division 2009 sharing of information via
the Internet as integral to
dealing with this type of violence. The National Center on Elder Abuse has state resources such
as helplines and hotlines listed directly on its website in addition to listing where to report
nursing home abuses and information about Adult Protective Services. There are also National
Elder Abuse Awareness public service announcements that call attention to the issue.

Some sources cite that a key prevention tactic could be the further use of intervention
programs in hospital settings, which are lacking due to an absence of training in this area.26
Recently there has been a rise in electronic checklists within the hospital setting regarding
surgical procedures. The incorporation of certain elements such as signs and symptoms of abuse
could be integrated into these checklists. As more move towards the use of tablets and electronic
records, this opens up a unique opportunity to start progressing to a more holistic approach in
healthcare. Additionally with the ability to train remotely, technology can be used to keep those
in the healthcare industry abreast of proper diagnosis of elder abuse and what to do about it.

Lastly, the role of social media should be highlighted here. Social media platforms such
as Facebook and Twitter, along with communications tools such as Skype, allow those
traditionally cut off from the outside world the means to connect with family as well as a wider
community. According to a 2009 study from AARP, about one-third of people 75 and over live

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alone.27 MyWay Village, a social network installed in nursing homes, allows residents to connect
with new people and share their memories and experiences. Equipped with training sessions, it is
easy to pick up and residents can send friends messages, play games and most importantly not
feel like they are isolated.28

 Youth Violence

Youth violence is closely linked with other forms of violence as youths who are exposed
to other types of violence, have an increased propensity towards committing violent acts
themselves. Adolescents and young adults are often both victims and perpetrators of youth
violence. WHO notes that violence involving youth greatly adds to the costs of welfare and
health services, decreases productivity and even “undermines the fabric of society”.29

Technology, particularly the role social media can play, frequently is viewed as having a
negative effect on youth. From online bullying to violent YouTube videos and video games,
these are often cited as leading to increased violence amongst youth. Even a term has been
assigned to the type of harassment that occurs through e-mail, instant messaging, and websites or
via the mobile phone: “electronic aggression”.30

Regardless of the potential harm, youth are increasingly using social media and there are
ways in which it can be used positively. With the increase in use of mobile phones by teens, this
opens a unique window to reach each one on an individual basis. loveLife, a program in South
Africa launched a web-based mobile program called MYMsta. This mobile social network
enables the youth population to access information about HIV, employment opportunities,
scholarships and other tips to improve their lives.31 It also allows them to talk about concerns
relating to sexual health and get responses from trained counselors.

loveLife implores other services to reach youth such as their call-back service which
offers users free mobile connectivity to a counselor. Users send a message to the service saying,
‘Please Call Me’ and the automated system calls them back and links them to an available
trained counselor.32 Texting in this regard is also used domestically in the United States. The
National Dating Abuse Helpline recently made its services available via text message by
allowing teens to text “loveis” to 77054 and receive help from trained peer advocates.33

In another effort to reach out to teens, particularly in reference to intimate partner
violence or dating violence, Futures Without Violence developed the online campaign That’s
Not Cool. That’s Not Cool encourages teenagers to decide for themselves what’s okay, or not
okay, in their relationships by incorporating videos, interactive games, and an online forum for
teens to share their stories and receive advice. That’s Not Cool recently launched an avatar
application where teens can create their own personalized mobile phone character in response to
animated videos addressing digital dating abuse. Using text-to-speech technology, the character
speaks the teen’s response and the result is a speaking avatar video that can be posted and shared
with their peers on Facebook & Twitter.34

In relation to youth gangs, an innovative partnership has emerged in relation to a Chicago
based organization CeaseFire which combines science and street outreach to track where

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violence is heating up and interrupt to calm the situation down. With Ushahidi,
FrontlineSMS:Medic and PopTech, the project PeaceTXT will look at how mobile tools, such as
those used by other crisis mapping organizations, and mobile messaging can accelerate
CeaseFire’s success already in decreasing deaths.35

 Child Abuse

Child abuse takes the form of infanticide, mutilation, abandonment and other forms of
physical and sexual violence.36 It is a universal problem and often increases the likelihood of
adult forms of illness and disease. There is also a unique cultural aspect to child abuse as the
standards and expectations of proper parenting can range in different countries and societies.
More often than not, the term technology when combined with the idea of child abuse conjures
up images of child porn on the Internet and other negative ways in which recent innovations have
further harmed children. As with all forms of violence, technology also offers unique ways in
which to prevent this type of abuse.

