Rahu em health operations research report june 2015

Using Facebook and Website to Increase Access to SRHR Information and Services among Young People in Uganda

i

This work is a product of Reach a Hand Uganda (RAHU), and the Sexual Reproductive Health and Rights Alliance, Uganda. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of the above Institutions.

Rights and Permissions The material in this work is subject to copyright. Because the RAHU team encourages dissemination of its knowledge, this work may be reproduced, in whole or in part, for noncommercial purposes as long as full attribution to this work is given.

Any queries on rights and licenses, including subsidiary rights, should be addressed to the Executive Director, Reach a Hand Uganda, P.O Box Kampala, Uganda, Tel: +256 312-275 683.

Š 2015 Reach a Hand Uganda (RAHU), P.O Box

Kampala

Telephone: +256 312-275 683 Email: info@reachahand.org Internet: http://www.reachahand.org/

Citation: Reach a Hand Uganda, (RAHU). 2015. Factors and actors that determine the effectiveness of e/mhealth strategies used by RAHU to increase access to SRHR information among young people in Uganda. E/mhealth operations research report.

ii

Table of Contents Acknowledgements .......................................................................................................................vi Acronyms and Abbreviations ..................................................................................................... vii Executive Summary .................................................................................................................. viii CHAPTER ONE .......................................................................................................................... 1 1.0 Background ............................................................................................................................ 1 1.1

Context and Rationale ...............................................................................................................1

1.2

Background of ASK Programme and RAHU..........................................................................2

1.3

How was this e/mhealth operations research implemented? .................................................3

1.4

Ethical Review and Approval ...................................................................................................5

CHAPTER TWO .......................................................................................................................... 6 2.0 Young peoples’ perceptions and attitudes towards RAHU’s Sautiplus Facebook page and website............................................................................................................................ 6 2.1 Methods of data collection from young people ..............................................................................6 2.2 What kind of young people currently use RAHU’s website and Sautiplus Facebook pages ............................................................................................................................................8 2.2.1 Online Respondents .................................................................................................................................. 8 2.2.2 Focus Group Discussion Participants........................................................................................................ 9

2.3 Sources of information about RAHU’s on-line Platforms and Reasons for access ....................9 2.4 How Frequent and Extensive Do Young People Visit Sautiplus on-line pages ........................11 2.5 Young People Perceptions towards Access and the Design of RAHU’s on-line Platforms .....12 2.6 SRHR Information Accessed by Young People from Sautiplus on-line Platforms ..................14 2.7 Young People’s Usage of the Information Offered on Sautiplus on-line Platforms ................15 2.8 Sautiplus on-line Platforms Contribution to Increased Uptake of RH services .......................16 2.7 Appreciation, Perceived Advantages and Recommendations for Platform Improvement

by Young People ......................................................................................................................17 2.7.1 Young People’s Appreciation of the Platforms ....................................................................................... 17 2.7.2 Young People’s Perceived Advantages of online Platforms ................................................................... 20 2.7.3 Young People’s Suggestions for RAHU’s online Platforms Improvement ............................................ 21

CHAPTER THREE ................................................................................................................... 24 3.0 Staff perceptions and attitudes towards RAHU’s Sautiplus Facebook page and website 24 3.1. Method of Data Collection from Staff .........................................................................................24 3.2 Characteristics of the Staff Interviewed ......................................................................................25

iii

3.3 RAHU’s Readiness for E&MHealth Programming ....................................................................25 3.3.1 On-line Programming Needs Assessment ............................................................................................... 25 3.3.2 Presence of Infrastructure ....................................................................................................................... 26 3.3.3 Availability of resources (human, time and finances) ............................................................................. 26 3.3.3 Management Support for e/mhealth programming ................................................................................. 28

3.4 Staff Perceptions of e/mhealth Programming .............................................................................28 3.3.1 Perceived advantages of e/mhealth programming by staff ..................................................................... 28 3.3.2 Perceived challenges of e/mhealth programming by staff ...................................................................... 29

3.5 Current Platform Design and Maintenance ................................................................................31 3.6 Staff Perceived Added Value of Online Platforms to other RAHU’s Information Dissemination Channels ..........................................................................................................31 3.7 Needs for program improvement and sustainability as reported by staff ................................32

4.0 Expert observation of RAHU’s Sautiplus Facebook page and website ............................. 33 4.1 Observation methods .....................................................................................................................33 4.2 What kind of information is offered on RAHU’s Sautiplus Facebook page .............................33 and website ...........................................................................................................................................33 4.3 Expert observation of the platform design and content generation ..........................................34 4.4 Observation of the audience engagement on RAHU’s on-line Platforms .................................34

CHAPTER FIVE ....................................................................................................................... 36 5.0 Use of Results to Improve RAHU’s Online Platforms ....................................................... 36 5.1 Programming opportunities identified by the e/mhealth operations research .........................36 5.2 Program gaps identified by the operations research ..................................................................36 5.3 Implications of the e/mhealth OR findings and observations to RAHU ...................................37 6.3 Recommendations ..........................................................................................................................41 6.4 Results Dissemination and action planning .................................................................................42

Appendices .................................................................................................................................. 44 Appendix 1: List of RAHU’s Young People trained in Research ....................................................44 Appendix 2: List of RAHU’s Core Team for this Operational Research .......................................44 Appendix 3: Staff In-depth Interview Guide .....................................................................................45 Appendix 4: IDI Consent Form ..........................................................................................................48 Appendix 5: Focus Group Discussion Guide .....................................................................................51 Appendix 6: Observation Checklist....................................................................................................56 Appendix 7: On-line Questionnaire....................................................................................................61 Appendix 8: OR Approval Letters .....................................................................................................69

iv

List of Tables Table 1: Summary of Key Study Indicators ................................................................................................ xv Table 1: Summary of RAHU’s e/mhealth operational research implementation. ........................................ 3 Table 2: Socio-demographic characteristics of online respondent. .............................................................. 8 Table 3: Socio-demographic characteristics of FGD participants ................................................................ 9 Table 4: Information Sought from Sautiplus Online Platforms by Young People. .................................... 14 Table 5: Rating of information offered on Sautiplus platforms .................................................................. 16 Table 6 : Socio-demographic Characteristics of the Staff Interviewed ...................................................... 25

List of Figures Figure 1: Sources of information about RAHU's platforms........................................................................ 10 Figure 2: Reasons for accessing Sautiplus Facebook and website as reported by On-line respondents .... 11 Figure 3: Frequency of visits at Sautiplus and website ............................................................................... 12 Figure 4 : Factors influencing access to internet as reported by Respondents ............................................ 14 Figure 5 : Ease of finding information at Sautiplus Facebook page and website ....................................... 14 Figure 6: SRHR information and services which are usually referred. ...................................................... 17 Figure 7: Young people's rating of the information offered on RAHU's online platforms. ........................ 18 Figure 8: Young people's Opinion of RAHU's online design and lay-out. ................................................. 20 Figure 9 : Young respondents' suggestions for improvement. .................................................................... 22

v

Acknowledgements We would like to express our sincere gratitude to all the stakeholders who contributed information and offered other support for this research project, including; the Uganda National Coordination Office for ASK programme, the ASK operational research (OR) team in the Netherlands, the young people and RAHU staff who participated in the interviews, the young researchers who collected and managed the data, and the district-level stakeholders. We are grateful to RAHU’s research core team and the team of young researchers for your cooperation and tireless efforts contributing to the successful implementation of this operations research.

Special thanks to Bakshi Asuman, Atukunda Athibert, Nakayima Beatrice, Naluzze Preeme Sharon, Kintu Keneth, Kisekka Edward, Akamutuha Conviirene, Mubiru Alex, and Bamulanzeki Samuel.

Guidance for this report was provided by Ms. Kantjil Janssen and Pinar Okur of Rutgers WPF, the contact person of OR working group in the Netherlands and Ms. Diana Nanyange, the National ASK programme Coordinator.

The tremendous work done by the consultants; Ms. Susan Babirye, Dr. Aloysius Ssennyonjo and Dr. Suzanne N Kiwanuka is acknowledged and highly appreciated.

vi

Acronyms and Abbreviations AIDS:

Acquired Immune Deficiency Syndrome

ASK:

Access, Services and Knowledge

CSE:

Comprehensive Sexuality Education

e-health:

Health interventions that utilize electronic technology

emhealth:

Health interventions that utilize electronic and mobile technology

RAHU:

Reach a Hand Uganda

HCT:

HIV Counseling and Testing

HIV:

Human Immunodeficiency Virus

IEC:

Information, Education and Communication (materials)

IGA:

Income Generating Activity

m-health:

Health interventions that utilize mobile telecommunications technology

MYP:

Meaningful Youth Participation

SRH:

Sexual and Reproductive Health

STI:

Sexually Transmitted Infections

SRHR:

Sexual and Reproductive Health and Rights

OR:

Operational Research

YFS:

Youth-Friendly Services

vii

Executive Summary Background and rationale: The application of electronic and mobile solutions for health (eHealth and mHealth) in developing countries is expanding quickly, including in the field of Sexual and Reproductive Health (SRH). The Access, Services, Knowledge (ASK) program which is currently being implemented in Uganda seeks to use e/m health strategies to increase direct access to SRH information and services to young people. A number of review papers1 noted that the research done in e/m health field is limited to short term effectiveness, client- provider assessment of technologies and cost of small scale pilots. Therefore, evidence is not sufficient to determine effectiveness or even sustainability of these interventions beyond pilot phases funding.

It is against this background that this OR broadly aimed at providing evidence about use of e/m health strategies for expanding direct access to SRHR information and services among young people in Uganda by conducting a comprehensive assessment of RAHU’s Sautiplus website and facebook pages, discussing their effectiveness, facilitating factors, current challenges, gaps, opportunities and tendencies.

RAHU’s Operations Research Implementation: Seven young people were trained using Rutgers’ Explore Training Manual on training of young people in research that was adapted for this OR. An Organizational-level Steering Committee (core team) of four members was also established to oversee the process, provide guidance and prepare for use of results for program improvement. The operations research was introduced to the district stakeholders in Jinja and Iganga prior to data collection. The data collection tools i.e. the FGD discussion guide was pre-tested at Hana Mixed School while the on-line tool was pretested until 10 records were got.

Eight in-depth interviews were held with RAHU’s staff; three from top management and five implementers. An observation of Sautiplus Facebook page and website was done. The 1

WHO 2011 (mHealth: New horizons for health through mobile technologies: second global survey on eHealth.), Aranda-Jan et al 2014 (Systematic review on what works, what does not work and why of implementation of mobile health (mHealth) projects in Africa. BMC Public Health 2014, 14:188 http://www.biomedcentral.com/1471-2458/14/188)

viii

observation focused on a period of three months that preceded the observation exercise. One hundred thirty five records were attained through the on-line tool from Dec 2014 to April 2015.

Eight Focus Group Discussions were held with non-users of RAHU’s Sautiplus website and face book pages. The consultancy team will share the OR findings with the OR working group in the Netherlands for their input before sharing it with RAHU. The Consultancy team will discuss with RAHU the strength and gaps identified by the OR and action points. District and National level dissemination meeting will be held.

Key findings: Online survey and Focus group discussions with young people: One hundred thirty five (135) people responded to the online survey. Eighty five (85%) remained for analysis after data cleaning. Their mean age was 22.2 years but age of respondents ranged from 18 to 39 years. Majority of these respondents were male (71.4%) and in urban areas (95.2%). Many of these were in school (47.6%). Regarding the FGD, 91 young people were reached. Their age ranged from 13-19 years. Slightly more than half of these were male (58.2%).

The leading sources of information about RAHU’s online platform were School outreaches (25%), Peer educators (22.6%) and Facebook adverts (17.8%). The main reasons that attract respondents to these platforms include content (53.5%), platform design (23.8%) and Interactive nature (22.6%).

The majority of respondents to the online survey reported visiting the platforms at least weekly (69%). About 17 % visited daily, 21.4 % visited more than twice per week and 30.9% visited once per week. First time visitors were 17.8% of the respondents. Regarding the time for visiting the e/mhealth channels, majority of respondents reported visiting mostly in afternoon and evening at 27.3% and 38% respectively. However, most respondents visited these platforms for less than one hour (91.6%). In fact, 41.6% reported spending less than 30 minutes.

Regarding the perception of the respondents towards the design of the platforms, over 70% reported that they were satisfied. Concerning the aspect of access, 66.6% and 71.4% of respondents reported that they were allowed to access internet at home and school respectively.

ix

However, there were notable challenges. Almost sixty percent (59.5%), 54.7 %, 42.8% and 44% of the respondents respectively reported internet connection, costs, lack of ownership of gadgets and limited time as the major challenges in accessing e/mhealth channels.

Many respondents (60%) reported ease of accessing the information they wanted. The most sought information was on SRHR as reported by 85.7% of all respondents. Other common topics reported included entertainment (70.2%) and Training (82.1%).Among the SRHR topics, majority of respondents reported seeking information on relationships (91.6%) while none (0%) reported seeking information on sexual citizenship.

Half of the respondents reported that information was very helpful (51%) and it was easy to understand. Three quarters (75%) reported that the information was of good quality and 53% found the information youth friendly respectively. More than 80% reported getting referred for additional information. Most referral information was on condoms (76.1%), HCT (72.7%0, reproductive health services (72.6%) but STI treatment was very low (28.5%).

