Effectiveness of web-based education on Kenyan and Brazilian adolescents' knowledge about HIV/AIDS, abortion law, and emergency contraception: findings from TeenWeb.

Little evidence is available about the utility of web-based health education for students in low resource settings. This paper reports results from an evaluation of the TeenWeb project, a multi-year, web-based health education intervention implemented in two urban settings: Nairobi, Kenya (N=1178 school students) and Rio de Janeiro, Brazil (N=714 school students). A quasi-experimental, school-based pre-test/post-test design was implemented at each study site to determine if easy access to web-based reproductive health information, combined with intellectual "priming" about reproductive health topics, would result in improved knowledge and attitudes about topics such as condom use, access to HIV testing, emergency contraception and abortion laws. Students in web-access schools completed one web-based module approximately every 6-8 weeks, and in return, had access to the Internet for at least 30 min after completing each module. Although students were encouraged to access project-supplied web-based health information, freedom of web navigation was an incentive, so they could choose to access other Internet content instead. Most measures showed statistically significant differences between students in "web" and "comparison" conditions at post-test, but only about half of the differences were in the hypothesized direction. Results of an embedded experiment employing more directed feedback tripled the likelihood of correctly reporting the duration of emergency contraception effectiveness. Review of URL logs suggests that the modest results were due to inadequate exposure to educational materials. Future intervention should focus on teen's purposeful searching for health information when they are in personal circumstances of unmet health needs.

Franchising reproductive health services.

OBJECTIVES: Networks of franchised health establishments, providing a standardized set of services, are being implemented in developing countries. This article examines associations between franchise membership and family planning and reproductive health outcomes for both the member provider and the client. METHODS: Regression models are fitted examining associations between franchise membership and family planning and reproductive health outcomes at the service provider and client levels in three settings. RESULTS: Franchising has a positive association with both general and family planning client volumes, and the number of family planning brands available. Similar associations with franchise membership are not found for reproductive health service outcomes. In some settings, client satisfaction is higher at franchised than other types of health establishments, although the association between franchise membership and client outcomes varies across the settings. CONCLUSIONS: Franchise membership has apparent benefits for both the provider and the client, providing an opportunity to expand access to reproductive health services, although greater attention is needed to shift the focus from family planning to a broader reproductive health context.