Currently accepted at: JMIR Formative Research
Date Submitted: Sep 23, 2023
Open Peer Review Period: Sep 23, 2023 - Nov 18, 2023
Date Accepted: Apr 3, 2024
(closed for review but you can still tweet)
This paper has been accepted and is currently in production.
It will appear shortly on 10.2196/53034
The final accepted version (not copyedited yet) is in this tab.
Digital intervention to improve health services for young people in Zimbabwe: process evaluation of ‘Zvatinoda’ (what we want) using the RE-AIM framework
ABSTRACT
Background:
Youth have a high burden of HIV and sexually transmitted infections but low uptake of services in Southern Africa. The Zvatinoda intervention, co-designed with youth, aimed to increase demand for and use of health services among 18-24 year olds in Chitungwiza, Zimbabwe.
Objective:
The intervention was tested in a feasibility study among four groups of seven youth, total 28 youth, to assess feasibility and acceptability.
Methods:
The intervention consisted of mobile phone based discussion groups, supplemented by ‘ask the expert’ sessions. Youth facilitators, supported by an ‘Auntie’, engaged youth in anonymous chats about youth-prioritised topics. Feedback was generated for healthcare providers about youth needs. Mixed methods included a quantitative pre- and post- intervention questionnaire (n=28), in-depth interviews with participants (n=15) and facilitators (n=4), discussion group chats and expert guest sessions (n=24), facilitators de-brief meetings (n=12), and a log of technical challenges. Descriptive quantitative analysis and thematic qualitative analysis was conducted. The RE-AIM framework was used to analyse and present findings on 1) Reach; 2) Effectiveness; 3) Adoption; 4) Implementation; and 5) Maintenance of the intervention within the feasibility study.
Results:
Mobile delivery enabled reach of diverse groups, despite COVID-19 lockdowns. Health knowledge scores improved from pre- to post- questionnaire, particularly contraception (14% to 100%) and HIV treatment (21% to 100%). Self-reported attendance at a health centre in the past 3 months (32% to 86%) also improved. Interaction with other youth, the support of an older, knowledgeable ‘Auntie’ , and anonymity were key to facilitating peer learning. Chat participation was variable, largely due to network challenges and school/work commitments. Regular feedback to providers was impossible due to COVID-19 restrictions. Instead, youth presented their needs to stakeholders through a music video, summaries of key themes from chat groups, and at a final workshop.
Conclusions:
The Zvatinoda intervention proved acceptable and feasible, and shows promise for increasing young people’s knowledge and health seeking behaviour. Potential modifications include introducing in-person discussions once the virtual group has bonded, and enhancing feedback to service providers.
Citation
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