8. UCT: Insights into the implementation study

OPTIMIZING SEXUAL AND REPRODUCTIVE HEALTH FOR OUR ADOLESCENTS AND YOUNG PEOPLE Prof Cathy Ward, Dr Hlengiwe Sacolo, Chelsea Coakley, Consolata Nsanzimpaka Nsanzubuhoro, A/ Prof Elona Toska

DIGITAL HEALTH WEEK 10 October 2022

PRESENTATION OUTLINE • Potential of mobile phones in improving adolescents SRH • Research goal • Research team • Approaches & Considerations • Way forward • Discussion

AFRICA YOUTH’S CHALLENGES! Africa has the youngest population in the world and will count 100 millions more youth by 2030 (UN DESA, 2019)

Among young men

4,500

New HIV infections among adults

(aged 15-24 years)

15%

Among young women

22%

(aged 15 years and older)

(aged 15-24 years)

37% Among young people

every day

(aged 15-24 years)

Ages 15-19 Ages 20-29 Ages 30-39

Africa has the highest number of HIV infections and highest number of new infections among among youth (UNAID, 2020)

WHY AN APP FOR SRH? • Urgent need for good, accurate, engaging SRH education • App-based interventions • Easy, low-cost way to go to scale • Supports fidelity to the intervention • Engages the target audience • Cuts out the “cringe” factor for adultadolescent models

MOBILE PHONE USE & ADOLESCENTS’ SRH?

Access to internet: 69% of youth worldwide (40% only in Africa)

Public health experts and policymakers suggest that the use mobile phone for health will improve ASRHR

With the increasing internet coverage, mHealth presents opportunities to increase adolescent’s SRH knowledge

Future mHealth programme implementations can benefit from ongoing research on the topic

MOBILE PHONES: ACCESS, USE – SEX DIFFERENCES Higher proportion of access among girls than boys

Adolescents use mobile phone more for social media than for health-related information (MW study) For WhatsApp

56

Girls

31

For SMS

34

For Facebook

Boys

45

54

22

39

43 HIV information

8

Sex information

11

5

Health information

3

11 60

40

20

13 0

20

40

Percent

Access to mobile phone

Mobile phone use

Boys

Girls

60

SOUTH AFRICA

Findings – only health use combined with social media makes a difference!

• No significant association between phone access and sexual risk behaviours • Health content use is associated with reduced risks of sex after substance use (in general and mainly for boys) and infrequent condom use (in general and for both boys and girls)

Banougnin, Toska, et al. analyses in progress.

WHY RESEARCH?

1. No unintended, nor any harmful effects 2. Investigate if the app works to achieve desired outcomes (effectiveness) 3. Explore how the app is taken up, used by young people (acceptability & feasibility) 4. Cost the intervention to support prioritization & scale-up

DESIGNING PUBLIC HEALTH INTERVENTIONS COMPLEX ISSUES, COMPLEX SOLUTIONS

STUDY PHASES

Phase 1.

Formative research

Phase 2.

Effectiveness

Phase 3.

Refine, adapt Acceptability Feasibility

Phase 4.

Costing & Scale-Up

STUDY TEAM Prof Cathy Ward Principal Investigator

Dr Bolade Banougnin Lead quantitative investigator

A/ Prof Elona Toska Co-Principal Investigator

Chelsea Coakley Co-Investigator

Dr Hlengiwe Sacolo Lead Investigator

Consolata Nsanzimpaka Nsanzubuhoro Early Career Researcher

PHASE 1. FORMATIVE RESEARCH 1. To understand initial impressions of the look and feel, usability and content of the App including the acceptability of survey questions.

2. To explore potential barriers and facilitators to initial engagement.

3. To explore experiences and lessons learnt (what worked well and what didn’t)

PHASE 2. RESEARCH OBJECTIVES 1. To use the inbuilt data collection system, pre- and postintervention surveys, and qualitative interviews to investigate initial evidence of effectiveness on target outcomes by evaluating the effect of the programme on primary and secondary outcomes 2. To examine the impact of the Love Land App in promoting positive behaviour change (including developing adolescents’ decision making, communication and negotiation skills in a safe virtual environment to prevent early sexual initiation, unwanted pregnancies, STIs and sexual violence).

WHAT DO WE NEED TO ESTABLISH EFFECTIVENESS • POPULATION: age-group, location, platform (school, community), etc.

• INTERVENTION: design refined and tested with young people • CONTROL: school-based study?

• OUTCOME(S): knowledge, beliefs, norms, self-reported practices, access to SRH services • TIMELINE: how long do we expect change to take place in/ happen

PHASE 3.

IMPLEMENTATION SCIENCE

How do we get what works to people with greater quality, speed, fidelity, efficiency, and relevant coverage?

IMPLEMENTATION SCIENCE: REQUIREMENTS FOR SUCCESS

WHAT

HOW

WHO + WHERE

Implementation Science Adapted from the National Implementation Research Network

16

SEX DIFFERENCES

Mzantsi Wakho: access & social media use works differently for boys and girls!

Access and social media use were non-protective of multiple sexual partnership for boys but protective for girls

IMPLEMENTATION SCIENCE RESEARCH QUESTIONS (e.g.)

• Does it work the same for adolescent boys and girls?

• Does it work differently when delivered in schools or out-of-school clubs?

• Are facilitators (peers, teachers, etc.) needed?

• YOUR EXAMPLES?

NEXT STEPS • Partnerships and stakeholder engagement • Intervention development/ update • Research funding applications

THANK YOU

cathy.ward.sa@gmail.com Elona.Toska@uct.ac.za HNSacolo@gmail.com