Evaluation of a Mobile Health Intervention to Improve Sexual and Reproductive Health Outcomes Among Kenyan Adolescents Living in Urban Informal Settlements

Обзор

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.

Подробное описание

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.

Вмешательства

• Комбинированный продукт Chatbot 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.

Первичные конечные точки

• Self-efficacy to abstain [Срок оценки: Baseline and 6 months post-intervention]
• Sexual self-efficacy [Срок оценки: Baseline and 6 months post-intervention]
• Perceived advantages of delaying sex [Срок оценки: Baseline and 6 months post-intervention]
• Perceived disadvantages of delaying sex [Срок оценки: Baseline and 6 months post-intervention]
• Attitudes towards condoms [Срок оценки: Baseline and 6 months post-intervention]
• Perceived norms of delaying sex [Срок оценки: Baseline and 6 months post-intervention]
• Subjective norms about condoms [Срок оценки: Baseline and 6 months post-intervention]
• Intention to abstain from sex [Срок оценки: Baseline and 6 months post-intervention]
• Intentions to use condoms [Срок оценки: Baseline and 6 months post-intervention]
• Sexual Behavior [Срок оценки: Baseline and 6 months post-intervention]

Вторичные конечные точки (6)

• Knowledge about sexual and reproductive health [Срок оценки: Baseline and 6 months post-intervention]
• Self-reported STI symptoms [Срок оценки: Baseline and 6 months post-intervention]
• Self-reported history of adolescent pregnancies [Срок оценки: Baseline and 6 months post-intervention]
• Intention to test and treat STIs [Срок оценки: Baseline and 6 months post-intervention]
• Intention to use SRH services [Срок оценки: Baseline and 6 months post-intervention]
• Retention of Digital Champions [Срок оценки: Start-up of intervention through six-month intervention period]

Критерии участия

Adolescent participants

Критерии включения

• 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

Критерии исключения

• 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.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Да

Дизайн исследования

Распределение

Нерандомизированное

Модель

Параллельные группы

Маскирование

Открытое

Основная цель

Профилактика

Центры проведения

Kenya · 1 центр

• Amref Health Africa in Kenya — Nairobi

Идентификаторы

NCT: NCT07587281 · 1200 · R21TW012623

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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