Pilot Implementation of a User-Driven, Web-Based Application Designed to Improve Sexual Health Knowledge and Communication Among Young Zambians: Mixed Methods Study

Abstract

Background Digital health interventions show promise in improving the uptake of HIV services among adolescents and young people aged 15 to 24 years in sub-Saharan Africa. Objective This study aimed to pilot-test a theory-based, empirically grounded web-based application designed to increase condom-related knowledge, sexual and reproductive health (SRH) communication, and healthier choices among young Zambians. Methods We conducted a pre-post quasi-experimental evaluation of the user-driven Be in the Know Zambia (BITKZ) web application using web-based surveys and in-depth interviews (IDIs) on the phone. We enrolled participants using social media advertisements. Our final analysis set comprised 46.04% (749/1627) of participants in the intervention group (which received the BITKZ link) and 53.96% (878/1627) of participants in the comparison group (no intervention). We collected survey data at study enrollment (baseline) and 5 weeks after the first enrollment in each group. Approximately 85% (637/749) of BITKZ users completed a user survey, of whom 9.3% (59/637) participated in IDIs. We calculated the time interfacing with BITKZ using the application log files. We conducted descriptive analyses to describe baseline characteristics and the user experience. At the endline, we assessed association using a t test and adjusted logistic regression for binary outcomes and ordinal regression for ordered outcomes, conditioning on age, sex, marital status, and employment status. We used adjusted average treatment effects (aATE) to assess the effects of BITKZ intervention. We conducted rapid matrix analyses of IDI transcripts in Microsoft Excel, sorting the data by theme, gender, and experience rating. Results Users rated BITKZ highly (excellent: 352/609, 57.8%; good: 218/609, 35.8%). At the endline, the intervention group had a higher level of knowledge related to condoms (adjusted odds ratio [aOR]: 1.35, 95% CI 1.06-1.69) and on wearing condoms correctly (aOR: 1.23, 95% CI 1.02-1.49). Those who had full-time employment had increased odds of knowing how to wear condoms correctly (aOR: 1.67, 95% CI 1.06-2.63) compared with those who reported being unemployed, as did men when compared with women (aOR: 1.92, 95% CI 1.59-2.31). Those in the intervention group were more likely to score higher for intention to test for sexually transmitted infections (STIs; aATE 0.21; P=.01) and HIV (aATE 0.32; P=.05), as well as for resisting peer pressure (aATE 2.64; P=.02). IDIs corroborated increased knowledge on correct condom use among men and female condoms among women, awareness of STIs and testing, and resistance to peer pressure. Interviewees provided examples of more open SRH communication with partners and peers and of considering, adopting, and influencing others to adopt healthier behaviors. Conclusions Despite the high baseline awareness of SRH among Zambian adolescents and young people with internet access, BITKZ provided modest gains in condom-related knowledge, resistance to peer pressure, and intention to test for STIs and HIV.

Impact of sexual and reproductive health interventions among young people in sub-Saharan Africa: a scoping review

“…With the increasing popularity of mobile based interventions with young people, they promise to improve SRH services utilisation young people. In the present review, four studies utilised mHealth interventions to improve SRH outcomes ( 33 , 35 , 61 , 62 ). Nuwamanya and colleagues, 2020, used an internet based mobile phone application to improve the use of modern contraceptive methods ( 35 ).…”

“…Gichangi and colleague, 2022, reported that there was a statistically significant drop in the average absolute number of contraceptives myths and misconceptions believed by the mHealth intervention arm between baseline and endline ( 33 ). Sharma and colleagues 2022, reported that at the endline, an mHealth intervention resulted in higher level of knowledge related to condoms and on wearing condoms correctly ( 61 ). According to Macharia and colleagues, (2023), there was a statistically significant difference in the total knowledge scores in the mHealth intervention group compared with the control group.…”

“…Practice of medicine and public health interventions supported by mobile devices are effective strategies for improving reproductive health outcomes among young people as they promote SRH services utilization ( 33 , 35 , 61 , 62 ). This is partly due to their popularity among young people, privacy, and ability to reach populations with restricted access to direct SRH services ( 58 – 60 ).…”

Factors Associated with Commercial Sex Behavior among Male College Students Who Engaged in Temporary Heterosexual Behavior in Zhejiang Province, China

“…The school is an ideal place to conduct sex education for college students. It will be crucial in standardizing HIV/AIDS health education, expanding coverage and improving the effect of publicity by offering HIV/AIDS health education classes, and using the new Internet media to publicize HIV/AIDS prevention and control as well as improve knowledge and other measures [19,20].…”

Educação Em Saúde Nas Escolas Para Adolescentes: Combate as Infecções Sexualmente Transmissíveis

“…Além disso, as infecções sexuais são altamente contagiosas e podem ser transmitidas facilmente de uma pessoa para outra. Por isso, a prevenção é essencial para proteger não apenas a saúde individual, mas também de toda a comunidade (SHARMA, A., et al, 2022).…”