Regarding suggestions for improvement, the following were suggested: link to other pages (53.5), updating the pages routinely (76.1%), making these platforms more interactive (70.2%) and improving the platform design (57.1%).

In-depth Interviews with staff Out of the eight RAHU staffs were interviewed; three were from the management while five (5) were implementers. All the staffs interviewed were below 30 years, indicating a youth-led organization. One of the managers had worked in SRHR field for 14 years. The average working experience of the implementing staff in SRHR field was 2.7 years.

It was reported that on-line programming was informed by a needs assessment. The key insights from the assessment reported included; the need for capacity building for staff and peer educators, the need for more computers and staffs, and the increasing appreciation of on-line media by young people.

x

There was an overall agreement among the respondents that the available infrastructure at RAHU was adequate. For instance, there was unlimited internet access, each staff had access to a computer and a smart phone. It was also reported that RAHU had enough human resources. It has a big peer educators’ network that it could tap into. However, some respondents felt that the peer educators’ network had not yet been fully utilized. Other respondents recommended a need for additional staff. Positively, the respondents revealed that the staffs are competent to do e/mhealth programming and often exposed to continuous training. It was reported that RAHU has adequate funding but more is still needed for e/mhealth.

Findings on management support for e/mhealth programming showed that there was a lot of support received from the management. Mentorship and guidance, training opportunities, internet provision, and fostering collaboration with other organizations that do well in e/mhealth programming were mentioned as some of the existing mechanisms for management support.

When asked about the advantages of using e/mhealth, most respondents highlighted that it is a trendy thing. However, notable challenges were cost, national laws that limit content shared with young people and stringent school policies limit ownership of phones and use of internet.

Observation of RAHU’s online platforms: A structured observational assessment of RAHU’s Sautiplus Facebook page and website was conducted. The observation assessment generated rich and detailed information which included; user engagement i.e. likes, shares, comments; the platform design; the type content shared; and content generation Observation findings showed that gender, sexual and reproductive health, pleasure, violence, diversity and relationships were the common comprehensive sexuality education topics offered on RAHU’s Sautiplus Facebook page and website. Sexual citizenship related topics were not offered on the platforms during the three months study period.

Information was shared mainly in text, pictures and video formats. On average a message was posted on a daily basis on Facebook while for the website, content was not regularly updated.

During the observation it was noted that the website was not as interactive as the Facebook page that had questions from the audience. The questions were mainly in-boxed and not posted on the page. The common questions observed were questions about the physical address of the

xi

organization and relationship issues. Further observation of the referral information offered on RAHU’s online platforms revealed that referral information for additional information and services was barely provided on the platforms as reported by implementing staff.

Observation findings showed that RAHU’s Sautiplus Facebook page had over 31,000 followers.

The followers were mainly engaged through:- stories they posted, comments, shared links and likes. The other forms of engagements noted were through the uploading of pictures and videos.

Asking questions was also observed although on a small scale.

The top three stories with the most reach on the Sautiplus Facebook page during the study period were about; relationship (personal story), HIV prevention and teenage pregnancy stories with reach of 8,964, 16,008 and 4728 followers respectively. The top three most liked stories on the Sautiplus Facebook page were about: HIV prevention, relationship (cheating partner) and Gender Based Violence with 206, 43 and 85 likes respectively. Data from the platform observation showed that sharing of the stories offered on RAHU’s online platforms was limited compared to liking and commenting on the post. HIV prevention, relationship (personal story) and Hepatitis B stories were the most shared stories observed with only 28, 6 and 5 followers sharing them respectively

Programming opportunities identified by the e/mhealth operations research: We identified several programming opportunities that Reach a Hand Uganda ought to consider.

These include: 

There is a high appreciation and respect for online platforms by both young people and RAHU staff, coupled with existing familiarity with online platforms by young people.



Existing management support and sound staff technical capacity for e/mhealth programming plus the untapped strong peer educator network



Presence of other RAHU programs that could incorporate online platform promotion.



Existence of a big audience base in urban and peri-urban areas.



Appreciation of RAHU’s online platform design and trust in content offered by young people.

xii



High ownership and access to gadgets that access internet by young people.



Existence of computer laboratories in most secondary schools.



High interest of youth in true stories posted online.

OR Implications & Recommendations: 

RAHU should promote her platforms among young people in addition to strengthening the platform design efforts in order to maintain or even improve the good impression by the audience.



The online survey showed that young people mainly visited RAHU’s online platforms in the afternoon and evening. Therefore, RAHU’s message posting and audience engagement efforts should be capitalized in the afternoon and evening. This may imply working outside office hours.



Data from the online survey showed that majority of the people who used RAHU’s online platforms were 18 years and above (mean age 22.2 years) and mainly males. RAHU should therefore tailor its messages to fit profiles of typical users.



There is need for RAHU to not only regularly update content on its online platforms but also create room for innovative ways to make the content more engaging and entertaining that young people long to always return many more times. Games, real stories, quizzes and plays are some of the creative ways to make educational content engaging and entertaining.



Since youth are particularly attracted by true stories, RAHU can use true stories to incorporate learning for youth and embed links within these stories which direct them to other sources of information. RAHU could also consider developing case vignettes (sample fictional stories/scenarios) encompass multiple SRHR issues and can be used (one scenario at a time) to stimulate learning and discussions on their available platforms.



Data from on-line interviews and observation revealed that that majority of young accessed mainly reproductive health information from RAHU’s Sautiplus website platforms. During FGDs, young people revealed need for information on other topics such life skills, success stories, integration of sports into SRHR information, career guidance, business and job interview tips and drug abuse. Therefore, RAHU should

xiii

incorporate other types of information other than health which could to draw those passionate about it to the platform and hence also accessing SRHR information. 

There was high appreciation and commitment to e/mhealth programming by both RAHU’s top managers and implementing staff. Hence RAHU should focus more on tailoring capacity building to specific needs identified other than using generalized trainings



RAHU has a big peer educators’ network which needed to be fully utilized. RAHU should put in place structures to involve these peer educators.



Contrary to reports from the online survey that claimed that referral information was readily available, observation findings showed that referral information was minimal and hidden. RAHU should strengthen its efforts to provide referral information additional SRHR information and services to its audience. For example, having a referral corner/page on the main page would be an innovative way of offering referral information on Facebook and website.

xiv

Summary of Indicators

Table 1:

Summary of Key Study Indicators

Number of young researchers trained Total online responses Online responses after data cleaning Characteristics of online respondents Mean age Age range % male In-school Urban residents Have income generating activities Characteristics of FGD participants (8 non-users groups +1 users) Total number Age range % male Sources of information about RAHUâ&#x20AC;&#x2122;s e/mhealth platforms School outreaches Peer educators Facebook adverts What attracts respondents to online platforms Message content Platform design Being interactive Frequency of visiting Weekly Daily More than twice per week Once per week First time When visit most Evening Afternoon Duration of visit <1 hr <30 minutes Access to e/mhealth platforms Ownership/access to gadget Internet access at school Internet access at home Challenges Poor internet connection High costs Donâ&#x20AC;&#x2122;t own gadget Limited time Type of information accessed SRHR Entertainment Training

7 135 85 22.2 18-39 71.4 47.6 95.2 33.3 91 13-19 58.2 % of respondents 25 22.6 17.8 % of respondents 53.5 23.8 22.6 % of respondents 69 16.6 21.4 30.9 17.8 % of respondents 38 27.3 % of respondents 91.6 41.6 % of respondents >70 66.6 71.4 % of respondents 59.5 54.7 42.8 44 % of respondents 85.7 70.2 82.1

xv

Type of SRHR information accessed Relationships Sexual citizenship Referral for additional information Condoms HCT Reproductive health services STI treatment Rating of information provided Quality Useful Youth friendly Suggestion for improvement Link to other pages Routine update Make more interactive Improve design

% of respondents 91.6 0 % of respondents 76.1 72.7 72.6 28.5 % of respondents 75 76.2 52 % of respondents 53.5 76.1 70.2 57.1

xvi

CHAPTER ONE 1.0 Background 1.1 Context and Rationale The application of electronic and mobile solutions for health (eHealth and mHealth) in developing countries is expanding quickly, including in the field of Sexual and Reproductive Health (SRH). The Access, Services, Knowledge (ASK) program which is currently being implemented in Uganda seeks to use e/m health strategies to increase direct access to SRH information and services to young people. A number of review papers2 noted that the research done in e/m health field is limited to short term effectiveness, client- provider assessment of technologies and cost of small scale pilots. Therefore, evidence is not sufficient to determine effectiveness or even sustainability of these interventions beyond pilot phases funding. Impact assessment/ evaluation research is limited by complexity of strategies i.e. rapid technological change, unfamiliarity of providers and clients and technical complexity of the infrastructure itself.3 A survey4 of existing e/m tools at five (5) ASK partner organisations5 showed that despite overwhelming interest, integration of these on-line platforms into existing programs i.e.

Sautiplus plus at RAHU is still at its infancy6 and no evaluation of performance, processes or effectiveness has been done. Additionally, â&#x20AC;&#x153;traditionalâ&#x20AC;? communication and information strategies such as electronic media and face to face communication i.e. television talk shows and school outreaches were still strongly being used in providing SRH information to young people.

Furthermore, it was not clear under which conditions and how e/mHealth applications perform compared to the traditional platforms. Additionally, there were concerns over the possibilities of

2

WHO 2011 (mHealth: New horizons for health through mobile technologies: second global survey on eHealth.), Aranda-Jan et al 2014 (Systematic review on what works, what does not work and why of implementation of mobile health (mHealth) projects in Africa. BMC Public Health 2014, 14:188 http://www.biomedcentral.com/1471-2458/14/188) 3 Path Outlook 2012 (eHealth, mHealth, reproductive health. December 2012) and WHO 2011.

4 Report on findings of current e/mHealth strategies used by ASK partners in Uganda.

5 Reach a hand Uganda (RAHU), School Net Uganda, Restless development and Straight talk foundation (STF).

6 Reach a hand Uganda (RAHU) is much ahead in using social media but evaluation of effectiveness is not yet done.

1

effectively using modern technologies among youths especially in settings where many donâ&#x20AC;&#x2122;t own mobile phones and access to the internet is not guaranteed.

It is against this background that this OR broadly aimed at providing evidence about use of e/m health strategies for expanding direct access to SRHR information and services among young people in Uganda by conducting a comprehensive assessment of RAHUâ&#x20AC;&#x2122;s Sautiplus website and facebook pages, discussing their effectiveness, facilitating factors, current challenges, gaps, opportunities and tendencies. Specifically, the research explored the dynamics (actors and factors) that determine the effectiveness of the e/m health strategies used by RAHU to increase access to SRH information/services among Ugandan young people.

1.2 Background of ASK Programme and RAHU The Access, Services and Knowledge (ASK)programme is a 3 year program (2013 to 2015) funded by the Dutch Ministry of Foreign Affairs with the aim of enhancing uptake of Sexual Reproductive Health (SRH) services among young people aged between 10-24 years, including underserved groups. The programme which is a joint effort of 8 organizations comprising of Rutgers WPF, Simavi, AMREF Flying Doctors, CHOICE for Youth and Sexuality, dance4life, Stop AIDS Now!, the International Planned Parenthood Federation (IPPF), and Child Helpline International (CHI) is implemented in 7 countries namely Kenya, Uganda, Ethiopia, Ghana, Senegal, Pakistan and Indonesia.

In Uganda, the programme is implemented through 12 partners including RAHU. RAHU is a non-profit youth led organization that aims to address the key issues that leave Ugandan youths vulnerable to health outcomes like, HIV, Sexual Transmittable Infections (STIs), and unintended pregnancy. RAHU focuses on changing social norms and values that limit access to Sexual Reproductive

Health

(SRH)

services

and

information

through

designing

effective

communication strategies and campaigns to create awareness and mitigate sexual health problems among the young people. RAHU mainly operates in central region districts although under the ASK programme, Jinja and Iganga are its operational districts.

2

Central in the ASK program is to develop and implement (new technology) innovations in order to improve access to SRHR information and/or quality of service delivery, with the goal of increasing information seeking and uptake of services by youth and hard to reach populations.

Under the ASK program, RAHU implements the Sautiplus campaign. The campaign that started in September 2013 uses multiple platforms such as facebook, website, twitter, television, radio and google+ among others to distribute comprehensive Sexuality Education (CSE) messages to young people (10-24 years) both in and out of school.

1.3 How was this e/mhealth operations research implemented?

Seven young people were trained using Rutgers’ Explore Training Manual on training of young researchers. This was intended to ensure Meaningful Youth Participation (MYP) and to build capacity for young people in RAHU’s peer educators’ network in operations research. This team included; five data collectors and two data entrants. These were selected by RAHU in consideration of their membership in RAHU’s peer educators’ network. An Organizational-level Steering Committee (core team) of four members was also established to oversee the process, provide guidance and prepare for use of results for program improvement. The core team members were taken through a one day national joint ASK partners’ training to orient them on e/mhealth operations research, and work planning. (See Annex 1 for a list of RAHU’s research core team and young researchers.)

Table 1: Summary of RAHU’s e/mhealth operational research implementation.

