@Article{info:doi/10.2196/53034,
author="Mackworth-Young, Constance Ruth Sina
and Charashika, Privillage
and Larsson, Leyla
and Wilding-Davies, Olivia Jane
and Simpson, Nikita
and Kydd, Anna Sorrel
and Chinyanga, Theonevus Tinashe
and Ferrand, Rashida Abbas
and Mangombe, Aveneni
and Webb, Karen
and Doyle, Aoife Margaret",
title="Digital Intervention to Improve Health Services for Young People in Zimbabwe: Process Evaluation of `Zvatinoda!' (What We Want) Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) Framework",
journal="JMIR Form Res",
year="2024",
month="Sep",
day="24",
volume="8",
pages="e53034",
keywords="adolescents; young people; digital health; mobile intervention; HIV; sexual and reproductive health; Zimbabwe",
abstract="Background: Youth in Southern Africa face a high burden of HIV and sexually transmitted infections, yet they exhibit low uptake of health care services. Objective: The Zvatinoda! intervention, co-designed with youth, aims to increase the demand for and utilization of health services among 18-24-year-olds in Chitungwiza, Zimbabwe. Methods: The intervention utilized mobile phone--based discussion groups, complemented by ``ask the expert'' sessions. Peer facilitators, supported by an ``Auntie,'' led youth in anonymous online chats on health topics prioritized by the participants. Feedback on youth needs was compiled and shared with health care providers. The intervention was tested in a 12-week feasibility study involving 4 groups of 7 youth each, totaling 28 participants (n=14, 50{\%}, female participants), to evaluate feasibility and acceptability. Mixed methods process evaluation data included pre- and postintervention questionnaires (n=28), in-depth interviews with participants (n=15) and peer facilitators (n=4), content from discussion group chats and expert guest sessions (n=24), facilitators' debrief meetings (n=12), and a log of technical challenges. Descriptive quantitative analysis and thematic qualitative analysis were conducted. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was adapted to analyze and present findings on (1) reach, (2) potential efficacy, (3) adoption, (4) implementation, and (5) maintenance. Results: Mobile delivery facilitated engagement with diverse groups, even during COVID-19 lockdowns (reach). Health knowledge scores improved from pre- to postintervention across 9 measures. Preintervention scores varied from 14{\%} (4/28) for contraception to 86{\%} (24/28) for HIV knowledge. After the intervention, all knowledge scores reached 100{\%} (28/28). Improvements were observed across 10 sexual and reproductive health (SRH) self-efficacy measures. The most notable changes were in the ability to start a conversation about SRH with older adults in the family, which increased from 50{\%} (14/28) preintervention to 86{\%} (24/28) postintervention. Similarly, the ability to use SRH services even if a partner does not agree rose from 57{\%} (16/28) preintervention to 89{\%} (25/28) postintervention. Self-reported attendance at a health center in the past 3 months improved from 32{\%} (9/28) preintervention to 86{\%} (24/28) postintervention (potential efficacy). Chat participation varied, largely due to network challenges and school/work commitments. The key factors facilitating peer learning were interaction with other youth, the support of an older, knowledgeable ``Auntie,'' and the anonymity of the platform. As a result of COVID-19 restrictions, regular feedback to providers was not feasible. Instead, youth conveyed their needs to stakeholders through summaries of key themes from chat groups and a music video presented at a final in-person workshop (adoption and implementation). Participation in discussions decreased over time. To maintain engagement, introducing an in-person element was suggested (maintenance). Conclusions: The Zvatinoda! intervention proved both acceptable and feasible, showing promise for enhancing young people's knowledge and health-seeking behavior. Potential improvements include introducing in-person discussions once the virtual group has established rapport and enhancing feedback and dialog with service providers. ",
issn="2561-326X",
doi="10.2196/53034",
url="https://formative.jmir.org/2024/1/e53034",
url="https://doi.org/10.2196/53034"
}