Abuse in intimate partner relationships is a human rights violation and a social and public health problem [1,2]. In Aotearoa, New Zealand, 1 in 3 women experience physical or sexual violence by a partner, with rates higher for indigenous Māori (58%) compared with New Zealand European (34%) women [3,4]. For many, their first experience of relationship abuse is during adolescence (13-18 years) [5-9]. Relationship abuse may include psychological, physical, sexual, or cyber abuse threats [10-12]. There is a small but growing body of literature examining relationship abuse prevalence, prevention, and intervention during this critical period of adolescence, when individuals transition from childhood to adulthood [13-15]. Comprehensive, accessible, innovative, and cost-effective interventions are required to prevent intimate partner abuse among young people. However, frequently, research programs appear to be done on rather than with young people, and few studies provide an indigenous lens. Given the significant health and social inequities of indigenous Māori in Aotearoa, New Zealand, we embarked on a program of co-designed research to develop and evaluate a personalized healthy relationship smartphone app using a taitamariki- (young person) and Māori-centered approach. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, including qualitative and quantitative data collection methods, was used to examine the adoption and implementation of the app in 8 pilot secondary schools in New Zealand [16,17]. In this paper, we present a trial protocol for testing the effectiveness of the app.

As a team, we are committed to including the voice of young people in our work, consistent with their right to express opinions freely and have these considered in any matter that affects them [18,19]. We will convene taitamariki advisory groups (TAGs) to enable young people to cocreate the app using participatory research principles [20] and cocreation processes [21,22]. Before the formal trial, Māori team members experienced in child advocacy and focus group methodology (ME, TD, and TWBU) recruited and facilitated 2 cohorts of TAGs. TAG members and their parents provided written consent to participate in this research project. The initial tuakana (older) TAG included 7 taitamariki from 1 New Zealand region. At recruitment, they ranged in age from 15 to 17 years and included both taitamatane (boys; n=4) and taitamahine (girls; n=3); 5 of the 7 taitamariki self-identified as Māori. As the app was developed and trial was planned, meetings were convened kanohi-ki-te-kanohi (face-to-face), supplemented with communication via a private Facebook group. The second teina (younger) TAG members are recruited from our pilot schools across New Zealand and include 15 taitamariki (boys, n=4; girls, n=11). Communication includes kanohi-ki-te-kanohi meetings, videoconferencing, and interaction on Instagram. TAG members participated in project branding, app development, and trial design. The project branding Harmonised was chosen by the TAG. The TAG members will participate in the implementation, interpretation of findings, and dissemination.

As a team, together with our community advisors, we are committed to a Māori-centered approach. At our first team hui (meeting), we specified our purpose, kaingākau (values), tikanga (right way of doing things in a Māori worldview), and whanonga pono (principles) to guide our mahi (work). A Māori-centered approach is premised on the bicultural relationship between Māori as tangata whenua (indigenous people of the land) and tauiwi (nonindigenous people) [23]. This research privileges a Māori worldview, ensuring that processes and outcomes are beneficial for Māori, inclusive of Māori values, expectations, and needs, and cedes control to protect Māori interests.

Early in the development of this research program, we took a philosophical turn from the mainstream deficit-based approach of reducing violence to a Māori well-being and strengths-based approach of promoting healthy relationships. From that point, we problematized our processes and decisions. For example, we identified that available validated measures focused on measuring adolescent relationship abuse (or dating violence) rather than measuring healthy relationships—the core focus of the research. In addition, identified measures were predominantly developed for adults and modified for young people, often without input from young people themselves. Finally, we could identify no measures for our variables of interest that represented a Māori or indigenous youth perspective. Therefore, in many respects, we are traveling uncharted territory, balancing cross-disciplinary and cross-cultural bodies of knowledge.

As people are increasingly seeking health information from the internet [24,25], mobile health interventions offer promise for improved health and well-being across the life span [26,27]. There is also evidence of value in the development of mobile health interventions aligned with indigenous frameworks [28-30]. In research with taitamariki Māori in Northland New Zealand about healthy and unhealthy intimate relationships, taitamariki expressed a need for more information and more effective support from friends and whānau [31,32]. However, rather than being lectured to or given advice when they haven’t asked for it, they suggested safe, easily accessible social media and web-based tools to use privately [33]. The Harmonised app is meant to address this information need identified by taitamariki Māori. The intent is to develop a resource that would supplement, rather than replace, other healthy relationship learning in schools, whānau, or families or communities. New Zealand secondary schools have a range of digital technology devices [34] and a Ministry of Education–funded Chrome Education License [35].

The Harmonised healthy relationship smartphone app was developed consistent with our taitamariki- and Māori-centered approach. Development was iterative, involving repeated cycles of taitamariki input, app development, and testing. Our software engineer and app developer worked together in applying the specifications identified by taitamariki in focus groups, usability testing, and by our TAG members (Figure 1). Taitamariki specified their desire for an interactive, private social network that allows taitamariki users to (1) create their own relationship profile and choose their relationship values, (2) learn about common relationship issues (healthy relationship information and skill resources), and (3) post issues or comments about their relationships with others. Taitamariki control whether to make posts private (sharing only with selected safe people) or public (shared anonymously). Responding to the taitamariki desire for better support from their friends and whānau, the Harmonised app supports 2 user types: (1) primary users are taitamariki, with access to all app functions, and (2) secondary users are friends, whānau, or family and community who have access to healthy relationship information resources only, unless invited as a primary user’s safe person to comment on a specific post.

