Supporting Contraceptive Decision-Making in the Intermediated Pharmacy Setting in Kenya

Research Background and Issues

• Issues or Challenges: Adolescent girls and young women (AGYW) in sub-Saharan Africa lack contraceptive decision-support resources tailored to their needs. In Kenya, this demographic faces sociocultural barriers, financial constraints, privacy concerns, and limited health literacy when accessing contraceptive services. Although pharmacies are a key avenue for AGYW to obtain contraceptive products, the quality of counseling provided in these settings is often inadequate.
• Significance: Studies show that unmarried young women and adolescents without access to modern contraceptive methods have a high rate of unintended pregnancies. Failure to address these challenges may lead to adverse health and socioeconomic outcomes, particularly in impoverished and resource-constrained environments. This research aims to improve AGYW's reproductive health outcomes by enhancing contraceptive decision support.
• Research Motivation: Pharmacies are preferred by AGYW for contraceptive services due to their lower privacy exposure risk and convenience. However, existing pharmacy counseling fails to meet the needs of this population. Additionally, most AGYW lack educational tools that align with their actual needs and preferences regarding contraception.

Solution

• Method or Solution: The research team developed a tablet-based application called Mara Divas, designed to provide contraceptive education and decision support for AGYW in Kenyan pharmacy settings. Through human-computer interaction design, the app integrates audio, video, and text content to help users understand information about various contraceptive methods while recording their preferences for contraceptive features.
• Innovations:
  • Applied the theory of "Intermediated Interaction" to pharmacy scenarios, identifying the critical role of pharmacists in facilitating technology use and information dissemination.
  • Designed a personalized contraceptive education tool focused on the needs of young women rather than simply offering a single recommended method.
  • Developed multilingual support (including voice options) and an intuitive interface for users with low digital skills or literacy levels.
• Implementation Steps and Technology:
  1. Developed the Android tablet application using the Flutter framework.
  2. Content centered on AGYW concerns, such as side effects, privacy, and long-term bodily impacts.
  3. Tablets placed in private consultation rooms within pharmacies, with headphones provided for user convenience.
  4. Users answer questionnaires to identify their contraceptive preferences and make choices based on app recommendations.
  5. Role of pharmacists:
     • Assist users in understanding app content (especially for those unfamiliar with technology).
     • Address follow-up questions and provide further explanations.

Research Outcomes

• Specific Outcomes:
  • Completed the initial design and development of the Mara Divas application, gathering feedback from users and pharmacy staff through workshops in Kisumu County, Kenya.
  • The app content received widespread approval from AGYW and pharmacists, with video content (featuring peer and professional testimonials) fostering trust and engagement among users.
  • Findings suggest that such applications have potential value in addressing decision-support gaps within pharmacy environments.
• Advantages Over Existing Solutions:
  • Emphasized human-centered design principles, taking into account the digital, linguistic, and health knowledge differences across AGYW age groups.
  • Provided an equitable solution for accessing information, particularly for users unable to independently access smartphones or reliable contraceptive information.
  • The "intermediated" model, supported by pharmacists, extended the app's reach to low-skill and low-information-access populations.
• Experiments or Evaluations:
  • Workshop feedback indicated that younger AGYW significantly benefited from the video and voice features, while older AGYW particularly valued the app's contraceptive decision-support functions.
  • Pharmacists noted that the app systematically addressed common questions from AGYW, enhancing the efficiency of counseling services.
• Limitations and Future Directions:
  • Limitations:
    • The app is currently limited to pilot studies in one county in Kenya, which may not ensure nationwide applicability or meet diverse needs in other countries.
    • Features targeting young men or educating male populations have not been included, restricting the app's potential to disseminate contraceptive information to broader audiences.
  • Future Directions:
    • Test the app's effectiveness in other regions and contexts.
    • Explore expanding the app to additional settings beyond pharmacies, such as community health centers.
    • Consider incorporating male contraceptive education content and promoting greater male involvement in contraceptive decision-making.