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Njoki N, Cutherell M, Musau A, Mireri D, Nana-Sinkam A, Phillips M. Applying Human-Centered Design to Replicate an Adolescent Sexual and Reproductive Health Intervention: A Case Study of Binti Shupavu in Kenya. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200557. [PMID: 38123950 PMCID: PMC10749645 DOI: 10.9745/ghsp-d-22-00557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023]
Abstract
We present a case study describing the use of human-centered design (HCD) to determine how to adapt intervention components from an existing contraceptive uptake program for adolescent girls in 4 geographical contexts (Ethiopia, northern Nigeria, southern Nigeria, and Tanzania) for use in Kenya. First, we prioritized existing intervention components to be tested in Kenya using sacrificial concepts. Through these concepts, we identified key insights and behavioral archetypes from which to build higher-fidelity prototypes, leveraging existing program knowledge and resources while responding to unique opportunities for Kenyan adolescent girls. After 2 rounds of prototyping, we launched a high-fidelity intervention designed to improve contraceptive uptake among girls. We used program experience to identify strategies for improvement during early implementation. The resulting model, Binti Shupavu, is designed to tap into girls' aspirations and connect them with contraceptive use, build their trust in the health system, and work with influencers to build support for adolescent contraceptive use, following the global user journey. In the first year of implementation (January-December 2022), the intervention was scaled from 90 facilities to 360 facilities and reached 60,111 adolescent girls aged 10-19 years. Of these, 21,698 were new voluntary contraceptive users (36%) and an additional 3,873 (19%) were continuing users.Our design process suggests that HCD is a promising tool for navigating replication. The emphasis on users' perspectives, testing to learn, and collaboration facilitated a deep understanding of the new user population, thus guiding program designers to balance using existing components with developing new ones based on the population's unique needs. Finally, HCD has potential to support the localization agenda if design teams are supported by national, regional, and global experts to be aware of and use the evidence and implementation experience from earlier work.
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Affiliation(s)
| | | | | | | | | | - Mary Phillips
- Population Services International, Washington, DC, USA
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Luigi-Bravo G, Maria Ramirez A, Gerdts C, Gill R. Lessons learned from developing and implementing digital health tools for self-managed abortion and sexual and reproductive healthcare in Canada, the United States, and Venezuela. Sex Reprod Health Matters 2023; 31:2266305. [PMID: 37870150 PMCID: PMC10595388 DOI: 10.1080/26410397.2023.2266305] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Affiliation(s)
| | | | - Caitlin Gerdts
- Vice President for Research, Ibis Reproductive Health, Oakland, CA, USA
| | - Roopan Gill
- Executive Director and Co-founder, Vitala Global Foundation, Vancouver, Canada
- Clinician Investigator, Assistant Professor, Department of Obstetrics & Gynecology, University of Toronto, Toronto, Canada
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Daniels J, Peters RPH, Portle S, Mashabela N, Struthers H, Radebe O, Nel D, Medina-Marino A, Bongo C, Stephenson R. Developing the Speaking Out and Allying Relationships Intervention on Videoconference for HIV-Positive GBMSM in Eastern Cape, South Africa. Am J Mens Health 2023; 17:15579883231197355. [PMID: 37675590 PMCID: PMC10486223 DOI: 10.1177/15579883231197355] [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: 03/26/2023] [Revised: 08/01/2023] [Accepted: 08/09/2023] [Indexed: 09/08/2023] Open
Abstract
In South Africa, HIV prevalence for gay, bisexual, and men who have sex with men (GBMSM) is as high as 49.5%, yet only 25.7% are taking treatment, resulting in transmission risk between partners and the need for dyadic interventions for men in relationships. Through our preliminary research, we identified the evidence-based intervention Healthy Relationships (HR)-an HIV risk assessment and status disclosure intervention for those in relationships-to be tailored into videoconference format for partnered HIV-positive GBMSM in South Africa. The HR adaptation, called SOAR (Speaking Out & Allying Relationships), applied a human-centered design approach. In-depth interviews were conducted with HIV-positive GBMSM (N = 15) to refine intervention preferences with results used to establish a beta SOAR. A trained interventionist conducted SOAR functionality (n = 6) and usability (n = 7) tests with separate invited groups composed of the original participants interviewed. Field logs, focus group discussions, and a study-specific preference survey were administered. Thematic analysis and descriptive statistics were completed with a convergent analytical approach used to understand usability. Overall experience of GBMSM in SOAR was good (69%) or excellent (31%). More than half of the participants (61%) rated using videoconferencing for SOAR as good, with 38% rating it as fair. All participants stated that SOAR was understandable and satisfactory with willingness to recommend it to other GBMSM. This adaptation approach was effective, and the resultant SOAR intervention has the potential to improve individual coping and HIV communication skills with partners to engage with biomedical prevention and in turn support GBMSM couples.
