A Smartphone Game to Prevent HIV Among Young Africans (Tumaini): Assessing Intervention and Study Acceptability Among Adolescents and Their Parents in a Randomized Controlled Trial

Sabben, Gaëlle; Mudhune, Victor; Ondenge, Ken; Odero, Isdorah; Ndivo, Richard; Akelo, Victor; Winskell, Kate

doi:10.2196/13049

Cited by 34 publications

(33 citation statements)

References 26 publications

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“…Few feasibility studies investigate feasibility of methodology for DGBL effectiveness evaluation. Sabben et al (2019) tested the feasibility of a study aimed towards the effectiveness assessment of a smartphone game to prevent HIV among youngsters in Kenya. Their study focused on the acceptability of study aspects among adolescents (i.e., the target group of the game) and their parents by means of gameplay log files, a questionnaire and focus groups.…”

Section: Feasibility Studiesmentioning

confidence: 99%

Digital Game-Based Learning effectiveness assessment: Reflections on study design

All

Castellar

Looy

2021

Computers & Education

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Despite efforts for defining best practices for assessing Digital Game-Based Learning (DGBL) effectiveness, lack of scientific rigor is yet to be established. This has led to academics and educational practitioners doubting the quality of evidence and practical value of scientific research in educational settings. Hence, the present manuscript aims to test the feasibility of previously defined best practices by means of 3 feasibility studies: one in formal, one in health and one in corporate education. Results firstly show a more nuanced view on previously defined best practices regarding control groups: a) inclusion of an educational activity is not always desirable and depends on whether absolute or relative effectiveness is assessed and b) keeping instructional time equal in experimental and control group does not comply with the time efficiency outcome of DGBL. Secondly, several non-intervention related elements jeopardizing internal validity have been established: a) failed randomization, which can be tackled with blocked randomization and b) pre-test effects, which can be tackled with carefully piloted parallel versions of tests. Lastly, additional indicators for motivational and efficiency outcomes in a selfpaced distance learning context have been established: a) motivation during/after the training should be expanded with motivation to start playing and b) time required to finish the training should be expended with time required to follow-up on learners. Recommendations in the present manuscript are not exhaustive or generalizable to all contexts, but do provide preliminary insights into feasible experimental designs for DGBL effectiveness studies.

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Section: Feasibility Studiesmentioning

confidence: 99%

Digital Game-Based Learning effectiveness assessment: Reflections on study design

All

Castellar

Looy

2021

Computers & Education

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“…While young people remain the most connected population group to digital platforms(87), there is a clear digital divide, as more than 60% of young adults in Africa do not have access to internet (88, 89). Findings of this review show overall high acceptability of e-Health interventions (34, 50), as adolescents highlighted opportunities presented by digital technology, for example by reducing the cost of in-person interaction (53). Yet concerns raised around connectivity issues, lack of access to devices and unintended disclosure of confidential information (53, 73) represent challenges for the acceptability, equitable access and effectiveness of e-Health programs.…”

Section: Discussionmentioning

confidence: 91%

“…Parker et al (2013) (42) defined acceptability as how the intended individual recipients react to a program, guided by the Bowen feasibility framework (57). A further two studies conceptualized acceptability as an implementation outcome and focused on value, appeal and likeability: Kibel et al (2019)(58) referred to the perception among stakeholders that a certain element of the program was valued, agreeable, or satisfactory, while Sabben et al (2019)(34) defined acceptability as appeal, relevance, value, usability, and understandability, based on the Technology Acceptance Model’s (TAM) framework (59).…”

Section: Resultsmentioning

confidence: 99%

“…These are presented in Table 1, by type of intervention, for studies with both low and high overall acceptability. The main reasons e-Health interventions were acceptable to adolescents were: knowledge gained from the intervention regarding their sexual health (34, 65), the privacy these interventions provided (23, 48) and knowing how to make use of the intervention (25, 34). Adolescents who instead did not find these interventions acceptable felt that the content was not culturally appropriate (23, 25, 65), highlighted technological glitches (48, 50, 65) or were concerned with inclusiveness where, for example, not all the young adults had access to a necessary device or risked unintended disclosure of private information when sharing devices (65, 73).…”

Section: Resultsmentioning

confidence: 99%

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A decade of Acceptability Research with Adolescents in Africa: Systematic review and evidence map

