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

点击翻译按钮获取中文摘要

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.