JMIR Publications

ABSTRACT

Background:

Interactive digital health interventions show promise to improve uptake of HIV services and accelerate decline in HIV incidence among adolescents and young people (AYP) ages 15-24 in sub-Saharan Africa.

Objective:

To pilot-test a theory-based, empirically grounded web-based application designed to increase condom-related knowledge, sexual and reproductive health (SRH) communication, and healthier choices, among young Zambians.

Methods:

We conducted a pre-post quasi-experimental evaluation of the user-driven, interactive ‘Be in the Know Zambia’ (BITKZ) application through online surveys and phone in-depth interviews (IDIs). Using social media advertisements, we enrolled 1377 AYP in the intervention (received BITKZ link) and 1494 AYP in the comparison group (no intervention). We collected survey data at study enrollment (baseline) and 5-weeks after first enrollment in each group. Our final analysis set comprised 749 intervention and 878 comparison participants (N=1627). 637 BITKZ users completed a user survey, of whom, 59 participated in IDIs on BITKZ experience and effect. We calculated time interfacing with BITKZ through application log files. Descriptive analyses helped determine intervention and control participant comparability at baseline and, describe user experience. Comparisons between intervention and control participants at end-line were assessed comparing means using a t-test and adjusted logistic regression for binary outcome and ordinal regression with ordered outcome conditioning on age, sex, marital status, and employment status. We used adjusted average treatment effect to assess effects of BITKZ intervention. We conducted rapid matrix analyses of IDI transcripts on excel, sorting data by theme, gender, and experience rating (excellent, satisfactory, poor).

Results:

Median interaction time with BITKZ application was 17 minutes (interquartile range[IQR]: 6-48 minutes). Users rated BITKZ highly (56.4% excellent, 37.2% good). Those in the intervention group were more likely to score higher for intention to test for sexually transmitted infections (STIs) (0.21; P=.01) and HIV (0.32; P=.05) and, for resisting peer pressure (2.64; P=.02). At end-line, the intervention group (aOR-1.35; 95%CI 1.06-1.69) and > primary education (range aOR 3.02-5.72) had higher odds of increased condom-related knowledge. Intervention group had 27% (95%CI 1.06-1.54) and, full-time workers had 67% (95%CI 1.06-2.63) increased odds of knowing how to wear condoms correctly. Men had an almost two-fold increase (aOR-1.92; 95%CI 1.59-2.31) in odds of knowing how to wear condoms correctly compared to women. IDIs corroborated increased knowledge on correct condom use among men and on female condoms among women, awareness of STIs and testing, and resisting peer pressure. Interviewees provided examples of more open SRH communication with partners and peers and of considering, adopting, and influencing other to adopt healthier behaviours.

Conclusions:

Despite high baseline awareness of SRH among Zambian AYP with internet access, BITKZ provided modest gains in condom-related knowledge, resistance to peer pressure, and intention to test for STIs and/or HIV. Clinical Trial: N/A