Providing young people with information on sexual reproductive health clearly, directly and without restriction: this is the mission of health workers, educators and researchers all around the world, particularly in resource-limited countries in which sexual health still remains a taboo subject.
In his doctoral project at the UOC, "Leveraging mobile phone-based technologies to provide on-demand adolescent sexual reproductive health information in a resource-limited setting: Kibra, Nairobi County", Kenyan researcher Paul Macharia analyses the potential of mobile technologies for resolving this problem and helping bring sexual health to Kenya's young (open access to the results of his work).
It was an interdisciplinary thesis split between the eHealth Center and the Faculty of Computer Science, Multimedia and Telecommunications. Following its defence last December, Macharia received his PhD from the UOC's Network and Information Technologies programme. He was supervised by Antoni Pérez Navarro, a researcher in the ICSO group, and Carme Carrion Ribas, principal investigator at the eHealth Lab. We spoke with Macharia to gain a better understanding of his work's goals and results.
Adolescents need knowledge, skills and values with regard to sexual and reproductive health. To what extent are these important for empowering them and ensuring their health?
Sexual reproductive health has a lifelong impact on adolescents, their families and their communities. Benefiting from knowledge, skills and values with regard to sexual health strengthens the decision-making process and determines their behaviour. It also helps prevent sexually transmitted infections (STIs), adolescent pregnancies and emotional impacts that may put their mental health at risk, among other problems.
What is sexual education like for young people in Kibra and in Kenya as a whole?
Generally speaking, sexual education is in the hands of parents, as scarcely any information is provided at school. Research indicates that just some 15% of adolescents have access to this kind of information. It's estimated that, of the 32,017 new cases of HIV reported in Kenya in 2020, 11,229 (or 35%) involved adolescents and young adults aged between 15 and 24. These figures highlight the urgent need to provide information on sexual and reproductive health to young people in Kenya.
What are the main difficulties in getting this information to them?
The cultural, religious and social barriers. There are also legal and political challenges: for example, adolescents under 18 are not allowed to receive contraceptive information or services. A number of healthcare providerstake a kind of "surveillance" role over adolescents trying to access sexual and reproductive health services. They seek to establish what's best or right for these adolescents based on their own standards and values, and this has a negative impact on health outcomes.
Are mobile phones an effective way of reaching these adolescents and providing them with the information they need?
Yes, for a number of reasons. Adolescents and young people use their phones to access the internet, social media and means of communication like messaging and voice calls. By offering information on sexual health on mobile phones, the content can be personalized to meet their needs, information is available on demand and there is increased confidentiality for users.
Part of your study is based on the idea of providing information on sexual and reproductive health via an app. Could you outline this briefly for us?
Sure! We used a human-centred design (HCD) approach. This involved two aspects: firstly, establishing the requirements for information around sexual and reproductive health and the gap among adolescents in Kibra and, secondly, understanding which mobile technology they preferred for receiving on-demand information.
What were the main results?
In the qualitative study, adolescents indicated that they needed information on identifying STIs, sexual relations, abstinence among the under-18s, contraceptives for the over-18s and drug use. They preferred unstructured supplementary service data (USSD) technology, which is based on interaction through short messages that are not stored on users' devices.
Was the app for guiding adolescents in decision-making and improving their health outcomes useful?
The results of the research showed a significant statistical change in the understanding of sexual health, something that may result in improved decision-making. Adolescent users indicated that it was possible for them to be able to identify STI symptoms more quickly, and we hope that this leads them to seek medical help to improve their health outcomes.
Do you believe that eHealth and technology with a human-centred approach can change the future of medicine and health?
Definitely, for a number of reasons. Lots of eHealth apps and procedures have been developed around the world in the last decade, but very few have become a healthcare standard. This is due, chiefly, to shortcomings in usability and the user experience. HCD leverages user feedback to iteratively improve the end product, helping it to meet their needs and requirements. Additionally, in resource-limited settings, like Kenya, there are not enough healthcare providers. eHealth procedures could help improve access to quality healthcare services.
How important is it to find innovative ways of combining fields such as information, technology, networks and health and to continue researching in this field?
Innovative approaches are called for in order to meet current and emerging needs around accessing healthcare, particularly in resource-limited contexts. They're needed in the design, development and creation of eHealth procedure prototypes. Generally, the human-centred design approach involves a multidisciplinary team with a range of skills and experience, which has a positive impact on the design of the end product. The procedures created with this kind of approach have the potential to become the standard for medical care.
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