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Shifra: Mobile Health for Mobile Populations

Shifra is a web app that directly addresses access issues for young refugees and seeking sexual and reproductive health information.

Photo of Beccah Bartlett
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When using 15-24 years as a global definition for young people we see a demographic who are most at risk of contracting sexually transmitted infections, experiencing an unplanned pregnancy, missing out on basic education, being targeted for hate crimes based on their sexuality or gender identity and for many, being targeted for sex and human trafficking especially if they are stateless or living within a mobile setting as many refugees and asylum seekers do.

What we can also see in this group are the most prolific users of mobile technology and some of the fiercest advocates for human rights and social justice in the world. By listening to and working with youth and young people we are better able to meet their needs and create space for them to be able to lead and manage health interventions that directly affect their own lives and access to services.

Shifra is a mobile health (mHealth) intervention that:

  • Increases accessible, culturally sensitive sexual and reproductive health information in the user's language of choice (including highly visual content for low literate populations)
  • Connects users to accessible and respectful sexual and reproductive health services that specialise in refugee and migrant health
  • Maps user searches to build on the granular data which determines trends and illuminates unseen and unmet need by geographic regions thereby helping us to work with partners to affect meaningful service and policy change and reduce resource wastage at the local level.

Addressing the specific health concerns of women and girls in refugee scenarios has been shown to improve the health knowledge of the communities that surround them, and is essential to increasing their safe and successful integration into host countries.

One of the primary weaknesses of this approach is a general lack of high-quality, digitised reproductive health information that can be provided to communities in crisis. Shifra's anonymous user trend data map unmet and unseen need and we then work with community-based service providers to improve services and reduce resource wastage based on these findings.

Supporting women and girls’ access to comprehensive reproductive health services not only saves lives, it also increases their chances of achieving higher education, longer-term employment and benefits entire communities through shared information and education.

Shifra is state of the art and the first of its kind, both in Australia and in the world. The web app currently operates in Arabic for community members and English for health providers. Shifra will be accessible to Victoria’s five largest non-English speaking populations by the end of 2018, national by the end of 2019 and global by 2022.

At mAdapt, we work with young to design the health information and pathways to knowledge that we share on Shifra. We also focus on mentoring these young people so that they become the skilled changemakers guiding us on where Shifra needs to increase its reach and how to best achieve this goal.

In particular, we focus our attention on young women of colour, most from refugee and displaced backgrounds to develop their existing skills in innovation, design and web development. By using human-centred design and community-based participatory approaches, mAdapt aims to put refugees at the forefront of the design and development process of this mHealth intervention. This encourages legitimacy, community control and stakeholder buy-in. mAdapt works with academic, industry and health network partners as well as community members to develop this mHealth product and plan to trial its acceptance, implementation and usefulness within northwest Melbourne-based refugee communities.

Skills acquisition and mentoring opportunities are offered to all community members who are interested in collaborating on this health intervention. This includes previous partnerships with Monash School of Art Design and Architecture (MADA) to develop the user interface of the initial mHealth product and current negotiations for coding and programming workshops with organisations that promote gender equality to increase the exposure of interested refugees to the science, technology, engineering, arts and mathematics (STEAM) fields. 

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Photo of Myrna Derksen

Within the main challenge on improving SRHR education and services for young people, reaching refugee young people and especially women is a huge challenge in itself. Inspiring to see how you involve the target group in the development of Shifra, not only content wise, but also in the design. "Nothing about us, without us!" You really take an extra step to live up to that ideal.

Photo of Beccah Bartlett

Hi Myrna Derksen Thank you so much for your comment and 1000 apologies for the delay in replying. It means a lot that you see how hard we are working with the community to ensure this isn't something that is done to or for them but WITH them. My hope is that we develop the exisiting capacity of community members so that in a few years they're running and implementing mAdapt's next projects, not me ;)

Photo of Myrna Derksen

That would be great indeed!

Photo of Anne-Laure Fayard

Thanks Beccah Bartlett for sharing Shifra. From the video, it seems that the app is user-friendly and provides lots of information. I was curious to know how young people got to know about it. Campaigns? Flyers? Clinics and professionals? Words of mouth?
I am also of course very impressed by HCD and community-design approach taken to develop this tool. I'd love to know more about the process.
Thanks!
I found particularly interesting how the anonymous data was used to uncover needs and develop potential services. Kim Kimosop check out this app as it answers some of your questions regarding how to use app services to collect data.

Photo of Beccah Bartlett

Thank you Anne-Laure Fayard ! At the moment, mAdapt is using a Train the Trainers model and engaging community champions to share via word of mouth and social media. This is within the refugee communities. Within the health worker communities, I am using similar “guerrilla marketing” (i.e. free/low cost) techniques since we have no funding for marketing. Luckily, I have many health contacts as I work in this community and am reaching out to them to no just be advocates but to be active user testers as this increases their stakeholder buy in and feeling of being a part of the development and co-design process.

We used Photovoice and GIS Goalongs as well as UX co-design sessions with refugees, funders, program managers, policy officers and health professionals to gather our data. This included mental mapping, card sorts and tech literacy surveys (we want to know which social media platforms each young community is using and capitalise on that). We continually went back to the community to check and recheck our findings/analyses we correct iterating and moving on.


The analytics on the web app help us see how many people are looking at what content, in which area and how often. We create maps from the trend data to determine if there are hotspots for content, especially that which traditionally doesn’t get disclosed to healthcare staff (e.g. abortion, LGBTQI, family violence) and cross-reference this with language preference (currently we’re only in English and Arabic but when we incorporate other languages this will be more relevant for individualised community outreach. For example, maybe the Arabic community in NW suburbs of a city is demonstrating the desire to know more about unplanned pregnancy whilst the Karen community in the SW wants info on navigating consent and the Dinka population in the SE wants to know about childhood vaccination schedules. For me, it’s all about understanding that each community has its own knowledge gaps and preferences for learning (some are more tech savvy, others more traditional, some want videos, other pictures)

Photo of Anne-Laure Fayard

Thank you Beccah Bartlett for this detailed response. I'm really impressed by the depth of your work (you might consider re-submitting during ideation as it is still in a pilot phase).
I love the co-creation and HCD aspect (and the empowerment it generates) as well the mapping element.
On the mapping element, I just posted about https://challenges.openideo.com/challenge/youth-srh/research/voices-of-youth-maps-mapping-a-city-s-risks-in-haiti/
It also reminds me of an idea we posted with students for another challenge a while back: https://challenges.openideo.com/challenge/refugee-education/ideas/the-inventory

On the train-the-trainee model, I have seen it in action with a Youth Club in Nepal and was really impressed: https://challenges.openideo.com/challenge/youth-srh/research/sexual-and-reproductive-health-and-rights-srhr-for-all

You might also find Charles' project interesting (esp. for the marketing aspect): https://challenges.openideo.com/challenge/youth-srh/research/empowering-youth-with-youth-friendly-health-services-in-malawi

Good luck with this project which I'm sure is having and will have so much impact on the communities you're working with.

Photo of Beccah Bartlett

Thank you Anne-Laure Fayard This is all amazing. I'm checking out now. You're aces and will def resubmitting later. Thanks again!
Beccah