Co-design of a digital health intervention to provide pharmacy-based, person-centered contraceptive decision support for youth in Kenya

Résumé

Adolescent girls and young women (AGYW; age 15-24 years) face intersectional barriers to undesired pregnancy prevention, with profound health consequences. Community pharmacies remain a relatively untapped opportunity to improve the reach and quality of contraceptive care for youth. The purpose of this study was to co-design and prototype a digital health, person-centered contraceptive decision support application (the Mara Divas App) tailored for Kenyan AGYW. We engaged AGYW with recent experience seeking contraception in a pharmacy, and pharmacy providers who dispense contraceptive methods, to participate in full-day human-centered design workshops. The design team analyzed visual artifacts, official written notes, and transcripts to generate insights, which were used by the technical team to modify the prototype between and after workshops. We conducted four co-design workshops among AGYW (n = 33), and pharmacy providers (n = 10). Journey mapping highlighted AGYW anxiety rooted in social stigma throughout their pharmacy experience and limited contraceptive knowledge. Friendly, nonjudgmental providers and respect for privacy were critical to engaging AGYW despite their tendency to avoid interaction and make purchases at "rocket speed." Emergency contraception seekers need a "hook" motivating them to engage with the app, as they have low motivation to engage in contraceptive counseling due to perceived limited options. All content could be engaged in three languages by screen; AGYW switched languages frequently during app use. AGYW preferred video and visual content to text, though audio narration of text was popular. Additional features were added to enhance navigability, which was initially limited among the youngest participants. AGYW desired the app to project a confident, powerful "diva." We used human-centered design approaches to generate key design insights related to engaging youth seeking emergency contraception in pharmacies, overcoming literacy challenges with multilingual audiovisual content, and addressing negative contraceptive beliefs. Future research is needed to study the feasibility and determinants of app implementation.

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