Strengths, Weaknesses, Opportunities, and Threats Analysis of the Use of Digital Health Technologies in Primary Health Care in the Sub-Saharan African Region: Qualitative Study.

BACKGROUND: Digital health technologies (DHTs) have become increasingly commonplace as a means of delivering primary care. While DHTs have been postulated to reduce inequalities, increase access, and strengthen health systems, how the implementation of DHTs has been realized in the sub-Saharan Africa (SSA) health care environment remains inadequately explored. OBJECTIVE: This study aims to capture the multidisciplinary experiences of primary care professionals using DHTs to explore the strengths and weaknesses, as well as opportunities and threats, regarding the implementation and use of DHTs in SSA primary care settings. METHODS: A combination of qualitative approaches was adopted (ie, focus groups and semistructured interviews). Participants were recruited through the African Forum for Primary Care and researchers' contact networks using convenience sampling and included if having experience with digital technologies in primary health care in SSA. Focus and interviews were conducted, respectively, in November 2021 and January-March 2022. Topic guides were used to cover relevant topics in the interviews, using the strengths, weaknesses, opportunities, and threats framework. Transcripts were compiled verbatim and systematically reviewed by 2 independent reviewers using framework analysis to identify emerging themes. The COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist was used to ensure the study met the recommended standards of qualitative data reporting. RESULTS: A total of 33 participants participated in the study (n=13 and n=23 in the interviews and in focus groups, respectively; n=3 participants participated in both). The strengths of using DHTs ranged from improving access to care, supporting the continuity of care, and increasing care satisfaction and trust to greater collaboration, enabling safer decision-making, and hastening progress toward universal health coverage. Weaknesses included poor digital literacy, health inequalities, lack of human resources, inadequate training, lack of basic infrastructure and equipment, and poor coordination when implementing DHTs. DHTs were perceived as an opportunity to improve patient digital literacy, increase equity, promote more patient-centric design in upcoming DHTs, streamline expenditure, and provide a means to learn international best practices. Threats identified include the lack of buy-in from both patients and providers, insufficient human resources and local capacity, inadequate governmental support, overly restrictive regulations, and a lack of focus on cybersecurity and data protection. CONCLUSIONS: The research highlights the complex challenges of implementing DHTs in the SSA context as a fast-moving health delivery modality, as well as the need for multistakeholder involvement. Future research should explore the nuances of these findings across different technologies and settings in the SSA region and implications on health and health care equity, capitalizing on mixed-methods research, including the use of real-world quantitative data to understand patient health needs. The promise of digital health will only be realized when informed by studies that incorporate patient perspective at every stage of the research cycle.

HIV knowledge, risky behaviours and public health care services attendance among adolescents from the Grassroot soccer Zimbabwe programme.

BACKGROUND: Interventions aimed at improving accessing of health care services, including HIV testing, remain a priority in global HIV eradication efforts. Grassroot Soccer Zimbabwe (GRSZ) is an adolescent health organisation that uses the popularity of soccer to promote healthy behaviours. We assessed HIV knowledge levels, risky behaviours and attitudes in school going adolescents and young adults who attended GRSZ programmes and determined if HIV knowledge levels were associated with increased levels of accessing of health care services by youths. METHODS: This was a cross-sectional study carried out on 450 participants aged 13-30 years who attended at least one of the three programmes offered by GRSZ. Self-administered and self-reporting questionnaires were used to collect information on participants' demographics, knowledge on HIV and reproductive health, sources of information, access to HIV and reproductive health services and attitudes and risky behaviours. RESULTS: A total of 392 (87.1%) responses were received. High HIV and reproductive health knowledge levels were recorded (77.7%) on our scale with females recording higher levels (81.1%) than males (71.1%). The majority of participants (72%) indicated willingness to abstain from risky behaviours such as use of drugs and attending youth sex parties. However about 33.3% of the participants who had sexual intercourse reported having condomless sex. There was marginal association between high HIV and reproductive health knowledge levels and accessing health care services in the past 24 months (p = 0.045). CONCLUSIONS: HIV and reproductive health knowledge levels were relatively high among adolescents and were associated with accessing health care services in the past 24 months. There however are some gaps associated with engaging in risky sexual behaviours such as condomless sex which could be addressed by using these findings to assist organizations working with adolescents, educators and policy makers in developing programmes that address adolescent sexual behaviours.

Process Evaluation of a Sport-Based Voluntary Medical Male Circumcision Demand-Creation Intervention in Bulawayo, Zimbabwe.

INTRODUCTION: Grassroot Soccer (GRS) developed 2 brief and scalable voluntary medical male circumcision (VMMC) promotion interventions for males in Bulawayo, Zimbabwe, consisting of a 60-minute interactive, soccer-themed educational session with follow-up behavioral and logistical reinforcement. Both interventions were led by circumcised male community leaders ("coaches") ages 18-30. "Make The Cut" (MTC) targeted adult males on soccer teams and "Make The Cut+" targeted boys in secondary schools. We conducted a process evaluation of MTC and Make The Cut+ to investigate perceptions of program impact, intervention components, and program delivery; participants' understandings of intervention content; and factors related to uptake. METHODS: We conducted 17 interviews and 2 focus group discussions with coaches and 29 interviews with circumcised (n = 13) and uncircumcised participants (n = 16). RESULTS: Findings demonstrate high program acceptability, highlighting the coach-participant relationship as a key factor associated with uptake. Specifically, participants valued the coaches' openness to discuss their personal experiences with VMMC and the accompaniment by their coaches to the VMMC clinic. CONCLUSIONS: Should the coach quality remain consistent at scale, MTC offers an effective approach toward generating VMMC demand among males.

