Burnet Institute, Melbourne, Australia.
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
JMIR Mhealth Uhealth. 2020 May 29;8(5):e15096. doi: 10.2196/15096.
Female sex workers (FSWs) have high rates of both unintended pregnancy and HIV, but few health promotion interventions address their contraceptive needs or other sexual and reproductive health and rights (SRHR) concerns. A broader approach integrates contraceptive promotion with HIV and sexually transmitted infection (STI) prevention and management, alcohol awareness, gender-based violence and rights, and health care utilization. The Women's Health Intervention using SMS for Preventing Pregnancy (WHISPER) mobile phone intervention uses a participatory development approach and behavior change theory to address these high-priority concerns of FSWs in Mombasa, Kenya.
This paper aimed to (1) describe the process of development of the WHISPER intervention, its theoretical framework, key content domains and strategies and (2) explore workshop participants' responses to the proposed intervention, particularly with regard to message content, behavior change constructs, and feasibility and acceptability.
The research team worked closely with FSWs in two phases of intervention development. First, we drafted content for three different types of messages based on a review of the literature and behavior change theories. Second, we piloted the intervention by conducting six workshops with 42 FSWs to test and refine message content and 12 interviews to assess the technical performance of the intervention. Workshop data were thematically analyzed using a mixed deductive and inductive approach.
The intervention framework specified six SRHR domains that were viewed as highly relevant by FSWs. Reactions to intervention content revealed that social cognitive strategies to improve knowledge, outcome expectations, skills, and self-efficacy resonated well with workshop participants. Participants found the content empowering, and most said they would share the messages with others. The refined intervention was a 12-month SMS program consisting of informational and motivational messages, role model stories portraying behavior change among FSWs, and on-demand contraceptive information.
Our results highlight the need for health promotion interventions that incorporate broader components of SRHR, not only HIV prevention. Using a theory-based, participatory approach, we developed a digital health intervention that reflects the complex reality of FSWs' lives and provides a feasible, acceptable approach for addressing SRHR concerns and needs. FSWs may benefit from health promotion interventions that provide relevant, actionable, and engaging content to support behavior change.
女性性工作者（FSW）意外怀孕和感染艾滋病毒的比率都很高，但很少有健康促进干预措施能够满足她们的避孕需求或其他性与生殖健康和权利（SRHR）需求。更广泛的方法将避孕推广与艾滋病毒和性传播感染（STI）预防和管理、酒精意识、基于性别的暴力和权利以及医疗保健的利用结合起来。利用短信预防怀孕的妇女健康干预（WHISPER）手机干预措施采用参与式发展方法和行为改变理论，以解决肯尼亚蒙巴萨 FSW 的这些高优先级问题。
本文旨在（1）描述 WHISPER 干预措施的制定过程、其理论框架、关键内容领域和策略；（2）探讨参与研讨会的人员对拟议干预措施的反应，特别是针对信息内容、行为改变结构以及可行性和可接受性。
研究团队在干预措施制定的两个阶段与 FSW 密切合作。首先，我们根据文献回顾和行为改变理论起草了三种不同类型的信息内容。其次，我们通过与 42 名 FSW 进行六次研讨会来测试和完善信息内容，并进行 12 次访谈来评估干预措施的技术性能，从而对干预措施进行了试点。使用混合演绎和归纳方法对研讨会数据进行了主题分析。
干预框架指定了六个被 FSW 视为高度相关的 SRHR 领域。对干预内容的反应表明，提高知识、结果预期、技能和自我效能感的社会认知策略与研讨会参与者产生了共鸣。参与者认为内容很有启发性，大多数人表示他们将与他人分享这些信息。经过改进的干预措施是一个为期 12 个月的 SMS 计划，包括信息和激励信息、描绘 FSW 中行为变化的榜样故事以及按需提供避孕信息。
我们的研究结果强调需要制定包含更广泛的 SRHR 内容的健康促进干预措施，而不仅仅是预防艾滋病毒。我们使用基于理论的参与式方法制定了一种数字健康干预措施，反映了 FSW 生活的复杂现实，并提供了一种可行、可接受的方法来解决 SRHR 问题和需求。健康促进干预措施可以为 FSW 提供相关、可操作和引人入胜的内容，以支持行为改变。
