UNLABELLED: Background To evaluate the feasibility and acceptability of a text message intervention to improve young people's knowledge of sexual reproductive health (SRH) and harms related to smoking in Indonesia.
METHODS: A quasi-experimental short message service (SMS) trial of young people aged 16-24 years receiving twice weekly SMS over a 10-week intervention period. Pre- and post-online demographic and risk behaviour surveys were used to assess changes in knowledge. Among respondents who completed both surveys, we assessed changes in knowledge before and after SMS intervention using paired McNemar's test and differences in mean knowledge score using a paired t-test.
RESULTS: In total, 555 eligible young people were enrolled into the SMS intervention; 235 (42%) completed a follow-up survey, of which 198 (84%) were matched to a baseline survey. Median age of participants was 19 years and the majority were female (63%). The mean knowledge score significantly increased between baseline and follow-up surveys for SRH questions [2.7, (95% CI 2.47, 2.94) vs 3.4 (95% CI 2.99, 3.81) (P = <0.01)] and smoking-related questions [3.8 (95% CI 3.66, 3.99) vs 4.1 (95% CI 3.99, 4.28) (P = 0.03)]. A majority of participants reported that the SMS intervention increased their knowledge (95%) and were a useful reminder (95%).
CONCLUSIONS: An SMS intervention was feasible, acceptable and improved adolescents' SRH knowledge and smoking knowledge in a low- to middle-income setting. SMS interventions targeting young people need to be scaled up, with the potential to explore additional topics around healthy lifestyle, nutrition and physical activity.
BACKGROUND: Sexually Transmitted Infections (STIs) are a major public health challenge globally especially among adolescents and young adults in lower-middle-income countries (LMICs) in Africa including Ghana. In light of this, mobile phone innovations are advocated to enhance public health education and prevention of STIs in developing health systems.
OBJECTIVE: This study assessed mobile phone usage among adolescents and young adult populations pursuing tertiary education and their use of these technologies in the education and prevention of STIs.
METHOD: This was a cross-sectional analytical study among 250 adolescents and young adults aged 18-24 at Ghana's premier and biggest public University. The study was however conducted in only one public university in the Greater Accra region which potentially poses generalizability challenges due to socio-cultural and economic differences in other regions of the country. Data was collected using structured questionnaire and data analysis done with STATA (version 12.0). Univariate probit regression (VCE, Robust) analysis was used to determine factors associated with adolescents and young adult population's usage of mobile phones in the education and prevention of STIs.
RESULTS: Out of the 250 adolescents and young adults interviewed, 99% owned mobile phones. Out of this number, 58% them were smartphone users. Also, it was found that male young adults (Coef. = 1.11, p = 0.000) and young adults who owned a smartphone (Coef. = 0.46, p = 0.013) were more likely to use mobile phones for education and prevention of STIs.
CONCLUSION: Mobile phone penetration among young adults is nearly 100% in line with the national trend. Additionally, these young adults largely believe in the use of mobile phone programmes for STIs education and prevention. Moreover, respondents were found to be more comfortable using mobile applications than traditional text messaging or phone calls in STIs education and prevention. Future mobile phone programmes for STIs education and prevention should consider innovating customized mobile applications to promote acceptability by the youth and enhance sustainability of such interventions on STIs in Ghana. Even though this study was conducted in only one public university in Ghana, the findings are nonetheless informative and future researchers could consider using a larger sample size across private and public universities in other regions of the country.
BACKGROUND: Young people aged 15 to 24 years account for one-third of new adult HIV infections. Controlling the HIV epidemic requires effective interventions targeted toward young people and their needs. Smartphone games offer a promising avenue for reaching this population with evidence-based HIV prevention interventions. It is crucial to the effectiveness of these interventions that they be acceptable and intrinsically motivating to adolescents as well as acceptable to their parents.
OBJECTIVE: Tumaini is a narrative-based smartphone game designed to help prevent HIV among young Africans aged 11 to 14 years by delaying first sex and increasing condom use at first sex. Following a 16-day feasibility study of Tumaini, we assessed the acceptability (1) of the intervention, where acceptability was operationalized as appeal, relevance, value, usability, and understandability, and (2) of this study and a planned future randomized controlled efficacy trial.
METHODS: During the randomized feasibility study (n=60) of Tumaini in western Kenya in spring 2017, 30 participants used the intervention on a study-provided smartphone. The app automatically logged participant interaction with the game in time-stamped log files. All 30 participants completed an Audio Computer-Assisted Self-Interview-based game experience survey, and 27 took part in 4 focus group discussions (FGDs) about the game's appeal, relevance, value, usability, and understandability. Their parents (n=22) also participated in 4 FGDs about the acceptability of the intervention, of this study, and of a planned efficacy trial. Survey data were analyzed using SAS software (SAS Institute Inc); FGD transcripts were coded and analyzed in MAXQDA 12 (Verbi GmbH); and gameplay log files were analyzed using Microsoft Excel.