Somefun

Casale

Hauptronnie

et al. 2021

Preprint

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Interventions aimed at improving adolescent developmental outcomes are more likely to be successful if the young people they target find them acceptable. However, no standard definitions or indicators exist to assess acceptability, acceptability research with adolescents in LMICs is still limited, and no known reviews synthesise the evidence from Africa.We conducted a systematic review of peer-reviewed studies assessing intervention acceptability with young adults (aged 10-24) in Africa, published between January 2010 and June 2020. This paper maps and qualitatively synthesizes the scope, characteristics, and findings of these studies, including definitions of acceptability, methods used, the type and objectives of interventions assessed, and overall findings on adolescent acceptability.The review was carried out in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Key word searches generated 4692 unique records and 55 final eligible studies, assessing 60 interventions. Most studies were conducted in Southern Africa, of which 32 jointly in South Africa and Uganda. The majority of interventions assessed for acceptability could be classified as HIV or HPV vaccine interventions (10), E-health (10), HIV testing interventions (8), support group interventions (7) and contraceptive interventions (6). The objectives of most interventions were linked to SDG3, specifically to HIV and sexual and reproductive health. Acceptability was overall high among these published studies. 22 studies provided reasons for acceptability or lack thereof, some specific to particular types of interventions and others common across intervention types.Our review exposes considerable scope for future acceptability research and review work. This should include: extending acceptability research beyond the health (and particularly HIV) sector and to regions in Africa where this type of research is still scarce; including adolescents earlier, and potentially throughout the intervention process; further conceptualising the construct of acceptability among adolescents and beyond, and examining the relationship between acceptability and uptake.Key QuestionsWhat is already known?Addressing the developmental needs of adolescents in African countries is critical if the continent is to achieve its sustainable development goals (SDGs).Many interventions aimed at strengthening adolescent developmental outcomes have not achieved desired impact, and adolescent involvement is often poorly envisaged and implemented.Uptake and effectiveness of interventions is likely to be higher if these interventions are acceptable to adolescent end-users.What are the new findings?Acceptability of interventions assessed in Africa was generally high among adolescents.Understanding of the intervention, ease of use, adequate emotional support, autonomy, confidentiality and protection from stigma were key overarching themes explaining why young people found interventions acceptableWhat do the new findings imply?Intervention developers and implementers across the continent should pay attention to these key aspects of interventions and their delivery.It is important to strengthen adolescents’ understanding of interventions, involve adolescents early on in intervention development, and engage with the broader context within which adolescent acceptability is shaped.There is a need for more acceptability research in important areas for adolescent development beyond (physical) health and, within the health sector, beyond HIV.

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“…Higher levels of engagement were associated with higher knowledge scores up to a year later. Participants in the intervention group who were sexually active reported lower odds of self-reported pregnancy from baseline to 15 months Winskell et al 2018 [ 33 ]; Sabben et al 2019 [ 44 ] Country: Kenya Setting: Community-based (participants were recruited from schools) Study design: RCT Sample size: 60 participants (30 participants in the intervention group and 30 participants in the control group) Gender: Males and Females Age: 11–14 years The determine the influence of the intervention on increased age of sexual debut and condom use at sexual debut Intervention group: participants received Tumaini, a narrative-based game for android smartphones. The game comprisesapproximately 12 h of discrete gameplay and is designed to be replayed so that players can observe the outcomes of the different decisions.…”

Section: Resultsmentioning

confidence: 99%

Mobile health interventions for HIV/STI prevention among youth in low- and middle-income countries (LMICs): a systematic review of studies reporting implementation outcomes

Nwaozuru

Obiezu-Umeh

Shato

et al. 2021

Implement Sci Commun

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Background Advances and proliferation of technologies such as mobile phones may provide opportunities to improve access to HIV/STI services and reach young people with high risk for HIV and STI. However, the reach, uptake, and sustainability of mobile health (mHealth) HIV/STI interventions targeting young people aged 10–24 years in low- and middle-income countries (LMICs) are largely unknown. To address this gap and to inform implementation science research, a review was conducted to summarize what is known, and what we need to know about implementing mhealth interventions for HIV/STI prevention targeting young people in LMICs. Methods We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for this review. Drawing upon Proctor’s eight implementation outcome measures, we evaluated the acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability of m-health HIV/STI interventions targeting young people in LMICs. The search was performed from September 2020–January 2021 and updated on March 1, 2021, in Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, SCOPUS, Global Health, and Web of Science. Eligible studies were required to include an HIV/STI prevention outcome, target young people aged 10–24 years, include a comparison/control group, and reporting of atleast one implementation outcome as outlined by Proctor. Results A total of 1386 articles were located, and their titles and abstracts were screened. Of these, 57 full-text articles were reviewed and subsequently, and 11 articles representing 6 unique interventions were included in the systematic review. Acceptability 6 (100%), appropriateness 6 (100%), and feasibility 5(83%) were the most frequently evaluated implementation outcomes. Adoption 2 (33%), fidelity 1 (17%), and cost 1 (17%) were rarely reported; penetration and sustainability were not reported. Conclusions This review contributes to implementation science literature by synthesizing key implementation outcomes of mHealth HIV/STI interventions targeting young people in LMICs. Future research is needed on m-health HIV/STI implementation outcomes, particularly the penetration, cost, and long-term sustainability of these interventions. Doing so will enhance the field’s understanding of the mechanisms by which these interventions lead or do not lead to changes in high HIV/STI risk and vulnerability among young people in LMICs.

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A Smartphone Game to Prevent HIV Among Young Africans (Tumaini): Assessing Intervention and Study Acceptability Among Adolescents and Their Parents in a Randomized Controlled Trial

Cited by 34 publications

References 26 publications

Digital Game-Based Learning effectiveness assessment: Reflections on study design

Digital Game-Based Learning effectiveness assessment: Reflections on study design

A decade of Acceptability Research with Adolescents in Africa: Systematic review and evidence map

Mobile health interventions for HIV/STI prevention among youth in low- and middle-income countries (LMICs): a systematic review of studies reporting implementation outcomes

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