Step in the Activity Objective implementation National-level  Discuss further the possibility Joint Core team and feasibility of engagement implementing the e/mhealth meeting operations research  Assess Organization readiness to implement the OR activity  Assess the readiness of ASK partners to begin OR protocol development  Draw work plans for the OR

What was done/achievement  The consultancy team met five different research core teams from the ASK partners engaged in e/mhealth programming and established rapport with them  The consultancy team successfully gained the interest of the core teams in implementing this e/mhealth OR.  The team was able to establish that three partners were willing to begin right way while the other two opted to

3

activity

Stakeholder engagement meeting

 Promote the OR and its benefits to the broader stakeholders in the district  To obtain district buy-in into the activity as well as support

Capacity building for young researchers

 To orient participants on e/mhealth strategies under RAHU.  To orient the young people on e/mhealth Operations research under RAHU.  To train young people as researchers for the OR.  To practice for field activities through role-modeling.

Tool pre-testing

 To pre-test the research tools developed for the e/mhealth OR.

In-depth Interviews

 To generate staffs’ perceptions towards RAHU’s on-line platforms.  To observe RAHU’s Facebook page and website and asses its design and content.

Platform Observation

On-line survey

Focus group discussions Dissemination

 To use an on-line tool to collect the views and opinions of users of RAHU’s Sautiplus face book and website in regards to these platforms.  To generate users’ and nonusers’ perceptions towards RAHU’s on-line platforms.  Use findings to inform

start three months down the road.  Each team drew a draft work plan for the activity.  The Consultancy team together with a core team member successfully introduced the OR to the district stakeholders in Jinja and Iganga.  The district stakeholders endorsed the activity and appreciated the need for evidence based programming.  Successfully trained seven young people from RAHU’s peer education network in; research basics, operations research, oriented them on OR tools and had hands on experience in collecting data in Jinja and Iganga.

 The data collection i.e. the FGD discussion guide was pre-tested at Hana Mixed School in Kampala.  Whereas the on-line tool was pretested until five records were got.  The pretest informed tool improvement before actual data collection.  Eight in-depth interviews were held with RAHU’s staff; three from top management and five implementers.  An observation of Sautiplus Facebook page and website was done. The observation focused on a period of three months that preceded the observation exercise.  135 records were attained through the on-line tool from Dec 2014 to April 2015  Eight Focus Group Discussions were held with non-users of RAHU’s Sautiplus website and face book pages.  The consultancy team will share the

4

and use of findings

interventions

OR findings with the OR working group in the Netherlands for their input before sharing it with RAHU. ď&#x201A;ˇ The Consultancy team will discuss with RAHU the strength and gaps identified by the OR and action points. ď&#x201A;ˇ District and National level dissemination meeting will be held.

1.4 Ethical Review and Approval

This OR protocol was reviewed and approved by the Makerere University School of Public Health Higher Degrees, Research and Ethics Committee and National Council of Science and Technology (See annex 4. Copy of approval letters)

Other ethical considerations: Research assistants informed all study participants of their rights and risks of participating in the study. Written consent was obtained from all study participants (online, FGD & IDI) after explaining the purpose of the study. Participation in the study was voluntary.

Throughout this study, privacy and confidentiality was emphasized. All data was collected in a private setting. Confidentiality was assured by removal of identifiers and restriction of raw data to only those who were directly involved in the study.

5

CHAPTER TWO 2.0 Young peoples’ perceptions and attitudes towards RAHU’s Sautiplus Facebook page and website 2.1 Methods of data collection from young people Both quantitative and qualitative study methods i.e. online semi structured survey and Focus Group Discussions (FGDs) were used to examine and report detailed views of young participants (10-24 years) in response to the research questions.

On-line survey: A sample size of 400 young people was targeted for the online survey to assess aspects related to RAHU’s Sautiplus Facebook page and website. The sample size was calculated using a webbased sample size calculator (http://www.openepi.com/OE2.3/SampleSize/SSPropor.htm), based on three factors: the estimated population of young people who may have accessed e/m health platform by RAHU (in this case not known, maximum variability proportion of 0.5 has been used); the confidence level at 95%; and the margin of error at 5%.The response rate of 15-20% was also considered given that this was the first time this population (young people accessing social media/website information by ASK partners) was surveyed online.

The online survey tool was posted on RAHU’s Sautiplus website and Facebook pages in December 2014. Automated daily reminders of the survey were put on the studied pages throughout the study period to promote response. Only 135 responses were generated and downloaded in excel sheet by April 2015. After data cleaning, 85 recorded remained. Data was analyzed using SPSS XBM version 17 statistical package. The analysis was mainly descriptive, frequency/percentage distribution tables, graphs and cross-tabulations were the main form of presentation and analysis for the study.

It was not possible to restrict age and geographical coverage of this web-based data collection method. Slow response and multiple submissions were the biggest challenges of this process.

6

Focus Group Discussions: A total of eight focus group discussions were conducted with in-school non-users of RAHU’s e/mhealth platforms. Efforts to find users in the study schools were futile. The FGDs were conducted in the five schools covered by RAHU in the ASK districts; three in Jinja district (Jinja SS, Kiira College Butiki and PMM Girls school) and two in Iganga district (King of Kings S.S and Iganga S.S). Each FGD comprised of 8-12 participants. FGDs explored youths’ perceptions and attitudes towards aspects of e/mhealth strategies (such as access, design and implementation) and how the young people used the provided SRHR information. A pre-test Focus Group Discussion of users at Hana Mixed School in Kampala was included in the analysis to provide some in-depth insights from users. School authorities were used to mobilize FGD respondents.

Data from the FGDs were analyzed using a thematic framework approach based on key themes, concepts and emergent categories. Quotes from the respondents were used to illustrate and emphasize the voices and points made by respondents.

All in-school students (boys and girls) aged 10 or older were eligible to participate and all those above the age of 24 were excluded.

Training of young researchers: Seven young people were trained using Rutgers’ Explore Training Manual on training of young researchers. The content was adapted to suit the Operations research. The young people were trained to ensure Meaningful Youth Participation (MYP) and to build capacity for young people in RAHU’s peer educators’ network in operations research. This team included; five data collectors and two data entrants. These were selected by RAHU in consideration of their membership in RAHU’s peer educators’ network. The research assistants were trained for four days, on research basics, e/mhealth OR objectives, quality control, record taking and research ethics prior to the beginning of data collection process. The training involved face to face talk and mock interviews and fieldwork to familiarize with the data collection tools. Use of various training approaches was aimed at ensuring accuracy, consistent, uniformity and validity of the dialogues. More about the training can be seen in the photos below.

7

2.2 What kind of young people currently use RAHU’s website and Sautiplus Facebook pages 2.2.1 Online Respondents The mean age of the respondents was 22.2 years, age range was 18-39, and 74% of the respondents were young people while 16.4% were outside the age range of RAHU’s target audience of 10-24 years. Male respondents constituted the biggest proportion (71.4%) of the online respondents while 47.6% of the study respondents were still in school. Majority of the online respondents (95.2%) resided in urban areas while 33.3% reported engaging in Income Generating Activities (IGA). This showed that youths in urban areas mainly accessed RAHU’s Sautiplus Facebook page and website. The details can be seen in the table below.

Table 2: Socio-demographic characteristics of online respondent.

Percent

10-14 15-19 20-24 25-30 30 + Missing

Frequency (N=84) 0 16 47 11 03 07

Female

24

28.5

Variable Age

0 (%) 19 55.9 13 3.5 8.3

Sex

8

Male

60

71.4

In-school Out of school

40 44

47.6 52.3

None Primary school Secondary school Tertiary education Residence Urban Peri-urban Rural Engaged in IGA Yes No

0 0 24 60

0 0 28.5 71.4

80 02 02

95.2 2.3 2.3

28 56

33.3 66.6

Schooling status

Education level

2.2.2 Focus Group Discussion Participants A total of 91 in-school young people were engaged in the eight (8) focus group discussions conducted. The age range of participants was 13-19. Male participants constituted the biggest proportion (58.2%) of the FGD participants. The details can be seen in the table below.

Table 3: Socio-demographic characteristics of FGD participants

FGD Identifier FGD 1- Jinja FGD 2- Jinja FGD 3- Jinja FGD 4- Jinja FGD 5- Jinja FGD 1- Iganga FGD 2- Iganga FGD 1- Hana

FGD Type Non-user Non-user Non-user Non-user Non-user Non-user Non-user User

Composition Female 0 0 12 7 7 3 5 4

Male 12 12 0 5 4 8 5 7

Mean Age of Respondents 16.2 14.5 16.7 15 16 15.5 16 15.5

2.3 Sources of information about RAHUâ&#x20AC;&#x2122;s on-line Platforms and Reasons for access School outreaches, peer educators, friends and Facebook adverts were the main sources of information about RAHUâ&#x20AC;&#x2122;s on-line Platforms with 25%, 22.6%, 22.6% and 17.8% respectively

9

reporting them. Teachers and RAHU’s IEC materials were the least sources of information about RAHU’s on-line platforms with only 5.9% and 3.5% of the on-line respondents respectively reporting having known RAHU’s Sautiplus website and Facebook pages through these sources.

30 25.0 Percentage of respondents

25

22.6

20

22.6 17.8

15 10 5.9 5

3.5

2.3

0 Peer Educator Academy

Peer Educator

Facebook Advert

RAHU's IEC Materials

School Outreach

Teacher

Friend

Figure 1: Sources of information about RAHU's platforms

Most of the on-line respondents (53.5%) reported that they were attracted to RAHU’s Sautiplus Facebook page and website because of the messages shared on these platforms. According to them, messages are informative, educative and beneficial. However, much as majority were attracted by content, 23.8% and 22.6% of the respondents were attracted by the platform design and friendship making/interaction respectively. This can be seen in the pie-chart below.

10

Reasons for A ccess

Making/Interracting with Friends 23%

Platform Design 24%

Educative/Informati ve Messages 53%

Figure 2: Reasons for accessing Sautiplus Facebook and website as reported by On-line respondents

2.4 How Frequent and Extensive Do Young People Visit Sautiplus on-line pages Many people (69%) visit the Sautiplus Facebook page and website every week. Specifically, 16.6% of the respondents visited these pages every day; 21.4%, 2 or more times a week and 30.9% visit the pages once a week. Some people had visited Sautiplus on-line pages for more than 6 months (19%); in fact, 10.7% of respondents had visited these pages for over a year.

Only 17.8% reported that this was their first visit to the page (see Figure 3). The visits were mainly done in the evening and afternoons with 38% and 27.3% of respondents reporting often visiting RAHUâ&#x20AC;&#x2122;s online pages at those times respectively. Most of the people stayed on the page not more than an hour (91.6%) and 41.6% particularly spent less than 30 minutes. These were mainly respondents who reported secondary level of education. These findings matched with the focus group discussions where majority of the participants mentioned that they were mostly allowed to access the computer laboratories in the afternoons. One participant remarked:

11

“……yes it’s easy to access internet because every after lunch we have a provision for those who want to have the internet, we have a good number of computers there so we can access them” Male Participant, FGD 1-Jinja.

Frequency of Platform Visits 2 or more times a month 9%

First time visit 23%

Once a month 8%

Everyday 21%

Once a week 39%

Figure 3: Frequency of visits at Sautiplus and website

2.5 Young People Perceptions towards Access and the Design of RAHU’s on-line Platforms Over 70% of the respondents reported ownership and/or access to another person’s gadget (phone or computer) which they used to access the on-line platforms and many (66.6% & 71.4%) reported being allowed to access internet at School and home respectively. On the other hand, only 33.3% and 28.5% were not allowed to access internet at School and home respectively.

Over a half of the respondents (59.5% and 54.7%) reported that poor connections and the cost of internet were the biggest challenges limiting their access to the on-line platforms (See Figure 4).

This finding matched with the FGD findings were one participant remarked: “At school it may be a little easier for me to access internet because at home, my parents do not allow me to have a phone. I have to get some money and move to the internet

12

café. I cannot get money every day so maybe in a week if am lucky I may go to a café twice because at home getting money is a challenge”. Male Participant, FGD 1-Jinja

Other participants had this to say about internet access: “It’s difficult for me at school to use the internet or the phone because they do not allow us to possess phones at school but at home I can access it”. Male Participant, FGD 3Jinja “Much as we are allowed to use the computer lab but time given is limited. You are given 20 minutes to surf and do everything you want on the computer as other people will be waiting for their turn, they push you out before you surf whatever you wanted”. Male Participant, FGD 2-Jinja “It’s too hard at school, sometimes the internet is too slow and time given is limited”.

Male Participants, FGD 2-Jinja Majority of the online respondents reported that it was either very easy or easy to find the information needed whenever they visited RAHU’s on-line Platforms (See Figure 5).

Percentage of Respondents

70 60 50 40 30

59.5

54.7 44

42.8

20

30.9 10

28.5

20.2

0 Its expensive

Don't own gadget

Limited Limited time Poor internet Restriction Distance to Computer connection from elders internet point Skills Internet Access Challenges

13

Figure 4 : Factors influencing access to internet as reported by Respondents Ease of Finding Information on the Platform Very Difficult 0% Difficult 2%

Easy 38% Very Easy 60%

Figure 5 : ease of finding information at Sautiplus Facebook page and website

2.6 SRHR Information Accessed by Young People from Sautiplus on-line Platforms Among the on-line respondents, the biggest proportion (85.7%) reported accessing reproductive health information from Sautiplus online platforms. The other type of information accessed on Sautiplus platforms were training opportunities and entertainment information with 82.1%and 70.2% respectively. Majority (91.6%) of those who had sought reproductive health information had specifically sought information do with relationships (See Table 2).