RESULTS: Adolescent participants' survey responses indicated that Tumaini scored well with players on all indicators of acceptability (appeal, relevance, value, usability, and understandability). Focus group analyses aligned with these findings and emphasized a high degree of player engagement with the game, which was supported by log file analysis. Adolescent participants were eager for additional content, and parents were receptive to a longer study involving biomarkers, based on their positive experiences with this study. There is scope to improve communication with parents about their role in the intervention. As the game was tested in beta version, there is also scope to fine-tune some of the game mechanics to increase usability.
CONCLUSIONS: This study shows the strong acceptability of an interactive smartphone-based game both to adolescents and their parents in western Kenya and that of the study methods used to pilot-test the intervention. It also suggests that longitudinal efficacy studies of this type of intervention, including those using biomarkers, have the potential to be acceptable among parents.
TRIAL REGISTRATION: ClinicalTrials.gov NCT03054051; https://clinicaltrials.gov/ct2/show/NCT03054051 (Archived by WebCite at http://www.webcitation.org/70U2gCNtW).
BACKGROUND: The control of HIV/AIDS has been a contemporary public health success story however, whilst infection rates are falling and people are living longer due to antiretroviral therapy, adolescents and young people remain disproportionally affected. Infection rates and AIDS-related deaths continue to increase in these age groups in some areas globally. This has been primarily attributed to structural barriers including HIV-services not being youth friendly with opening hours conflicting with school time, fears around unintended disclosure and confidentiality, and the attitudes of healthcare professionals-but research targeting these specific age groups remains limited. Early mHealth (i.e., the use of mobile and wireless devices to assist in achieving health objectives) projects have been shown to improve health outcomes in other disease areas and health settings however, amongst people living with HIV, current research is limited. The aim of this study was to explore barriers to HIV care and the acceptability and feasibility of using mHealth to improve retention into care and ART adherence for young people living with HIV (16-24 years old) in Lusaka, Zambia.
METHODS: Qualitative in-depth interviews and focus group discussions were carried out in four CIDRZ-supported health facilities in Lusaka, Zambia. Six interviews were carried out with nurses and peer-support workers working with young people living with HIV and three focus groups with a total of 24 young people. Recruitment was via purposive sampling. Interviews and focus groups were recorded, translated and transcribed and entered into NVivo for thematic analysis.
RESULTS: Twenty-four of the young persons interviewed had access to mobile phones and reported using them for social networking, information gathering and regular communication. Barriers to HIV care and adherence were largely underpinned by stigma. Participants described healthcare facilities as not being conducive for confidentiality and therefore were reluctant to be seen attending or collecting medication from the pharmacy due to possible unintended disclosure and consequential HIV-related stigma. Clinic opening and waiting times and experiences with healthcare professionals also served as barriers. It was felt unanimously by participants that mHealth would be beneficial in improving retention into care and ART adherence in young people living with HIV.
CONCLUSIONS: HIV-related stigma remains a barrier to care. With growing access to mobile phones and internet, and a growing population of adolescents who are already using their phones to support each other and seek information, mHealth appears to be both a feasible and acceptable tool to support retention, provide young people with information, and potentially reduce time spent at health facilities via appointment reminders and electronic drug refill requests.
OBJECTIVES: To evaluate whether text-messaging programs can improve reproductive health among adolescent girls in low- and middle-income countries.
METHODS: We conducted a cluster-randomized controlled trial among 756 female students aged 14 to 24 years in Accra, Ghana, in 2014. We randomized 38 schools to unidirectional intervention (n = 12), interactive intervention (n = 12), and control (n = 14). The unidirectional intervention sent participants text messages with reproductive health information. The interactive intervention engaged adolescents in text-messaging reproductive health quizzes. The primary study outcome was reproductive health knowledge at 3 and 15 months. Additional outcomes included self-reported pregnancy and sexual behavior. Analysis was by intent-to-treat.
RESULTS: From baseline to 3 months, the unidirectional intervention increased knowledge by 11 percentage points (95% confidence interval [CI] = 7, 15) and the interactive intervention by 24 percentage points (95% CI = 19, 28), from a control baseline of 26%. Although we found no changes in reproductive health outcomes overall, both unidirectional (odds ratio [OR] = 0.14; 95% CI = 0.03, 0.71) and interactive interventions (OR = 0.15; 95% CI = 0.03, 0.86) lowered odds of self-reported pregnancy for sexually active participants.
CONCLUSIONS: Text-messaging programs can lead to large improvements in reproductive health knowledge and have the potential to lower pregnancy risk for sexually active adolescent girls.
BACKGROUND: While mobile health (mHealth) programs are increasingly used to provide health information and deliver interventions, little is known regarding the relative reach and effectiveness of these programs across sociodemographic characteristics. We use data from a recent trial of a text-messaging intervention on adolescent sexual and reproductive health (SRH) to assess the degree to which mHealth programs reach target adolescent subpopulations who may be at higher risk of poor SRH outcomes.
