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Changing contraceptive conversations

A moderated, safe space to talk about contraception - ask questions or share experience - with clinical information 'pinned' to threads.

Photo of Paula Baraitser
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Tell us about your vision for this project: Share one sentence about the impact you would like to see from this project in five years

We will provide a safe space to talk about contraception for 500,000 young people in remote areas of Tanzania + Nepal. We combine the value of user experience + clinical advice + link to services. We engage new users through a unique combination of online/offline engagement building trust + supporting use through community outreach. Tailoring the intervention to each context with local design we will also deliver robust evaluation to generate learning that supports scale and spread.

Who will implement this idea? Or what’s your strategy to implement in the next 6-18 months?

Partnership - SH:24 ( award winning digital start up providing online sexual health services) + established Tanzanian clinical officer student organisation providing sexual health education and outreach in remote areas of Tanzania. + Britain Nepal Medical Trust (50 years experience in community development and outreach). Responsibilities: SH:24 - clinical oversight/training + design + software development. COTC club/BNMT - local engagement + moderation of contraceptive conversations SH:24 - design + clinical oversight + evaluation 1 full time post COTC club/BNMT - 3 days/week in each organisation for project management/delivery

How has your idea changed based on feedback?

In the last 2 weeks we developed a prototype to test assumptions. We invited students attending sexual health training sessions in Mtwara to text their questions. We created a Contraceptive Conversations Facebook page in Swahili and posted the questions/answers on the page. Within 48 hours with no promotion the page was seen by 177 people with more questions/comments. The COTC club effectively moderated the conversation with SH:24 communicating with Whatsapp and google translate.

Using a human-centered design approach, you may uncover insights that lead to small or foundational changes to your organization’s existing strategy or processes in order to unlock the potential of your idea. How would your organization go about making such changes?

SH:24 employs an agile development process that invites constant adaptation and change -structured around four phases: Discovery - a range of low fidelity prototypes developed to test assumptions with users Alpha - more refined prototypes, built and tested with private users Beta - a live version and invites further testing Live optimisation - continued scrutiny of the service once it is live. We evaluate what we do to inform decisions and share our findings (see publication list).

How long have you been working on the project?

4

What year was your organization or group started?

2013

How many full time staff are needed to implement your idea?

2

What most attracted you to the UNFPA Young People's Sexual and Reproductive Health Challenge?

SH:24 is well known for its design-led innovation in the UK, winning the British Medical Journal Innovation Team of the Year award in 2017. We think this work is relevant outside the UK but will require a process of design-led service innovation to develop a product that is built around the needs of service users. The UNFPA Challenge acknowledges the importance of agile development and design and offers opportunities to translate our work across contexts.

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Opportunity Areas – Select those that apply

  • mHealth

What specific problem(s) are you trying to address? (300 character limit)

Young people (particularly those in remote areas) want more information and support on contraception. They look for this online but find it difficult to know which sites to trust, or to find the information they need or understand the language used. Existing sites rarely link to local services.

What are some of your unanswered questions about the problem(s) you are working to address? (500 character limit)

We are piloting online ‘contraceptive conversations’ in the UK, learning about the right mix of website/forum/SMS questions/ information pages/chat bot to help young people learn from clinicians and each other. We want to understand reach in low-income settings with platforms like whatsapp, ‘read it to me’ software and automated translation to cross language/literacy barriers. We want to understand the right approach to offline/online engagement through outreach with online follow up.

Who are your end users? (1000 character limit)

We propose testing in two areas where we have 10 years experience of sexual health education with local NGOs. 1. Young people 14-25 in Mtwara, Tanzania where 48% of births are to women aged 16-19 years. Asha is a secondary school student in Mtwara. She has heard about most methods of contraception but has some questions. Does the pill make you infertile? Does the implant cause blood to build up inside of you? These concerns have stopped her using contraception and pregnancy will mean that she has to leave school. She finds out about contraceptive conversations during sexual health education 2. Young people in Kathmandu valley. With 25% of women, mothers by age 18 and sex outside marriage stigmatised, young women rely on emergency contraception or medical abortion purchased from pharmacies to control fertility. Sangeeta would like a more reliable option but does not know where to go and has no-one to ask until an outreach session at her college introduces a new website.

Explain your idea. (500 character limit)

Effective interventions to reduce unintended pregnancy require contraceptive information and support for use. Young people struggle to find this online. Reviewing contraceptive conversations on social networking sites we found lists of questions, mainly in English, limited searchability, inaccurate information. We will provide a co-produced, lightly moderated, fully searchable, multi-language, safe space for young people to ask questions + share experience with clinical support.

What is your value proposition? (500 character limit)

An accessible, free, anonymous place for contraceptive discussion - safe and moderated. An approach that leverages the accessibility of social networking, values young people’s experience and adds clinical advice for myth busting and signposting. A design that leverages our track record of agile development and co-production with young people to deliver excellent user experience. A combination of face-to-face community engagement with online follow up. Robust evaluation to share learning.