Table 4: Information Sought from Sautiplus Online Platforms by Young People.

Responses from the Online Survey, RAHU, e/mhealth Operations Research, 2015 Respondents Percentage of Respondents Who:

Mean age

Male (n=60)

Female (n=24)

22.5

22

80

100

Type of Information Accessed from Sautiplus on-line platform (%) Reproductive Health Information

14

Responses from the Online Survey, RAHU, e/mhealth Operations Research, 2015 Respondents Percentage of Respondents Who: Entertainment

75

58.3

Job Opportunities

48.3

41.6

Entertainment Opportunities

93.3

54.1

News

83.3

62.5

Specific SRHR information accessed from Sautiplus on-line platform (%) (n=48 Gender 89.5 Sexual and Reproductive Health

(n=24) 62.5

95.8

79.1

0

0

Pleasure

60.4

20.1

Violence

68.7

79.1

Diversity

51.4

45.8

Relationships

91.6

95.8

Sexual Citizenship

Further investigations on additional information needed by young people showed that, 47.6% of the online respondents felt some information was missing on the platforms. The following types of information were reported as additional information needed on the platforms; life skills, success stories, integration of sports into SRHR information, career guidance, business and job interview tips, drug abuse and homosexuality information. When asked which type of information embarrassed them to access from on-line platforms, all those who attempted to answer this question (only seven people) mentioned information related to sexual intercourse.

One FGD participant reported finding sexual pleasure information embarrassing to access from on-line platforms. She remarked: “….I may not be at ease reading information on sex in a computer lab”. Female Participant, FGD 3-Jinja 2.7 Young People’s Usage of the Information Offered on Sautiplus on-line Platforms Understanding the content is an important step to information usage. From the online survey, the majority of the respondents (94%) reported that they found the information provided on Sautiplus online platforms easy enough to understand to their satisfaction. Only 6% of the online respondents felt the information provided on Sautiplus online platforms was not

15

satisfactorily easy to understand. Over a half of the respondents (51%) reported that the information provided on Sautiplus online channels was very helpful. Other 35.7% of the respondents felt the information provided was helpful whereas some 13% of respondents were not sure whether the information provided was helpful or not (see Figure 5). These findings matched with the FGD findings although the FGD participants further noted that much as the information shared was helpful, it was too brief. One participant remarked: “…….they talk about useful topics but they don’t bring out everything that you need to know”. Female Participant, FGD 1-Hana 60 51.1 Percentage of respondents

50 40

35.7

30 20 13 10 0 Very helpful

Helpful

Not Sure

Table 5: Rating of information offered on Sautiplus platforms

2.8 Sautiplus on-line Platforms Contribution to Increased Uptake of RH services Over 80% of the online respondents reported finding referral information for additional SRHR information and services on the Sautiplus website and Facebook page. Condoms, HCT services and reproductive health services were the main services referred for on RAHU’s on-line Platforms with 76.1%, 72.7%, and 72.6% respectively reporting them. Pregnancy care and delivery as well as STI counseling and treatment were the least services referred for on RAHU’s on-line platforms with

only 33.3% and 28.5% of the on-line respondents respectively reporting having referred for these services on Sautiplus Facebook page and or website. More than half of the respondents (64.2%)

16

reported having seen referral services for Post Abortion Care on Sautiplus Facebook page and or website. Discussions with RAHU’s online platform users during the focus group discussions also revealed that young people were referred for additional information and services. Two participants remarked: “Yes, we are referred for reproductive health services like Reproductive Health Uganda”. Female Participant, FGD 1-Hana “They gave me a telephone helpline that I can all for more information”. Male Participant, FGD 1-Hana

80 Percentage of respondents

70 60 50 40

76.1

72.7

64.2

30 20

76.1

72.6

33.3

33.3

10 0 Reproductive Health

HCT

STI Treatment

PAC

FP services

Pregnancy Care & Delivery

Condoms

Referral Services

Figure 6: SRHR information and services which are usually referred.

2.7 Appreciation, Perceived Advantages and Recommendations for Platform Improvement

by Young People 2.7.1 Young People’s Appreciation of the Platforms Willingness of the on-line respondents to recommend RAHU’s online platforms to their friend was extremely high at 100%. Similarly, over 80% of the online respondents felt RAHU’s online platforms allowed them to share ideas openly. However, discussions with users of RAHU’s

17

online platforms during the FGD expressed some reservation on sharing their ideas on the platform. One participant remarked: “RAHU itself is an organization and many people have access to the information posted on its pages. You can’t tell how many people access your information, if posted.

Sometimes you fear to write your private things (concerns)”. Male Participant, FGD 1Hana

Findings on the general perceptions of young people towards the information offered on RAHU’s online platforms showed that; 75% of respondents approved that the information offered was of high quality. Further still, 76.2% of respondents approved that the information offered on RAHU’s online platforms was useful. Over half of the respondents (52.3%) felt the information offered was youth friendly and 44.4% felt it was understandable. Thirty six percent of the respondents felt the information offered was not understandable and the language used was inappropriate (see figure 7).

Information Rating by Young People 50

Percentage of Respondents

45 40

44

41.6

39.2

35 30

Completely Agree

33.3

Agree

25

27.3

20

29.7

29.7

Disagree

22.6

21.4 13 10.7

5

0

1.1

Don’t Know

19

15 10

Completely Disagree

13 5.9 4.7

14.2 0 1.11.1

13

13

Neutral

2.3

0 High Quality

Understable

Useful

Youth Friendly

Figure 7: Young people's rating of the information offered on RAHU's online platforms.

18

Discussions with non-users of RAHU’s online platforms during the focus group discussions also revealed high appreciation of online platforms. Young people felt it was cool and fashionable to have a Face book page. Some participants remarked: “I think Facebook is easy because I have many friends now when you send me the message, say RAHU sends me a message on FB, I will share it with Paul, Calvin so they will all have a chance to comment. If I suggested to him (Paul) a page, we shall all be sharing the same information rather than a newspaper where he will ask for a copy. So face book becomes even easier and faster?” Male respondent, FGD 1-Jinja “……because right now in this generation a person without a Face book account is totally a real villager. So now days as you use Face book, I think in butikino everybody has a facebook account accept those who are staunch Christians”. Male Participant, FGD 2-Jinja

About the design and layout of RAHU’s online platforms, findings showed that; 81.7% of respondents trusted the content offered on the website. Further still, 55.9% of respondents approved that it was easy to navigate through RAHU’s online platforms to find the information needed. About 43% of the respondents agreed or completely agreed that the videos shared on RAHU’s online platforms were attractive to watch while 42.4% agreed or completely agreed that believed that the language used was appropriate (see figure 8).

19

Rating of Platform Design by Young Peaople

Percentage of Respondents

60

54.7

50 40

Completely Agree 32.1

30.9 29.7

30

20.2 20

25 26.1 21.4

13

10.7 10

13 9.5 4.7

5.9 2.3

0 0

Agree

27.3 22.6

20.2 11.9

15.4

Completely Disagree Disagree Don’t Know Neutral

2.3

0

0 Trust Website Messages

Easy to Navigate

Appropriate Language

Attractive Videos

Figure 8: Young people's Opinion of RAHU's online design and lay-out.

Focus Group Discussions on the design and layout of RAHU’s online platforms indicated that majority of young people appreciated RAHU’s platform design and layout. Some young people believed the videos shared were of good quality while others thought it was easy to navigate through the platforms: “I like the videos. They are of high quality but when the internet is slow, you cannot play them”. Male Participant, FGD 1-Hana “It’s easy to find the posts, to comment on the posts and ask about what I didn’t understand”. Male Participant, FGD 1-Hana “Its youth friendly because the posts are about young people’s problems which at times help others young people to solve their own issues or even get courage and hope”.

Female Participant, FGD 1-Hana 2.7.2 Young People’s Perceived Advantages of online Platforms Focus group discussions on the advantages of using online platforms to disseminate SRHR information to young people indicated that some young people were in support of online

20

channels while others thought not all young people could access online platforms. Some young people thought online platforms were effortless as compared to face-to-face means, others said online channels are quick/faster while others highlighted the navigation challenges: “It’s very easy to pass on sex information using online platforms other than getting it orally because people shy away from giving sex information”. Female respondent, FGD 1-Iganga “It’s easy to ask a burning sexual problem on face book since our parents are not on face, so they will not get to know our sexual problems”. Male respondent, FGD 4- Jinja “…….. but someone who didn’t log in like the morning may not know what was there if he/she logged in the evening especially, if they don’t have the skill to navigate through the page”. Female respondent, FGD 4- Jinja 2.7.3 Young People’s Suggestions for RAHU’s online Platforms Improvement Findings on young people’s suggestions for platform improvement showed that; majority of the online respondents wished-for more routine update of messages and making the platforms more interactive (76.1% and 70.1% respectively) (see figure 9).

21

Young People's Suggestions for Platform Improvement 76.1

80

70.2 Percentage of Respondents

70 60

57.1

53.5

50 40 30 20 10 0 Link to other pages

Routine update of messages

Make it more interractive

Improve design

Figure 9 : Young respondents' suggestions for improvement.

The above finding matched with the findings from FGDs where young people suggested making the platform more interactive. One participant had this to say: “I think concerning Face book, daily posting is good. If you post information on a daily or even after every one hour for instance, you post in something about cleanliness and then the next hour you post maybe on sexual morals, guys are going to get interested and they will love it”. Male Participant, FGD 1- Jinja.

“Quick response, like when I send a message sometimes it takes long to get feedback, at least it should be done in one day”. Female Participant, FGD 1-Hana

Other participants wished for offline or free content search: “They should not charge us for searching Reach a Hand information on internet”. Male Participant, FGD 1- Iganga Other suggestions from FGDs included; need for additional information other than SRHR, face to face promotion of the platform especially in rural schools and lengthy posts:

22

“You should get agents who should come and teach us about these platforms in our schools”. Female Participant, FGD 1-Iganga “You should talk about real life stories” Male Participant, FGD 2-Iganga Yes, sometimes it’s clear sometimes it’s not. They post something very educative yes, but in most cases summarized”. Male Participant, FGD 1-Hana

23

CHAPTER THREE 3.0 Staff perceptions and attitudes towards RAHU’s Sautiplus Facebook page and website 3.1. Method of Data Collection from Staff In-depth Interviews (IDI) were used to generate staff views and judgments of RAHU’s Sautiplus Facebook page and website. An in-depth guide was developed and used to guide face- to-face in-depth interviews with RAHU staff. The study population consisted of eight (8) staffs; three (3) at management level and five at the implementation level. The staffs were identified purposively considering their roles at RAHU. The researcher together with the selected RAHU staffs chose the ideal time and place for the interviews. The respondents were offered on-front consent before being included in the study. The consent form was read to the participants to facilitate clear understanding. The respondents consented by signing the consent forms. Confidentiality was maintained by use of anonymous identifiers and restriction to raw data to only those who were directly involved.

In-depth Interviews (IDIs) generated rich and detailed information concerning the staffs’ perceptions towards the studied platforms, current design and maintenance processes, added value to other information dissemination means by RAHU as well as the needs for program development. Open ended questions were used to dig deeper into the subject of discussion. The interview was recorded using a tape recorder. The in-depth interview guide was pre-tested and feedback used to refine it.

The audio taped in-depth interviews were transcribed by the researcher. The data was analyzed using a thematic framework approach, following the key themes, concepts and emergent categories that evolved during data processing. The researcher then manually analyzed the findings theme by theme.

24

3.2 Characteristics of the Staff Interviewed Out of the eight RAHU staffs were interviewed; three were from the management while five (5) were implementers. All the staffs interviewed were below 30 years, indicating a youth-led organization. One of the managers had worked in SRHR field for 14 years. The average working experience of the implementing staff in SRHR field was 2.7 years. A Peer Educator engaged in managing RAHU’s on-line platforms was also one of the study’s five implementers. He had three years’ experience working in SRHR field.

Table 6 : Socio-demographic Characteristics of the Staff Interviewed

Key Identifier

informant

Sex of Respondent

Age of Respondent

No. of years in working in SRHR field

Manager 1 Manager 2 Manager 3 Implementer 1

Male Male Male Female

25 25 25 25

7 14 2 4

Implementer 2 Implementer 3

Male Male

23 25

3 1

Implementer 4 Implementer 5

Female Female

28 23

0.5 3

3.3 RAHU’s Readiness for E&MHealth Programming 3.3.1 On-line Programming Needs Assessment Findings on whether RAHU had conducted a needs assessment in regards to on-line programming showed that a needs assessment had been conducted and among some of the key insights from the assessment reported included; the need for capacity building for staff and peer educators, the need for more computers and staffs, and the increasing appreciation of on-line media by young people e.t.c. One respondent remarked:

25

“Yes we did some needs assessment and we realized that there are different challenges……. The overwhelming questions from young people require additional manpower”. Implementer

However, some respondents were not certain as to whether the needs assessment for e/mhealth programming was done. This was mainly common among the implementers.

