mHealth Intervention
Conditions
Keywords
Sex Education, Pregnancy in Adolescence, Sexually Transmitted Infections, Adolescent, Software, Prevention, Cell Phone, Sexual Health, Reproductive health, mHealth, Cost Effectiveness
Brief summary
This two-year study evaluates a mobile phone-based comprehensive sexuality education program designed to support adolescent sexual and reproductive health in Kenya, where rates of teenage pregnancy and sexually transmitted infections remain high. The program, called AskDoki, delivers age-appropriate health information through the WhatsApp platform and is supported by trained youth peer leaders known as Digital Champions, who help adolescents access and use the program. Communities participating in the study are assigned either to receive the AskDoki program with Digital Champion support (intervention communities) or to not receive the program (comparison communities). Adolescents in both intervention and comparison communities complete surveys before the program begins and again six months after implementation of the AskDoki program. The surveys assess health knowledge, attitudes, perceptions, and intended behaviors related to sexual and reproductive health. The study compares changes in survey responses over time between intervention and comparison communities to assess the program's effectiveness. It also evaluates how feasible it is to use Digital Champions to support adolescents' engagement with the mobile program and examines the cost-effectiveness of this approach.
Detailed description
Despite recent improvements in adolescent sexual and reproductive health outcomes in Kenya, rates of unsafe sex, unintended pregnancy, abortion, and sexually transmitted infections remain high. School based comprehensive sexuality education has been shown to improve adolescent sexual and reproductive health outcomes; however, implementation in Kenya is often limited by curriculum constraints and challenges faced by teachers, including limited time, training, and resources. As a result, many adolescents lack access to adequate sexuality education outside the formal school setting. Mobile health technology may offer a cost effective approach to delivering comprehensive sexuality education to adolescents. Amref Health Africa in Kenya developed and pilot tested a mobile, WhatsApp based artificial intelligence chatbot called AskDoki, designed to provide age appropriate comprehensive sexuality education. Preliminary findings suggested that pairing the digital curriculum with trained youth peer leaders-referred to as Digital Champions-may enhance reach, engagement, and effectiveness, particularly among adolescents with limited access to personal mobile devices. Pacific Institute for Research and Evaluation (PIRE), in collaboration with Amref Health Africa, is implementing AskDoki in urban informal settlements in Kenya using a community based approach. The study uses a quasi experimental design in which communities are assigned either to receive the AskDoki program supported by Digital Champions or to serve as comparison communities without access to the intervention. Adolescents aged 15 to 19 years complete surveys at baseline and six months after program implementation. The study evaluates changes over time in key determinants of sexual and reproductive health behaviors, including knowledge, attitudes, perceptions, self efficacy, and behavioral intentions, and compares outcomes between intervention and comparison communities. In addition, the study includes a process evaluation to assess the feasibility, acceptability, and implementation of the Digital Champion strategy. A cost effectiveness analysis is conducted to estimate the cost per adolescent reached and the cost per adolescent achieving improvements in key outcomes.
Interventions
COMBINATION_PRODUCTChatbot providing comprehensive sexuality education plus youth peer facilitators
A chatbot designed to provide comprehensive sexuality education (named "AskDoki") to adolescents is deployed in a community targeted to receive the intervention along with peer facilitators. The facilitators are young adults (named "Digital Champions") who are trained to promote and facilitate access and use among adolescents of a chatbot.
Sponsors
Pacific Institute for Research and Evaluation
Fogarty International Center of the National Institute of Health
Amref Health Africa
Michigan State University
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
The study uses a quasi-experimental design with a nonequivalent control cluster.
