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Mackworth-Young CRS, Charashika P, Larsson L, Wilding-Davies OJ, Simpson N, Kydd AS, Chinyanga TT, Ferrand RA, Mangombe A, Webb K, Doyle AM. Digital Intervention to Improve Health Services for Young People in Zimbabwe: Process Evaluation of 'Zvatinoda!' (What We Want) Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) Framework. JMIR Form Res 2024; 8:e53034. [PMID: 39316784 DOI: 10.2196/53034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 03/26/2024] [Accepted: 04/03/2024] [Indexed: 09/26/2024] Open
Abstract
BACKGROUND Youth in Southern Africa face a high burden of HIV and sexually transmitted infections, yet they exhibit low uptake of health care services. OBJECTIVE The Zvatinoda! intervention, co-designed with youth, aims to increase the demand for and utilization of health services among 18-24-year-olds in Chitungwiza, Zimbabwe. METHODS The intervention utilized mobile phone-based discussion groups, complemented by "ask the expert" sessions. Peer facilitators, supported by an "Auntie," led youth in anonymous online chats on health topics prioritized by the participants. Feedback on youth needs was compiled and shared with health care providers. The intervention was tested in a 12-week feasibility study involving 4 groups of 7 youth each, totaling 28 participants (n=14, 50%, female participants), to evaluate feasibility and acceptability. Mixed methods process evaluation data included pre- and postintervention questionnaires (n=28), in-depth interviews with participants (n=15) and peer facilitators (n=4), content from discussion group chats and expert guest sessions (n=24), facilitators' debrief meetings (n=12), and a log of technical challenges. Descriptive quantitative analysis and thematic qualitative analysis were conducted. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was adapted to analyze and present findings on (1) reach, (2) potential efficacy, (3) adoption, (4) implementation, and (5) maintenance. RESULTS Mobile delivery facilitated engagement with diverse groups, even during COVID-19 lockdowns (reach). Health knowledge scores improved from pre- to postintervention across 9 measures. Preintervention scores varied from 14% (4/28) for contraception to 86% (24/28) for HIV knowledge. After the intervention, all knowledge scores reached 100% (28/28). Improvements were observed across 10 sexual and reproductive health (SRH) self-efficacy measures. The most notable changes were in the ability to start a conversation about SRH with older adults in the family, which increased from 50% (14/28) preintervention to 86% (24/28) postintervention. Similarly, the ability to use SRH services even if a partner does not agree rose from 57% (16/28) preintervention to 89% (25/28) postintervention. Self-reported attendance at a health center in the past 3 months improved from 32% (9/28) preintervention to 86% (24/28) postintervention (potential efficacy). Chat participation varied, largely due to network challenges and school/work commitments. The key factors facilitating peer learning were interaction with other youth, the support of an older, knowledgeable "Auntie," and the anonymity of the platform. As a result of COVID-19 restrictions, regular feedback to providers was not feasible. Instead, youth conveyed their needs to stakeholders through summaries of key themes from chat groups and a music video presented at a final in-person workshop (adoption and implementation). Participation in discussions decreased over time. To maintain engagement, introducing an in-person element was suggested (maintenance). CONCLUSIONS The Zvatinoda! intervention proved both acceptable and feasible, showing promise for enhancing young people's knowledge and health-seeking behavior. Potential improvements include introducing in-person discussions once the virtual group has established rapport and enhancing feedback and dialog with service providers.