One underlying risk factor cited for a parent’s proclivity towards committing child abuse
is a lack of education on the expectations of their child’s development.37 There has been a recent
rise in health text messaging programs geared towards reaching traditionally underserved groups
with important health information. For instance, in the United States the Text4Baby program
piloted by the Department of Health and Human Services (HHS) is a public-private partnership
that provides pregnant women and new mothers with free health text messages. The messages
range from tips on how to care for your baby as well as information on what to expect during
pregnancy. Evaluations of the program are scheduled to be available in 2013 and the model is
already being taken abroad with IVR technology (the use of voice instead of text). Another text
program HHS is due to roll out next year is Text4KidsHealth. Through the Health Resources
and Services Administration (HRSA) text messages will be developed on nutrition and physical
activity to be used for future programs targeting the parents of children 1-5 years of age.38

The mobile phone can act as a reporting tool for cases of child abuse. As seen earlier in
relation to collective violence, there is power is capturing images of typically ignored issues and
bringing them to light in the mainstream media. Using one’s mobile phone in combination with
community reporting is an easy way for stories to hit the Web and be shared across masses of
people through YouTube, blogs and other social media channels.39 One can do a simple google
search online and find numerous online campaigns, blogs and other videos calling for action and
attention to the issue of child abuse.

The traditional hotlines available to children, such as the National Child Abuse Hotline
run via Childhelp, offer another medium of help and prevention. Childhelp also has information
on its website to help children in discerning if they are being abused and what action they can
take.40 In addition, health professionals play a key role in identifying any signs of child abuse in
their patients. Incorporating this as part of their training, or including information and prompts in
the tools they use such as checklists or reminders could help in preventing additional cases of
abuse.

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Self-Directed Violence

Lastly, violent acts that one inflicts upon himself or herself are classified as self-directed
violence. This includes both suicidal behavior and self-abuse. In the United States,
approximately over 35,000 commit suicide every year. This doesn’t even take into consideration
suicide attempts or self-abuse. Additionally the most recent state-by-state data available is from
prior to the 2008 economic crisis.41 Annually more than 1 million people attempt to take their
own lives and approximately 60 million Americans experience a mental health disorder
including posttraumatic stress disorder (PTSD) and depression, in any given year.42

The WHO cites proper diagnosis of mental disorders is important, but in addition so is
support for those who are contemplating such destructive acts. Again Telehelp lines and call
centers are influential. There are numerous lifelines, hopelines and other crisis services out
there. Opportunities now also exist for easy access to information and therapies online. The rise
of online support groups also allows for those suffering to reach out and connect with others
ensuring that they know they are not alone. The more awareness and access to services permits
many to move past the social stigma often attached to depression and suicide.

On the mobile platform there has been some debate over the creation and use of suicide
prevention applications. To have the applications verified and appropriate for the user in addition
to the possibility of producing any impact is contested. The QPR Institute released an Android
app that turned the book “The Tender Leaves of Hope, Helping Someone Survive a Suicide
Crisis” into a digital booklet in hopes of reaching more families and individuals.43 Some mobile
applications let users track their moods and experiences, providing supplemental information for
them as well as their therapists. An app called “mobile therapy” has a "mood map" that pops up
on a user's screen where the user can then indicate how they are feeling. In response the app then
offers “therapeutic exercises" ranging from "breathing visualizations to progressive muscle
relaxation" and ways on how to disengage from a stressful situation.44

