Final report

Transcription

Final report

Annual Report 2014
Access, Services and Knowledge (ASK),
Youth Empowerment Alliance (YEA)
Using Facebook and Websites
to Increase Access to SRHR
Information and Services
among Young People in Uganda
Final Report
Utrecht, March 2016
Authors: Susan Barbiye, Kantjil Janssen & Pinar Okur1
1
Corresponding author: p.okur@rutgers.nl
© Rutgers 2016
Suggested citation:
Barbiye S., Janssen K. & Okur P., 2016, “Using Facebook and Websites to Increase Access to SRHR
Information and Services among Young People in Uganda”, Rutgers & RAHU
The Access, Services and Knowledge (ASK) programme is a three-year programme (from 2013 to
2015) funded by the Dutch Ministry of Foreign Affairs with the aim of improving the SRHR of young
people (10 – 24 yrs.), including underserved groups. The programme which is a joint effort of eight
organizations comprising of Rutgers (lead), Simavi, Amref Flying Doctors, CHOICE for Youth and
Sexuality, dance4life, Stop AIDS Now!, the International Planned Parenthood Federation (IPPF), and
Child Helpline International (CHI) is implemented in 7 countries, namely Ethiopia, Ghana, Indonesia,
Kenya, Pakistan, Senegal, and Uganda. Operations research (OR) was identified as an integral part of
activities in the ASK programme. The aim was to enhance the performance of the program, improve
outcomes, assess feasibility of new strategies and/or assess or improve the programme Theory of
Change.
Table of Contents
Acknowledgements .......................................................................................................................vi
Acronyms and Abbreviations ..................................................................................................... vii
Executive Summary .................................................................................................................. viii
CHAPTER ONE .......................................................................................................................... 1
1.0 Background ............................................................................................................................ 1
1.1
Context and Rationale ...............................................................................................................1
1.2
Background of ASK Programme and RAHU..........................................................................2
1.3
How was this e/mhealth operations research implemented? .................................................3
1.4
Ethical Review and Approval ...................................................................................................5
CHAPTER TWO .......................................................................................................................... 6
2.0 Young peoples’ perceptions and attitudes towards RAHU’s Sautiplus Facebook page and
website............................................................................................................................ 6
2.1 Methods of data collection from young people ..............................................................................6
2.2 What kind of young people currently use RAHU’s website and Sautiplus Facebook
pages ............................................................................................................................................8
2.2.1 Online Respondents .................................................................................................................................. 8
2.2.2 Focus Group Discussion Participants........................................................................................................ 9
2.3 Sources of information about RAHU’s on-line Platforms and Reasons for access ....................9
2.4 How Frequent and Extensive Do Young People Visit Sautiplus on-line pages ........................11
2.5 Young People Perceptions towards Access and the Design of RAHU’s on-line Platforms .....12
2.6 SRHR Information Accessed by Young People from Sautiplus on-line Platforms ..................14
2.7 Young People’s Usage of the Information Offered on Sautiplus on-line Platforms ................15
2.8 Sautiplus on-line Platforms Contribution to Increased Uptake of RH services .......................16
2.7 Appreciation, Perceived Advantages and Recommendations for Platform Improvement
by Young People ......................................................................................................................17
2.7.1 Young People’s Appreciation of the Platforms ....................................................................................... 17
2.7.2 Young People’s Perceived Advantages of online Platforms ................................................................... 20
2.7.3 Young People’s Suggestions for RAHU’s online Platforms Improvement ............................................ 21
CHAPTER THREE ................................................................................................................... 24
3.0 Staff perceptions and attitudes towards RAHU’s Sautiplus Facebook page and website 24
3.1. Method of Data Collection from Staff .........................................................................................24
3.2 Characteristics of the Staff Interviewed ......................................................................................25
iii
3.3 RAHU’s Readiness for E&MHealth Programming....................................................................25
3.3.1 On-line Programming Needs Assessment ............................................................................................... 25
3.3.2 Presence of Infrastructure ....................................................................................................................... 26
3.3.3 Availability of resources (human, time and finances) ............................................................................. 26
3.3.3 Management Support for e/mhealth programming ................................................................................. 28
3.4 Staff Perceptions of e/mhealth Programming .............................................................................28
3.3.1 Perceived advantages of e/mhealth programming by staff ..................................................................... 28
