Abstract
Khuluma is a psychosocial and peer-to-peer mHealth intervention that uses text messaging to facilitate support groups for adolescents living with HIV (ALWH) with the aim of contributing toward positive health outcomes. Although use of mobile technology in the form of mHealth interventions has proliferated recently in the field of health, published literature describing methods and processes of its application are limited. We present a set of methods and processes utilised to develop and pilot the Khuluma mHealth intervention amongst young people (15–20 years) in South Africa. We recruited and enrolled 52 adolescents (15–20-year olds) from four clinics in Pretoria and Cape Town to participate in a 6-month pilot of Khuluma. Participants were ALWH, aware of their status, on antiretroviral therapy for more than 12 months, and not suffering from severe depression. We conducted four pre and post intervention focus group discussions (FGDs) with a proportion of ALWH (n = 36) enrolled in the pilot study using participatory methods. Several processes were utilised to then implement this pilot study. These included engaging ALWH for minor study implementation modifications; forming virtual groups; activating the mHealth platform; facilitating and delivering the Khuluma intervention. The acceptability of the intervention was informed by follow-up focus group discussions and text message data. The initial participatory processes helped to tailor the intervention design to participants' needs. The peer-led facilitation of the groups allowed for the provision of sensitive psychosocial support that allowed young people to express themselves freely, develop a sense of self-worth, and interact more. The nature of the mobile technology also allowed participants to build friendships beyond their geographic area and interact with their peers in real time. Within the evolving context of COVID-19, establishing evidence-based processes and methods for intervention design and curation in virtual spaces is critical.
Highlights
Advances in the functionality, speed, and availability of mobile devices and networks, coupled with the increased penetration of mobile phones especially among young people [1,2,3], has garnered interest in the utilisation of mobile phones in health service delivery [4,5,6,7,8]
A needs assessment, which included a series of semistructured individual interviews with Health Care Professionals (HCPs) and adolescents living with HIV (ALWH) (13–18 year olds) and further focus group discussions (FGDs) with ALWH, was conducted to determine challenges associated with treatment uptake, key issues facing young people beyond the clinic, modes of communication and gender norms, and their use of technology
The role of virtual spaces in the provision of psychosocial support was shown to be more critical than ever before, due to restrictions on social interaction imposed as a result of COVID-19 lockdowns
Summary
Advances in the functionality, speed, and availability of mobile devices and networks, coupled with the increased penetration of mobile phones especially among young people [1,2,3], has garnered interest in the utilisation of mobile phones in health service delivery [4,5,6,7,8]. Trials and feasibility studies have shown the effectiveness of mHealth interventions in targeting a variety of health conditions including HIV prevention and treatment, noncommunicable diseases, mental health and TB in high and lowincome settings. These interventions provide health information, e-reminders, generate awareness, monitor medication adherence, and facilitate consultation and even diagnosis [11, 12], while utilising voice messaging, text messaging (SMS), multi-media messaging, software for easy data collection and gamification [6,7,8]. MHealth provides a confidential safe space within which adolescents can freely express themselves [13,14,15]
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