A Harmonised moderation protocol guides safe practices for all posts (posts and comments), minimizing the risk of harm to primary app users, harmful use of the app, and harm to the platform. The protocol is aligned with best practice safety and security measures from Netsafe [36], Technology Safety [37], and others [21,38]. The moderation protocol includes automated (inappropriate language block and suicidality or self-harm automated message), human (daily review by the research team with the ability to block posted comments or individual users), community-based (users’ report inappropriate content), and reputation-based moderation. An escalation pathway identifies procedures, should moderators have a safety concern. The safe and responsible use of the app is communicated to all users. The protocol is aligned to the New Zealand Harmful Digital Communications Act 2015.

Healthy relationship resources are collated by a Harmonised resource working group to provide taitamariki with the information they have requested. The topics covered include, for example, communication, consent, dealing with anger, and how to talk with your parents or children about healthy relationships and sexuality. The working group followed a protocol for resource selection, modification, and permission for use. Resources include links to videos, quizzes, brief articles, and stories from a range of open-access sources. Where to get help is a recommended resource for all users. New Zealand and Māori resources were prioritized.

Following a beta test version available in June 2017, version updates continued with bug fixes and enhancements. In some cases, changes were made in response to requests by school staff (eg, ability for persons to accept or not accept a safe person’s invitation). As a prevention intervention, there is also attention to promoting the app for all taitamariki, regardless of relationship status. For example, presenting the interactive selection of relationship values as a requirement before advancing to the app feed allows all taitamariki to participate in the healthy relationship values exercise. We also use gender-diverse language, sensitive to the minority (estimated at 3.8%) of Aotearoa young people attracted to others of the same sex or both sexes [21,39,40].

The hybrid app in English and Te Reo Māori (translation by a certified Māori language interpreter) is available across the digital ecosystem, including mobile devices (smartphones and tablets), laptops, and desktop computers. The app was first published in June 2018 in the Apple App Store, Google Play Store, and web browser by the Auckland University of Technology Enterprises Ltd. To increase privacy, the app is personal identification number code–protected to keep information safe once a user moves away from the screen. To reduce the risk of harm from nontaitamariki inappropriately posting (eg, trolling), the posting function is limited to students enrolled at participating schools and validated during app registration against email lists provided by the schools.

We are investigating the adoption and implementation of the interactive, personalized healthy relationship Harmonised app in 8 pilot secondary schools in New Zealand using the well-established RE-AIM evaluation framework [16,17]. Mixed method data sources include a quantitative web-based taitamariki survey, focus groups with taitamariki and school stakeholders (persons identified by schools who are involved in their response to taitamariki health and well-being), app use data, school engagement notes, and itemized costs (Table 1). In this paper, we present the trial protocol for testing the effectiveness of the Harmonised app using a quantitative web-based taitamariki survey.

We hypothesize (primary analysis) that implementation of the app (compared with before implementation) will (1) increase taitamariki relationship self-efficacy (RSE; primary outcome) and (2) increase taitamariki well-being, general health, cybersafety management, and connectedness (secondary outcomes). We will also conduct (3) primary analyses limited to Māori participants (subgroup analyses). Other measures include school and student characteristics and taitamariki help-seeking and barriers to getting help.

A pragmatic, stepped wedge, cluster randomized (one-directional crossover) trial in 8 pilot secondary schools tests the effectiveness of the Harmonised app. Secondary schools in New Zealand include years 9 through 13 (5 years of high school, generally young people aged 13 to 17 years). In the stepped wedge design, the app is implemented in all 8 schools in one of 2 school terms, with the order of implementation determined at random [41-44]. There are 5 assessments (web-based surveys) per school and 2 time steps over a 15-month trial period (Table 2). Our protocol description follows the CONSORT (Consolidated Standards of Reporting Trials) stepped wedge, cluster randomized trial extension [44]. The study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619001262190) on September 12, 2019.

The trial protocol was approved by the Auckland University of Technology Ethics Committee (application number: 17/71), approved on May 3, 2017. All schools have a pathway for students needing health and well-being services, including social workers, counselors, and health providers. Consent to participate is provided by each school’s principal and Board of Trustees. Schools follow their processes for sharing information about the study with parents and gaining parental consent (information and consent forms provided by researchers). Students choosing to participate in the survey provide consent in the introduction to the web-based survey that details confidentiality. Students were identified using a randomized code number. All communication and visits with schools are documented by the research staff and reviewed by senior investigators as contextual data and to audit trial conduct. Our Harmonised ethical research practice and data sharing protocol provides a process for accessing Harmonised data aligned with our Māori-centered approach, available on request. Guided by our tikanga, we will prioritize taitamariki, schools, and whānau to disseminate our findings.

The Harmonised trial will generate robust evidence to evaluate the impact of introducing a healthy relationship app into secondary schools. Importantly, this strengths-based taitamariki- and Māori-centered research counters the dominant adult-focused and deficit-based intimate partner violence literature. Working with taitamariki and community advisors, we have created the Harmonised brand focusing on what young people have told us about healthy partner relationships. The Harmonised app provides a safe digital network with resources for taitamariki to consider the values that are important to them for a healthy intimate partner relationship.

This pragmatic trial offers an opportunity and challenge to understand whether a healthy relationship digital resource can be embedded in the secondary school environment and whether the resource benefits taitamariki, particularly Māori. Secondary schools are busy places that are typically underresourced to meet all the complex needs to support students and families to flourish. Our Harmonised study guided by explicit tikanga and using mixed methods guided by the RE-AIM framework will make an important contribution to understanding drivers of and barriers to conducting research in this unique setting. Our trial measures will identify whether the introduction of the app improves taitamariki partner RSE, well-being, general health, cybersafety management, and connectedness.