The ARMADILLO text message intervention to improve the sexual and reproductive health knowledge of adolescents in Peru: Results of a randomized controlled trial.

BACKGROUND: The ARMADILLO Study determined whether adolescents able to access SRH information on-demand via SMS were better able to reject contraception-related myths and misconceptions as compared with adolescents receiving pushed SMS or no intervention. TRIAL DESIGN: This trial was an unblinded, three-arm, parallel-group, individual RCT with a 1:1:1 allocation. Trial registration: ISRCTN85156148. METHODS: This study was conducted in Lima, Peru among participants ages 13-17 years. Eligible participants were randomized into one of three arms: Arm 1: access to ARMADILLO's SMS information on-demand; Arm 2 access to ARMADILLO SMS information pushed to their phone; Arm 3 control (no SMS). The intervention period lasted seven weeks. At baseline, endline, and follow-up (eight weeks following endline), participants were assessed on a variety of contraception-related myths and misconceptions. An index of myths-believed was generated. The primary outcome assessed the subject-specific change in the mean score between baseline and endline. Knowledge retention from endline to follow-up was also assessed, as was a 'content exposure' outcome, which assessed change in participants' knowledge based on relevant SMS received. RESULTS: In total, 712 participants were randomized to the three arms: 659 completed an endline assessment and were included in the primary analysis. Arm 2 participants believed fewer myths at endline compared with control arm participants (estimated subject-specific mean difference of -3.69% [-6.17%, -1.21%], p = 0.004). There was no significant difference between participants in Arm 1 vs. the control Arm, or between participants in Arm 1 vs. Arm 2. A further decrease in myths believed between endline and follow-up (knowledge retention) was observed in all arms; however, there was no difference between arms. The content exposure analysis saw significant reductions in myths believed for Arm 1 (estimated subject-specific mean difference of -9.47% [-14.83%, -4.11%], p = .001) and Arm 2 (-5.93% [-8.57%, -3.29%], p < .001) as compared with the control arm; however Arm 1's reduced sample size (n = 28) is a severe limitation. DISCUSSION: The ARMADILLO SMS content has a significant (but small) effect on participants' contraception-related knowledge. Standalone, adolescent SRH digital health interventions may affect only modest change. Instead, digital is probably best used a complementary channel to expand the reach of existing validated SRH information and service programs.

Our world through our eyes: adolescents use photovoice to speak their mind on adolescent health, well-being, and sexuality in Lima, Peru.

Peru's approach to its 5.7 million 10- to 19-year-olds has shifted toward positive youth development. Following that trend, our objective was to facilitate Peruvian adolescents' use of photovoice to better understand the factors affecting their health, well-being, and sexuality and to work with adolescents to present policy and programmatic recommendations. Photovoice sessions were carried out with low-income 12- to 16-year-olds (n = 13) from Lima. Sessions included basic photography and ethics, photo taking, and descriptions and discussions using the SHOWeD (What do you See here? What is really Happening? How does this relate to Our lives? Why does this problem or strength exist? What can we Do about it?) method. Participants grouped their photos into a "photo story." Each section of the story consisted of a message and 4 to 10 photos. Each photo had a caption that answered the SHOWeD questions. Messages were (a) "health and well-being in danger of extinction," (b) "with some signs of hope," (c) "innocence in spite of everything," (d) "what we as adolescents have," and (e) "but we lack opportunities to live a better life and a responsible sexuality." Participants presented the photo story to program planners, policy makers, and community members. Results underscore the value of including adolescents in program and policy planning and affirm that photovoice can achieve such inclusion. Photovoice provides a concrete method for adolescents to speak their mind through image and word.