“I am not sure but I think they did a needs assessment”. Implementer

3.3.2 Presence of Infrastructure There was an overall agreement among the respondents that the available infrastructure was adequate. Findings on the state of infrastructure pointed out that; there was unlimited internet access, each staff had access to a computer and had a smart phone. Respondents mentioned that may be in future as RAHU grow more infrastructure will be needed.

“At the moment I think our infrastructure is adequate but like I said RAHU is growing there is time to get even much better”. Manager “……….at the moment every member of the team can at least access internet, they can access a computer, but as we grow, the team will grow and more of these will be needed.

Right now the team has full time access to internet and at least a computer”.

Implementer

3.3.3 Availability of resources (human, time and finances) Human resources: Findings on the availability of resources showed that some respondents felt RAHU had enough human resources with a big peer educators’ network which it could tap into while other respondents mentioned the need for additional staff. The later was common among implementers. Some respondents thought that the peer educators’ network had not yet been fully utilized.

26

“You know with human resource we have because we train these peer educators and if each of these peer educators was seated on a computer then we would have a lot of support”. Manager

I think we need someone else (additional staff) but it will also depend on the expansion of e/m platforms. It may not be very big so we may not need a big team”. Implementer “We have enough human resource, but financial resources we are still fundraising…”.

Manager Further probing on the capacity of RAHU’s human resources revealed that the staff were competent to do e/mhealth programming and often exposed to continuous training. Respondents cited; refresher trainings, expert talks, self and team learning as approaches through which their capacity was build.

However, majority of the respondents mentioned need for continuous

capacity building of the e/mhealth team. It was also reported that, e/mhealth staff worked as a team and each staff had an area of specialty. Further still, majority of the in-depth interviewees reported no prior e/mhealth working experience besides managing personal online pages. This showed that this was their first time exposure doing e/mhealth programming at RAHU. “The staff is competent to use E&M platforms, but as we know this is technology, every day things change and as they evolve we have these refresher courses for the staff”. Manager

Financing for e/mhealth

Yes currently resources are available but we have also established ourselves in Uganda as social media ambassadors, in order to compete favorably. We have also sent out funding proposals and we hope they will get some funding especially the youth hub”.

Manager

Another respondent noted that e/mhealth financing has picked up and should be given funding priority.

27

“……..it would be very unfortunate if they are no funds for e/mhealth programming. This should be what everyone wants to fund”. Manager

3.3.3 Management Support for e/mhealth programming Findings on management support for e/mhealth programming showed that there was a lot of support received from the management. Respondents reported that RAHU management highly appreciated e/mhealth programming and actively solicited for its funding. Further discussions on the types of support received from management revealed both technical and financial support.

Among the support mentioned included; mentorship and guidance, training opportunities, internet provision, and fostering collaboration with other organizations that doing well in e/mhealth programming. One respondent remarked: “There is a lot of support that comes from management for online communication channels because they are our core business. There is room for trainings, management at least solicits for these trainings, there has been presence of full internet access at office, and the peer educators who use their smart phones at least are facilitated with airtime to buy data bundles..........”. Implementer

3.4 Staff Perceptions of e/mhealth Programming 3.3.1 Perceived advantages of e/mhealth programming by staff Discussions on the use of internet and mobile technology supported platforms to pass on SRHR information to young people in Uganda revealed that the interviewed staffs were in support of e/mhealth programming. They reported that e/mhealth programming was fast growing and direct to the audience: “Since internet use is a first growing trend among young people, it’s a tool we can adopt and use to pass on information and young people can easily adopt to it and easily get to it”. Manager

28

“I think it’s an easier way to get to young people without intermediaries; they are getting the information straight off the internet and straight off their social media pages. I think it’s the way to go if we want to easily reach them (young people) because this is what they do every day, so if you put the information there then they will get it”. Implementer

Furthermore, majority of the respondents mentioned that use of internet and mobile technology supported platforms to disseminate health information was now the trend. One respondent remarked: “It’s now becoming more of a fashion to access information through internet. I have been to Jinja and I have met young people asking each other if they are on Facebook and if not then what you are waiting for. So for me I think it’s the way to go”. Implementer

Further discussions showed that the respondents believed that access to devices that accessed online platforms like phones, computers among others was on increase in Uganda including in local schools. One respondent said: “I think the current generation is so much more into social media, even the young adolescents; our target audience the 12 to 24 years. In fact the biggest percentage of people in the urban and peri-urban can access devices like phones, computers and even simple schools now have computer labs where by students can access internet”.

Implementer 3.3.2 Perceived challenges of e/mhealth programming by staff Further probing on what the respondents thought about use of internet and mobile supported channels highlighted a major concern over the cost of accessing these platforms by young people. According to the concern respondents, much as online communication channels are the latest thing in Uganda, the cost of internet bundles is still on a high side especially for the young ones to afford. One respondent remarked: “In Uganda it’s still challenging where you find that it’s a bit expensive for young people to access internet. Much as there internet subsidizing campaigns like Face book zero and

29

another one that MTN launched recently of loading 500 UGX then you access whatsup, face book and tweeter at a lower price, but young people still find it a little expensive”.

Implementer

Another concern expressed by the respondents was that of the national policies that limit certain content for instance the anti homosexuality and anti pornography bills. According to some respondents, there was demand for information on homosexuality and yet it’s would be violating the law if you provided such information. One respondent remarked: “…..you know that sexuality is also somehow like pornography, there are some pictures that are explicit, some communication that is explicit. But we try to balance because we do not want to be tagged on as those who support pornography in this country”.

Manager

Similarly strict school policies were also reported by respondents as a limitation to e/mhealth programming. Respondents reported policies like; restriction of phones in school, limited access to computer laboratories and restriction of sexuality education especially in Muslims schools. “……if you are going to a Muslim school you need to know that these people view sexuality information in a certain way, you need to be in line with their policy”.

Implementer

Further probing on the limitations of e/mhealth programming revealed some cultural and social restrictions. Respondents reported the following cultural and social limitations respectively; shying away from open discussion of some sexuality topics, and boys being friendlier to use of technology than girls. In addition to the above, respondents noted that rural youths in particular had limited access to internet. Unanimously respondents reported the slow internet connections in the country as an access limitation and also pointed out that at organization level, they had no limitations to e/mhealth programming. One respondent remarked:

30

“At RAHU there are no limitations. We are going without any limitations. For the country, the biggest limitation that we have is the slow internet connections that we keep facing”. Manager

3.5 Current Platform Design and Maintenance Discussions on how the RAHU’s online platforms are designed and maintained revealed varying responses from the interviewed staff. Some respondents mentioned that the design of RAHU’s online platforms was done by specific people after team discussion while other respondents reported that that the design and maintenance of the platforms was done by a number of people.

This was common with the Facebook page where it seemed there was no clear cut on the responsibility of platform designing and maintenance across managers and implementers. One respondent remarked: “With the process of designing we have someone who is doing our design work, we sit with them they understand the concept, we tell them we need something to go out, it has to be like this, they understand it and they sit and design it. So we all get involved”.

Manager 3.6 Staff Perceived Added Value of Online Platforms to other RAHU’s Information Dissemination Channels Discussions on the added value of online platforms revealed that the interviewed staffs believed that online platforms complemented the face to face strategies. They noted that online and face to face platforms promoted each other and supplemented the information disseminated on the other.

Further probing also showed that the respondents believed that online platforms enabled them to reach a wider coverage even where they couldn’t easily reach physically. One respondent remarked: “When you are going to have an outreach you share about it online and you keep the young people updated with what is happening at the outreach on social media. During the outreaches you encourage them to continue the discussion you have had with them on the social media platforms”. Implementer

31

3.7 Needs for program improvement and sustainability as reported by staff Discussions on what is needed for emhealth program improvement and sustainability showed that all the in-depth interviewees pointed at three conditions, which they perceived to enhance program improvement. These conditions included; continuous training of the implementing staffs such that they are regularly updated with the technological advances, proper planning, and training and involvement of the peer educators in content development and regular platform message posting: “We need a lot of improvement in planning, because planning is normally haphazard if the team decides then it’s left to the implementing person and you find that there is a big gap between the two; the top management and the person that is implementing”.

Implementer “I think more planning will make our work easy because when you plan, you can easily schedule the posts and just keep pushing them out. And the people you are trying to target with this information will get correct and consistent information”. Manager

Another respondent said what is needed is more youth involvement in implementation of the platforms.

“Lets remove the beaucracy and involve the young people themselves in content development, ask them what they think and use the feedback”. Implementer

32

CHAPTER FOUR 4.0 Expert observation of RAHU’s Sautiplus Facebook page and website 4.1 Observation methods A structured observational assessment of RAHU’s Sautiplus Facebook page and website was conducted. An observation checklist was developed and used to guide the observation of the two platforms to produce information on the nature, operations and information offered on the platforms. The observation assessment generated rich and detailed information which included; user engagement i.e. likes, shares, comments; the platform design; the type content shared; and content generation.

The observation focused on the platform activities for the period of three months that preceded the observation exercise. The observation forms were completed during and immediately following an observation. Written notes, listing ideas or relationships were noted during the observation.

Data from the observation was analyzed manually, following the key themes, concepts and emergent categories that evolved during data processing. The researcher then manually analyzed the findings theme by theme.

4.2 What kind of information is offered on RAHU’s Sautiplus Facebook page and website Observation findings showed that gender, sexual and reproductive health, pleasure, violence, diversity and relationships were the common comprehensive sexuality education topics offered on RAHU’s Sautiplus Facebook page and website. Sexual citizenship related topics were not offered on the platforms during the three months study period. Other types of information shared other than SRHR information included; training and some news.

33

About the common questions asked by the young people, the observation noted that the design of the website did not allow the audience to share feedback or ask any questions. In otherwords the website was not interractive. Observation on the facebook page, showed that there were a few questions coming in from the audience. The questions were mainly inboxed and not posted on the page. The common questions observed were asking about the physical address of the organization and relationship issues. It was observed that on average it took two days to respond to the followers questions/concerns.

Further observation of the referral information offered on RAHU’s online platforms revealed that referral information for additional information and services was barely on the platforms. The little that the observers noted were hidden within stories and not easily seen.

4.3 Expert observation of the platform design and content generation Data from the observation assessment of RAHU’s Sautiplus website and facebook page showed that the design and layout of the observed platforms was good but there was still room for improvement. Information was shared mainly in text, pictures and video formats.

Further observation of content generation on the platforms revealed that for the facebook page, on average a message was posted on a daily basis while for the website, content was not regularly updated. During the three months observed, no content update was done on the Sautiplus website. The observation findings further showed that content was mainly generated by the organization. The messages shared on the platforms were precise.

4.4 Observation of the audience engagement on RAHU’s on-line Platforms Observation findings showed that RAHU’s Sautiplus facebook page had over 31,000 followers.

The followers were mainly engaged through, post stories, comments, share links and likes. The other forms of engagements noted were pictures and videos that were uploaded. Questions were asked but this happened on a small scale. Feedback from the audience was only observed on the facebook page and not the website.

34

The observation findings also showed that the top three most reached stories on the Sautiplus Facebook page during the study period were; relationship (personal story), HIV prevention and teenage pregnancy stories with 8,964, 16,008 and 4728 followers reaching them through either reading, liking, sharing respectively.

In relation to the above, the observation findings further showed that the top three most liked stories on the Sautiplus Facebook page during the study period were; HIV prevention, relationship (cheating partner) and Gender Based Violence with 206, 43 and 85 likes respectively.

Data from the platform observation showed that sharing of the stories offered on RAHUâ&#x20AC;&#x2122;s online platforms was limited compared to liking and commenting on the post. HIV prevention, relationship (personal story) and Hepatitis B stories were the most shared stories observed with only 28, 6 and 5 followers sharing them respectively.

The Sautiplus Facebook page in-built analytical features revealed the following information; there were more visits in the first week of February 2015 (227 visitors) with an average post likes of 25900 in the month of February, the least visitors during the study period visited during the first week of April 2015 (02 visitors); Photo views were quite high; and the highest reach was attained during paid reach at 20,366 compared to 15,775 highest during unpaid reach. Reach refers to all people reached by the platform information through the various ways i.e. post view, photo/video view, comment, share, like e.t.c.

35

CHAPTER FIVE 5.0 Use of Results to Improve RAHU’s Online Platforms 5.1 Programming opportunities identified by the e/mhealth operations research We identified several programming opportunities that Reach a Hand Uganda ought to consider.

These include: 

High appreciation and respect for online platforms by both young people and RAHU staff, coupled with existing familiarity of online platforms by young people.



Management support and sound staff technical capacity for e/mhealth programming plus the untapped strong peer educator network



Presence of other RAHU programs that could incorporate online platform promotion



Existence of a big audience base in urban and peri-urban areas.



Appreciation of RAHU’s online platform design and trust in content offered by young people



High ownership and access to gadgets that access internet by young people



Existence of computer laboratories in most secondary schools

5.2 Program gaps identified by the operations research The following gaps were identified by the operations research and observations during the operations research implementation: 

Low awareness of RAHU’s online platforms among in school young people



Irregular update of content on RAHU’s online platforms (especially on Sautiplus website)



Unclear structures for platform design and maintenance.



Minimal and hidden referral information for additional SRHR information and services



Limited staff capacity specifically on content development (current practices not systematic).