3.3.2 Perceived challenges of e/mhealth programming by staff ...................................................................... 29
3.5 Current Platform Design and Maintenance ................................................................................31
3.6 Staff Perceived Added Value of Online Platforms to other RAHU’s Information
Dissemination Channels ..........................................................................................................31
3.7 Needs for program improvement and sustainability as reported by staff ................................32
4.0 Expert observation of RAHU’s Sautiplus Facebook page and website ............................. 33
4.1 Observation methods .....................................................................................................................33
4.2 What kind of information is offered on RAHU’s Sautiplus Facebook page.............................33
and website ...........................................................................................................................................33
4.3 Expert observation of the platform design and content generation ..........................................34
4.4 Observation of the audience engagement on RAHU’s on-line Platforms .................................34
CHAPTER FIVE ....................................................................................................................... 36
5.0 Use of Results to Improve RAHU’s Online Platforms ....................................................... 36
5.1 Programming opportunities identified by the e/mhealth operations research .........................36
5.2 Program gaps identified by the operations research ..................................................................36
5.3 Implications of the e/mhealth OR findings and observations to RAHU ...................................37
6.3 Recommendations ..........................................................................................................................41
6.4 Results Dissemination and action planning .................................................................................42
Appendices .................................................................................................................................. 45
Appendix 1: List of RAHU’s Young People trained in Research ....................................................45
Appendix 2: List of RAHU’s Core Team for this Operational Research .......................................45
Appendix 3: Staff In-depth Interview Guide .....................................................................................46
Appendix 4: IDI Consent Form ..........................................................................................................49
Appendix 5: Focus Group Discussion Guide .....................................................................................52
Appendix 6: Observation Checklist....................................................................................................57
Appendix 7: On-line Questionnaire....................................................................................................62
Appendix 8: OR Approval Letters .....................................................................................................70
iv
List of Tables
Table 1: Summary of Key Study Indicators ................................................................................................ xv
Table 1: Summary of RAHU’s e/mhealth operational research implementation. ........................................ 3
Table 2: Socio-demographic characteristics of online respondent. .............................................................. 8
Table 3: Socio-demographic characteristics of FGD participants ................................................................ 9
Table 4: Information Sought from Sautiplus Online Platforms by Young People. .................................... 14
Table 5: Rating of information offered on Sautiplus platforms .................................................................. 16
Table 6 : Socio-demographic Characteristics of the Staff Interviewed ...................................................... 25
List of Figures
Figure 1: Sources of information about RAHU's platforms........................................................................ 10
Figure 2: Reasons for accessing Sautiplus Facebook and website as reported by On-line respondents .... 11
Figure 3: Frequency of visits at Sautiplus and website ............................................................................... 12
Figure 4 : Factors influencing access to internet as reported by Respondents ............................................ 14
Figure 5 : Ease of finding information at Sautiplus Facebook page and website ....................................... 14
Figure 6: SRHR information and services which are usually referred. ...................................................... 17
Figure 7: Young people's rating of the information offered on RAHU's online platforms. ........................ 18
Figure 8: Young people's Opinion of RAHU's online design and lay-out. ................................................. 20
Figure 9 : Young respondents' suggestions for improvement. .................................................................... 22
v
Acknowledgements
We would like to express our sincere gratitude to all the stakeholders who contributed
information and offered other support for this research project, including; the Uganda National
Coordination Office for ASK programme, the ASK operational research (OR) team in the
Netherlands, the young people and RAHU staff who participated in the interviews, the young
researchers who collected and managed the data, and the district-level stakeholders. We are
grateful to RAHU’s research core team and the team of young researchers for your cooperation
and tireless efforts contributing to the successful implementation of this operations research.
Special thanks to Bakshi Asuman, Atukunda Athibert, Nakayima Beatrice, Naluzze Preeme
Sharon, Kintu Keneth, Kisekka Edward, Akamutuha Conviirene, Mubiru Alex, and Bamulanzeki
Samuel.
Guidance for this report was provided by Ms. Kantjil Janssen and Pinar Okur of Rutgers WPF,
the contact person of OR working group in the Netherlands and Ms. Diana Nanyange, the
National ASK programme Coordinator.