Again there are risks involved. Often blame is placed on technology and media for
suicide, particularly teen suicide in relation to the rise of cyberbullying. It is difficult to
determine how much media and technology play a role in these deaths. Some instances become
sensationalized such as the case of a Florida teenager in 2008 that posted a live stream video of
completing the act of suicide online, encouraged by others he was chatting with online at the
time.45 With over 87 percent of teens (ages 12-17) using the Internet and 19 million teens sharing
their lives through text messages, this is definitely a cause for concern. As much as mobile
phones, chat rooms and other forms of communication can help teens work through their issues,
they can also push teens in the opposite direction.

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Overarching Gaps and Trends

Through the program implementation cases above several arching gaps and trends begin
to emerge, many similar to others using these tools in differing fields. In this section we will
examine some of these gaps and what we can do about them.

Data Collection and Surveillance

A common problem in the field is the collection and distribution of valid, useful and
analyzed data. As cited in the first WHO World Report on Violence and Health, countries around
the world are at different stages of capacity for collecting data.46 There is a lack of quality and
lack of uniformity in the data itself. In addition, the problem of only knowing “the tip of the
iceberg” remains, as many instances of violent acts remain undetected and unreported.

The use of ICTs can create certain efficiencies in Elements of a Well Designed
data collection as well as in its quality and associated Information System:
1. A streamlined data entry
information flows.47 Currently, partly due to the need for
process
donor reporting, data collection is fragmented and siloed.
2. The direct digital capture of
Particularly through the use of mobile phones in the
laboratory test results or
developing world, opportunities to increase the collection
clinical diagnoses
and access to data and health information have increased.
3. Efficient data merge
Electronic capture of data can decrease human error and
capabilities from multiple data
increase the speed of analysis.
sources
Talk about the use of unique identifiers, such as 4. Automated data quality checks
biometric data, and the use of electronic health records to 5. Rapid search, retrieval, and
track patients have become increasingly commonplace. visualization capabilities
This type of data capture and storage can create better 6. Early warning alerts for
coordination across health systems to share data potential disease threats and
horizontally.48 Having access to broader data could lead disease outbreaks.
to different actions and outcomes. Additionally the use of Ranck 2011
ICTs and mobiles could aid health professionals, from
doctors to community healthcare workers, in accessing and retrieving information.

EpiSurveyor and Commcare are examples of tools that have just started to breech into
this area. EpiSurveyor allows anyone to create an account, design forms and download them to
their mobile phone to collect data for free. Commcare is free and open-source software that aids
community healthcare workers (CHW) in case management through their mobile phone. The
software contains registration forms, checklists, danger sign monitoring, and educational
prompts and is designed to help manage enrollment, support, and tracking of all of the CHW’s
clients and activities. The data that is collected is sent to the cloud for easy analysis and retrieval.

Another project ChildCount+ is a platform designed and used by the Millennium Villages
Project. ChildCount+ uses SMS text messages to assist and coordinate the activities of
community based health care providers such as CHWs. CHWs can use text messages to register

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patients and report on their health status. This information is sent to a central web based
dashboard which can then provide a real-time view of the current status of the community.49
There are also other numerous software kits being used in the developing world such as EpiInfo,
OpenXdata, Open Data Kit, Open Dream, Open MRS, OpeneLIS, Open-Clinica, District Health
Information System (DHIS), Managing News, Sahana, Geo-Chat, Riff/Evolve, Mesh4x,
Ushahidi, and Epidefender.50

Research and Evaluation

Along with the needs listed above for data collection and surveillance, common metrics
for monitoring and evaluation especially for programs using ICTs and mobile devices are
lacking. There is serious gap in vigorous evaluation of the many pilot programs that are utilizing
these new mediums of communication and determining their overall impact.

