Institute for Health and Aging; Bixby Center for Global Reproductive Health; University of California, San Francisco, 490 Illinois St. 123J, San Francisco, CA 94158, USA.
School of Public Health; University of California, Berkeley; 2121 Berkeley Way, Berkeley, CA, 94704, USA.
Soc Sci Med. 2023 Mar;320:115683. doi: 10.1016/j.socscimed.2023.115683. Epub 2023 Jan 14.
Adolescent girls and young women (AGYW; ages 15-24) in sub-Saharan Africa face many barriers to accessing preventive sexual and reproductive health (SRH) services. We drew upon the strengths of two complementary approaches, human-centered design and behavioral economics, to craft a holistic, highly-tailored, and empathetic intervention to motivate AGYW to seek contraception and HIV self-test kits at community drug shops. To encourage engagement, we embedded "nudge" strategies at different opportunity points (uncovered during our design research) along the care-seeking and service delivery journey. Our Malkia Klabu intervention is a loyalty program designed to enhance drug shops' role as SRH providers through which AGYW earned punches for shop purchases redeemable for small prizes; free SRH products could be requested at any time. From our 4-month pilot in Shinyanga, Tanzania, we assess the extent to which different behavioral nudge strategies motivated behaviors as predicted by synthesizing findings from (1) in-depth interviews with AGYW and shopkeepers, (2) shop program records, (3) shop observations, and (4) customer exit surveys. Overall, we find that AGYW and shopkeepers were motivated by many intervention features as intended and consistent with hypothesized mechanisms. We found strong evidence of social norms for helping to spread awareness of Malkia Klabu among peers, prize incentives for drawing AGYW back to shops, and the opt-out default membership gift of an HIV self-test kit for encouraging testing uptake and exploration of contraceptives. Shopkeepers in both arms noted increased community status from distributing HIV self-testing kits (ego). Malkia Klabu shopkeepers experienced increased customer traffic and business revenues (incentives), which reduced shopkeepers' gatekeeping tendencies and earned them additional recognition as champions of AGYW well-being. Integrating human-centered design and behavioral economics was effective for developing an innovative and effective intervention that simultaneously met the different needs of economic actors in support of public health priorities.
撒哈拉以南非洲的青春期女孩和年轻女性（年龄在 15-24 岁之间）在获得预防性性健康和生殖健康（SRH）服务方面面临许多障碍。我们借鉴了以人为中心的设计和行为经济学这两种互补方法的优势，精心设计了一个全面、高度定制且富有同理心的干预措施，以激励 AGYW 在社区药店寻求避孕和 HIV 自我检测包。为了鼓励参与，我们在寻求护理和服务提供的过程中不同的机会点（在我们的设计研究中发现）嵌入了“推动”策略。我们的 Malkia Klabu 干预措施是一个忠诚度计划，旨在通过该计划增强药店作为 SRH 提供者的角色，通过该计划，AGYW 可以为商店购买赚取可兑换小奖品的打孔；任何时候都可以免费要求提供 SRH 产品。从我们在坦桑尼亚的欣延加的 4 个月试点中，我们评估了不同的行为推动策略在多大程度上激发了行为，这是通过综合（1）与 AGYW 和店主的深入访谈、（2）商店计划记录、（3）商店观察和（4）客户退出调查的结果来实现的。总的来说，我们发现 AGYW 和店主像预期的那样受到许多干预措施的激励，这与假设的机制一致。我们有强有力的证据表明，帮助在同龄人中传播 Malkia Klabu 的意识的社会规范、吸引 AGYW 回到商店的奖品激励以及默认选择的艾滋病毒自我检测包作为加入礼物，以鼓励检测和探索避孕药具，这些都得到了验证。两个组的店主都指出，分发艾滋病毒自我检测包提高了社区地位（自我）。Malkia Klabu 店主的客流量和业务收入增加（激励），这减少了店主的把关倾向，并使他们作为 AGYW 健康的拥护者获得了额外的认可。将以人为中心的设计和行为经济学相结合，对于开发创新且有效的干预措施非常有效，该措施同时满足了支持公共卫生重点的经济行为者的不同需求。