Fewer formats and functionalities used to disseminate SRHR information via online platform



Minimal integration of online platforms with other current offline programs i.e. face to face programs

36



Low usage of platform inbuilt statistical information and other research findings to inform programming

5.3 Implications of the e/mhealth OR findings and observations to RAHU The study findings showed a high appreciation of online platforms both by users of RAHU’s online platforms as well as the in-school non users. In fact discussions with non-users of RAHU’s platforms during the focus group discussions revealed that young people believed that having a Face book page was cool and fashionable. Similarly, FGDs on the design and layout of RAHU’s online platforms indicated that majority of the users appreciated RAHU’s platform design and layout. In particular young people believed that the videos shared were of good quality and it was easy to navigate through the platforms. Over 80% of online respondents trusted the content offered on the website. This implies that RAHU should take advantage of this positive situation to promote her platforms among young people in addition to strengthening the platform design efforts in order to maintain or even improve the good impression by the audience.

The online survey showed that young people mainly visited RAHU’s online platforms in the afternoon and evening. In fact 38% and 27.3% of online respondents reported often visiting RAHU’s online pages in the afternoon and evening times respectively. The average stay on the page was less than an hour. These findings give a clue on the proper timing and frequency of online information posting. Burnam et al (2012) emphasized that the timing of communication messages (i.e., time of day, frequency, and sequencing) is vital in ensuring convenience and receptivity of the end user. Therefore RAHU’s message posting and audience engagement efforts should be capitalized in the afternoon and evening. RAHU should also create room for overtime dedication to online audience engagement beyond office hours.

Data from the online survey showed that majority of the people who used RAHU’s online platforms were 18 years and above (mean age 22.2 years) and mainly males. The survey findings also showed that a big proportion of young people (95.2%) who used RAHU’s platforms were mainly urban and peri-urban residents. These findings provide a sound understanding of the situational context which is a fundamental pre-condition for e/mhealth programming. The

37

implication of this finding is that RAHU should be mindful of the information needs of this older group of young people who dominates its audience. It also highlights the need for concentrated promotion of the online platforms among the very young young people (10-17 years) and other hard to reach groups. Teachers, in particular in-school clubs’ patrons are a good resource for inschool promotion of online platforms. In addition, previous research has noted that to increase uptake of online information, one may have to provide incentives.7 The survey showed that young people often visited RAHU’s Sautiplus website and Facebook pages. In fact 69% of the respondents reported visiting these pages at least every week. Some respondents had visited the platforms for more than 6 months (19%) while 10.7% of respondents had visited the platforms for over a year. These finding imply that there is need for regular updates of messages offered on the online platforms such that the regular visitors do not feel tired of same messages. The observation findings showed that the messages on the platforms were not regularly updated and not “sticky”. For example, the Sautiplus website messages had not been updated for the last three months. This implies that regular visitors of this page went through the same content over and over again. Therefore there is need for RAHU to regularly update content on its online platforms but also create room for innovative ways to make the content more engaging and entertaining that young people long to always return many more times. Games, real stories, quizzes and plays are some of the creative ways to make educational content engaging and entertaining.

The survey showed high ownership and easy access to personal or another person’s gadget i.e. phone or computer. Over 70% of the online respondents reported ownership and/or access to another person’s gadget (phone or computer) which they used to access the on-line platforms.

This finding is similar to the findings one study8 that looked at actual and potential access to SRHR information through various platforms in Uganda in 2010, which reported that 27% of about 1500 secondary school students in Mbarara district (south-western Uganda) owned a 7

. Sheila Kinkade and Katrin Verclas: Wireless Technology for Social Change. Washington, DC and Berkshire, UK:

UN Foundation–Vodafone Group Foundation Partnership, 2008 8

. Mitchell KJ, Bull S, Kiwanuka J, Ybarra ML. Cell phone usage among adolescents in Uganda: acceptability for

relaying health information. Health Educ Res. 2011 Oct;26(5):770–81. doi: 10.1093/her/cyr022

38

phone. Easy access to gadgets that access internet is a facilitating factor for making SRHR content directly available and accessible for youths through online platforms. Therefore it is a positive indicator for e/mhealth programming in Uganda. Related to the above, the survey showed that 66.6% and 71.4% of respondents were allowed to access internet at School and home respectively. This implies that there is opportunity for RAHU to negotiate with other school administrations (those that restrict internet access) to allow internet access and may be put restrictions on the access timing.

Data from on-line interviews showed that majority of young people (85.7%) accessed reproductive health information from RAHU’s Sautiplus website platforms. Observation of the RAHU’s online platforms revealed that comprehensive sexuality education topics were the major topics offered compared to any other type of information. In fact, sexual and reproductive health as well as relationship topics i.e. HIV prevention, Cheating, GBV among others drew more comments, sharing, and likes from the Face book audience. This could be partly because RAHU’s online platforms were mainly accessed by older young people 18 years and above yet in Uganda young people typically become sexually active at an early age. By 15 years of age, 11% of Ugandan adolescents have initiated sex and by 18 years 64% of young people have had their first sexual encounter.9 This implies that during content development RAHU should priorities the information needs of this sub age group who dominates its audience. Related to the above, discussions on additional information needs highlighted the following information topics needed by young people; life skills, success stories, integration of sports into SRHR information, career guidance, business and job interview tips, drug abuse and homosexuality information. The implication of this finding is that there need to incorporate other types of information other than health. This is information is likely to draw those passionate about it to the platform and hence also accessing SRHR information.

In-depth discussions on the organizational capacity, showed high appreciation and commitment to e/mhealth programming by both RAHU’s top managers and implementing staff. Further probing revealed that the staff were competent to do e/mhealth programming and but mentioned 9

.Uganda Bureau of Statistics (UBOS) and ICF International Inc:Uganda Demographic and Health Survey

2011.UBOS and Calverton, Maryland: ICF International Inc 2012.

39

need for continuous capacity building of the e/mhealth team. This implies that RAHU should focus more on bridging the current capacity gaps rather than having generalized trainings since the staff are generally competent but have minor gaps that need to be filled with specialized trainings. About the resources, the findings showed that RAHU had enough human resources with big peer educatorsâ&#x20AC;&#x2122; network which needed to be fully utilized. The implication of this finding is that RAHU needs to put in place structures for proper online platforms design and maintenance including clearly stipulated peer educator responsibilities. Trained peer educators could be a good resource for regular tracking of the follow of information on the platforms as well us message updates.

In relation to the above, findings showed that RAHU had adequate infrastructure for e/mhealth programming. Data from staff interviews also showed that there was funding assurance of the current e/mhealth programs but uncertainty for future funding existed among staff. The implication of these findings is that RAHU need not to spend more on infrastructure but rather use the available funds for other pressing program needs like promotion of the online platforms.

There is also need to advance current fundraising efforts for e/mhealth programming.

Furthermore, although the online survey showed that over 80% of the respondents reported finding referral information for additional SRHR information and services on the Sautiplus website and Facebook pages, on the contrary observation findings showed that referral information was minimal and hidden. This implies that RAHU should strengthen its efforts to provide referral information additional SRHR information and services to its audience. For example, having a referral corner/page on the main page would be an innovative way of offering referral information on Facebook and website.

Lastly, findings on whether RAHU had conducted a needs assessment in regards to e/mhealth programming revealed mixed answers; according to the managers interviewed a needs assessment had been conducted while some implementers were not aware of this. The implication of this finding is that the dissemination and use of research finding is still lacking.

Therefore RAHU should develop measures to disseminate research findings across the all stakeholders and use the findings to inform programming.

40

6.3 Recommendations 1. Considerable effort is needed to promote RAHU’s online platforms in schools. Special effort is needed for the upcountry schools. RAHU should intensify the current platform promotion efforts as well as employ other sustainable promotion strategies such as use of in-school club patrons, computer laboratory in-charges to continuously give information to students about RAHU’s online platforms. These can be supplemented by the usual school visits by RAHU staff.

2. Generally overall capacity of RAHU to implement e/mhealth programs is adequate.

However, small gaps in the staff capacity do exist which require specialized trainings.

Specifically, RAHU should conduct a staff capacity assessment in regards to e/mhealth implementation in order to identify the precise staff knowledge and skill gaps that need to be filled. This research noted a gap in content development and packaging capacity.

3. There is need for RAHU to focus its efforts to a few online platforms and then expand little by little. From the findings and observations during the OR implementation processes, it was evident that currently RAHU operates many online platforms, some of which are well-known to some staff. This situation tends to scatter RAHU’s efforts and limits the performance of all the platforms. A few platforms i.e. Facebook and website could be prioritized and given targeted efforts to great platform improvement.

4. There is need to explore measures to enable young people access online content at a subsidized cost or no cost. Offline content access strategies can be explored to supplement direct online information access. These will address the issue cost of access that was raised by both the young people and RAHU staff.

5. Considerable effort is needed to make RAHU’s online platforms interactive and entertaining.

RAHU should explore innovative strategies like live stream on the website, quizzes, and games among others. Regular update of information on the platforms should also be emphasized. All these approaches could stimulate young people’s engagement and motivation for revisits. Further still small incentives i.e. promotional materials to regular visitors or winners could also be a good strategy to promote the platforms and a motivating factor for revisiting the platforms. Peer educators (if well trained and guided) could be a good resource to regularly update the platforms. Related to the above, RAHU should invite

41

stories (true or fictional) from young people with content relevance. These can be used to stimulate participation. In addition, RAHU can annually request youth to give their thoughts on what content they want to see and even solicit for content from followers in order to have regular content updates for the site.

6. There is critical need for RAHU to make its planning for emhealth implementation more efficient. Efforts to redefine the implementation structures for emhealth platforms are need.

7. Further research is needed on; 1) the quality of content offered on RAHU’s online platforms is needed, and 2) the information needs of the young people 10-14 years old. In addition, RAHU should develop a culture to use data to guide programming. For example, the online platforms’ in-built statistics are a rich source of data which could inform implementation decision making.

6.4 Results Dissemination and action planning After data analysis, a dissemination and action planning workshop will be organized at organization level before the joint national stakeholders’ dissemination meeting. The objectives of this workshop will be to share the e/mhealth operations research (2015) findings and use the findings to initiate evidence-based e/mhealth programming at RAHU. At the action planning workshop, the results of the the e/mhealth operations research (2015) will be disseminated by the consultant to RAHU staff. The participants will discuss the findings of the e/mhealth operations research (2015) and through participant engagement, obtain recommendations for improvement of RAHU’s online platforms. The initial action points generated in the workshop will be refined

by RAHU’s top management with the help of the consultant. The initial action plan will appended to this research report.

42

43

Appendices Appendix 1: List of RAHU’s Young People trained in Research No. 1.

2.

3.

4.

5.

6.

7.

8.

Name Nakayima Beatrice NaluzzePreeme Sharon AkamutuhaCoviirene KintuKeneth Kisekka Edward Mubiru Alex K Bamulanzeki Samuel AtukundaAthibert

Responsibility Peer Educator Peer Educator Peer Educator Peer Educator Peer Educator Peer Educator Peer Educator Program Officer

Appendix 2: List of RAHU’s Core Team for this Operational Research

No. 1.

2.

3.

4.

Name Humphrey Nabimanya Bakshi Khan Atukunda Athibert KintuKeneth

Responsibility Executive Director Programs Manager Program Officer Peer Educator

44

Appendix 3: Staff In-depth Interview Guide ASK E&M HEALTH OPERATIONAL RESEARCH – IDI GUIDE (SYSTEM FACTORS)

INTERVIEWER COMPLETES A1 – A5 BEFORE INTERVIEW A1

Organisation name:

A2

E/M health platforms used by Organisation

A3

District(s) covered by Organisation under ASK

A4

Name of interviewer

A5

Interview Date

THE INTERVIEWER IDENTIFIES KEY INFORMANT(IMPLEMENTING STAFF OR MANAGEMENT TEAM MEMBER) INVOLVED IN E&MHEALTH AND FILLS IN THE REST OF THE QUESTIONNAIRE Hello. My name is _______ and I am working with ASK program_______________ on a study exploring the factors and actors that determine the effectiveness of RAHU’s e/m health platform to improve access to SRHR information and services among young people in Uganda. We appreciate that you play an important role is shaping these platforms and that is why we want to hear from you about your involvement and interaction with these e&mhealth channels. This is your chance to let ASK program and your organization (RAHU) know your views concerning the e/mhealth platforms i.e. the design, content, operational processes and the changes you would wish to be made on them.

I would like to read you a description of the study and then you can decide if you want to participate. If you choose to participate in the study, it is important that you answer each question as thoughtfully and honestly as possible. Please be patient if some questions don’t apply to you: we need to ask everyone the same questions. Be sure to understand the instructions below before you begin to answer. Thank you very much for being an important part of this survey.

I'd like to start by recording your briefsocio-demographic characteristics.

RESPONDENT CHARACTERISTICS 1

GENDER OF RESPONDENT

MALE

1

FEMALE

2

45

2

How old are you?

AGE:

3

What is your role here?

BOARD MEMBER1 TOP MANAGEMENT2 PROGRAM MANAGER3 PROGRAM OFFICER4 PEER EDUCATOR5 TEMPORARY VOLUNTEER

OTHER (SPECIFY) : _________________96 4

How long have you worked in SRHR field?

5

How long have you worked at this organisation?

KNOWLEDGE, SKILLS & ATTITUDE TOWARDS E/MHEALTH PLATFORMS 1.