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Affiliation(s)
- Joseph Daniels
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Remco P. H. Peters
- Foundation for Professional Development, East London, South Africa
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Sarah Portle
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | | | | | | | - Dawie Nel
- Engage Men’s Health, East London, South Africa
| | - Andrew Medina-Marino
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Cikizwa Bongo
- Foundation for Professional Development, East London, South Africa
| | - Rob Stephenson
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
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Beeman A, Kwesiga J, Ippoliti N, Bhandari T, Pandya G, Acam FA, Lee S, Hope R, Gibbs T, Levine J. Using human-centered design to co-design dedicated menstrual health spaces with people who menstruate in Bidi Bidi refugee settlement, Uganda: Learnings for further adaptation and scale in humanitarian settings. BMC Womens Health 2023; 23:319. [PMID: 37340385 DOI: 10.1186/s12905-023-02421-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/09/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Many people who menstruate in low- and middle-income countries struggle to manage their menstruation safely, hygienically, and with dignity. This is exacerbated in humanitarian settings with limited access to menstrual products and safe, private spaces for changing, washing, and disposing of menstrual products. To address these challenges, Youth Development Labs (YLabs) used a human-centered design approach to co-design the Cocoon Mini, a safe, physical structure for managing menstruation in the Bidi Bidi Refugee Settlement in Uganda. METHODS The study comprised five phases, including background research, design research, rough prototyping, live prototyping, and a pilot study. A total of 340 people, including people who menstruate, male community members, and community stakeholders, participated in interviews, focus groups, and co-design sessions. Solution prototypes were created, evaluated, and iterated upon in each successive project phase. The final intervention design, the Cocoon Mini, was evaluated qualitatively for feasibility and acceptability during a three-month pilot using structured interviews with 109 people who menstruate utilizing Cocoon Mini structures, 64 other community members, and 20 Cocoon Mini supervisors. RESULTS Results showed widespread desirability and acceptability of the Cocoon Mini among people who menstruate and other community members. Overall, 95% (104/109) of people who menstruate stated the space had made menstrual health management easier, primarily by providing designated waste bins, solar lights, and additional water sources. The Cocoon Mini provided an increased sense of physical and psychological safety in knowing where to privately manage menstruation. Furthermore, the Cocoon Mini demonstrated that an intervention could be run and maintained sustainably at the household level in humanitarian contexts, without continued external stakeholder intervention. Each Cocoon Mini structure costs approximately $360 USD to build and maintain and serves 15-20 people who menstruate, leading to a cost per person of $18-$24. Furthermore, attaching an incinerator to the structure for easier and quicker disposal of waste bin contents (compared to transporting full waste bins elsewhere) costs $2110 USD. CONCLUSIONS People who menstruate lack access to safe, private spaces for menstrual health and product disposal in humanitarian settings. The Cocoon Mini provides a solution for the safe and effective management of menstruation. Customizing and scaling up dedicated menstrual health spaces should be considered a high-priority intervention in humanitarian settings.
