Evidence brief: Co-producing access to care with young people living in Zambia through digital and vending machine-enabled innovation in sexual and reproductive health: A place-based, human-centred design research approach

Abstract

Digital health innovation can fail to move beyond prototype or pilot stages or achieve intended outcomes due to a lack of involvement and attunement to local context. This article shares the potential of place-based co-production to support the development, acceptability and usability of context-attuned, digital health service innovation for young people. To illustrate the approach, we report on a collaborative, interdisciplinary project involving a Zambian public health research partner based in Lusaka, Zambia, three European universities and a not-for-profit digital innovation partner. Our youth-led, co-production process involved 6 stages: recruitment of youth Co-design Leaders; role play-based care pathway co-design; app co-design; digital prototype development; stakeholder consultation; and digital pathway testing. We used a combination of qualitative social science research, community and arts-based, human-centred design and digital innovation methods. Young people traced the digital testing and sampling process from accessing self-testing and sampling kits to laboratory processing of results through to how results should be communicated. They were encouraged to evaluate how these processes would work in the context of their everyday lives. We systematically embedded this ideation work into a technically functional ‘eHealth Yabwela’ app and clinical or laboratory worker-facing web application which young people user tested. Our place-based focus encouraged elicitation of whole pathway, in situ, logistical feasibility alongside social and technical concerns, enabling us to engage with potential adoption and accessibility barriers during the design process. Youth-led co-production created the conditions for participants to lead discussions, voice requirements and hold the project team accountable. Young people recognised that advocacy, overcoming digital inequalities, and further co-production with healthcare workers already facilitating youth-friendly healthcare provision would be needed to integrate the pathway within local systems.

1. Introduction

Globally, uptake of HIV and STI testing among young people in conventional clinical settings remains suboptimal [1]. This is an issue because knowing HIV status contributes to prevention of onwards transmission and can be a first step in accessing treatment [2]. Curable sexually transmitted infections (STIs) can cause serious morbidity, including pregnancy complications and infertility, and are well-recognised risk factors for HIV transmission [3]. There is also strong synergy between STIs and HIV, especially in young people, in whom high rates of untreated STIs may help explain high HIV incidence [4]. Women and girls are disproportionately affected by these issues, which along with lack of access to birth control, can hold consequences for their social and economic wellbeing across the lifecourse [5,6]. In 2022 the World Health Organization (WHO) described access to sexual health services for adolescents as “lagging behind the progress achieved for adults” [1]. Young people in sub-Saharan Africa experience social, economic and political barriers to accessing mainstream sexual and reproductive health (SRH) services [7]. Many say they feel judged or else are discriminated against when they attend health facilities seeking support with STIs, HIV testing and contraception [8–10]. On this basis, global health policy guidelines call for integrated, person-centred responses that simultaneously address stigma and discrimination [11].