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Mobile for Adolescent Sexual and Reproductive Health(m4ASH)
Health Innovation Challenge
Mobile for Adolescent Sexual and Reproductive Health (m4ASH)
Brief Summary of the Project
Adolescents are defined by WHO as those in the second decade of their lives. They have profound sexual and reproductive health problems including gender inequality, sexual coercion, early marriage, polygamy, female genital mutilation, unplanned pregnancies, closely spaced pregnancies, abortion, sexually transmitted infections (STIs) including HIV/AIDS. Lack of proper information and communication are the most important factors that exacerbate and perpetuate their health problems.
Adolescents are also becoming the leading subscribers of mobile phones and users of computers mainly for social networking.
The explosions of electronic technologies like the availability of internet either at home or school and the wide use of mobile phones are new opportunities to provide sexual health communication to adolescents.
Adolescents prefer sexual health information to be easily accessible, trustworthy, credible, confidential and non-threatening. So, my project aims at how to disseminate sexual health information to adolescents using mobile phones as efficient platform and tool.
Further inputs from mentors are crucial mainly in the area of market analysis and business modeling to develop this project further well and realise it so that it will be fruitful in bringing impacts in the area of sexual and reproductive health of the young generation.
1. Topic Selection, Concept, and Vision
Topic: Mobile for Adolescent Sexual Health (m4ASH)
Concept: Adolescents constitute a large segment of the population in all countries. It is a period of risk taking and reward seeking strongly influenced by the environment as well as individual factors. This results in a vulnerability to sexual and reproductive health problems due to a lack of access to age appropriate accurate health information. Simultaneously new neuroscience research in this age group tell us that the development of the brain is far from complete and that the environment and individual factors work together to mould decision making in the youth( 1). Youth across the world are also increasingly using technologies including telecom and internet services for social networking, communication and information gathering; making this a potentially powerful technology to use to support education as well as positive decision making for adolescents.
Vision: Adolescent friendly mobile platforms that can be used to impart information relevant to youth, which is embedded with sexual and reproductive health information.
2. Description of the problem
There are 1.8 billion young people in the world today in the age group 15-24 years by the estimation of the UNFPA( www.unfpa.org) . These account for approximately 20-28 per cent of populations across the developed and developing world. Of these the UNFPA states that
• Approximately 16 million adolescent girls become mothers annually.
• And forty percent of all new cases of HIV being diagnosed a day are in young people. Simultaneously the Population Reference Bureau has collected information on adolescent health in the “The World’s Youth Datasheet 2013” ( www.prb.org); in which the following facts emerge:
• Around the world, many young women in the age group 15 to 19 years are currently pregnant or have already given birth. Teenagers from the poorest rural households are more likely to become pregnant or give birth than those from the better off urban households.
• Child marriage is practiced in all regions of the world; with nearly half of the young women in South Central Asia and Western Africa having been married before the age of eighteen. This puts such women at a higher risk for early pregnancy, maternal morbidity and mortality and limits their educational opportunities and employment prospects.
• That though the information on the sexual transmission of HIV has increased in the adolescent age group, most young people do not have the means to knowledge or access to measures to protect themselves.
These problems are not only present in the developing world but Advocates for Youth describes the difference in the realities from Europe and the United States of America, where they have found
• Higher rates of pregnancy, births and abortions in adolescents in the US as compared with their European peers.
• A far lower use of contraception in sexually active youth in the US.
Life skills and youth focused programs to empower young people across the world are being expanded to include information on gender equality , the cultural roles of genders and the issues around rights, respect and responsibility. As the mobile phone coverage increases the world over; it has been found to be an acceptable and feasible method to conduct research and deliver healthcare messages as well as to support a change in behavior (1). Adolescents are becoming the front line users of mobile phones and internet technologies.
With respect to adolescents in the developed world, a new Pew survey on more than 800 teens aged 12 to 17 along with their parents, revealed that a total of 78 % of American teens own a cell phone, and almost half of them (47 %) own a smartphone. The survey also revealed a 14% increase in smart phone ownership by teens; from 23% in 2011 to 37% in 2013(2). “One half of these teens say they’re more likely to connect to the web on their smart device”(2).
Internet search engines such as Google are most used to find answers to sexual health questions by adolescents. Besides, social networking sites and text messaging are the two popular technologies among U.S. adolescents (3 ).
Even within a developing country setting of South Africa, a study showed that 70% of adolescents in a lower socio-economic group had access to a mobile phone (4).
Adolescents prefer sexual health information to be easily accessible, trustworthy, credible, confidential and non-threatening (3).
Adolescents also noted that the advantage of internet as it is available source information at all hours including weekends, after school and clinic hours when no other support is available. But, they also noted that sexual health information obtained from Internet is mostly non-user friendly which might be due to absence of appropriate online information sources and the time consumption that pose in shifting through hundreds of search engine results(3).
Pregnancy prevention, STIs, relationships, additional information about clinics or other in-person resources to make adolescents more aware of places they can physically go for sexual health care were most important topics that adolescents get interested for websites or text messaging programs should incorporate(3 ).
