Key Findings and Iterations to Intervention Design of CyberRwanda
| Key Finding | Iteration to Intervention Design |
|---|---|
| Supply-side barriers to quality care | |
| Youth often saw health care providers as “gatekeepers” to accessing methods and were afraid about the questions they might be asked at health care facilities | We pivoted the platform away from simply linking to clinics to providing direct-to-consumer products and information directly in the hands of youth to reduce barriers associated with gatekeeping. Medically relevant screening is conducted at point of order to minimize bias-related barriers to FP/RH care and expedite the interaction between provider and youth. Youth can choose from a selection of pharmacists with transparent pricing. |
| Youth strongly preferred pharmacies as a point of access for contraception due to expediency and privacy | Deliver products and services via pharmacies: Young people’s priority concerns for privacy and expediency informed the pivot to supplying products via pharmacies instead of clinics, as originally planned. The platform also links to all public clinics in the intervention districts for longer-term methods. |
| Pharmacists lacked confidence in addressing young peoples’ SRH needs and had knowledge gaps on FP | Designed tailored training modules with and for pharmacists and pharmacy staff to address common misinformation, provide training on adolescent-friendly care, and support self-identification of provider bias to help providers improve access to care for adolescents. |
| Demand-side barriers to quality care | |
| Program lacked content on economic opportunity and job readiness, making it less appealing to youth and less acceptable to parents | The webcomic stories and FAQs now include content on preparing for employment and address gender stereotypes on careers. The site links to job search resources. The site tagline is “learn about relationships, your body, and your future.” |
| Boys had clearly expressed needs for information on health, relationships, and reproductive health | Content, characters, and the direct-to-consumer platform were codesigned and implemented with and for young men. |
| Youth lacked access to trusted, nonjudgmental information in accessible language they could understand | Characters were designed with youth to represent trusted personas for young men, women, and parents. A webcomic format was introduced to deliver information in a compelling, locally relevant way, focused on addressing key behavioral barriers and social and environmental norms that stigmatized access to FP/RH services. All content was reviewed by gender and behavior change and validated by youth. Finally, it was approved by the National Health Communications Committee to ensure alignment with national guidelines. |
| Young people were primarily concerned with lack of privacy and confidentiality in accessing information and services | To minimize barriers to engagement and allay fears about confidentiality, no identifiable data were collected from youth, even though this limited the ability to track individual user engagement. All data from the CyberRwanda platform were gathered and stored in compliance with General Data Protection Regulation guidelines. The shop was designed so that users can order without supplying personal information, without needing to request the product in person from the pharmacist. An order code is provided, which is needed to collect their order, with an optional SMS to their phone. |
| Given low levels of knowledge on FP/RH, youth often seek help for a specific problem rather than a specific product | In the shop, we pivoted to include both products for quick access for informed users and added common scenarios as another pathway to access products on the platform for naïve users or users experiencing a crisis (e.g., “I had unprotected sex.”). When a user clicks on those scenarios, they access essential information and recommendations of products and additional services available. |
Abbreviations: FAQs, frequently asked questions; FP, family planning, RH, reproductive health; SMS, short message service.