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Affiliation(s)
- Constance Ruth Sina Mackworth-Young
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Leyla Larsson
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Nikita Simpson
- Department of Anthropology and Sociology, School of Oriental and African Studies, University of London, London, United Kingdom
- The SHM Foundation, London, United Kingdom
| | | | | | - Rashida Abbas Ferrand
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Karen Webb
- Organization for Public Health Interventions and Development, Harare, Zimbabwe
| | - Aoife Margaret Doyle
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Isaacs N, Ntinga X, Keetsi T, Bhembe L, Mthembu B, Cloete A, Groenewald C. Are mHealth Interventions Effective in Improving the Uptake of Sexual and Reproductive Health Services among Adolescents? A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:165. [PMID: 38397656 PMCID: PMC10888173 DOI: 10.3390/ijerph21020165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024]
Abstract
Adolescents continue to face challenges to their sexual and reproductive health (SRH) both locally and internationally. Digital technologies such as the Internet, text messaging, and social media are often viewed as valuable tools for disseminating information on SRH. Mobile health, also known as mHealth, is a medical and public health practise that uses these digital technologies to communicate information. The literature has revealed that mHealth interventions have a positive outcome in delivering SRH information to adolescents. This review aimed to synthesise empirical studies that evaluate mHealth interventions and assess the extent to which these mHealth interventions promote sexual and reproductive health outcomes among young people. This scoping review reviewed the literature across four databases, including EBSCOhost, Scopus, Proquest, and Cochrane, and included 12 articles. The findings have shown that mHealth interventions are effective in enhancing sexual and reproductive health (SRH) knowledge and attitudes among young people in both low-middle and high-income countries. However, comprehensive longitudinal studies are necessary to measure the sustainability and long-term influence of mHealth interventions on behaviour. It is recommended that with artificial intelligence (AI) improvements, there is a possible path to bolstering mHealth interventions.
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Affiliation(s)
- Nazeema Isaacs
- Human Sciences Research Council, Pretoria 0001, South Africa; (X.N.); (T.K.); (B.M.); (A.C.); (C.G.)
- Impact Centre, Cape Town 8001, South Africa
| | - Xolani Ntinga
- Human Sciences Research Council, Pretoria 0001, South Africa; (X.N.); (T.K.); (B.M.); (A.C.); (C.G.)
- Centre for Community-Based Research, Durban 4001, South Africa
| | - Thabo Keetsi
- Human Sciences Research Council, Pretoria 0001, South Africa; (X.N.); (T.K.); (B.M.); (A.C.); (C.G.)
- Centre for Community-Based Research, Durban 4001, South Africa
| | - Lindelwa Bhembe
- Human Sciences Research Council, Pretoria 0001, South Africa; (X.N.); (T.K.); (B.M.); (A.C.); (C.G.)
- Centre for Community-Based Research, Durban 4001, South Africa
| | - Bongumenzi Mthembu
- Human Sciences Research Council, Pretoria 0001, South Africa; (X.N.); (T.K.); (B.M.); (A.C.); (C.G.)
- Centre for Community-Based Research, Durban 4001, South Africa
| | - Allanise Cloete
- Human Sciences Research Council, Pretoria 0001, South Africa; (X.N.); (T.K.); (B.M.); (A.C.); (C.G.)
- Public Health, Societies and Belonging (PHSB) Division, Cape Town 8001, South Africa
| | - Candice Groenewald
- Human Sciences Research Council, Pretoria 0001, South Africa; (X.N.); (T.K.); (B.M.); (A.C.); (C.G.)
- Centre for Community-Based Research, Durban 4001, South Africa
- Psychology Department, Rhodes University, Grahamstown 8001, South Africa
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Agu CI, Agu IC, Mbachu CO, Ezumah N, Onwujekwe O. A qualitative assessment of the impact of a community-embedded intervention on beneficiaries' attitudes and beliefs about adolescent sexual reproductive health in Ebonyi State, Southeast, Nigeria. Reprod Health 2024; 21:5. [PMID: 38212841 PMCID: PMC10782563 DOI: 10.1186/s12978-024-01738-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 01/03/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Adolescents and their communities in Ebonyi State, Nigeria have poor attitudes and beliefs towards adolescent sexual and reproductive health (SRH). This paper reports on the effects of a community-embedded intervention that focused on creating positive changes in the attitudes and beliefs of adolescents and community members to enhance adolescents' access to SRH information and services. METHODS This study adopted the Qualitative Impact Assessment approach to evaluate the changes in attitudes and beliefs about the SRH of adolescents from the perspectives of