3. Description of solution components
“The Columbia University Prevention Research Center (PRC) keeps abreast of new media and new trends in teenagers' communication patterns, such as the use of instant messaging, mobile Internet access, and gaming technology. In a recent state-of-the-art review, the researchers described health promotion opportunities available by tapping into the new media channels integral to youth culture. Their work supports the American Academy of Pediatrics' advice to pediatricians: understand and be ready to interact with families around the content and use of new technology”(5).
“ At two PRCs, research focuses on the potential of online social networks to reduce the occurrence of sexually transmitted diseases among young people. The University of Michigan PRC explores the power of an online community of peers to exchange accurate information and support healthy attitudes. The University of Maryland PRC is testing the effectiveness of an online community of organizations in sharing resources with residents and relieving the burden on local health clinics to offer education and services”(5).
In general, mobile technologies offer potentially huge opportunities to reach adolescents and address their sexual health concerns.
4. Market Analysis
Review of existing solutions to solve this problem
Adolescent sexual and reproductive health is being given due attention at local, national and global level in fact with the most noticeable effort seen in U.S. In U.S. alone, many health education organizations are using the Internet to promote adolescent and young adult sexual health through provision of dedicated websites for online support. These include Columbia University (http://www.goaskalice.columbia.edu), the National Campaign to Prevent Teen and Unplanned Pregnancy (http://www.sexreally.com,http://www.stayteen.org), and Planned Parenthood (http://www.plannedparenthood.org/teen-talk) (3).
Other programs like SEXINFO ( 6) in California have also been successful in sing text messaging to help at risk youth access information and appropriate treatment for sexual health problems.
5. Brainstorm solution options
The following outlets/platforms can be utilized by m4ASH project in culturally appropriate manner;
1. Free call service as hotline or helpline that deliver sexual health information by trained provider
2. Short message texting (SMS) to delivers health messages and conversations/chatting
3. Mobile Application that compile and provide the following platforms altogether
3.1 Online free counseling for adolescent users by providing secured logging in to websites 3.2 Social networking such as facebook, twitter and You Tube which disseminate health information
3.3 Adolescent centered online community of peers who share sexual health issues
3.4 Online resource regarding where about of sexual health service centers
3.5 Linking in to trustworthy Websites that address adolescent sexual health issues
4. Gamification: culturally adapted 'edutainment' portals; that is using the need for young people to play games and take risks which we know in the way their brains develop and using these to design games where they can take risks but which also help them to make positive decisions on SRH.
Rationale behind Gamification
Interactive games could be a potential solution ; the rational would include
1. Basic games which allow young people within the platform to take 'risks' eg drive after drinking if it is a simulation game...and linked to various outcomes such as more you drink ; the slower is your reaction time and the higher the risk for accidents.
2. These games can be culturally adapted to various cultural contexts.
3. Levels and activities can be flexibly adapted to suit the age groups.
4. Modules around gender roles and perceptions can also be adapted to the local settings.
6. Business Model description
- Ministry of Health
- Education organizations like Columbia University, Stanford university
- Mobile phone and telecom network providers
- International organizations like WHO,UNICEF
- Local and International NGOs
- Funding organizations like CDC, USAID
- Training and Research centers focusing on SRH such as Geneva Foundation for Medical Education and Research (GFMER) where I took my SRH course
. Adolescent and youth age groups interested to be subscribers
. Parents who are concerned about their young children’s SRH
.Health workers providing SRH service packages to adolescents
.Educators working in schools, colleges, universities and the like
. Interested institutions that are seeking inputs from such projects
Financial pooling Schemes
This project will work as a non-profit one that relay on funding. The financial aid obtained from different sources would be utilized to launch the program, cover running cost mainly for project staff and related expenses.
Feasibility studies can be conducted and other financial sources like insurance system, trust funding, taxation subsidies and revenue streaming can be opted as alternatives accordingly.
(1). Aggarwal NK. Applying mobile technologies to mental health service delivery in South Asia. Asian journal of psychiatry. Sep;5(3):225-30
(2). Pew Survey Shows Mobile Internet Use Soaring AmongTeens;March;2013 http: //www.redorbit.com/news/technology/1112802449/pew-study-teen-mobile-internet-use-soaring-031313/
(3). Adolescents' Views Regarding Uses of Social Networking Websites and Text Messaging for Adolescent Sexual Health Education. Selkie EM, Benson M, Moreno M. University of Minnesota, Dept of Pediatrics.Am J Health Educ. 2011 Jul ;42(4):205-212.Also available :http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3251629/
(4) . Van Heerden AC, Norris SA, Richter LM. Using mobile phones for adolescent research in low and middle income countries: preliminary findings from the birth to twenty cohort, South Africa. J Adolesc Health. Mar;46(3):302-4.
( 5). Adolescent Health; April 23, 2012; http://www.cdc.gov/features/adolescenthealth/?mobile=nocontent « Less
(6). Levine D, McCright J, Dobkin L, Woodruff AJ, Klausner JD. SEXINFO: a sexual health text messaging service for San Francisco youth. Am J Public Health. 2008 Mar;98(3):393-5.