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Malta M, Legrand S, Baptista da Silva A, Seixas M, Benevides B, Furtado Da Silva C. Rainbow resistance: development of a mobile app to address violence against LGBTQIA+ people in Brazil using a community based participatory research approach. HPHR. 2021;42. DOI: 10.54111/0001/PP2
During the last ten years Brazil has been registering at least one murder of LGBTQI+ person every day. While violence is widespread, interventions are scarce and often discontinued. We developed a novel mobile health (mHealth) intervention to address the rampant discrimination and violence against LGBTQI+ persons from Brazil.
We utilized a community-based participatory research (CBPR) approach to collect quantitative and qualitative data from the Brazilian LGBTQI+ community. The data underscored the development of a mobile app, the “Rainbow Resistance- Dandarah App”.
The study included 11 members from the Brazilian LGBTQI+ community on the Community Advisory Board (CAB). Fourteen focus groups discussions (FGDs) were conducted with 8-10 LGBTQI+ persons each, including rural and urban cities, as well as hard to reach areas from Brazil (e.g. slums and the Amazon Area). Ten in-depth interviews (IDIs) were then conducted with key informants, the vast majority of whom were community leaders and professionals providing services for LGBTQI+ persons experiencing discrimination/violence. Descriptive analysis of qualitative FGDs data included plotting a‘word cloud’ to visually represent word frequency. The most mentioned word was “violence”, followed by “safe”, “streets” and “alive”. Since its launch, over 4,000 have utilized the Rainbow Resistance – Dandarah app. Most participants to date are men, self-identified as gay/homosexual, White, with a median age of 26 years. The panic button was activated 61 times. The “Rainbow Resistance- Dandarah App” had high acceptability, feasibility and anticipated usability.
Discussion: Many FGDs participants mentioned the importance of the collaborative strategy utilized in the study, where the LGBTQI+ community was consulted to identify their specific needs, were invited to compose a highly active CAB, tested the app prototype and had the opportunity to criticize and contribute to final app improvements. Study participants requested additional features, including legislation relevant to the LGBTQI+ community and addresses of local services, non-governmental organizations, shelters, etc. Those additional features, including mental health screening and referrals to specialized care, are under development.
Trans Murder Monitoring project registered a total of 3664 murders of trans and gender-diverse since 2008. Of these murders, 82% were registered in Central and South America, including 43% in Brazil.1 Therefore, more trans people are killed in Brazil each year than in any other part of the world. During the last ten years, Brazil has also been registering around 1 murder of LGBTQI+ person every day. While violence is widespread, interventions are scarce and often discontinued.2
Herein we describe the community-based participatory research (CBPR) approach3,4 used to conduct formative research to guide the development of a novel mobile health (mHealth) intervention to address the rampant discrimination and violence against LGBTQI+ persons from Brazil. The “Rainbow Resistance- Dandarah App” was developed to help LGBTQI+ communities in Brazil map and report experiences of discrimination and violence, helping them avoid and/or cope with these experiences when they occur.
The study included 11 members from the Brazilian LGBTQI+ community on the Community Advisory Board (CAB). Fourteen focus groups discussions (FGDs) were conducted with 8-10 LGBTQI+ persons each, including rural and urban cities, as well as hard to reach areas from Brazil (e.g. slums and the Amazon Area). FGDs participants were recruited among members of the two major organizations in the country: Brazilian National Transgender Association (ANTRA) and Brazilian LGBT Association (ABGLT). Ten in-depth interviews (IDIs) were then conducted with key informants, the vast majority of whom were community leaders and professionals providing services for LGBTQI+ persons experiencing discrimination/violence. The major objective of those FGDs and IDIs was to identify the community needs that could inform our app development.
Descriptive analysis of qualitative FGDs data included plotting a‘word cloud’ to visually represent word frequency. The more commonly the term appeared, the larger the word appears in the plotted Figure 1. This brief visual analysis highlights the clear impact of violence within this community. The most mentioned word was “violence”, followed by “safe”, “streets” and “alive”. Many participants are street commercial sex workers, and it is a frequent perception that, “We go out with a client, but we don’t know if we will come back alive” (Transgender women, sex worker, 29yr, FGDs). Participants also highlighted their gratitude for having their voices and concerns heard and being included in the development and improvement of the Rainbow Resistance – Dandarah app.
Figure 1. Word cloud of the 50 most frequent words mentioned in the FGDs
Findings from FGDs and IDIs were reviewed by the study team and CAB members to finalize the app design and features. After the initial app build was completed, it was tested by study team and CAB members for a two-week period to ensure there were no performance issues. Once minor bugs were addressed, usability testing was conducted. Based on data from usability testing, additional app refinements were completed before the app was launched in December 2019 by the Oswaldo Cruz Foundation, a research branch from Brazilian Ministry of Health.5 The final app includes the following features: violence mapping and reporting as well as a panic button and features allowing violence victims access to support 24/7 (Figure 2).
Figure 2. Screenshots of Rainbow Resistance – Dandarah app (Source: Created by the authors)
Since its launch, over 4,000 have utilized the Rainbow Resistance – Dandarah app. Most participants to date are men (56.6%), self-identified as gay/homosexual (53.9%), White (47.3%), with a median age of 26 years (Table 1). The panic button was activated 61 times.