The tremendous work done by the consultants; Ms. Susan Babirye, Dr. Aloysius Ssennyonjo and
Dr. Suzanne N Kiwanuka is acknowledged and highly appreciated.
vi
Acronyms and Abbreviations
AIDS:
Acquired Immune Deficiency Syndrome
ASK:
Access, Services and Knowledge
CSE:
Comprehensive Sexuality Education
e-health:
Health interventions that utilize electronic technology
emhealth:
Health interventions that utilize electronic and mobile technology
RAHU:
Reach a Hand Uganda
HCT:
HIV Counseling and Testing
HIV:
Human Immunodeficiency Virus
IEC:
Information, Education and Communication (materials)
IGA:
Income Generating Activity
m-health:
Health interventions that utilize mobile telecommunications technology
MYP:
Meaningful Youth Participation
SRH:
Sexual and Reproductive Health
STI:
Sexually Transmitted Infections
SRHR:
Sexual and Reproductive Health and Rights
OR:
Operational Research
YFS:
Youth-Friendly Services
vii
Executive Summary
Background and rationale:
The application of electronic and mobile solutions for health (eHealth and mHealth) in
developing countries is expanding quickly, including in the field of Sexual and Reproductive
Health (SRH). The Access, Services, Knowledge (ASK) program which is currently being
implemented in Uganda seeks to use e/m health strategies to increase direct access to SRH
information and services to young people. A number of review papers 1 noted that the research
done in e/m health field is limited to short term effectiveness, client- provider assessment of
technologies and cost of small scale pilots. Therefore, evidence is not sufficient to determine
effectiveness or even sustainability of these interventions beyond pilot phases funding.
It is against this background that this OR broadly aimed at providing evidence about use of e/m
health strategies for expanding direct access to SRHR information and services among young
people in Uganda by conducting a comprehensive assessment of RAHU’s Sautiplus website and
facebook pages, discussing their effectiveness, facilitating factors, current challenges, gaps,
opportunities and tendencies.
RAHU’s Operations Research Implementation:
Seven young people were trained using Rutgers’ Explore Training Manual on training of young
people in research that was adapted for this OR. An Organizational-level Steering Committee
(core team) of four members was also established to oversee the process, provide guidance and
prepare for use of results for program improvement. The operations research was introduced to
the district stakeholders in Jinja and Iganga prior to data collection. The data collection tools i.e.
the FGD discussion guide was pre-tested at Hana Mixed School while the on-line tool was
pretested until 10 records were got.
Eight in-depth interviews were held with RAHU’s staff; three from top management and five
implementers. An observation of Sautiplus Facebook page and website was done. The
1
WHO 2011 (mHealth: New horizons for health through mobile technologies: second global survey on eHealth.),
Aranda-Jan et al 2014 (Systematic review on what works, what does not work and why of implementation of mobile
health (mHealth) projects in Africa. BMC Public Health 2014, 14:188
http://www.biomedcentral.com/1471-2458/14/188)
viii
observation focused on a period of three months that preceded the observation exercise. One
hundred thirty five records were attained through the on-line tool from Dec 2014 to April 2015.
Eight Focus Group Discussions were held with non-users of RAHU’s Sautiplus website and face
book pages. The consultancy team shared the OR findings with the OR working group in the
Netherlands for their input before sharing it with RAHU. The Consultancy team discussed with
RAHU the strength and gaps identified by the OR and action points. Joint and Regional level
dissemination meetings were held.
Key findings:
Online survey and Focus group discussions with young people:
One hundred thirty five (135) people responded to the online survey. Eighty five (85%)
remained for analysis after data cleaning. Their mean age was 22.2 years but age of respondents
ranged from 18 to 39 years. Majority of these respondents were male (71.4%) and in urban areas
(95.2%). Many of these were in school (47.6%). Regarding the FGD, 91 young people were
reached. Their age ranged from 13-19 years. Slightly more than half of these were male (58.2%).
The leading sources of information about RAHU’s online platform were School outreaches
(25%), Peer educators (22.6%) and Facebook adverts (17.8%). The main reasons that attract
respondents to these platforms include content (53.5%), platform design (23.8%) and Interactive
nature (22.6%).
The majority of respondents to the online survey reported visiting the platforms at least weekly
(69%). About 17 % visited daily, 21.4 % visited more than twice per week and 30.9% visited
once per week. First time visitors were 17.8% of the respondents. Regarding the time for visiting
the e/mhealth channels, majority of respondents reported visiting mostly in afternoon and
evening at 27.3% and 38% respectively. However, most respondents visited these platforms for
less than one hour (91.6%). In fact, 41.6% reported spending less than 30 minutes.