the beneficiaries of a community-embedded intervention namely, adolescents, parents, school teachers, and community leaders. The intervention was implemented in six local government areas in Ebonyi State, southeast Nigeria and the evaluation was undertaken four months after the implementation of the interventions commenced. Eighteen (18) interviews were conducted with 82 intervention beneficiaries including: (i) six in-depth interviews with school teachers; (ii) two sex-disaggregated FGDs with parents; (iii) two sex-disaggregated FGDs with community leaders; and (iv) eight sex-disaggregated FGDs with in school and out of school adolescents. A thematic analysis of data was performed with the aid of NVivo software, version 12. RESULTS The community-embedded intervention led to changes in individual attitudes and beliefs, as well as changes in community norms and values concerning adolescent SRH. Adolescents reported that following the community-embedded SRH intervention, they have become more comfortable discussing openly SRH issues with their peers, and they could more easily approach their parents and initiate SRH discussions. The parents of adolescents reported that following the intervention, they have become more willing to discuss sensitive SRH issues with adolescents, and frequently make out time to do so. It was also reported that parents no longer use euphemisms to describe sexual body parts, and community leaders now believe that it is all right to discuss SRH with adolescents. Hence, initiating or having SRH discussions with adolescents is no longer misconceived as encouraging sex, and menstruation in unmarried adolescents is no longer viewed as a sign of promiscuity. Respondents also highlighted changes in community norms of, (i) gendered parental communication of SRH matters, as both mothers and fathers have started discussing SRH issues with their adolescent boys and girls; and (ii) public shaming and discipline of pregnant teenage girls are on the decline. CONCLUSION The community-based intervention had a positive impact on individual attitudes and beliefs, as well as community and societal values and norms about adolescent SRH. Interventions that take into account community norms and values regarding adolescent SRH should be prioritized to enable the achievement of the SRH-related target of SDG 3.
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Affiliation(s)
- Chibuike Innocent Agu
- Health Policy Research Group, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Community Medicine, Alex-Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria
| | - Ifunanya Clara Agu
- Health Policy Research Group, University of Nigeria Nsukka, Enugu, Nigeria.
| | - Chinyere Ojiugo Mbachu
- Health Policy Research Group, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Community Medicine, University of Nigeria Nsukka, Enugu, Nigeria
| | - Nkoli Ezumah
- Health Policy Research Group, University of Nigeria Nsukka, Enugu, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Health Administration and Management, University of Nigeria Nsukka, Enugu, Nigeria
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Seretlo RJ, Mokgatle MM, Smuts H. Positive views, attitudes, and acceptability toward mHealth applications in addressing queer sexual and reproductive health: Healthcare providers and the queer individuals. Digit Health 2024; 10:20552076241272704. [PMID: 39221082 PMCID: PMC11363025 DOI: 10.1177/20552076241272704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 07/17/2024] [Indexed: 09/04/2024] Open
Abstract
Objective In the age of digital health, mankind has resources to write over the historical narrative of queer individuals' healthcare exclusions. The main purpose of this study was to explore the perspectives of both healthcare providers (HCPs) and queer individuals regarding the use of web-based tools and mobile health applications (mHealth apps) in the context of addressing queer individuals' sexual and reproductive health services and needs (SRHSN). Methods An overall study was conducted as an exploratory sequential mixed method. This article provides findings from the performed qualitative cycle. The selection method was led by purposeful sampling, which targeted 33 HCPs delivering SRHSN within the defined study settings. Additionally, respondent-driven sampling was employed to select 22 queer individuals. Throughout the study, semi-structured one-on-one face-to-face interviews were used to collect data. Results Four major themes and related sub-themes emerged from HCPs and queer individuals: (a) aid queer individuals with consultations and treatment improvements, (b) drawing parallels with technology in other sectors, (c) enhancing knowledge and education, and (d) positive perception of technological advancements. Conclusions In accordance with our findings, HCPs and queer individuals were all positive and sees mHealth apps as a tool to address SRHSN for homosexual people.
