Zvatinoda! (What we want!): Increasing demand and uptake of sexual and reproductive health services by young people in Zimbabwe

兹瓦蒂诺达！

• 批准号: MR/T003200/1
• 负责人: Aoife Doyle
• 金额: $ 19.31万
• 依托单位: London School of Hygiene & Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2019
• 资助国家: 英国
• 起止时间: 2019 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FT003200%2F1
• 关键词: Zvatinoda; What; want; Increasing; demand

Over 3000 adolescents die every day due to largely avoidable causes. Most of these deaths occur in low- and middle-income countries. Use of appropriate preventive and treatment services could prevent many of these deaths but young people are less likely than adults or younger children to access healthcare. Risky sexual practices and reluctance to seek medical care in adolescence (10-19 years) and young adulthood (20-24 years) will affect long-term sexual and reproductive health. Adolescence and young adulthood, therefore, provide a window of opportunity for establishing healthy behaviours which can improve health and well-being later in life. However, not all health services are youth friendly and we don't know enough about the kinds of services that young people (YP) want and what would, for example, encourage them to attend a clinic. Research shows that mobile health interventions can improve knowledge, attitudes and behaviours among young people, but we don't know whether mobile health interventions can increase use of health services. We will work with YP to develop and test the feasibility of an intervention that will improve health service use in Mutare District, Zimbabwe. The Zvatinoda! intervention will involve 'Auntie' moderated discussion groups for YP and feedback to service providers on how to make sexual and reproductive health (SRH) services more youth-friendly. We will address the following questions:1. Why are YP not accessing SRH services and which factors are malleable and have the greatest scope for change? 2. What is the most acceptable and feasible Zvatinoda! discussion group format? We will conduct individual and group discussions with YP to find out more about their lives. We will explore whether using a technology platform e.g. WhatsApp, SMS, is a good way to interact with YP about their health. We will ask YP to help us to design the discussion group component of the intervention. Discussion groups will provide information, peer support, and be led by a 'mobile Auntie or Uncle' - a culturally appropriate mentor who can provide guidance and problem solve challenges to uptake of health services. 3. What is the most acceptable and feasible health facility feedback format?We will hold discussions with health system and community members to find out more about the YP's health needs and the facilitators and barriers to youth friendly health service provision. We will explore the potential for feedback on YP's needs and preferences to inform health service design. We will ask service providers to help us to design the feedback component of the intervention. 4. Could there be any negative consequences of the intervention and how could we mitigate against such events?5. Is it feasible to implement the Zvatinoda! intervention among YP aged 16-24 living in the geographical catchment area of 2 primary care clinics? We will analyse the conversations that take place on the Zvatinoda! groups. We will share information on YPs' needs and preferences with service providers and community members and encourage them to use this information to improve the quality and youth-friendliness of their services. To understand how our intervention worked or didn't work, we will talk to participating YP, community members and health care providers. We will also get their suggestions on how to improve the intervention. We will consider the resources that would be needed for potential sustainability and scale-up.6. How would we measure the effectiveness of the Zvatinoda! mHealth intervention in improving service provider practice and attitudes, and increasing use of health services by YP?We will identify the most appropriate health outcomes for the main evaluation study, and the most appropriate measures of youth engagement, satisfaction with health services, and health worker attitudes. We will explore the feasibility of using routine health service records to monitor health service uptake by YP.

每天有3000多名青少年死于基本上可以避免的原因。这些死亡大多发生在低收入和中等收入国家。使用适当的预防和治疗服务可以防止许多此类死亡，但年轻人获得医疗保健的可能性低于成年人或年幼儿童。青春期(10-19岁)和青壮年(20-24岁)的危险性行为和不愿求医将影响长期的性健康和生殖健康。因此，青春期和青壮年为建立健康的行为提供了机会之窗，这些行为可以改善晚年的健康和幸福。然而，并不是所有的医疗服务都是对年轻人友好的，我们对年轻人想要什么类型的服务以及什么可以鼓励他们去诊所的了解还不够。研究表明，移动卫生干预可以改善年轻人的知识、态度和行为，但我们不知道移动卫生干预能否增加卫生服务的使用。我们将与YP合作开发和测试干预措施的可行性，以改善津巴布韦穆塔雷区的卫生服务使用情况。兹瓦蒂诺达！干预措施将包括“阿姨”主持的YP讨论小组，以及向服务提供者反馈如何使性健康和生殖健康(SRH)服务更有利于青少年。我们将解决以下问题：1.为什么YP不使用SRH服务？哪些因素是可塑性的，并且有最大的变化空间？2.什么是最可接受和最可行的Zvatinoda！讨论组形式？我们将与YP进行个人和小组讨论，以更多地了解他们的生活。我们将探索使用WhatsApp、短信等技术平台是否是与YP就他们的健康进行互动的好方法。我们将请求YP帮助我们设计干预的讨论组部分。讨论小组将提供信息、同伴支持，并由一位“移动阿姨或叔叔”领导--一位适合文化的导师，可以提供指导和解决问题，帮助人们接受医疗服务。3.最可接受和可行的卫生机构反馈形式是什么？我们将与卫生系统和社区成员进行讨论，进一步了解青年计划的卫生需求，以及提供青年友好型卫生服务的促进者和障碍。我们将探索关于YP的需求和偏好的反馈的可能性，以便为卫生服务设计提供参考。我们将请求服务提供商帮助我们设计干预的反馈部分。4.干预会有任何负面后果吗？我们如何减轻这种事件？5.实施兹瓦蒂诺达可行吗？对居住在两个初级保健诊所地理集水区的16-24岁青年的干预？我们将分析在Zvatinoda上发生的对话！组。我们会与服务提供者和社区成员分享有关展翅计划的需要和喜好的资料，并鼓励他们利用这些资料改善服务质素和方便年青人。为了了解我们的干预措施是如何起作用的，我们将与参与计划的社区成员和医疗保健提供者交谈。我们还将听取他们关于如何改进干预的建议。我们将考虑潜在的可持续性和扩大规模所需的资源。我们如何衡量Zvatinoda的有效性！在改善服务提供者实践和态度，以及通过青年计划增加对卫生服务的利用方面的卫生干预？我们将为主要评价研究确定最合适的健康结果，以及青年参与度、对卫生服务的满意度和卫生工作者态度的最合适的衡量标准。我们将探索使用常规卫生服务记录来监测青少年儿童卫生服务接受情况的可行性。

项目成果

Digital intervention to improve health services for young people in Zimbabwe: process evaluation of 'Zvatinoda' (what we want) using the RE-AIM framework (Preprint)

改善津巴布韦年轻人健康服务的数字干预：使用 RE-AIM 框架对“Zvatinoda”（我们想要的）进行过程评估（预印本）

• DOI: 10.2196/preprints.53034
• 发表时间: 2023
• 作者: Mackworth-Young C