Eligibility
Sex/Gender
ALL
Age
15 Years to 19 Years
Healthy volunteers
Yes
Inclusion criteria
Adolescent participants Inclusion criteria: * age 15-19 * residing in one of the informal settlements participating in the study * not planning to relocate for 18 months * not currently married or living as married * comprehension of informed consent * willing to provide assent/consent
Exclusion criteria
* Age 14 and younger * Age 20 and older * Married/living as married * Planning to relocate within 18 months * Not residing in one of the informal settlements participating in the study * Unable to comprehend informed consent * Unwilling to provide assent/consent.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Self-efficacy to abstain | Baseline and 6 months post-intervention | Change in respondents' confidence in their ability to abstain from sex. Example item: "I can refuse sex when I don't feel like having sex." Five summed items. Response options are on a 5-point Likert scale (Strongly disagree to Strongly agree). |
| Sexual self-efficacy | Baseline and 6 months post-intervention | Change in respondents' confidence to negotiate and use condoms. Example item: "I can negotiate condom use with a potential partner". Eight summed items. Response options are on a 5-point Likert scale (Strongly disagree to Strongly agree). |
| Perceived advantages of delaying sex | Baseline and 6 months post-intervention | Change in respondents' perceptions about the advantages of delaying sex. Example item: "Waiting until I am older before I have sex will… Help me achieve my life's goals." Five summed items. Response options are on a 5-point Likert scale (Strongly disagree to Strongly agree). |
| Perceived disadvantages of delaying sex | Baseline and 6 months post-intervention | Change in respondents' perceptions about the disadvantages of delaying sex. Example item: "Waiting until I am older before I have sex will… Make me look old-fashioned." Four summed items. Response options are on a 5-point Likert scale (Strongly disagree to Strongly agree). |
| Attitudes towards condoms | Baseline and 6 months post-intervention | Change in respondents' perceptions about condom use. Example item: "It is OK to use condoms." Five summed items. Response options are on a 5-point Likert scale (Strongly disagree to Strongly agree). |
| Perceived norms of delaying sex | Baseline and 6 months post-intervention | Change in respondents' beliefs about perceived norms among people in one's life (friends, parents, other family, boyfriend/girlfriend) concerning delaying sex. Example item: "Most of my friends think that I should wait until I am older before I have sex." Four summed items. Response options are on a 5-point Likert scale (Strongly disagree to Strongly agree). |
| Subjective norms about condoms | Baseline and 6 months post-intervention | Change in respondents' beliefs about perceived norms among people in one's life (friends, parents, other family, boyfriend/girlfriend) concerning condoms. Example item: "My friends think that I should carry a condom." Four summed items. Response options are on a 5-point Likert scale (Strongly disagree to Strongly agree). |
| Intention to abstain from sex | Baseline and 6 months post-intervention | Change in respondents' intention to have sex within next month, 6 months, a year. Example item: "I intend to have sex within the next month." Three items summed and averaged. Response options are on a 5-point Likert scale (Strongly disagree to Strongly agree). Responses are inversely coded to reflect intention to abstain from sex. |
| Intentions to use condoms | Baseline and 6 months post-intervention | Change in respondents' intention to use a condom during sexual intercourse. Single item: "I plan to use a condom when I have sexual intercourse." Response options are on a 5-point Likert scale (Strongly disagree to strongly agree). |
| Sexual Behavior | Baseline and 6 months post-intervention | Change in respondents' sexual behavior. Example item: "Have you had vaginal sex with anyone in the past 6 months?" (yes/no). Three items to assess any sexual activity (i.e., anal, oral, and vaginal sex). |
| Frequency of sexual activity | Baseline and 6 months post-intervention | Change in how often respondents had sex in past month. Single item: "In the past month, how frequently did you have sex?" Five response options from "Zero times" to "More than four times a week." |
| Condom use at last sex | Baseline and 6 months post-intervention | Condom used at last sex reported in survey. Single item: "Did you or your partner use a condom the last time your had sex?" (yes/no). |
| Condom use consistency | Baseline and 6 months post-intervention | Condom use frequency reported in survey. Single item: "In the past month, how frequently did you use a condom when having sex?" Five response options ("Never, none of the time" to "Always, every time"). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Knowledge about sexual and reproductive health | Baseline and 6 months post-intervention | Measures change in knowledge about sexually transmitted infections (STIs), sexual behavior, and pregnancy. Example item: "Can a person who looks strong and healthy be HIV positive?" (yes/no) Items will be summed and averaged. |
| Self-reported STI symptoms | Baseline and 6 months post-intervention | Respondents' self-reported STI symptoms. Example item: "Do you currently have any of the following symptoms?... Sore or lesions in your genital area or anus" (yes/no). Six items will be used to derive prevalence and distribution of STI symptoms. |
| Self-reported history of adolescent pregnancies | Baseline and 6 months post-intervention | Respondents' self-reported history of pregnancy and impregnating someone. Example item: "Are you or your partner currently pregnant?"" |
| Intention to test and treat STIs | Baseline and 6 months post-intervention | Two survey items assessing intentions to test and treat STIs. Example item: "I plan to visit a clinic to test for STIs if I have symptoms." Two summed items. Response options are on a 5-point Likert scale (Strongly disagree to strongly agree). Items were newly created for this study. |
| Intention to use SRH services | Baseline and 6 months post-intervention | Increase in intention to use SRH services. Single item: "I plan to visit a clinic for family planning services." Response options are on a 5-point Likert scale (Strongly disagree to strongly agree). Item was newly created for this study. |
| Retention of Digital Champions | Start-up of intervention through six-month intervention period | Percent of Digital Champions retained (number retained at end of intervention period divided by total number hired) based on program administration records. |
Countries
Kenya
Contacts
PRINCIPAL_INVESTIGATORWinfred (Winnie) K. Luseno, Ph.D.
Pacific Institute for Research and Evaluation
Outcome results
None listed