mHealth and Young People in South Africa

"The key players in the provision of mHealth services for young people have been the non-profit sector organizations seeking to further their reach or to strengthen existing public health programmes."

This report identifies and explores the use of mHealth resources designed to provide adolescents and young people in South Africa with sexual and reproductive health and rights (SRHR), family planning and healthy pregnancy information and advice.  The report looks at young people’s self-reported online behaviours and preferred sources of information on health-related issues and their experiences with using their mobile phones including the enablers and barriers to the use of mobile phones for health-related activities.  The purpose of the report is to understand strengths and limitations of existing mHealth services in reaching adolescents and young people in South Africa, particularly those who are especially vulnerable or marginalised, with information and other services that will promote their sexual and reproductive health and wellbeing, including the health and wellbeing of infants and children born to young parents. The report was commissioned by HealthEnabled as part of a grant provided by the United Nations Children’s Fund (UNICEF) South Africa with a view to assessing opportunities and gaps for using digital tools to support HIV prevention and treatment for babies, children, and adolescents in South Africa.

The 25 digital mHealth resources profiled in this report include sms-based platforms, mobisites, chat groups such as MXit and Whats App, interactive mobile phone magazines/books, and toll-free help lines. Seventeen out of 20 mHealth services were provided by non-profit organisations, while three of them were run by profit-making organisations as a free service, namely BeingGirlSA by Proctor and Gamble, Crossroads Generation by Deutsche Welle Network, and Destiny Toll-free line by Ndalo Media in partnership with the South African Depression and Anxiety Group.

Data was collected during the period from November to December 2015. Primary data were collected through focus group discussions with young people and an online survey of young people. Furthermore, key informant interviews were conducted with individuals involved in the development of the various mHealth services documented in the review. Secondary data on mHealth services were also reviewed and used to inform a framework contained in the report profiling the characteristics of mHealth interventions in South Africa, in terms of the type of technology used, target audience, content development, demographic characteristics of audience reached and any evaluation findings and implementation challenges experienced and lessons learnt.
 
The findings can be summarised as follows (as extracted from the Executive summary):
“The study found that young people in urban and rural areas use their mobile phones regularly for communicating socially as well as to seek information on a range of issues such as career advice, entertainment, education and research and health. Eighty-four percent of young people expressed willingness and openness to obtaining sexual health information using their mobile phones, if it was free. Differing views were expressed about whether they would prefer to communicate directly with a professional via text or voice call. Some were in favour of the anonymity of talking to a stranger, while others did not feel comfortable to discuss personal issues and take advice from a stranger. Of those who were in favour of engaging directly with a professional, texting was preferred over voice communication as it offered more privacy. The cost of mobile data and airtime was cited as a major influence on the extent to which young people currently use their phones for information and their willingness to use mHealth services. Most of the young people who reported that they have been tested for HIV have either been pregnant or are currently pregnant. Also most of the young people who reported never having been tested for HIV have either not had children (in the case of females) or are males.

Out of twenty-five services addressing SRHR (including HIV prevention, treatment and care), maternal and child health, nineteen services were specifically aimed at young people and adolescents. The majority of services offered included information aimed at increasing knowledge and shifting norms around sex, sexuality and sexual and reproductive health while some services offered emotional support and counseling, for instance, to young people living with HIV. Significant gaps in information were found with regard to variables such as the numbers of users reached and their demographic characteristics. Many services reported that they had not built in the required systems to collect and monitor this level of information, while other services did not have the information readily available at the time of the report. Few services were developed on the basis of a clearly articulated behaviour change theory or model and none of the services have as yet formally evaluated their impact on health related behaviour and knowledge among young people. Anecdotal evidence from young people interviewed in
focus groups suggests that digital health services are not well marketed to their intended audience, limiting their reach.”

Based on the findings, the report makes the following recommendations:

• Existing or future digital health interventions should be strengthened in terms of having sound monitoring and rigorous evaluation systems in order for decisions to be made on the basis of evidence on their efficacy in contributing to young people’s health outcomes.
• Content should be based on social and behaviour change theory and evidence, should conform to international best practice and should be scientifically accurate.
• Content should be developed with a view to ensuring maximal engagement and interactivity to ensure reinforcement of key messages and desired behaviours and continuous moderation is required to ensure consistency in messaging as well as the safety of young users on digital platforms.
• Services that are well marketed and zero-rated to users with constantly updated content stand the highest likelihood of high uptake among young people.
• mHealth solutions should be developed that target boys and young men, as well as girls and young women with information about HIV testing and counselling.  These should ideally link them to their nearest testing centre as this demographic has been shown to have low uptake of HIV testing and counselling.