2.

3.

4.

5.

6.

7.

8.

9.

What do you think about use of internet and mobile technology supported platformsi.e. social media, SMS or telephone helpline to pass on SRHR information to young people in Uganda?

I heard that <name organization> usese/m health platformsin sharing SRRH information.

What are these platforms that you are currently using?

What is your role in the planning, implementation and evaluation of the ASK program and specifically the e/m health platforms?

What is your experience in using internet and mobile technology supported platforms to increase access to SRHR information to young people?

What is the experience and background of your organizations team members working on e/m health platforms?

Has your organization ever supported implementing staff to acquire technical skills related to use of e/m technology supported platforms?

Any kind of support given by management in preparation for your work?

Are there any environmental (social structures, organizational norms, policy& regulations) limitations for e/m health programming in your organization and country at large?

ORGANIZATIONAL READINESS FORE/MHEALTH PROGRAMMING

1.

Is your organization ready to expand/take on e/m health programming? a. Has your organization done any needs assessment in regard to this subject? b. Do you have adequate ICT infrastructurein place? I.e. internet connections, computers etc. c. Do you have adequate resources (human, finance & time) for internet and mobile technology supported communication platforms? d. Is the staff competenceenough to use e/m health platforms? e. Is it easy to access funds for e/m health programming? Are the funds available?

46

IMPLEMENTATION PROCESSES, MANAGEMENT SUPPORT& IT COMPETENCES

1.

2.

3.

How easy do you find using e/mhealth platforms compared to traditional communication modes?

What is your opinion on the process of page or site design (social media, website etc.)?

How is the process of content development? Do you have enough resources? Is it systematic?Do feel involved in making decisions on the content?

4. How do you rate the management support?

5. How are the staffs working on these platforms motivated?

6. To what extent do you feel involved in making decisions regarding changing or adopting e/mhealth strategies at your organization?

7. Mention some of the challenges encountered while trying to use these new technologies to promote behavior change among the youth?

8. How can they be overcome?

9. How can ICTs be effectively integrated into traditional medium of delivery of SRHR information to young people?

10. What implementation process improvements would you recommend to easy your work or to better serve your audience?

CONTENT &M&E 1.

What factors do you consider when designing, implementing and evaluating e/mhealth platforms to increase access to SRHR information?

2. What kind of SRHR information is currently being provided by <name organization>through e/mhealth channels?

3. How actively are you involved in content generation on e/mhealth platforms at you organization?

4. Are there any materials/training provided for that role?

5. How do you rate the above?

6. How often is content changed?

7. What factors explain the content updating patterns reported above?

8. What kind of SRHR information should be provided by <name organization>through e/mhealth channels?

9. What are the reasons for your answers?

10. In your opinion, how does e/mhealth compare with traditional communication channels effectively deliver SRHR information to young people in ASK district?

11. What are the reasons for your response?

12. Does your organization have a laid plan to evaluate these e/m health programs?

If yes, has any evaluation been done and how were the findings used?

FINAL WORDS

1.

2.

3.

4.

5.

6.

What do you think about your current e/m health platforms at this time?

Overall, how appropriative do you feel it is touse e/m health strategies to increase access to SRHR among young people in the ASK project districts and Uganda in general?

What are your biggest concerns about e/m health programming in your organization?

What do you think is the best option to improve e/m health programming in your organization?

What information or services could encourage more young people access information through e/m health platforms?

Do you have any final questions or recommendations to make?

READ OUT LOUD: Thank you for your participation!

47

Appendix 4: IDI Consent Form Reach a Hand Uganda (RAHU) IDI Consent Form– Implementing / Management staff

Title:Exploring the dynamics (factors and actors) that determine the effectiveness of e/m health strategies used

by Reach a Hand Uganda to improve access to SRHR information and services among young people in Uganda.

Sponsor:WPF Rutgers Principal Investigator:Babirye Susan,ASK Project-Reach a Hand Uganda, Kampala

Introduction Good morning/afternoon. My name is _____________. We are working on an operational research study exploring the factors and actors that determine the effectiveness of e/m health strategies used by RAHU to improve access to SRHR information and services among young people.

Purpose of the study The purpose of this study is to learn about users’ (current & prospective)and providers perceptionsand experiences using/providing RAHU’s e/m health strategies thereby strengthening evidence based practice and program development. The other purpose of this study is to generate knowledge on ways to improve program operations and for strategic dissemination of program results/publication. We want to be sure that you understand the purpose and your responsibilities in the research before you decide if you want to be in it. Please ask us to explain any words or information that you may not understand.

Procedures The interview will last about between 60 and 90 minutes, but you may stop it at any time. I will talk with you about your role in RAHU’s e/m health programming. I will also ask about your institutional readiness to take on e/m health programming i.e. culture, infrastructure, financial and content readiness. I will ask you questions about your support of these strategies, management experiences, staff motivation as well as monitoring and evaluation of these strategies. If you agree, we would like to record this interview to help us make an exact record of what you said. We will not write your name on the tape. We will destroy the record when the research is completed. Staff from the study team will look at the transcripts from this interview but your name will not be included.

Who will participate in the study Implementing staff directing working on RAHU’s e/m health platforms and management staff will be interviewed tobetter understand their experiences and feelings about these strategies. We expect to interview about 10respondents from this organization. You have been selected as part of this group, and we are asking you to participate in an interview.

Possible Risks

48

We do not expect that you are at risk of any bad things happening to you by participating in this interview. You may feel uncomfortable answering some of our questions. You are not obliged to answer them. I will ask you to respond honestly and to the best of your ability. There is no need to worry if you do not know the answer to a question. We will not discuss your responses with anyone.

Possible Benefits The information that you share with us will inform e/m health programming at organizational, program and other levels of planning.By participating in this interview, you will have a chance to share your experiences with decision makers.

Confidentiality We will protect information you share with us to the best of our ability. We will not use your name in any reports. We will not tell anyone about your participation. We will not tell anyone the answers you give in this interview.

Compensation for the participant in this study If you agree to participate, you will receive NO compensate you for your time.

Questions and rights as a participant The Higher Degrees, Research and Ethics Committee of Makerere University School of Public Health and The Uganda National Council of Science and Technology approved this study.

If you have any questions about the research or your participation in the research, you may contact Dr. Suzanne Kiwanuka, the Chair, Higher Degrees, Research and Ethics Committee of Makerere University School of Public Health P.O BOX 7072, Kampala, Uganda on Tel No: 0701-888 163 or 0312-291 397

Alternatives/Statement of voluntariness You are free to decide if you want to participate in this interview or not. If you decide not to participate, this will not be reported to anyone. Your decision will not affect your position and the services you receive from RAHU. If there is a question you do not feel comfortable answering, you can tell me so, and we can skip over it. You may also stop the interview at any time.

Confirmation of your consent to participate Do you understand all I have just told you and do you agree to participate in this study? If you agree to participate in this study, you will need to sign this form.

PARTICIPANT AGREEMENT

49

PARTICIPANT: I have read the study information / The study information has been read to me. I have been asked if I have any questions, and these have been answered to my satisfaction. I freely agree to participate. _____________________________ Name

_____________________________

_____________

Signature or Thumb Print

Date

INTERVIEWER: I certify that the nature and purpose, the potential benefits, and possible risks associated with participating in this research have been explained to the above individual, and the individual has consented to participate. _____________________________ Name

_____________________________ Signature

_____________ Date

50

Appendix 5: Focus Group Discussion Guide REACH A HAND UGANDA ASK E&M HEALTH OPERATIONAL RESEARCH - FGD GUIDE Number of participants 8-12 SECTION 1: Introductions Note: Welcome everybody and thank them for being part of the discussion. Introduce yourself as working with a team from Reach a Hand Uganda (RAHU) in collaboration with the district health office and introduce the subject of discussion. Then give a summary of the verbal consent below and allow each one of them to introduce them thereafter.

Wekalirize: Sangaza buli mutuntu era omwebaze okwikiriza okwetaba mumusomo guno.

Weyandule ng’akola ni RAHU nga mugemaganiza walala ni offisi ey’obulamu ku distirikiti.Yandula omulamwa gw’omusomo guno mme oyinhongole ebigemagana ku musomo guno. Wa buli muntu akasera okweyandula.

Summary of the verbal consent Dear Participant, You have been selected to participate in this study “Exploring the dynamics (factors and actors) that determine the effectiveness of three e/m health strategies by RAHU to improve access to SRHR information and services among young people in Uganda”. We appreciate that you play an important role in shapingthe strategies intended to reach you with SRHR information and that is why we want to have a discussion with you today.The generated data will inform subsequent e/m health programming through knowledge on what works and what does not work.

Ssebo/nyabo, Olondeibwa okwetaba mumusomo guno ogugya okwekalirisa ebintu ebiviraku enkola enkalamu ey’empereza dha RAHU edhiweleza amawulire geby’obulamu eri abavubuka ng’adhibita mu masiimu n’omutimbagano nkani internet mu Uganda. Twidhi era tusiima nti oliwamugaso inho mukutumbula empereza dhino edhigendeleirwa okusasanya amawulire geby’obulamu eri abavubuka, n’ensonga lwaki tugya kuwayamu niwe olwaleero. Byetunawaya biidha kuyamba okw’ongera omutindo mumpereza dhino nailala by’ogya okutukoba kuki ekirungi kumpereza dhaife naki kyoyenda okukyusamu.

Taking part in this discussion is voluntary and what we shall discuss today shall be kept confidential and only used for purposes of improving the e/m health platforms implemented by RAHU and the 51

ASK programme partners.You are free to take part in this discussion but should you feel like you want to leave at any point, you are also free. If you have any questions about the study, raise it now or should you need any further information about what we are doing, you can contact Dr. Suzanne Kiwanuka, the Chair, Higher Degrees, Research and Ethics Committee of Makerere University School of Public Health on Tel No: 0701-888 163 or 0312-291 397 or Ms. Babirye Susan, the principal investigator on Tel No: 0712-210 002. We would also like to inform you that you that we shall be recording the discussion, just for the purposes of us capturing everything that we might miss out when taking notes.The interview will take about 60-90 minutes and your participation or refusal to participate in this interview will not affect the services you receive in any way.If you agree to provide information to the researcher under the conditions of confidentiality set out on this sheet form, please register on the registration sheet.

Oluwayo

luno

lwakyeyendele

era

byetunawaya

bidha

kukumibwa

nga

byakyama.

Biidhakukozesebwa mukutumbula empereza dhino edha RAHU edhikozesebwa okusasanya amawulire geby’obulamu eri abavubuka mu pologulamu ya ASK. Oliwayidembe okwetaba mumusomo guno oba okuloba era w’oyendela okugya wonawona oliwayidembe. Bwoba n’ekibuuzo kyonakyona ekigemagana kumusomo guno, okobola okukibuuza kati oba okubuuza Dr. Suzanne Kiwanuka, akulira, Higher Degrees, Research and Ethics Committee eya Makerere University School of Public Health kwisimu: 0701-888 163 oba 0312-291 397 oba kubiraMs. Babirye Susan, akulira omusomo guno kwisimu: 0712-210 002. Twenda okukutegeza nti tugya kugemywa kulutambi byetugya okuwaya okusobola obutelabira byetuwayiya. Oluwayo luno lwidha kumala wagati wesaawa n’esaawa endala n’ekituntu. Okwetaba oba obutetaba mumusomo guno tikyidha kukukosa naile. Bwoba oyikiriza okwetaba muluwayo luno, wandika erinayo ilala lyonka ku kapapulo akokwewandisa ketugya okukuwa.

Note: 1. Make sure the tape recorder is switched on to the start of the interview.

2. Use the demographic log sheet to register the participants (by registering only their first name) Ice breaker 1. Shall we start by introducing ourselves? (Let the participants introduce themselves) 2. What do you understand by sexual and reproductive health and rights (SRHR) information?

3. Where have you gotten SRHR information in the past 12 months?

SECTION2: E&M HEALTH PLATFORMS 52

4. Tell me more about the SRHR information sources that use internet and mobile technologies for instance websites, SMS or telephone helpline and social media etc.

Probe for:  The different e/m health platforms they have been exposed to  E&M health platforms by RAHU (website and social media)  How did you hear about these platforms?  How they access these platforms?  How often they access the platforms?

5. Does RAHU’s website/social media platform meet your needs?

Probe:  When you access the website/social media, do you get the SRHR information needed?  Is the information provided on the website/social media comprehensive enough to your satisfaction?  What do you like most about the content provided on RAHU’s website/social media page?  Is there any information you needed but never found it on RAHU’s website/social media?  Are you referred for the SRHR services you would like to receive?  Are the referral points accessible and affordable for you?

6. Does the cost of accessing these e/m health platforms meet your income and ability to pay: Probe:  How easy or difficult is it for you to access SRHR information through e/m health platforms?  Is it affordable for you to access the website/social media pages for SRHR information?(gadget ownership, cost for internet)  Have you ever failed to access to the website/social media pages for SRHR information because of money?

7. How accessible are these platforms in relation to the location of service and that of the young people?

Probe: a) Is the environment you leave in convenient for you to access these platforms?

8. Does RAHU’s website/social media platform meet your constraints and preferences?

Probe: a) Are these e/m health platforms easy to operate using your limited IT skills? b) Does the content and its design meet your expectations? c) Is the content changed regularly? d) Are you able to express your concerns and get response too? e) Are you able to access these platforms any time and at any location? f) Do you feel your privacy is safeguarded on these platforms?

