Frances H Ampt, MPH,#1,2 Kelly L’Engle, PhD,#3 Megan S C Lim, PhD,1,2 Kate F Plourde, MPH,4 Emily Mangone, MSc,5 Collins Mudogo Mukanya, MA,6 Peter Gichangi, PhD,7,8,9 Griffins Manguro, MPH,9 Margaret Hellard, PhD,1,10 Mark Stoové, PhD,1,2 Matthew F Chersich, PhD,8,11 Walter Jaoko, PhD,12 Paul A Agius, MSc,1,2 Marleen Temmerman, PhD,8,9,13 Winnie Wangari, BA,9 and Stanley Luchters, PhD1,2,8,13
Affiliations
1 Burnet Institute, Melbourne, Australia
2 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
3 University of San Francisco, San Francisco, CA, United States
4 FHI 360, Durham, NC, United States
5 School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
6 mHealth Kenya, Nairobi, Kenya
7 Technical University of Mombasa, Mombasa, Kenya
8 Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent University, Ghent, Belgium
9 International Centre for Reproductive Health, Mombasa, Kenya
10 Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia
11 Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
12 University of Nairobi, Nairobi, Kenya
13 Aga Khan University, Nairobi, Kenya
Frances H Ampt, Burnet Institute, 85 Commercial Rd, Melbourne, 3004, Australia, Phone: 61 2 9282 2111, Email: ua.ude.tenrub@tpma.secnarf.
Abstract
Background
Female sex workers (FSWs) have high rates of both unintended pregnancy and HIV, but few health promotion interventions address their contraceptive needs or other sexual and reproductive health and rights (SRHR) concerns. A broader approach integrates contraceptive promotion with HIV and sexually transmitted infection (STI) prevention and management, alcohol awareness, gender-based violence and rights, and health care utilization. The Women’s Health Intervention using SMS for Preventing Pregnancy (WHISPER) mobile phone intervention uses a participatory development approach and behavior change theory to address these high-priority concerns of FSWs in Mombasa, Kenya.
Objective
This paper aimed to (1) describe the process of development of the WHISPER intervention, its theoretical framework, key content domains and strategies and (2) explore workshop participants’ responses to the proposed intervention, particularly with regard to message content, behavior change constructs, and feasibility and acceptability.
Methods
The research team worked closely with FSWs in two phases of intervention development. First, we drafted content for three different types of messages based on a review of the literature and behavior change theories. Second, we piloted the intervention by conducting six workshops with 42 FSWs to test and refine message content and 12 interviews to assess the technical performance of the intervention. Workshop data were thematically analyzed using a mixed deductive and inductive approach.
Results
The intervention framework specified six SRHR domains that were viewed as highly relevant by FSWs. Reactions to intervention content revealed that social cognitive strategies to improve knowledge, outcome expectations, skills, and self-efficacy resonated well with workshop participants. Participants found the content empowering, and most said they would share the messages with others. The refined intervention was a 12-month SMS program consisting of informational and motivational messages, role model stories portraying behavior change among FSWs, and on-demand contraceptive information.
Conclusions
Our results highlight the need for health promotion interventions that incorporate broader components of SRHR, not only HIV prevention. Using a theory-based, participatory approach, we developed a digital health intervention that reflects the complex reality of FSWs’ lives and provides a feasible, acceptable approach for addressing SRHR concerns and needs. FSWs may benefit from health promotion interventions that provide relevant, actionable, and engaging content to support behavior change.
Keywords: sex work, mobile health (mHealth), unintended pregnancy, qualitative research
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