A Sport-Based Intervention to Increase Uptake of Voluntary Medical Male Circumcision Among Adolescent Male Students: Results From the MCUTS 2 Cluster-Randomized Trial in Bulawayo, Zimbabwe.

BACKGROUND: Mathematical models suggest that 570,000 HIV infections could be averted between 2011 and 2025 in Zimbabwe if the country reaches 80% voluntary medical male circumcision (VMMC) coverage among 15- to 49-year-old male subjects. Yet national coverage remains well below this target, and there is a need to evaluate interventions to increase the uptake. METHODS: A cluster-randomized trial was conducted to assess the effectiveness of Make-The-Cut-Plus (MTC+), a single, 60-minute, sport-based intervention to increase VMMC uptake targeting secondary school boys (14-20 years). Twenty-six schools in Bulawayo, Zimbabwe, were randomized to either receive MTC+ at the start (intervention) or end (control) of a 4-month period (March to June 2014). VMMC uptake over these 4 months was measured via probabilistic matching of participants in the trial database (n = 1226 male participants; age, 14-20 years; median age, 16.2 years) and the registers in Bulawayo's 2 free VMMC clinics (n = 5713), using 8 identifying variables. RESULTS: There was strong evidence that the MTC+ intervention increased the odds of VMMC uptake by approximately 2.5 fold (odds ratio = 2.53; 95% confidence interval, 1.21 to 5.30). Restricting to participants who did not report being already circumcised at baseline, MTC+ increased VMMC uptake by 7.6% (12.2% vs 4.6%, odds ratio = 2.65; 95% confidence interval, 1.19 to 5.86). Sensitivity analyses related to the probabilistic matching did not change these findings substantively. The number of participants who would need to be exposed to the demand creation intervention to yield one additional VMMC client was 22.7 (or 13.2 reporting not already being circumcised). This translated to approximately US dollar 49 per additional VMMC client. CONCLUSIONS: The MTC+ intervention was an effective and cost-effective strategy for increasing VMMC uptake among school-going adolescent male subjects in Bulawayo.

Audits of adolescent prenatal care rendered in Bulawayo, Zimbabwe.

OBJECTIVE: To evaluate the adequacy of recorded prenatal care provided to adolescents in Bulawayo, Zimbabwe. DESIGN: A quantitative descriptive design, using checklists to audit 80 prenatal records, based on the assumption that care recorded reflects care rendered. SETTING: Four clinics and two hospitals providing public prenatal and birth services in Bulawayo, Zimbabwe. PARTICIPANTS: 80 Adolescents' prenatal records were audited. MEASUREMENT AND FINDINGS: Recorded prenatal care was checked according to the expected prenatal activities: history taking, health education and counselling, physical examinations, routine laboratory tests, client evaluations and planning for birth. KEY CONCLUSIONS: documentation in the prenatal records was incomplete, especially on aspects of health promotion and social history. IMPLICATIONS FOR PRACTICE: Inadequacies in prenatal records could denote poor prenatal care rendered to adolescents, limiting the potential benefits pregnant adolescents and their infants could derive from these services in Bulawayo. In-service education should be offered to the midwives to enhance their knowledge and skills on health assessment, history taking, physical examinations and accurate documentation of all aspects of prenatal care.

Midwives' perceptions about adolescents' utilisation of public prenatal services in Bulawayo, Zimbabwe.

OBJECTIVES: to identify midwives' perceptions about adolescents' failure to utilise prenatal services or to initiate such utilisation late during their pregnancies. DESIGN: a quantitative descriptive and exploratory design, using questionnaires to collect data, to describe midwives' perceptions about factors influencing pregnant adolescents' non-utilisation or late utilisation of prenatal services. SETTING: 20 public health centres (comprising two hospitals and 18 primary health-care clinics) rendering prenatal services, distributed throughout the city of Bulawayo, Zimbabwe. PARTICIPANTS: 52 midwives, rendering prenatal services in Bulawayo, completed questionnaires. MEASUREMENTS AND FINDINGS: demographic, socio-economic, knowledge-related and service-related factors (unfriendly midwives and substandard prenatal services) influenced pregnant adolescents' late or non-utilisation of prenatal services. KEY CONCLUSIONS: transport costs and charges for prenatal services were major factors influencing adolescents' late or non-utilisation of prenatal services. Adolescents needed more knowledge about the advantages of prenatal services. Effective prenatal services should be provided by friendly and welcoming midwives. IMPLICATIONS FOR PRACTICE: pregnant adolescents need more knowledge about the advantages of prenatal services, and these should be more accessible. Charges for public prenatal services must be reduced or abandoned; subsidised or free public transport for pregnant adolescents could enhance their utilisation of prenatal services.