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Paula commented on Changing contraceptive conversations

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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Paula commented on Changing contraceptive conversations

Many thanks for your helpful comments. Our thoughts on each of the question below:

1. Can pilots in Tanzania and Nepal generate learning to inform scale and spread? Our process of discovery and testing combined with more formal evaluation will focus on generalisable learning to inform scale and spread. Key questions include:
* What is the most appropriate mix of online/offline engagement to reach young people in remote areas?
* What are the advantages/disadvantages of different types of online fora - discussion fora/Facebook/Whattsap?
* What is the right mix of user and clinician generated content?
The agile design process will answer questions about what works while the more formal content analysis of interactions will answer questions on why it works. Both types of data, but particularly the latter will inform the development of similar interventions in different contexts.

2. The COTC club and sexual health professionals working with BNMT already receive training in non-directive contraceptive counselling. The COTC club receive an annual 1 week training course in both contraceptive counselling and community outreach. They develop this learning through group discussion and reflection/evaluation of their outreach interventions. I have recently led the development of a MOOC (massive open access online course) on contraceptive counselling on behalf of the UK Faculty of Sexual and Reproductive Health Care of the Royal College of Obstetricians and Gynaecology. This course is designed to be accessible on mobile phones from anywhere and relevant to clinicians working in many contexts. It will form part of the training package available to staff in both contexts.

3. The differences between this intervention and those that already exist are:
*The intervention uses a unique combination of online/offline engagement to support participation by young people in remote areas.
*The intervention explores strategies to work across languages using automated translation software to ensure that information is accessible.
*Our agile design approach will explore how approaches developed in UK/US contexts can be optimised for new populations.
*We have reviewed existing interventions. Even the widely used interactive ones have long lists of questions that are difficult to navigate, limited searchability, limited clinical presence. We would like to explore strategies to improve user experience of these interventions.

4. Moderation. We have previous experience of moderation of national sexual health fora described here https://www.jmir.org/2014/4/e108/. Our experience suggests that it requires small amounts of time daily to facilitate. We anticipate learning from new cultures of online interaction, for example, rating responses, user polls and links to relevant information and automation of some responses. Building new knowledge on how these strategies may work will be part of the outputs of this project and will seek t maximise the efficiency of our moderation approach.

5. Sustainability. Our business model for this project in the UK includes links to service provision, such as online contraceptive services. Our initial testing in remote areas will rely on public sector or NGO support.

6. Evaluation. We have extensive experience of rigourous/responsive evaluation of online sexual health interventions (see list of publications in attached documents section). Our ability to run innovation and evaluation at the same time is one of the strengths of our application.