A mixed methods investigation of implementation barriers and facilitators to a daily mobile phone sexual risk assessment for young women in Soweto, South Africa

Background: Accurate self-report of sexual behavior assists in identifying potential HIV exposure in HIV prevention trials. Brief mobile phone assessments, completed daily or after sexual activity, can improve the validity and reliability of self-reported sexual behavior and allow for remote survey completion outside of the clinic setting. We conducted a qualitative study to better understand participants mobile phone use and to explore their perspectives on how to improve an existing mobile application-based sexual risk assessment.Methods: Sexually active, HIV seronegative men (n = 14) and women (n = 15) aged 18–39 years were recruited through an HIV counseling and testing clinic and community outreach in Soweto, South Africa. We conducted qualitative research through four age-stratified focus group discussions (FGDs) and analyzed a brief socio-demographics and mobile phone access questionnaire. All participants completed a sexual risk assessment before the FGD. Using a framework analytic approach, data were coded with Nvivo software.Results: All participants had access to mobile phones and internet, and 27 (93.1%) were able to download applications on their personal phones. Participants preferred mobile risk assessments to be offered in a choice of South African languages, using formal language (as opposed to emojis), with straight-forward wording and limited to five to 10 questions. Most participants found it acceptable to complete the assessment once a week, on a weekday, while a few were willing to complete it after each sexual encounter. It was suggested that a message reminder to complete the assessment should be sent at least daily until it is completed. The majority agreed that a password-protected application with a discreet logo was ideal for privacy, ease of use and flexibility for completion in any setting. A concern with this format, however, was the potential data use requirement. Participants expressed privacy concerns with using SMS, WhatsApp and other social media for risk assessments. Most agreed on an airtime incentive between ZAR5-10 (USD 0.29–0.58) per survey. Participants encouraged researchers to provide feedback to them about their sexual risk.Conclusions: Completion of mobile phone sexual risk assessments can be optimized with minimal incentives by ensuring that questionnaires are simple, brief, infrequent and have trusted privacy measures.

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Material deprivation and sexual risk nexus among young people in urban disadvantaged settings in Malawi and South Africa

10.21203/rs.2.14855/v1 ◽

2019 ◽

Author(s):

Mphatso Kamndaya

Keyword(s):

South Africa ◽

Young People ◽

Sexual Risk ◽

Young Women ◽

Risk Taking ◽

Mixed Methods Research ◽

Young Men ◽

Material Deprivation ◽

Sub Saharan Africa ◽

Sexual Risk Taking

Abstract Objective: Understanding how context-specific measures of urban disadvantage are associated with sexual risk is critical to the refinement of effective HIV prevention interventions in urban disadvantaged settings in sub-Saharan Africa . This study describes how a mixed methods research design was used to get a more nuanced understanding of young people’s experience of material deprivation and their motivation for sexual risk-taking in urban disadvantaged settings. The study involved secondary analysis of data (n=560) from South Africa, primary qualitative study with 60 young people and household survey (n = 1,071) in Malawi. Legitimation strategies were used to identify inferences from the findings. Material deprivation characteristics that explained the most variance in sexual risk were determined by using logged coefficients multiplied by their standard deviations. Results: In South Africa, financial difficulty (0.16 = (log 2.11)*(0.50)) exerted the strongest effects on sexual risk followed by deprivation (0.10 = (log 1.43)*(0.66)) among young women, while for young men, material deprivation (0.04 = (log 1.20)*(0.50)) showed significant effects on sexual risk-taking. However in Malawi, material deprivation (0.08 = (log 1.37)*(0.58)) and unemployment (0.12 = (log 1.77)*(0.50)) were the most influential indicators of deprivation associated with coercive sex among young women and young men respectively.

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Contextualised strategies to increase childhood and adolescent vaccination coverage in South Africa: a mixed-methods study

BMJ Open ◽

10.1136/bmjopen-2018-028476 ◽

2020 ◽

Vol 10 (6) ◽

pp. e028476

Author(s):

Charles Shey Wiysonge ◽

Phetole Walter Mahasha ◽

Duduzile Edith Ndwandwe ◽

Ntombenhle Ngcobo ◽

Karen Grimmer ◽

...