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Affiliation(s)
- R. J. Seretlo
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, Medunsa 0204, South Africa
| | - M. M. Mokgatle
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, Medunsa 0204, South Africa
| | - H. Smuts
- Department of Informatics, University of Pretoria, Pretoria, South Africa
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Akwara E, Pinchoff J, Abularrage T, White C, Ngo TD. The Urban Environment and Disparities in Sexual and Reproductive Health Outcomes in the Global South: a Scoping Review. J Urban Health 2023:10.1007/s11524-023-00724-z. [PMID: 37052774 PMCID: PMC10100607 DOI: 10.1007/s11524-023-00724-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 04/14/2023]
Abstract
By 2050, the Global South will contain three-quarters of the world's urban inhabitants, yet no standardized categorizations of urban areas exist. This makes it challenging to compare sub-groups within cities. Sexual and reproductive health and rights (SRHR) are a critical component of ensuring that populations are healthy and productive, yet SRHR outcomes within and across urban settings vary significantly. A scoping review of the literature (2010-2022) was conducted to describe the current body of evidence on SRHR in urban settings in the Global South, understand disparities, and highlight promising approaches to improving urban SRHR outcomes. A total of 115 studies were identified, most from Kenya (30 articles; 26%), Nigeria (15; 13%), and India (16; 14%), focusing on family planning (56; 49%) and HIV/STIs (43; 37%). Findings suggest significant variation in access to services, and challenges such as gender inequality, safety, and precarious circumstances in employment and housing. Many of the studies (n = 84; 80%) focus on individual-level risks and do not consider how neighborhood environments, concentrated poverty, and social exclusion shape behaviors and norms related to SRHR. Research gaps in uniformly categorizing urban areas and key aspects of the urban environment make it challenging to understand the heterogeneity of urban environments, populations, and SRHR outcomes and compare across studies. Findings from this review may inform the development of holistic programs and policies targeting structural barriers to SRHR in urban environments to ensure services are inclusive, equitably available and accessible, and direct future research to fill identified gaps.
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Affiliation(s)
| | - Jessie Pinchoff
- Population Council, One Dag Hammarskjold Plaza, New York, NY, 10017, USA.
| | - Tara Abularrage
- Population Council, One Dag Hammarskjold Plaza, New York, NY, 10017, USA
| | - Corinne White
- Population Council, One Dag Hammarskjold Plaza, New York, NY, 10017, USA
| | - Thoai D Ngo
- Population Council, One Dag Hammarskjold Plaza, New York, NY, 10017, USA
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Zhao J, Li Y, Wang X, Wang Z, Yu S, Li T. Assessment of knowledge, attitude, and practice of sexual health among students in a Chinese medical college: a cross-sectional study. Sex Med 2023; 11:qfad015. [PMID: 37228768 PMCID: PMC10204649 DOI: 10.1093/sexmed/qfad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 05/27/2023] Open
Abstract
Background Sexual health is an essential part of overall well-being, and medical students' sexual education, level of sexual knowledge, and attitudes toward sexual health will affect their sexual behavior. Aim To explore the correlation among medical decision tendency, sex education level, and sexual health KAP (knowledge, attitudes, and practices). Methods We conducted a cross-sectional survey in March 2019. Data were collected via online surveys with a self-developed questionnaire covering sexual KAP and sexual education. We used Spearman correlation to assess the effect of sexual education on KAP after scoring the related questions. Outcomes Outcomes included descriptive analysis and correlation of medical and nursing students' KAP and education regarding sexual health. Results Medical and nursing students hold a high level of sexual knowledge (74.8%) and a positive attitude toward premarital sex (87.5%) and homosexuality (94.5%). By conducting the correlation analysis, we observed that medical and nursing students' tendency to support friends' homosexuality was positively correlated with the view that medical intervention for transgender or gay/lesbian people is unnecessary (P < .01). A positive correlation was also found between medical and nursing students who want more diverse sexual education and who would tend to provide patients with more humanistic care regarding their sexual needs (P < .01). Clinical Translation Medical and nursing students who want more diverse sexual education and who had higher scores in the sexual knowledge test tend to provide their patients with more humanistic care regarding sexual needs. Strengths and Limitations The research shows the current situation of medical and nursing students' sexual education experience and preference and sexual knowledge, attitudes, and behavior. Heat maps were used to more intuitively describe the correlation between medical students' characteristics and their sexual knowledge, attitudes, and behaviors and sex education. The results may not be generalizable across China, as the participants were from 1 medical school. Conclusion It is essential to provide sexual education for medical and nursing students to ensure a more humanistic approach to patient care regarding sexual needs; therefore, we recommend that medical schools invest in sexual education for medical and nursing students throughout their education.
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Affiliation(s)
| | | | - Xuezhu Wang
- School of Clinical Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Zhaojian Wang
- School of Clinical Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Si Yu
- School of Clinical Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Tao Li
- Corresponding author: School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 9, Dongdansantiao St, Dongcheng District, Beijing, 100730, China.
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