Adaptation of mHealth approaches to optimise adolescents’ Sexual and Reproductive Health Rights in Nigeria, Kenya and Malawi through co-creation

Sub-Saharan Africa has the highest fertility, child marriage and maternal mortality rates globally, with a high unmet need for access to modern contraception (family planning) (WHO 2019). Two-thirds of the global annual maternal deaths are in SSA (WHO 2019). Young women and girls are disproportionately vulnerable: about half of pregnancies among adolescents aged 15–19 in SSA are unintended, and almost half of these end in abortion, most of which are unsafe (Guttmacher 2020). The use of modern contraception among married women aged 15-49 years in SSA is 30%. There is a socio-economic (SE) gradient, whereby women in the lowest SE group have the highest fertility rates and lowest contraceptive prevalence rates (UN 2022).

The overall aim of the project is to adapt existing SRH interventions for adolescents for delivery via mhealth approaches and obtain preliminary evidence of efficacy and acceptability that will inform the design of a definitive RCT to determine effectiveness and cost-effectiveness in Northern Nigeria, Western Kenya, Malawi.

Research questions: 

·       What are the needs and preferences of adolescents?

·       What level, when, and from whom do adolescents need support to access and
   use the intervention/programme?

·       Will user testing result in an easy-to-use, useful, and potentially effective
  programme to be tested in future studies?


Approach / methods / Outputs & why innovative
We will use an iterative, collaborative transdisciplinary approach combining interdisciplinary research, dialogue and decision-making with key stakeholders and rapid piloting and evaluation of small-scale innovations in overlapping work packages (WP):
We will adapt SRH education interventions/programmes for smartphone/tablet/computer for adolescents (age range and any other definer) (development phase MRC Complex Intervention Framework). We will use Co-Creation, Intervention Mapping (IM) and (mobile evaluation from SR) to guide the process.

Work packages

Work streams will include systematic reviews, adaptation of existing interventions (co-creation), pilot evaluation with embedded qualitative interviews, and dissemination activities.

We will convene and work with adolescent-led coalitions involving key stakeholders in three different country contexts: Northern Nigeria, Western Kenya and Malawi where the research team already established well-developed partnerships.

We will adapt, implement, and evaluate appropriate mHealth approaches. Common elements are likely to include [TBC} and community health workers supported within an equitable knowledge ecosystem including schools, health centres, researchers and government and non-government service providers.

 

Outcomes

The collaborative approach in each country together with training and mentoring for key stakeholders and knowledge sharing between countries through online webinars throughout the project will ensure local capacity is strengthened and the pilot interventions will be sustainable.

Impact

The impact of the interventions, conditions necessary for scaling up and replication elsewhere will be assessed through an evaluation using a collaborative outcome reporting approach in the final year of the project with the final conclusions and recommendations co-produced with key stakeholders from each country in a final project conference in one of the countries.