A unique factor around the use of ICTs is the possibility for real time evaluation. In addition,
linking data from one program to others could lead to a clearer view of where the field is and
where it is heading. This could be quite impactful. However issues remain over a lack of
understanding of the capabilities and realities around the use of ICTs, a lack of common data
standards that support interoperability and the creation of information-sharing policies.51
Conversations around the “enterprise architecture”, or rather the “plumbing” of systems, are in
the early stages. We have yet to have hit a point where projects are no longer functioning
independently in siloes, but sharing data leading to a leveraging of each other’s results. This
element of “interoperability”, or the ability to share data quickly and accurately across different
application and through the health system, will be an important barrier to overcome in the
coming years if large-scale impact regarding ICTs and mobile devices is to be realized.

Lastly, and related to sharing data across silos, are concerns over privacy and security.
Unease over the ability for users’ to retain anonymity, especially given the nature of collective
violence or intimate partner violence, is understandable and should remain at the forefront of any
project implementation. Data ownership remains a concern as well if projects continue to strive
for scale in implementation or begin to share data is between programs or with the health system
at large.

Dissemination and Implementation

In the implementation of violence prevention programs, ICTs can play a pivotal role
throughout the program and intervention design section. Multiple modes of telecommunications
exist, but mobile explosion both within the United States and globally provide additional
opportunities for impact. Common elements of program implementation can include the use of
electronic forms and checklists, remote training for healthcare professionals, the use of crowd
sourcing and social media platforms, the use of SMS and video or television.

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However, a larger issue
remains, which is the exchange of
information and lessons learned
throughout not only the violence
prevention community but the public
health field at large. In this capacity,
online platforms can aid in the
dissemination and sharing of
knowledge. Although not widely
instituted yet, GHD Online and the
mHealth Alliance’s Healthunbound
platforms offer a peek into what is
possible. With the rise of webinars
and remote access to meetings, and
the ability to share presentations
online through websites such as
slideshare, avenues for information sharing and collaboration have increased.

Lastly, institutions should not overlook these platforms for supporting their advocacy
campaigns and ability to raise funds for the implementation of programs. Multiple programs now
use e-cards and online petitions, or request advocates to share program information with their
social networks. Text campaigns have become particularly popular over the past few years,
allowing individuals to donate to certain causes via their mobile phones. Eight days after the
earthquake in Haiti in 2011, the American Red Cross had raised approximately $22 million via
text messaging. Donors texted the word “Haiti” to 90999 and a $10 pledge was automatically
added to the person’s phone bill.52

Recommendations

1. Undertake a full landscape analysis of the use of ICTs in violence prevention

Time and resources should be dedicated to a full landscape analysis on the intersection
between ICTs and the field of violence prevention, with particular emphasis on the mobile
phone in relation to the developing world.

2. Learn from other fields and each other

Particularly the mServices and mHealth space can have a lot to offer in terms of uses of new
innovations and lessons learned. Conversations around the employment of electronic health
records, interoperability and development of common metrics to evaluation are being
explored. Additionally, the typologies of violence outlined in this paper are repeatedly
interrelated and interdependent. Using new platforms for information sharing and
collaboration, as well as the possibility of sharing data and lessons learned with each other,
could greatly push the field forward.

13

3. Develop common metrics for monitoring and evaluation

With the ever pressing need to know if these technologies are making a positive impact, the
development of common metrics for monitoring and evaluation is important. With the ability
for near real time analysis of data and given the nature of the infancy in this space,
collaboration around metrics and the actual evaluation of programs will be vital in knowing
what works and what does not.

4. Further explore privacy issues

Given the sensitivities that exist around certain types of violence, such as intimate partner
violence, the need for anonymity takes precedence. Issues around user privacy, the sharing of
data, reporting and so forth need to be further explored. The technologies themselves also
must be investigated to make certain they are not leaking sensitive information to a wider
public, for example via GIS mapping or forums on the internet.