METHODS: The study was conducted among girls aged 14-24 in 22 secondary schools in Accra, Ghana. The mHealth intervention was an interactive mobile phone quiz in which participants could win phone credit for texting correct answers to SRH questions. We use detailed data on individuals' level of engagement with the program, SRH knowledge scores, and self-reported pregnancy collected as part of the original trial to assess the extent to which engagement and program impact vary across parental education, sexual experience, SRH knowledge deficit, and parental support.
RESULTS: Eighty-one percent of participants engaged with the mHealth program, with no evidence that the program disproportionally reached better-off groups. The program was effective at increasing knowledge of SRH across all strata. Higher levels of engagement were associated with higher knowledge scores up to year later. There was no significant impact of the program on self-reported pregnancy within subgroups.
CONCLUSION: mHealth programs for adolescents have the potential to engage and increase SRH knowledge of adolescent girls across sociodemographic strata, including those who may be at higher risk of poor SRH outcomes.
TRIAL REGISTRATION: ClinicalTrials.gov NCT02031575 . Registered 07 Jan 2014.
BACKGROUND: As teenagers have easy access to both radio programs and cell phones, the current study used these tools so that young people could anonymously identify questions about sex and other related concerns in the urban environment of the Democratic Republic of Congo. The purpose of this healthcare intervention was to identify and address concerns raised by young people, which are related to sexual health, and which promote youth health.
METHODS: This healthcare intervention was conducted over a six month period and consisted of a survey carried out in Kinshasa. This focused on 14 to 24 old young people using phone calls on a radio program raising concerns related to sexuality. The radio program was jointly run by a journalist and a health professional who were required to reply immediately to questions from young people. All sexual health concerns were recorded and analyzed.
RESULTS: Forty programs were broadcast in six months and 1,250 messages and calls were recorded: 880 (70%) from girls and 370 (30%) from boys, which represents an average of 32 interventions (of which 10 calls and 22 messages) per broadcast. Most questions came from 15-19- and 20-24-year-old girls and boys. Focus of girls' questions: menstrual cycle calculation and related concerns accounted for the majority (24%); sexual practices (16%), love relationships (15%) and virginity (14%). Boys' concerns are masturbation (and its consequences) (22%), sexual practices (19%), love relationships (18%) and worries about penis size (10%). Infections (genital and STI) and topics regarding HIV represent 9% and 4% of the questions asked by girls against 7% and 10% by boys. Concerns were mainly related to knowledge, attitudes and competences to be developed.
CONCLUSIONS: Concerns and sexual practices raised by teens about their sexual and emotional life have inspired the design of a practical guide for youth self-training and have steered the second phase of this interactive program towards supporting their responsible sexuality.
OBJECTIVE: To evaluate the acceptability, information access, and potential behavioral impact of providing contraception information via text message on mobile phones to young people in Kenya.
METHODS: Three methods of data collection were implemented during the 17-month pilot period for the Mobile for Reproductive Health (m4RH) program in Kenya: automatic logging of all queries to the m4RH system; demographic and behavior change questions sent via short message service protocol (SMS) to everyone who used m4RH during the pilot period; and telephone interviews with a subset of m4RH users.
RESULTS: During the pilot period, 4817 unique users accessed m4RH in Kenya. Of these, 82% were 29 years of age and younger, and 36% were male. Condom and natural family-planning information was accessed most frequently, although users queried all methods. One in 5 used the m4RH system to locate nearby clinics. Respondents liked the simple language and confidentiality of receiving health information via mobile phone, and reported increased contraceptive knowledge and use after using m4RH.
CONCLUSION: Providing contraception information via mobile phone is an effective strategy for reaching young people. More research is needed to learn how to link young people to youth-friendly services effectively.
Background To evaluate the feasibility and acceptability of a text message intervention to improve young people's knowledge of sexual reproductive health (SRH) and harms related to smoking in Indonesia.
METHODS:
A quasi-experimental short message service (SMS) trial of young people aged 16-24 years receiving twice weekly SMS over a 10-week intervention period. Pre- and post-online demographic and risk behaviour surveys were used to assess changes in knowledge. Among respondents who completed both surveys, we assessed changes in knowledge before and after SMS intervention using paired McNemar's test and differences in mean knowledge score using a paired t-test.
RESULTS:
In total, 555 eligible young people were enrolled into the SMS intervention; 235 (42%) completed a follow-up survey, of which 198 (84%) were matched to a baseline survey. Median age of participants was 19 years and the majority were female (63%). The mean knowledge score significantly increased between baseline and follow-up surveys for SRH questions [2.7, (95% CI 2.47, 2.94) vs 3.4 (95% CI 2.99, 3.81) (P = <0.01)] and smoking-related questions [3.8 (95% CI 3.66, 3.99) vs 4.1 (95% CI 3.99, 4.28) (P = 0.03)]. A majority of participants reported that the SMS intervention increased their knowledge (95%) and were a useful reminder (95%).
CONCLUSIONS:
An SMS intervention was feasible, acceptable and improved adolescents' SRH knowledge and smoking knowledge in a low- to middle-income setting. SMS interventions targeting young people need to be scaled up, with the potential to explore additional topics around healthy lifestyle, nutrition and physical activity.