Table 1. Selected socio-demographic characteristics of LGBTQI+ persons utilizing the Rainbow Resistance – Dandarah app (N=4,311), 2019-2021
Variables | n | % |
Gender Identity (n=4,311) |
|
|
Men, Cisgender | 2043 | 47.4 |
Men, Transgender | 203 | 4.7 |
Women, Cisgender | 729 | 16.9 |
Women, Transgender | 229 | 5.3 |
Travesti1 | 72 | 1.7 |
Intersex | 58 | 1.3 |
Non Binary | 105 | 2.4 |
Queer | 4 | 0.1 |
Other/NA | 868 | 20.1 |
Sexual orientation (n=4,027) |
|
|
Bisexual | 567 | 14.1 |
Gay | 1757 | 43.6 |
Straight | 383 | 9.5 |
Homosexual | 381 | 9.5 |
Lésbian | 506 | 12.6 |
Pansexual | 284 | 7.0 |
Androsexual | 2 | 0.1 |
Asexual | 29 | 0.7 |
Other/NA | 118 | 2.9 |
Intersex |
|
|
No | 3690 | 93.0 |
Yes | 276 | 7.0 |
Race / Etnicity |
|
|
Asian | 72 | 1.8 |
White / Caucasian | 1874 | 47.3 |
Indigenous | 34 | 0.9 |
Mixed Race/Etnicity | 1230 | 31.0 |
Black / African Origin | 642 | 16.2 |
Other / NA | 114 | 2.9 |
Age (median, min, max) | 26 years (11-72) | |
Age group |
|
|
10 – 14 years | 88 | 2.2 |
15 – 19 years | 698 | 17.6 |
20 – 24 years | 892 | 22.5 |
25 – 29 years | 756 | 19.1 |
30 – 34 years | 475 | 12.0 |
35 – 39 years | 347 | 8.7 |
40 – 44 years | 286 | 7.2 |
45 – 49 years | 121 | 3.0 |
50 – 54 years | 67 | 1.7 |
55 – 59 years | 32 | 0.8 |
60+ years | 19 | 0.5 |
NA | 185 | 4.7 |
Person with disabilities |
|
|
No | 3877 | 97.8 |
Yes | 89 | 2.2 |
Many FGDs participants mentioned the importance of the collaborative strategy utilized in the study, where the LGBTQI+ community was consulted to identify their specific needs, were invited to compose a highly active CAB, tested the app prototype and had the opportunity to criticize and contribute to final app improvements.
The experience was empowering for participants as they have often been stigmatized and marginalized. During FGDs and IDIs they had an opportunity to have their voices heard, be appreciated and valued for their efforts, and feel a sense of pride for their meaningful contributions to the safety and health of their community.
Many participants identified problems to be further addressed, mostly related to the mapping feature. Standardized maps like Google Maps and Waze frequently miss specific locations, such as informal settlements (favelas or slums) as many streets are not included in formal maps of those cities. Therefore, when utilizing the ‘panic button’, several participants reported that their specific location was not available in the app. Participants also requested additional content on legislation relevant to the LGBTQI+ community and addresses of local services, non-governmental organizations, shelters, etc. Those additional features, including mental health screening and referrals to specialized care, are under development.
The Rainbow Resistance – Dandarah app was launched in December, 2019 with support from the Brazilian Ministry of Health. It is now a governmental strategy, at FIOCRUZ under its major strategies to tackle violence and discrimination against LGBTQIA+ persons in the country. The long term sustainability of our strategy is mostly based on the government support, while its feasibility and acceptability relies on our close collaboration with the LGBTQIA+ community from Brazil and professionals working with the community. This is the first app developed in Latin America, with fully governmental support, to address the specific needs of LGBTQIA+ persons experiencing violence and/or discrimination. It is our expectation that the strategy will continue to be available for years to come, undergoing frequent revisions and upgrades. The unique and close partnership between a government agency and the LGBTQIA+ community might guide more feasible, accessible and acceptable interventions in the future. However this additional step is beyond the scope of our work.
The Rainbow Resistance – Dandarah App received support from Parliament member Jean Wyllys, the first openly gay congressman from Brazil. We also acknowledge the support received from all Brazilian LGBTQI+ community, members of the Brazilian LGBTQIA+ Association (ABGLT) and the Transgender Nacional Association (ANTRA). Without this active community this project wouldn’t be possible. Monica Malta acknowledge support from NIMH/NIH (R21MH119496)
The author(s) have no relevant financial disclosures or conflicts of interest.
Monica Malta is a researcher for the Institute for Mental Health Policy Research /Centre for Addiction and Mental Health (IMHPR/CAMH). Monica is also a Professor for the Department of Psychiatry, University of Toronto, in Toronto, Canada.
Sara LeGrand is a Associate Research Professor of Global Health at the Duke Global Health Institute and the Center for Health Policy and Inequalities Research, and Co-Director of the Duke Sexual and Gender Minority Health Program, in Durham, NC, U.S.
Angelica Baptistta da Silva is a Researcher for the Department of Human Rights, Health & Cultural Diversity, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, in Rio de Janeiro, Brazil.
Michele Seixas is a MPH Student from the Sergio Arouca National School of Public Health, and is in the Oswaldo Cruz Foundation. Civil Society Advisory Group, UN Women Brazil, in Rio de Janeiro, Brazil.
Bruno Benevides is on the Leadership Board for the Brazilian National Transgender Association (ANTRA), and is the President for the Niteroi Diversity Group, in Rio de Janeiro, Brazil.
Cosme Marcelo Furtado da Silva is an Associate Researcher at the Department of Epidemiology and Quantitative Methods in Health in the Sergio Arouca National School of Public Health, and is in Oswaldo Cruz Foundation, in Rio de Janeiro, Brazil.
Clarisse Kalume is a Research Assistant and Researcher at the Department of Human Rights, Health & Cultural Diversity, Sergio Arouca National School of Public Health. They are also a member of the Oswaldo Cruz Foundation, and a Project Coordinator for the Micro Rainbow International Foundation, in Rio de Janeiro, Brazil.
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