Changing contraceptive conversations
A moderated, safe space to talk about contraception - ask questions or share experience - with clinical information 'pinned' to threads.
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.
Mariam is a secondary school student in Mtwara. She has heard about most methods of contraception but has important 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 at school. Too embarrassed to ask questions in class, she asks questions by SMS that evening.
Contraceptive conversations will link to accurate, highly visual information pages optimised to answer the questions of young people in the UK. These will require development and modification and translation to meet the needs of young people in Mtwara and Nepal. Linking to information of this sort will increase the efficiency of the service, removing the need to answer the same questions many times and providing additional information. The information pages will also link to local services.
The COTC club is a student run club at the Clinical Officer Training College in Mtwara. The club is popular and oversubscribed. Students are proud to go into local communities and share their expertise. They always have a meal afterwards and discuss the session they delivered. They receive annual training and support from UK sexual health experts via Partnerships London-Mtwara. This picture shows year 3 students training new club members from years 1 and 2.
A focus group with BNMT. Sangeeta might benefit from our proposed service. Sangeeta is 19 and studying. Born in Kathmandu, she went to boarding school at 7 after her mother left to work as a care assistant in Israel. Sangeeta uses emergency contraception to control her fertility. She gets this from the pharmacy - always wearing her motorcycle helmet to conceal her identity during pharmacy visits.
The COTC club visits schools, colleges and community organisations to provide teaching on sexual health and relationships. They teach in small groups, using interactive methods (quizzes, discussion, role play). They are well respected as future doctors but also young and approachable. These outreach sessions are few and far between, linking them to ongoing online support offers opportunities for sustained expert help.
Tuongee UZAZI WA Mpango
Contraceptive Conversations Facebook Page. We piloted this Facebook page as a way of testing the feasibility and acceptability of our project in Mtwara, Tanzania. During a sex and relationship education visit to a local college we provided a telephone number for students to text questions to the COTC club. Over the next week, club members received and answered 20 questions with 177 views on Facebook.
Clinical officer students preparing sex and relationship education sessions to be delivered in local schools. The members of the COTC club meet to prepare each sexual health outreach session that they deliver. They are trained in user-led counselling as part of their curriculum with additional training in sex and relationship education through a UK based NGO - the student club structure encourages shared learning among the students.
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?
What year was your organization or group started?
How many full time staff are needed to implement your idea?
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.
Share the URL for your Business Model Canvas Here
Our Canvas Business Model can be found here:
The Bedsider/Glow forum has millions of users who discuss issues related to fertility. This screen shot shows their contraceptive pill forum. Questions are asked and answered by users. We would like to build on this by increasing searchability, more links to information, bridging to local services, accessibility in several languages. We would like to build confidence to access these fora among young people in remote areas through online/offline engagement.
SH:24 offers contraception ordered online and delivered home in the UK. It also offers online testing and treatment for sexually transmitted infections. We are currently evaluating this intervention. The next phase of our work is to link online information to online sexual health services.
Opportunity Areas – Select those that apply
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.
SH:24 builds prototypes early to test with real users and modifies and refines in response to feedback.
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)
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.
SH:24 is an award winning, not-for-profit digital start up providing online services to generate new thinking about sexual health care
Where will your idea be implemented? (200 character limit)
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)
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.