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Affiliation(s)
- Aly Beeman
- Youth Development Labs (YLabs), KN 14 St, Kigali, Rwanda.
| | - Joseph Kwesiga
- Youth Development Labs (YLabs), KN 14 St, Kigali, Rwanda
| | | | - Tanya Bhandari
- Youth Development Labs (YLabs), KN 14 St, Kigali, Rwanda
| | - Geetika Pandya
- Youth Development Labs (YLabs), KN 14 St, Kigali, Rwanda
| | | | - Saehee Lee
- Youth Development Labs (YLabs), KN 14 St, Kigali, Rwanda
| | - Rebecca Hope
- Youth Development Labs (YLabs), KN 14 St, Kigali, Rwanda
| | - Theodora Gibbs
- Youth Development Labs (YLabs), KN 14 St, Kigali, Rwanda
| | - Jordan Levine
- Youth Development Labs (YLabs), KN 14 St, Kigali, Rwanda
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Kalinda C, Phiri M, Chimpinde K, Ishimwe MCS, Simona SJ. Trends and socio-demographic components of modern contraceptive use among sexually active women in Rwanda: a multivariate decomposition analysis. Reprod Health 2022; 19:226. [PMID: 36527042 PMCID: PMC9758849 DOI: 10.1186/s12978-022-01545-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The attainment of targets set for modern contraceptive use remains a challenge in sub-Saharan Africa. Rwanda, in its new Family Planning and Adolescent Sexual Reproductive Health/Family Planning (FP/ASRH) Strategic Plan 2018-2024 has set the attainment of a contraceptive prevalence rate (CPR) of 60% by 2024. To achieve this, identifying factors that enhance modern contraceptive use among sexually active women is critical. METHODS We used three Rwanda Demographic Health Surveys (RDHS) datasets collected in 2010, 2015, and 2019/2020 in a multivariable decomposition analysis technique to describe trends and identify factors influencing change in modern contraceptive use among sexually active women aged 15-49 years. Results presented as coefficients and percentages took into consideration the complex survey design weighted using StataSE 17. RESULTS Modern contraceptive use increased from 40% in 2010 to 52.4% in 2020 among sexually active women. About 23.7% of the overall percentage change in modern contraceptive use was attributable to women's characteristics which included women's education levels, number of living children, and being told about family planning at health facilities. Coefficients contributed 76.26% to the change in modern contraceptive use. This change was attributed to modern contraceptive use among young women between the age of 20-24 years, women's education level, the number of living children, changes in family size, and being visited by community health workers. CONCLUSION Rwanda remains on course to archive its 2024 family planning targets. However, there is a need to enhance programs that target sexually active adolescents and young adults, and women from rural areas to sustain the gains made. Furthermore, continuous support of community health workers will be key in exceeding the set targets of modern contraceptive use among sexually active women in Rwanda.
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Affiliation(s)
- Chester Kalinda
- grid.507436.30000 0004 8340 5635Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity, Kigali Heights, Plot 772 KG 7 Ave., P. O. Box 6955, Kigali, Rwanda
| | - Million Phiri
- grid.12984.360000 0000 8914 5257School of Humanities and Social Sciences, University of Zambia, Great East Road Campus, P. O. Box 32379, Lusaka, Zambia ,grid.11951.3d0000 0004 1937 1135School of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kafiswe Chimpinde
- grid.12984.360000 0000 8914 5257School of Humanities and Social Sciences, University of Zambia, Great East Road Campus, P. O. Box 32379, Lusaka, Zambia
| | - Marie C. S. Ishimwe
- grid.507436.30000 0004 8340 5635Institute of Global Health Equity Research (IGHER), University of Global Health Equity, Kigali Heights, Plot 772 KG 7 Ave, P. O. Box 6955, Kigali, Rwanda
| | - Simona J. Simona
- grid.12984.360000 0000 8914 5257School of Humanities and Social Sciences, University of Zambia, Great East Road Campus, P. O. Box 32379, Lusaka, Zambia
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Johnson T, Das S, Tyler N. Design for Health: Human-Centered Design Looks to the Future. GLOBAL HEALTH, SCIENCE AND PRACTICE 2021; 9:S190-S194. [PMID: 34845042 PMCID: PMC8628506 DOI: 10.9745/ghsp-d-21-00608] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Indexed: 11/15/2022]
Affiliation(s)
| | - Shilpa Das
- National Institute of Design, Ahmedabad, India
| | - Nikki Tyler
- United States Agency for International Development, Washington, DC, USA
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