ICRH Kenya

INTERNATIONAL CENTRE FOR REPRODUCTIVE HEALTH -KENYA

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Adolescent/Youth Reproductive Mobile Access and Delivery Initiative for Love and Life Outcomes (ARMADILLO)

Young people, defined as persons aged 15-24, constitute one-fifth of Kenya’s total Population, according to the 2009 national census. In the last decade, the

The government of Kenya has increasingly emphasized programming among young women through the Kenya Adolescent Reproductive Health Policy (2003). This policy aims at doubling the use of modern contraceptives from four to eight percent among sexually active adolescents (aged 15-19 years) and from 19.9% to 40% among youth (20-24 years) by 2015. National guidelines for family planning (FP) expressly support the provision of FP services for adolescents and youth. In order to accomplish these policy targets, strategic actions have been identified for promoting the health of adolescents and youth including the acknowledgement of their right to reproductive services and increasing their access to these services as unintended pregnancy among adolescents is a common public health problem globally, and is associated with significant health risks and social costs

ARMADILLO project study is funded by WHO, Department of Reproductive Health and Research. The research trial evaluates youth learning and information retention following delivery of Sexual Reproductive Health information via mobile phones. The study is to determine whether youth given access to Sexual Reproductive Health information through their mobile phones are more knowledgeable about contraception and better able to dispel contraception myths and misconceptions than those without access to SRH content via their mobile phones. Kilifi and Mombasa Counties are the study project areas. This is a multisite study which will refine the existing mHealth platform to the proposed Adolescent/Youth Reproductive Mobile Access and Delivery Initiative for Love and Life Outcomes (ARMADILLO) platform. The study is in two stages: stage 1 is the formative phase which has two phases and stage 2 is rollout/scaling up the intervention and measuring its impact. The formative research used qualitative methods to inform the development of an intervention, which would use the popular channel of (SMS) text messages to deliver SRH information to youth.

The formative research occurred in two phases: Phase 1 used a series of focus group discussions (FGDs) with two sets of participants – youth and parents/caregivers of youth – to test the appropriateness and acceptability of the finalized draft architecture and messages. In Phase 2 of this formative research, we developed and piloted the outcome measures that will be used in the Stage 2 coverage and impact study to determine program effectiveness. Youth participants were recruited from the target communities to complete a pre-and post-intervention test consisting of pilot SRH study measures. Youth participants were guided through a usability test by a member of the research team. The findings from this phase will be used to finalize intervention messaging and measurement tools for the Stage 2 coverage and impact study. Stage 1 of the ARMADILLO study established that mobile phones are currently part of young people’s lives and reinforced the fact that sexual and reproductive health messages delivered via text messages from a trusted source will most likely be acceptable to young people owing to its confidential nature.

Stage1 – developed and tested the message content that formed the ARMADILLO system for Stage 2: the effect of ARMADILLO on knowledge for action, attitudes and self-efficacy using quantitative and qualitative methods and Stage 3 – the coverage study. The main objective of stage 2 was to use an individually randomized design to assess differential learning related to sexual reproductive health and rights compared to those who are asked to learn on their own.  It was to determine whether youth given access to SRH information through their mobile phones are more knowledgeable about contraception and better able to dispel contraception myths and misconceptions than those without access to SRH content via their mobile phones. Following a series of focus-group discussions, the study used an individually-randomized, open three-arm comparative design to assess the study objectives. After obtaining written informed consent, individuals randomized to the ‘intervention’ arm of the ARMADILLO trial received access to ARMADILLO content over the course of the intervention and used their mobile phones to access this content on demand. Those randomized to the ‘contact’ arm were alerted to various SRH domains like health topics, including Relationships, Pregnancy and STIs; they will be encouraged to learn on their own. Those randomized to the ‘control’ arm received no intervention. Selected SRH outcomes were assessed via a survey at baseline, following the introduction of a new domain at intervention end, and at eight weeks (two months) following the end of the intervention. All outcomes of interest are linked to domains and content from the ARMADILLO system. Control group participants will receive no messaging; only assessments at baseline and times corresponding to the intervention end and follow-up for the other two groups. A series of in-depth interviews were also conducted with a sub-sample of intervention participants at intervention end, in order to assess the system’s usability.  These will include youth and adolescents aged 18-24 years, adults from private or public pharmacies, local, regional or national regulatory or those dealing with contraception and staff from local NGOs.