With the current proliferation of technology, researchers see the use of mobile health (mHealth) as a vital tool in reaching adolescents and facilitating behavior change among this population. mHealth can be described as a subcategory of electronic health (eHealth), specifically delivered on mobile and wireless technologies to support interventions. The use of mHealth has shown to be promising in addressing several barriers that impact the sexual and reproductive health of young people.
With an increase in smartphone usage globally, mHealth can benefit young people as it capitalizes on a familiar medium and mode of communication. mHealth via mobile phones is a particularly salient approach in sub-Saharan Africa, as mobile phone ownership among adolescents is 77% and internet penetration is high in many countries.
Dhakwa et al. assessed the effectiveness of mHealth in improving the linkage to reproductive health and HIV services as well as the turnaround time for referral completions among adolescent girls and young women (AGYW) in Zimbabwe. AGYW were enrolled through the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) program and had automatic reminders sent to their phones to facilitate access to services through text messages and a paper-based system.
The study observed 8,800 AGYW aged 10–19 years, with 4,355 referred through mHealth and 4,445 through the paper-based system. Dhakwa et al. found that over 95% of AGYW referred through mHealth completed referrals, compared to 87.8% that were referred through the paper-based system. The median for referral completion time was 1 day for mHealth and 11 days for the paper-based system. AGYW referred by mHealth were almost 18 times more likely to complete their referral compared to those referred by the paper-based system. The study concluded that the utilization of mHealth is beneficial in increasing the uptake of reproductive health and HIV services and reducing the referral completion time for AGYW in Zimbabwe.
In Nigeria, the use of mHealth was examined as an intervention to improve Antiretroviral Treatment (ART) adherence for adolescents and young adults living with HIV (AYALWH). Ahonkhai et al. used the Integrate, Design, Assess and Share (IDEAS) framework to develop the mHealth application, PeerNaija. As part of the IDEAS framework, a comprehensive development process was conducted which included targeting specific behavior via behavioral theory, prototyping, and direct engagement and feedback from AYALWH. To address common barriers to ART adherence such as forgetting to take ART, poor executive functioning, poor social support, and the indirect cost of clinic-based interventions, the PeerNaija application highlighted the social and peer-based nature of its features. Key features include reminders to take medication, ability to record doses taken, a chat-based social feature, and several gamification features and mechanics, including points, progress feedback, leaderboards, badges, and avatars. The gamification features further encourage adolescents to engage with the app while positively changing their behaviors through setting goals, building the capacity to overcome challenges, giving feedback, and comparing their progress. PeerNaija also stands as a mobile personal health record application that shares data with the OpenMRS electronic health record application used in Nigeria. Though PeerNaija is currently undergoing formal implementation and evaluation, theory based mHealth applications that utilize social incentives have the potential of improving adherence to ART for AYALWH in Nigeria.
Much success has been seen in the utilization of mHealth in South Africa, as it stands as a driver in the increase of universal health coverage.
Guest Editorial