Keyword(s):

South Africa ◽

Mixed Methods ◽

Vaccination Coverage ◽

Phase 1 ◽

Barriers And Facilitators ◽

Phase 2 ◽

Immunisation Coverage ◽

Online Questionnaire ◽

Phase 3 ◽

Adolescent Vaccination

IntroductionDespite the unparalleled success of immunisation in the control of vaccine preventable diseases, immunisation coverage in South Africa remains suboptimal. While many evidence-based interventions have successfully improved vaccination coverage in other countries, they are not necessarily appropriate to the immunisation needs, barriers and facilitators of South Africa. The aim of this research is to investigate barriers and facilitators to optimal vaccination uptake, and develop contextualised strategies and implementation plans to increase childhood and adolescent vaccination coverage in South Africa.MethodsThe study will employ a mixed-methods research design. It will be conducted over three iterative phases and use the Adopt, Contextualise or Adapt (ACA) model as an overarching conceptual framework. Phase 1 will identify, and develop a sampling frame of, immunisation stakeholders involved in the design, planning and implementation of childhood and human papillomavirus immunisation programmes in South Africa. Phase 2 will identify the main barriers and facilitators to, and solutions for, increasing vaccination coverage. This phase will comprise exploratory qualitative research with stakeholders and a review of existing systematic reviews on interventions for improving vaccination coverage. Using the findings from Phase 2 and the ACA model, Phase 3 will develop a set of proposed interventions and implementation action plans for improving immunisation coverage in South Africa. These plans will be discussed, revised and finalised through a series of participatory stakeholder workshops and an online questionnaire, conducted as part of Phase 3.EthicsEthical approval was obtained from the South African Medical Research Council (EC018-11/2018). No risks to participants are expected. Various steps will be taken to ensure the anonymity and confidentiality of participants.DisseminationThe study findings will be shared at stakeholder workshops, the website of Cochrane South Africa and academic publications and conferences.

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Pre-Implementation Barriers and Facilitators of an mHealth ART Adherence Counselling Intervention: Perspectives of NPO staff in South Africa (Preprint)

10.2196/preprints.23280 ◽

2020 ◽

Author(s):

Siobhan McCreesh-Toselli ◽

John Torline ◽

Hetta Gouse ◽

Reuben N Robbins ◽

Claude A Mellins ◽

...

Keyword(s):

South Africa ◽

Computer Literacy ◽

High Volume ◽

Barriers And Facilitators ◽

Hiv Care ◽

Successful Implementation ◽

Art Adherence ◽

Implementation Barriers ◽

Persons Living With Hiv ◽

Adherence Counselling

BACKGROUND Persons living with HIV (PLWH) in South Africa's expanding antiretroviral treatment (ART) program receive readiness counselling provided by Lay Counsellors (LCs). Both the delivery of content and counselling approach are difficult to standardize across multiple sites and providers. mHealth applications offer an opportunity in low resource settings to address these needs. OBJECTIVE The objective of this study was to explore the perceived pre-implementation barriers and facilitators of an mHealth intervention (“Masivukeni”) among staff at a large Cape Town-based HIV care non-profit organisation. METHODS Seven interviews and three focus groups were conducted with experienced LCs, their supervisors and managers. We used the Consolidated Framework for Implementation Research (CFIR) to explore perceived implementation barriers and facilitators of the Masivukeni intervention. RESULTS Several potential facilitators of the Masivukeni were identified, most notably interactive learning and facilitated updates. Barriers to implementation included security risks and costs of equipment, the high volume of patients needing to be counselled and variable computer literacy. CONCLUSIONS mHealth applications, such as Masivukeni, were perceived as being well-placed to address some needs of those who deliver ART adherence counselling in South Africa. However, the successful implementation of mHealth applications appeared to be dependent- on overcoming certain barriers in this setting.

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