Feasibility and Acceptability of a Mobile Phone Intervention to Improve Post-Rape Service Delivery in South Africa

"Use of mobile phone technology can play a significant role in creating awareness of the identified gaps in service provision for rape victims, improving delivery of services, and enhancing responsiveness and accountability of service providers.”

This study presents findings on mobile phone access, ownership, and use among rape victims accessing post-rape services at four centres in South Africa. These findings are analysed to assess the feasibility and acceptability of a mobile app through which rape victims can express their views on the quality of services and support offered by police and health-care workers, with the ultimate goal being to promote greater accountability between service providers and clients. The study defines feasibility as the extent to which the app can be easily used by the target audience (rape victims), and defines acceptability as the extent to which the target audience is willing to use the proposed innovation. The research also looked at users’ expectations and needs in order to inform the content, design, and structure of a mobile app.

The research was conducted for the Making All Voices Count initiative, which is being implemented by a consortium consisting of Hivos, the Institute for Development Studies (IDS), and Ushahidi. Making All Voices Count “is a programme working towards a world in which open, effective and participatory governance is the norm and not the exception. The programme’s research, evidence and learning contributes to improving performance and practice, and builds an evidence base in the field of citizen voice, government responsiveness, transparency and accountability (T&A) and technology for T&A (Tech4T&A).”

As explained in the brief, the study comprised qualitative and quantitative research with rape victims and caregivers accessing follow-up services at four rape care centres in Tshwane district, Pretoria. The findings showed very high mobile phone coverage and significantly high access and personal ownership and use, confirming that the proposed app would be a feasible platform for giving feedback on the quality of post-rape services. For example, of 140 participants enrolled in the study (108 rape victims and 32 caregivers), 86.4% reported owning a mobile phone. However, despite high self-reported levels of mobile phone ownership, the results also revealed that mobile phone theft during sexual assault was common, with 34 out of 63 participants (55%) who did not bring their mobile phones to their first visit to the facility reporting that their phone had been stolen during the assault.

The study also showed high levels of acceptability for using mobile phones to provide feedback on the quality of service delivery (95%) showing the potential value of such an intervention for improved communication between service users and providers. For example, almost all participants (95%) in the study were interested in taking part in confidential surveys about the quality of services via mobile phones, suggesting not just the acceptability of the proposed intervention, but also the potential value of such an intervention for improved communication between service users and providers.

Besides being able to give feedback on post rape services, focus group discussions found that receiving case updates and health information through the client experience app would be useful. Participants expressed that they would like to use the proposed app to be able to check on case progress and information on medication, in addition to receiving messages with appointment information and reminders of what was discussed during visits. On the other hand, participants also raised concerns about whether their feedback would indeed be used as intended - to make a difference to the delivery of care for rape victims in the country.

In light of the feasibility and acceptability findings highlighted in the study, the study team were able to develop the proposed mobile phone client experience app, which was successfully piloted for a four-month period (April – July 2016) at the four study sites. It was developed on a feature-phone-accessible USSD platform and required no installation on a mobile phone itself due to its dial-in code access. In terms of the structure and content of the app, it allowed clients to feed back on four domains of satisfaction: staff, services, physical environment and rooms, and information and advice. The staff domain allowed clients to select a service provider they want to rate: health staff, police, or court services. Feedback on the app showed that clients accessing post-rape care services at the rape crisis and care centres were very enthusiastic about the roll-out of the app pilot. The pilot showed that it is both feasible and acceptable for clients to use the USSD mobile app to report back on the quality of post-rape care services received. In addition, the facility staff, National Prosecuting Authority (NPA), and the National Department of Health (all structures involved in supporting rape victims) were generally very supportive towards the pilot. Facility staff were receptive to feedback, understanding that its purpose was not to blame staff for poor performance but to help make decisions for continuous quality improvement on service delivery. 

Based on the findings of the research and pilot intervention, the report makes the following case for the use of a mobile app to improve post-rape service delivery:”The uneven provision of quality services and the absence of coordinated mechanisms to hold providers of care for rape victims to account underscores the importance of the proposed mobile phone app. The app will aid in continuous improvement of services and user experience by supporting rape victims to confidentially rate the quality of services and hold service providers accountable. The feedback will be used to monitor service providers’ performance, with the aim of strengthening quality of care. It was found, from this study, that reporting of client experience will enable service providers to identify where to improve, identify any backlogs, strengthen accountability, and give the best possible service to all rape victims (Peter et al. 2016). The mobile phone app can further play a significant role in empowering people who have been disempowered through sexual assault. With its aim to provide a platform for rape victims to voice their experiences on service quality, this will ensure that services targeting rape victims in South Africa are shaped around the realities of victims, which should improve access to quality care. Engaging rape victims on delivery of care is also very important to increase awareness and knowledge of services.”