“I am not shy anymore”: A qualitative study of the role of an interactive mHealth intervention on sexual health knowledge, attitudes, and behaviors of South African adolescents with perinatal HIV

Abstract

Background South Africa has one of the highest burdens of adolescents with perinatally-acquired HIV (APHIV) in the world. APHIV in South Africa have limited access to sexual and reproductive health (SRH) education and services specific to their HIV status. When lacking comprehensive SRH education, APHIV are prone to sexual risk behaviors that can lead to unintended pregnancy, sexually transmitted infections, and HIV transmission. The use of mHealth interventions has been shown to deliver information, foster social support, and improve decision-making skills. In this study, we evaluate how an mHealth intervention influences sexual health knowledge and behaviors in APHIV. Methods We purposively enrolled adolescents from the intervention arm of a randomized clinical trial assessing a multi-module, moderated WhatsApp-based intervention—Interactive Transition Support for Adolescents Living with HIV (InTSHA)—within a government supported clinic in KwaMashu, an urban township of KwaZulu-Natal, South Africa. We conducted in-depth interviews based on World Health Organization guidelines for asking adolescents about SRH. We thematically analyzed data through an iterative, team-based coding approach combining deductive and inductive elements to contextualize SRH attitudes, knowledge, and behaviors before and after receiving the InTSHA intervention. Results Of the 21 participants, 13 (61.9%) were female and the mean age was 16.6 years. Most participants reported first learning about SRH as young teenagers in school through non-targeted and negative ways, seeking clarification through peers and the internet rather than clinicians or caregivers. Participants reported that InTSHA provided a holistic perspective on relationships, gender, and sexuality specific to growing up with HIV in South Africa. They praised the ability to give and receive information from peers in a moderated setting through the mHealth intervention, building their confidence, decision-making skills, and communication with partners and caregivers throughout their everyday lives. Despite reporting some technological challenges, adolescents agreed that InTSHA was convenient, confidential, and user-friendly. Conclusions South African APHIV receive incomplete and conflicting sexual education from peers, caregivers, teachers, and technology that can be supplemented by mHealth curricula targeted for the unique needs of APHIV. Future, scaled-up mHealth interventions can lower SRH stigma by expanding access to sexual education and peer support, supplementing adolescents’ existing SRH education.

A qualitative assessment of the impact of a community-embedded intervention on beneficiaries' attitudes and beliefs about adolescent sexual reproductive health in Ebonyi State, Southeast, Nigeria

“…The finding is comparable to the result from an evaluation study in the United States of America which reported a significant increase in the number of adolescents who approached their parents for discussions on different aspects of SRH, following a community-based SRH intervention [ 33 ]. The finding that adolescents are now more confident to engage their peers on SRH issues openly without fear of being stigmatized is similar to results from Northern Nigeria and South Africa [ 34 , 35 ].…”

Suicide Among Rural Primary School Learners in Zimbabwe: An Epidemic in Need of Mitigation

“…From the above submissions, some learners in rural areas have committed suicide due to poverty. Poverty can have a profound impact on individuals and communities, including rural learners, and can contribute to increased rates of suicide (Bergam et al, 2022). In Zimbabwe rural areas such as Mahoto rural area where this study.…”

Are mHealth Interventions Effective in Improving the Uptake of Sexual and Reproductive Health Services among Adolescents? A Scoping Review

“…Although no significant differences in treatment retention were observed between the two sample groups, results showed that the intervention group performed significantly better in HIV knowledge than the control group at the endline. In an urban township in KwaZulu-Natal, South Africa, the InTSHA intervention, a WhatsApp-based programme developed to influence SRH knowledge among adolescents with perinatally acquired HIV, has also shown favourable results [21]. Qualitative interviews with participants aged 15 to 19 who received the Interactive Transition Support for Adolescents Living with HIV (InTSHA) intervention revealed positive feedback on the programme.…”