Reaching the Hardest to Reach: Lessons Learned from a Feasibility Trial to Assess Online Services for Low-Income, Intimate Partner Violence Survivors in Brazil

Digital platforms are increasingly proposed to reach survivors of intimate partner violence (IPV) in low- and middle-income countries, yet few feasibility data exist. We assessed the viability of Mapa do Acolhimento, a volunteer-run Brazilian service that recently introduced video counselling by psychologists and remote navigation by social workers. Women (≥18 y) who self-registered between January and April 2024 and remained unmatched after 24 h (n = 316) were randomized 1:1:1 to counselling (T1 = 127), navigation (T2 = 90) or care-as-usual referrals (CAU = 99). Pre-specified feasibility metrics were recruitment yield, covariate balance, 90-day retention, and instrument performance. The online funnel enrolled 18.6 survivors per week initially, declining to 8.1 as social-media click-through rates fell; 91% resided in high-connectivity municipalities, and 41% screened positive for severe anxiety or depression. Baseline balance was achieved on 19/20 variables; race/ethnicity was imbalanced (Black/Indigenous 24% in T2 vs 6% in CAU; χ² = 11.7, p < .01). Overall retention was 14.2% (45/316); dropout was higher for survivors with high baseline anxiety, defined as the maximum value on the study’s adapted two-item anxiety index (aOR = 1.74), and for those using shared devices (aOR = 1.59). The PHQ-2 and GAD-2 displayed acceptable reliability (α = .78), but 28% of respondents exited immediately after the mental-health block, indicating survey-length fatigue. An unanticipated platform upgrade reduced eligible intake by ≈60%, rendering an adequately powered RCT infeasible. Findings show that a volunteer platform can recruit and randomize high-risk women at national scale, but rural reach, risk-responsive retention, and streamlined volunteer reporting must be strengthened. We propose evidence-based adjustments, plain-language messaging, hybrid recruitment, adaptive follow-up, and mobile-first reporting, and we outline methodological safeguards for future digital IPV trials in resource-constrained settings.