What's different about your idea compared to current solutions? (500 character limit)

Our idea is co-designed - starting with what users want, designing with data, making things simple to use, testing prototypes, deleting what doesn’t work, adding layers of functionality. Our service is co-produced - questions answered by young people with light touch moderation to maintain safety and accurate information. We will build on/modify models such as 'Bedsider' - testing strategies for low income settings, starting with offline engagement, building the online community.

What are the key reasons why end users would turn to your organization over another?

  • Convenience / Accessibility: Making products accessible

What would success look like for your end users? (500 character limit)

Success would mean making contraception conversations easy (on mobile devices); attractive (visually engaging); social (socially visible to supportive peers); timely (available 24/7); accessible (available in language of choice) to support effective contraceptive use.

How would you measure the impact your idea has on your end user(s) ? How will you measure the success of your program? (500 character limit)

We will measure both engagement and outcomes of engagement. We will describe numbers of users and patterns of use and content to understand: 1. Conversations – number and length and content 2. Sharing – exchange and distribution of content 3. Community formation – repeated use and establishment of online personas and relationships.

What strategies will/are you testing to acquire end users? (300 character limit)

Working with existing and established community sexual health outreach programmes in Tanzania and Nepal we have tested engagement with end users through online and offline networks to validate our assumptions around need and the process of engagement.

Key partnerships - Who will you partner with to make your idea work? (500 character limit)

We will collaborate with two organisations to understand need and validate solutions in two different contexts: 1. The ‘COTC Club’ – Zonal Health Training Centre, Mtwara brings 10 years experience of sexual health education led by clinical officer/nursing students. 2. BNMT UK - 50 years experience of adolescent sexual health promotion in Nepal. BNMT increasingly works through Birat Nepal Medical Trust as its local implementing partner.

What is your organization’s name? (150 character limit)

SH:24

Tell us more about you: (750 character limit)

SH:24 (www.sh24.org.uk) is an award winning, not-for-profit, digital startup providing online services to generate new thinking about sexual health care. A collaboration between clinicians, public health specialists and designers with a proven track record of innovative online sexual health service delivery. SH:24 has won awards for user experience (overall best UXUK, 2016), for design (nominated for the Design Museum, Design of the Year Award 2016) and for innovation (winner of the BMJ innovation team of the year, 2017). We use UK Government Digital Service principles in service development, starting with what users want, designing with data, making things simple to use, releasing minimal viable products early and testing them.

Organizational Characteristics

  • International/global organization

Where will your idea be implemented? (200 character limit)

Mtwara, Tanzania Kathmandu valley, Nepal

What do you need to get started? (500 character limit)

Financial support for: intervention design and software development by SH:24; clinical leadership in Tanzania and Nepal (part time) to moderate conversations; project management (part time); consumables; evaluation - conversation analysis to report on effectiveness, sustainability.

What is the current scale of your proposed innovation?

  • Global - within more than one geographic region globally

Experience in Implementation Country(ies)

  • Yes, for more than one year.

Expertise in Sector

  • I've worked in a sector related to my idea for more than a year.

Organization Location (200 character limit)

London, UK

What is your organizational status?

  • We are a registered non-profit, charity, NGO, or community-based organization.

What is the maturity of your innovation?

  • Existing Prototype or Pilot: I have tested a part of my solution with users and am iterating.

Website

www.sh24.org.uk

Attachments (1)

Published papers on the evaluation of online sexual health services and information.docx

Robust evaluation is very important to us and we seek to combine agile design with academic evaluation. This document lists our recently published papers including a randomised controlled trial of online testing for sexually transmitted infections due to be published in Plos Med on the 28th December. This shows that online STI testing doubles access to testing in the UK.

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Photo of Paula Baraitser
Team

Posted on behalf of Chris Howroyd, Director of Service Design at SH:24.

Q1. Scale and spread
We’re lucky enough to be working across three regions/communities/areas simultaneously. In addition to Tanzania and Nepal, we are working with users (prospective service users and clinicians) in the UK. This offers us the opportunity to build, test, learn across these very different contexts, to consider the proposition and UX with a much more diverse user base. We have already started to identify the needs of extreme users who will help us define more quickly and more effectively. The overarching proposition appears to be welcomed among users across these three countries, with the assumption -“people are not fully aware of their contraceptive choices and the pros and cons of each, nor empowered to make a well informed choice of which to use” - holding true. However, communities are complex and we would be naive to believe that just one execution of the proposition would work across borders (or even in specific areas within a country) – it will need a good dose of localisation, which will be user-led to revalidate local needs.

Q2. Moderation and sustainability
We’re aware that will need active, clinically led moderation (there appears to be much value in this for users). As Paula has outlined, we would principally look for social or public funding to enable and uphold this function, but are also aware that a more commercial path could be taken, as a complementary source – such as advertising models and commercial partnerships for products (sponsorships etc). Due to the nature of the service, we would not consider selling data. We are also considering the capacity of and interest in professionally qualified volunteer moderators.

Q3. Differentiation
This is naturally still a work in progress. Our work to date tells us that a forum alone will not be enough, clinically moderated or not. The service will need an additional dimension/feature/functionality, potentially through rich, dynamic information beyond that of communication (peer to peer or community based). Part of the discovery process will be to define and develop the most effective approach for the contexts where we intend to work.

Chris Howroyd
Director of Service Development, SH:24

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