5. Address development factors – move beyond intervention

Emphasis must be made on many of the underlying development factors that can lead to the
instigation and continued perpetration of violence. Factors such as poverty, lack of access to
the healthcare system, lack of access to education and economic inequality can make any
person or society ripe for violence. ICTs can be pivotal in addressing these issues such as the
use of mFinance in addressing poverty, tools for CHWs to help expand access to healthcare
and education through the use of computers or even mobile phones.

ENDNOTES
1
Krug, Etienne G., Linda D. Dahlberg, James A. Mercy, Anthony B. Zwi, and Rafael Lozano, eds. World Report on
Violence and Health. Rep. Geneva: World Health Organization, 2002.
1
2
Krug, mHealth Alliance. 2010. Web. James A. <http://www.mhealthalliance.org/about>.
About Etienne G., Linda D. Dahlberg,Oct. 2011.Mercy, Anthony B. Zwi, and Rafael Lozano, eds. World Report on
Violence and Health. Rep. Geneva: World Health Organization, 2002.
2
About mHealth Alliance. 2010. Web. Oct. 2011. <http://www.mhealthalliance.org/about>.
3
Grove, Jennifer V. "Social Networking Usage Surges Globally [STATS]." Mashable Business. Mashable, 19 Mar.
2010. Web. Oct. 2011. <http://mashable.com/2010/03/19/global-social-media-usage/>.
4
Elliott, Amy-Mae. "YouTube Facts: 10 Things You May Not Have Known." Mashable Business. Mashable, 19
Feb. 2011. Web. Oct. 2011. <http://mashable.com/2011/02/19/youtube-facts/>.
5
World Report on Violence and Health. WHO, 2002.
6
"WK 214 Mobile Phones: Communicating for Action." New Tactics in Human Rights. Center for Victims of
Torture. Web. Oct. 2011. <http://www.newtactics.org/WK214>.
7
Harvard Humanitarian Initiative. Disaster Relief 2.0: The Future of Information Sharing in Humanitarian
Emergencies. Washington, D.C. and Berkshire, UK: UN Foundation & Vodafone Foundation Technology
Partnership, 2011.
8
"Mapping The Egypt Protests and Libya Crisis." The Ushahidi Blog. Ushahidi, 07 Apr. 2011. Web. Oct. 2011.
<http://blog.ushahidi.com/index.php/2011/04/07/mapping-egypt-and-libya/>.
9
10
"What We Do." Witness.org. Witness.org. Web. Oct. 2011. <http://www.witness.org/about-us/witness-
background>.
11
12
Ibid

