Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.
JMIR Form Res. 2024 Sep 24;8:e53034. doi: 10.2196/53034.
Youth in Southern Africa face a high burden of HIV and sexually transmitted infections, yet they exhibit low uptake of health care services.
The Zvatinoda! intervention, co-designed with youth, aims to increase the demand for and utilization of health services among 18-24-year-olds in Chitungwiza, Zimbabwe.
The intervention utilized mobile phone-based discussion groups, complemented by "ask the expert" sessions. Peer facilitators, supported by an "Auntie," led youth in anonymous online chats on health topics prioritized by the participants. Feedback on youth needs was compiled and shared with health care providers. The intervention was tested in a 12-week feasibility study involving 4 groups of 7 youth each, totaling 28 participants (n=14, 50%, female participants), to evaluate feasibility and acceptability. Mixed methods process evaluation data included pre- and postintervention questionnaires (n=28), in-depth interviews with participants (n=15) and peer facilitators (n=4), content from discussion group chats and expert guest sessions (n=24), facilitators' debrief meetings (n=12), and a log of technical challenges. Descriptive quantitative analysis and thematic qualitative analysis were conducted. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was adapted to analyze and present findings on (1) reach, (2) potential efficacy, (3) adoption, (4) implementation, and (5) maintenance.
Mobile delivery facilitated engagement with diverse groups, even during COVID-19 lockdowns (reach). Health knowledge scores improved from pre- to postintervention across 9 measures. Preintervention scores varied from 14% (4/28) for contraception to 86% (24/28) for HIV knowledge. After the intervention, all knowledge scores reached 100% (28/28). Improvements were observed across 10 sexual and reproductive health (SRH) self-efficacy measures. The most notable changes were in the ability to start a conversation about SRH with older adults in the family, which increased from 50% (14/28) preintervention to 86% (24/28) postintervention. Similarly, the ability to use SRH services even if a partner does not agree rose from 57% (16/28) preintervention to 89% (25/28) postintervention. Self-reported attendance at a health center in the past 3 months improved from 32% (9/28) preintervention to 86% (24/28) postintervention (potential efficacy). Chat participation varied, largely due to network challenges and school/work commitments. The key factors facilitating peer learning were interaction with other youth, the support of an older, knowledgeable "Auntie," and the anonymity of the platform. As a result of COVID-19 restrictions, regular feedback to providers was not feasible. Instead, youth conveyed their needs to stakeholders through summaries of key themes from chat groups and a music video presented at a final in-person workshop (adoption and implementation). Participation in discussions decreased over time. To maintain engagement, introducing an in-person element was suggested (maintenance).
The Zvatinoda! intervention proved both acceptable and feasible, showing promise for enhancing young people's knowledge and health-seeking behavior. Potential improvements include introducing in-person discussions once the virtual group has established rapport and enhancing feedback and dialog with service providers.
南非的年轻人面临着艾滋病毒和性传播感染的高负担，但他们对医疗服务的利用率很低。
Zvatinoda! 干预措施是与年轻人共同设计的，旨在提高津巴布韦奇通圭扎市 18-24 岁年轻人对卫生服务的需求和利用。
该干预措施利用基于移动电话的讨论小组，并辅以“专家问答”环节。青年同伴辅导员在参与者优先考虑的健康主题上，通过匿名在线聊天来引导青年。青年的需求反馈被收集并与卫生保健提供者共享。该干预措施在一项涉及每组 7 名青年共 4 组、总计 28 名参与者（n=14，50%为女性参与者）的 12 周可行性研究中进行了测试，以评估可行性和可接受性。混合方法的过程评估数据包括预干预和后干预的问卷（n=28）、参与者（n=15）和同伴辅导员（n=4）的深入访谈、讨论小组聊天和专家嘉宾会议的内容（n=24）、辅导员的汇报会议（n=12）和技术挑战日志。进行了描述性定量分析和主题定性分析。采用 RE-AIM（可达性、有效性、采用、实施和维持）框架来分析和呈现以下发现：（1）可达性，（2）潜在效果，（3）采用，（4）实施，和（5）维持。
移动电话的提供促进了与不同群体的接触，甚至在 COVID-19 封锁期间也能做到这一点（可达性）。9 项措施中的健康知识得分在干预前后都有所提高。预干预的分数从避孕措施的 14%（4/28）到 HIV 知识的 86%（24/28）不等。在干预后，所有知识得分都达到了 100%（28/28）。10 项性与生殖健康（SRH）自我效能测量指标都有改善。最显著的变化是与家庭中长辈进行 SRH 对话的能力，从预干预的 50%（14/28）增加到了后干预的 86%（24/28）。同样，即使伴侣不同意，使用 SRH 服务的能力也从预干预的 57%（16/28）增加到了后干预的 89%（25/28）。自我报告过去 3 个月内去卫生中心就诊的情况从预干预的 32%（9/28）增加到了后干预的 86%（24/28）（潜在效果）。聊天的参与度存在差异，主要是由于网络挑战和学校/工作的承诺。促进同伴学习的关键因素是与其他青年的互动、年长且知识渊博的“阿姨”的支持，以及平台的匿名性。由于 COVID-19 的限制，向提供者提供定期反馈是不可行的。相反，青年通过在小组讨论中总结关键主题，并在最后一次面对面研讨会上展示音乐视频，向利益相关者传达了他们的需求（采用和实施）。随着时间的推移，讨论的参与度有所下降。为了保持参与度，建议引入面对面的元素（维持）。
Zvatinoda! 干预措施被证明是可以接受和可行的，为提高年轻人的知识和寻求健康行为的能力提供了希望。潜在的改进包括引入面对面的讨论，一旦虚拟小组建立了融洽的关系，并加强与服务提供者的反馈和对话。
