By Abigail Winskell, Project Director I, DISC, Ria Duffy, Associate Program Manager, HIV & SRH, Fana Abay, Marketing and Communications Director, Kendal Danna, Technical Advisor II, SRH, Philile Malindzisa-Simelane, Adolescent Girls and Young Women (AGYW) Program Lead
Women and girls represent a significant percentage of users of digital health interventions (DHI) in low- and middle-income countries (LMICs). Despite this, many digital health solutions available today are not reaching those who need them most. When designing DHIs, it is important to take into consideration the unique challenges that women and girls experience, particularly when accessing reproductive health services. In this blog post, we walk you through four examples across PSI programs of how we can design person-centered digital solutions that respond to their needs, preferences and unique challenges – an approach we call Consumer-Powered Healthcare.
Barriers to healthcare services
Social, cultural, and economic factors might make it difficult for women and girls to access healthcare. Designing inclusive DHI ensures that these barriers are identified and addressed, promoting equitable access to essential health services.
In Uganda and Nigeria, the Delivering Innovation in Self-Care (DISC) project is helping women take control of their sexual and reproductive health through self-inject contraceptives. The largest barriers to entry are limited knowledge and lack of belief that women can inject themselves.
In response, DISC launched the Discover Your Power omnichannel campaign, which complements community engagement with digital components (advertising, social media and chatbots) to successfully help interested women learn more about and access training for self-injection. The campaign shares content on Facebook, other social media sites, and Google to increase awareness and make self-inject relevant and accessible to women.
We employ a digital chatbot that serves as a confidential source to aid women in learning more about self-injection, how to use it, and where to buy it. Content and buying strategies are continually optimized in response to feedback from women about which messaging resonates and through digital data. DISC’s approach continues to help women along their self-care journey and spark fresh conversations about how self-inject methods can support women in achieving their life goals.
Rural adolescent girls and women have unique needs that require specialized attention. Inclusive DHI can be tailored to address topics like sexual and reproductive health, mental health, family planning, and maternal, neonatal and child health to ensure the content is relevant, effective, and responsive to their needs.
In Ethiopia, true to Smart Start‘s roots, a digital guide was developed from the original paper-based counselling tool, updated using a human-centered design approach. The path to digital design began with defining our design challenge, drawing on insights from rural married adolescent girls (i.e., clients) and couples who use sexual and reproductive health services, as well as the healthcare providers who deliver those services. The design challenge focused on a core question: How might we digitize Smart Start to help healthcare providers connect with clients/couples to deliver consistent, accurate, and engaging comprehensive sexual and reproductive health information and services, leaving clients delighted, confident, and prepared?
Based on this design challenge, the Smart Start digital guide was embedded in an app developed by combining all the insights from healthcare workers and clients after multiple prototype tests and interactions. The app affords providers the ability to deliver content in an interactive and engaging way. It increases message consistency and improves counseling and pre-counseling services to help clients and couples make informed and confident financial and contraceptive decisions. Learn more here
Power and autonomy
Inclusive DHI puts power in the hands of women and girls by providing them with information, tools, and resources to make informed decisions about their health. By involving women and girls in the design process, it can foster a sense of control and inclusion.
In Eswatini, the Girl Power project in collaboration with the Ministry of Health designed innovative digital health interventions targeting adolescent girls and young women (AGYW) of 10-29 years to prevent HIV and unintended pregnancies. These digital health solutions provide clients the flexibility, privacy, and self-efficacy needed to meet their health needs. Co-designing the Girl Power digital ecosystem with AGYW resulted in the development of the following digital platforms:
- Girl Power WhatsApp Chatbot: The chatbot is the entry point for AGYW to access SRH and HIV information and services privately and self-refer.
- Work Force App: A fully configurable, integrated web-based application for community level and facility-based health workers to electronically register, track clients for longitudinal engagement, keep client’s records, and issue referrals for linkage to care.
- Provider Behavioral Change for Youth-Centered Service Delivery eLearning: The eight-module eLearning course is a provider behavioral change training that builds knowledge and skills for youth-friendly service delivery in health facilities. It applies blended learning such as games, quizzes, and reflections, and provides educational materials.
Privacy and confidentiality
Women and girls experience external pressures that can have an impact on the choices they make regarding their sexual, reproductive, and mental health. To help reduce the impact of external factors on personal health choices, digital health interventions are designed to offer privacy and confidentiality to the women and girls who access them.
PSI’s Counseling for Choice (C4C) approach to contraceptive counseling gives health providers the tools and techniques they need to provide care that is non-stigmatizing, unbiased, and respects the clients voice, choice, and agency. A C4C counseling session is centered on the client’s individual needs and preferences and enables the client to choose a contraceptive method through a shared decision-making process. The C4C approach enables an environment where clients can feel safe and confident to ask questions, raise concerns, and become informed about their method options. PSI’s suite of C4C tools will soon include an e-learning package, another digital health solution that will be used to scale this person-centered counseling approach to new providers.
PSI’s C4C chatbot goes one step further, by helping clients through this decision-making process in the privacy of their own homes. The chatbot, intended as a pre-counseling tool, asks clients about their preferences and reproductive health goals, and offers them a few contraceptive method options that may meet their needs. It can also refer them to a provider who can offer this and other family planning methods. Armed with information about which methods may suit her best, a client is equipped to seek the care and services that she needs from a health provider.
By designing consumer-powered digital health interventions that are inclusive for women and girls, we support the creation of an enabling environment that strengthens their health and well-being, promotes gender equity, and contributes to inclusive health systems.