14

13
"Sexual Assault Statistics." National Center on Domestic and Sexual Violence. Web. Oct. 2011.
<www.ncdsv.org/images/SexualAssaultStatistics.pdf>.
14
Heatwole, Anneryan. "HarassMap: Tracking Sexual Harassment in Egypt with SMS." MobileActive.org. 23 Feb.
2010. Web. Oct. 2011. <http://mobileactive.org/harassmap-plan-track-sexual-harassment-egypt>.
15
Ibid
16
Verclas, Katrin. "Human Trafficking Hotline: Mobile Phones in the Fight Against Slavery | MobileActive.org."
MobileActive.org. MobileActive Corp, 07 Aug. 2007. Web. Oct. 2011. <http://mobileactive.org/human-trafficking-
hotlin>.
17
18
Ibid
19
"My Cause." BellBajao: Bring Domestic Violence to a Halt. Breakthrough. Web. Oct. 2011.
<http://www.bellbajao.org/my-cause/>.
20
"iPhone App." Love Is Not Abuse. Liz Claiborne Inc. Web. Oct. 2011.
<http://loveisnotabuse.com/web/guest/iphone>.
21
Papillon, Anthony. Developing a Text Messaging Based Community Domestic Violence Response System Using
FrontlineSMS. Rep. Advanced Data Concepts. Web. Oct. 2011.
22
"Mobile Livelihoods." Grameen Foundation. Grameen Foundation. Web. Oct. 2011.
<http://www.grameenfoundation.org/what-we-do/mobile-phone-solutions/livelihoods>.
23
Vital Wave Consulting. Women & Mobile: A Global Opportunity. Rep. Cherie Blair Foundation, Feb. 2010. Web.
Oct. 2011.
24
Ibid
25
26
Ibid
27
Clifford, Stephanie. "Online, ‘a Reason to Keep on Going’." The New York Times. The New York Times, 01 June
2009. Web. Oct. 2011. <http://www.nytimes.com/2009/06/02/health/02face.html>.
28
Ibid
29
30
Hertz MF, David-Ferdon C. Electronic Media and Youth Violence: A CDC Issue Brief for Educators and
Caregivers. Atlanta (GA): Centers for Disease Control; 2008.
31
Ngcobo, Njabulo. "Mobile LoveLife Goes Global." Daily Sun. 01 Nov. 2010. Web. 06 Nov. 2011.
<http://www.lovelife.org.za/press/media/article.php?uid=2982>.
32
"What We Do." LoveLife. LoveLife. Web. Oct. 2011. <http://www.lovelife.org.za/what/call_me.php>.
33
http://www.loveisrespect.org/
34
Pritchard, Sarah. "ICTs and Violence Prevention." Message to the author. 07 Oct. 2011. E-mail.
35
Meier, Patrick. "Launching PeaceTXT." The Ushahidi Blog. Ushahidi, 29 Oct. 2010. Web. Oct. 2011.
<http://blog.ushahidi.com/index.php/2010/10/29/peacetxt/>.
36
37
Ibid
38
"HHS Text4Health Projects: Open Government at HHS." HHS.gov. United States Department of Health and
Human Services. Web. Oct. 2011. <http://www.hhs.gov/open/initiatives/mhealth/projects.html>.
39
Nyirubugara, Olivier. "Unmasking Child Abuse with Mobile Phones - Articles." AfricaNews.com. Voices of
Africa Media Foundation, 05 Dec. 2010. Web. Oct. 2011.
<http://voicesofafrica.africanews.com/site/list_message/32169>.
40
http://www.childhelp.org/
41
National Center for Health Statistics. "Facts and Figures." American Foundation for Suicide Prevention. Web.
Oct. 2011. <http://www.afsp.org/index.cfm?fuseaction=home.viewpage>.
42
"Election 2010: Will Candidates Address the Facts? Check out State Suicide Rates and New Obama
Administration Numbers; Unemployed Persons and Veterans Are Especially at Risk." National Alliance on Mental
Illness. 14 Sept. 2010. Web. Oct. 2011. <http://www.nami.org/Template.cfm?Section=press_room>.
43
"Suicide Crisis Support - Android Market." Apps - Android Market. Web. Oct. 2011.
<https://market.android.com/details?id=qprinstitute.crisis>.
44
Trudeau, Michelle. "Mental Health Apps: Like A 'Therapist In Your Pocket' : NPR." National Public Radio. 24
May 2010. Web. Oct. 2011. <http://www.npr.org/templates/story/story.php?storyId=127081326>.
45
Friedman, Emily. "Florida Teen Live-Streams His Suicide Online." ABCNews.com. ABC News, 21 Nov. 2008.
Web. Oct. 2011. <http://abcnews.go.com/Technology/MindMoodNews/story?id=6306126>.

15

46
47
Jody Ranck, Health Information and Health Care: The Role of Technology in Unlocking Data and Wellness – A
Discussion Paper, (Washington, D.C.: United Nations Foundation & Vodafone Foundation Technology
Partnership), February 2011.
48
Ibid
49
http://www.childcount.org/
50
Ranck, 2001.
51
Ibid
52
Heath, Thomas. "U.S. Cellphone Users Donate $22 Million to Haiti Earthquake Relief via Text." The Washington
Post. 19 Jan. 2010. Web. Oct. 2011. <http://www.washingtonpost.com/wp-
dyn/content/article/2010/01/18/AR2010011803792.html>.

16

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