9. How comfortable are you with the characteristics of RAHU’s website/social media page?

Probe: 53

g) When you access the website/social media page; is it clear for you where to find the information you need? h) Describe your experience using these platforms? Are these platforms friendly? i) Was there anything that made it difficult for you to use RAHU’s website or social media page or is there any improvement that you can suggest?

SECTION 3: NON USERS 10. Do you know of any e/m health platforms providing SRHR information to young people?

11. Are you aware of any any e/m health platforms providing SRHR information to young people

by RAHU? 12. Are these platforms (website and social media) easily accessed in your community?

13. Why haven’t you accessed these platforms before?

14. What is your preferred source of SRHR information and why?

15. What are benefits of accessing SHRH information through e/m health platforms?

16. How best do you think these platforms can be extended to young people in your community?

Conclusion 17. Would you recommend RAHU’s website/ social media page to a friend? Why? 18. What changes would you like to be made on the current e/m health platforms used by RAHU to increase access to SRHR information to young people?

Thank you very much once again for taking part in this discussion.

We promise to use the information you have shared to serve you better as RAHU.

54

DEMOGRAPHIC REGISTRATION FORM District: ______________________________________

Sub county: ___________________________________________

School: _______________________________________ S/N

Name

Date:________________________________________________ Sex

Age

Educational level

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

55

Appendix 6: Observation Checklist REACH A HAND UGANDA ASK E&M HEALTH OPERATIONS RESEARCH-observation checklist Organisation_______________________________________________________________________ Platform observed__________________________________________________________________ Observation number: _______________________________________________________________ Date of platform observation: (dd/mm/yy):____________________________________________ Observer name/signature: _________________________________/_________________________ Supervisor signature/date _______________________________/___________________________ GENERAL INSTRUCTIONS: 1. For Facebook platform consider three months prior the study 2. For website to be done monthly over a period of two months.

3. Liaise with organisation to ensure availability of key persons who manage the platform (e.g. system administrators).

4. Access the platform and follow the guide below.

5. Further analysis of the platform Insights (inbuilt analytical features) should be summarised and provided by the system administrator.

INTERVIEW ELEMENT/CODING CATEGORY

CODE

CONTENT 1. What are the common comprehensive sexuality education (CSE) topics/themes shared on platform and how often? a. Gender (gender and sex; gender roles; masculinity and femininity; evolving social norms and values; gender

CIRCLE AND RECORD THE TIMES EACH TOPIC HAS APPEARED THE PAST WEEK. Yes

No

1

1

Appearance:

_________times

Yes

No

1

1

inequality)

b.

Sexual and reproductive health: (understanding STIs and HIV; pregnancy; sexual response; living with HIV; anatomy; sexuality).

56

c.

Sexual citizenship (human rights; policies, laws and structures; services and resources; participation; choice;

Appearance:

_________times

Yes

No

1

1

Appearance:

_________times

Yes

No

1

1

Appearance:

_________times

Yes

No

1

1

Appearance:

_________times

Yes

No

1

1

Appearance:

_________times

Yes

No

1

1

Appearance:

_________times

protection)

d.

Pleasure (sex should be enjoyable and consensual; sex is more than intercourse; biology and emotions; masturbation; relationships and communication)

e.

Violence (types; rights and laws; support options; community norms and myths about power and gender; prevention; referrals)

f.

Diversity (the range of diversity, e.g., faith, culture, ethnicity, ability/disability, sexual orientation; gender, sexual identity, HIV status, discrimination)

g.

Relationships (emotions; intimacy (emotional and physical), rights and responsibilities; power dynamics; coercion)

2. What other types of information are shared?

1. General news

2.

3.

Training

Job opportunities

CIRCLE AND RECORD THE TIMES EACH TOPIC HAS APPEARED THE PAST WEEK. Yes

No

1

1

Appearance:

________times

Yes

No

1

1

Appearance:

________times

Yes

No

57

4.

Other specify: ____________________________________________________

1

1

Appearance:

________times

Yes

No

1

1

Appearance:

________times

____________________________________________________ __

3. What are the various forms in which information is shared?

4. Who often generates content?

Text only Mainly Text Text and picture equally Mainly pictures Multimedia videos

1 2 3 4 5

Mainly organization1 Mainly target audience2 Both groups equally 3 Not easy to tell4

5. How often is the content generated?

Daily 1 2-3 times a week Weekly3 Bi-monthly 4 Monthly 5 Not regularly 6

2

6. What are the top five frequently asked questions by the followers? (Write in the space provided)

7. How often are the followers concerns/questions responded to?

Instant Daily 2 2-3 times a week Weekly4 Bi-monthly 5 Monthly 6 Not regularly 7

1 3

58

8. Are the funs referred for other SRHR information and services not provided by RAHI?

Yes No

1 0

USER ENGAGEMENT Yes

9. How are the platform followers engaged?

No Post stories1 1 Comment11 Ask questions 11 Share links11 Likes 11 Others 1

1

Specify__________________ ______________________ 10. What are the top three most liked topics and their total number of likes?

1st_____________________ 2nd____________________ 3rd____________________

11. What are the top three most shared topics and their total number of shares?

1st_____________________ 2nd____________________ 3rd____________________

12. Which three topics drew the most comments and how many comments did each drew?

1st_____________________ 2nd____________________ 3rd____________________

13. Are there links to other organizationâ&#x20AC;&#x2122;s social channels, like Twitter account and blog provided?

Yes No Other FB pages (not for ASK)

1

1

59

Twitter 1 Website 1 Blog 1 Others

1 1 1 1

1

Specify__________________ ______________________ 14. Summarise findings from facebookâ&#x20AC;&#x2122;s inbulit analytical features

15. What is your overall comment on the design and layout of the platform?

60

Appendix 7: On-line Questionnaire ASK E&M HEALTH OPERATIONAL RESEARCH – ON-LINE SURVEY QUESTIONNAIRE Thank you for accepting the invitation to participate in this study exploring the factors and actors that determine the effectiveness of this e/m health platform to improve access to SRHR information and services among young people in Uganda. We appreciate that you play an important role is shaping this platform and that is why we want to hear from you about our services. This is your chance to let Reach a Hand Uganda (RAHU) know your views concerning this page i.e. the design, content and the changes you would wish to be made on this page.

This study is completely voluntary, so you may skip any questions you do not wish to answer or stop the survey at any time. Your answers shall be kept strictly confidential and only used for purposes of improving the e/m health platforms implemented by RAHU and the other ASK Programme partners. We do not collect identifying information such as your name, email address or IP address.

If you choose to begin the survey, it is important that you answer each question as thoughtfully and honestly as possible. Please be patient if some questions don’t apply to you: we need to ask everyone the same questions. Be sure to read the instructions below before you begin to answer.

Thank you very much for being an important part of this survey.

Electronic Participation consent: Please select your choice below.

Clicking on the “agree” button below indicates that:  You have read and understood the above information  You voluntarily agree to participate If you or your do not wish you to participate in this interview, please decline participation by clicking on the “disagree” button? [__] Agree [__]

Disagree  END

INSTRUCTIONS: 1. This is not a test, so there is no right or wrong answers; we would like you to freely express yourself.

61

2. Circle or record only one response to each question, unless otherwise instructed.

SECTION A: Socio demographic characteristics To start, we would like to ask you some questions about yourself and your background.

NO.

QUESTIONS

A01

Are you:

A02

CODING CATEGORY

CODE Female

1

Male

0

What is your date of birth?

Enter birthdate

____/____/___ DAY MONTH YEAR

A03

How old are you?

A04

Where do you live? In which district of Uganda?

Enter age in years

[___|___]

Enter your current district of residence _______________

A05

A06

A07

What is the highest level of school that you attended?

Are you in school now?

Do you participate in any income generating activity?

None

1

Primary

2

Secondary

3

Tertiary

4

Yes

1

No

0

Yes

1

No

0

62

SECTION B: ACCESS AND DESIGN OF THE PLATFORM NO.

QUESTIONS

B01

How did you know about this Facebook/website page?

CODING CATEGORY

CODE Friend

1

Peer educator

2

School outreach

3

Teacher

4

Facebook adverts

5

RAHU IEC materials i.e.

6

brochures, files etc.

Other Specify: B02

B03

B04

When did you come to this page the first time?

How often do you visit this Facebook/website page?

When do you visit this page most?

This is my first visit

7 ______________ 1

Within past 4 weeks

2

Within past 2 - 6 months

3

Within past 7 - 12 months

4

Over a year ago

5

Everyday

1

4 To 6 Times Per Week

2

2 To 3 Times Per Week

3

One Time Per Week

4

2 To 3 Times Per Month

5

One Time Per Month

6

This Is My First Visit

7

Morning Afternoon Evening Weekend

1 2 3 4

63

NO.

QUESTIONS

B05

How much time do you spend on this page?

CODING CATEGORY

CODE

Less than 30 minutes Between 30 minutes and 1 hour More than 1 hour

1 2 3

B06

B07

What gadget do you use to access this Facebook page? Select all that apply.

Are you allowed to access internet at:

select all that apply Personal phone Another personâ&#x20AC;&#x2122;s phone Personal computer Public computers

select all that apply School Home

B08

What attracts you to this page?

Its design Interesting messages To make friends Interacting with young people Others(specify)

Yes

No

1

1

1

1

1

1

1

1

Yes

No

1

1

1

1

1 2 3 4 ______________

B09

When you visit this page, how easy is it to find the information you want?

Very easy Easy Difficult Very difficult

1 2 3 4

B10

What are the challenges with this Facebook page?

Slow Restricted access Not easy to find Poor design Not updated regularly Irrelevant messages Not interactive Others (specify)

1 2 3 5 6 7 8 _____________

64

NO.

QUESTIONS

B10

What challenges do you face to access internet/ this platform?

CODING CATEGORY

CODE

Select all that apply It is expensive

Yes

No

1

1

1

1

1

1

1

1

Restriction from elders

1

1

Distance to internet points

1

1

1

1

1

1

Do not own gadgets Limited computer skills Limited time Poor internet connection Restriction from elders

Others (specify)...................

B11

How do you think this page can be improved?

Routine update of messages Improve design Link to other pages with SRHR information.

Make it interactive Others (specify)

1 2 3 4 5 ______________

SECTION C: CONTENT ON THE PLATFORM Thank you for sharing that information. Now let’s talk more about the information you access on RAHU’s website/Facebook pages.

NO.

QUESTIONS

C01

Does this page allow you to share ideas openly?

CODING CATEGORY

CODE Yes No

1 0

Not sure 3

65

NO.

QUESTIONS

C02

What kind of information do you get through this page?

CODING CATEGORY Select all that apply: Reproductive health information Entertainment Job opportunities Training opportunities News Other Specify:

CODE Yes

No

1

1

1

1

1

1

1

1

1

1

_______

66

NO.

QUESTIONS

CO3

Specifically, what SRHR information have you accessed from this platform?

(Select all that applies)

CODING CATEGORY

CODE Yes

No

1

1

1

1

Pleasure

1

1

Violence

1

1

1

1

1

1

1

1

1

1

Gender Sexual and reproductive health Sexual citizenship

Diversity Relationships Other Specify:

_______

C04

C05

Is the information provided on this page easy enough to understand to your satisfaction?

Yes No

Is the information provided on this page often updated?

Yes No

1 0

1 0

C06

How helpful is the information got from this page?

Very helpful Helpful Not helpful Not sure

1 2 3 4

67

NO.

QUESTIONS

C07

Is there any information you feel is missing on this website?

CODING CATEGORY

CODE

Yes No

1 0

C08

Are you referred for additional information and health services?

Yes No

1 0

C09

Which service(s) were you referred for?

Please tick all that apply.

Yes

No

1

1

HIV counseling & testing

1

1

STI treatment and counseling

1

1

1

1

1

1

1

1

1

1

SRH information

Post-abortion care services Family planning services Pregnancy care and delivery Condoms Other (specify) ___________

C10

Have ever sought the referral services on this site?

Yes No

1 0

C11

Other than the available information, what other information would you want to get from this page?

Specify

___________________ ___________________ _______

68

NO.

QUESTIONS

C12

What kind of information would you find embarrassing to access from this page?

C13

If you have a personal question/concern/problem, would you share it openly or privately?

CODING CATEGORY

CODE

Specify

___________________ ___________________ _______

Openly Privately Both

1 2 3

C14

What is the reason for your response above?

C15

What other communication channels under Reach a hand Uganda (RAHU) have you accessed in the last 6 months?

C16

Would you recommend RAHUâ&#x20AC;&#x2122;s website/ social media page to a friend?

Why?

Specify

___________________ ___________________ _______

select all that apply Facebook Website Twitter Watsup Print material School visit Other Specify___________

What changes would you like to be made on the current e/m health platforms used by RAHU to increase access to SRHR

No

1

1

1

1

1

1

1

1

1

1

1

1

Yes

1

No

0

Specify C17

Yes

Specify

_________________ ___________________ ___________________ _______

information to young people?

Thank you for taking the time to respond to this survey. The information you have shared with us is very helpful. Our study team will make every effort to keep what you have shared confidential. END

Appendix 8: OR Approval Letters (to be attached) 69