Regarding the perception of the respondents towards the design of the platforms, over 70%
reported that they were satisfied. Concerning the aspect of access, 66.6% and 71.4% of
respondents reported that they were allowed to access internet at home and school respectively.
ix
However, there were notable challenges. Almost sixty percent (59.5%), 54.7 %, 42.8% and 44%
of the respondents respectively reported internet connection, costs, lack of ownership of gadgets
and limited time as the major challenges in accessing e/mhealth channels.
Many respondents (60%) reported ease of accessing the information they wanted. The most
sought information was on SRHR as reported by 85.7% of all respondents. Other common topics
reported included entertainment (70.2%) and Training (82.1%).Among the SRHR topics,
majority of respondents reported seeking information on relationships (91.6%) while none (0%)
reported seeking information on sexual citizenship.
Half of the respondents reported that information was very helpful (51%) and it was easy to
understand. Three quarters (75%) reported that the information was of good quality and 53%
found the information youth friendly respectively. More than 80% reported getting referred for
additional information. Most referral information was on condoms (76.1%), HCT (72.7%0,
reproductive health services (72.6%) but STI treatment was very low (28.5%).
Regarding suggestions for improvement, the following were suggested: link to other pages
(53.5), updating the pages routinely (76.1%), making these platforms more interactive (70.2%)
and improving the platform design (57.1%).
In-depth Interviews with staff
Out of the eight RAHU staffs were interviewed; three were from the management while five (5)
were implementers. All the staffs interviewed were below 30 years, indicating a youth-led
organization. One of the managers had worked in SRHR field for 14 years. The average working
experience of the implementing staff in SRHR field was 2.7 years.
It was reported that on-line programming was informed by a needs assessment. The key insights
from the assessment reported included; the need for capacity building for staff and peer
educators, the need for more computers and staffs, and the increasing appreciation of on-line
media by young people.
x
There was an overall agreement among the respondents that the available infrastructure at
RAHU was adequate. For instance, there was unlimited internet access, each staff had access to a
computer and a smart phone. It was also reported that RAHU had enough human resources. It
has a big peer educators’ network that it could tap into. However, some respondents felt that the
peer educators’ network had not yet been fully utilized. Other respondents recommended a need
for additional staff. Positively, the respondents revealed that the staffs are competent to do
e/mhealth programming and often exposed to continuous training. It was reported that RAHU
has adequate funding but more is still needed for e/mhealth.
Findings on management support for e/mhealth programming showed that there was a lot of
support received from the management. Mentorship and guidance, training opportunities,
internet provision, and fostering collaboration with other organizations that do well in e/mhealth
programming were mentioned as some of the existing mechanisms for management support.
When asked about the advantages of using e/mhealth, most respondents highlighted that it is a
trendy thing. However, notable challenges were cost, national laws that limit content shared with
young people and stringent school policies limit ownership of phones and use of internet.
Observation of RAHU’s online platforms:
A structured observational assessment of RAHU’s Sautiplus Facebook page and website was
conducted. The observation assessment generated rich and detailed information which included;
user engagement i.e. likes, shares, comments; the platform design; the type content shared; and
content generation
Observation findings showed that gender, sexual and reproductive health, pleasure, violence,
diversity and relationships were the common comprehensive sexuality education topics offered
on RAHU’s Sautiplus Facebook page and website. Sexual citizenship related topics were not
offered on the platforms during the three months study period.
Information was shared mainly in text, pictures and video formats. On average a message was
posted on a daily basis on Facebook while for the website, content was not regularly updated.
During the observation it was noted that the website was not as interactive as the Facebook page
that had questions from the audience. The questions were mainly in-boxed and not posted on the
page. The common questions observed were questions about the physical address of the
xi
organization and relationship issues. Further observation of the referral information offered on
RAHU’s online platforms revealed that referral information for additional information and
services was barely provided on the platforms as reported by implementing staff.
Observation findings showed that RAHU’s Sautiplus Facebook page had over 31,000 followers.
The followers were mainly engaged through:- stories they posted, comments, shared links and
likes. The other forms of engagements noted were through the uploading of pictures and videos.
Asking questions was also observed although on a small scale.
The top three stories with the most reach on the Sautiplus Facebook page during the study period
were about; relationship (personal story), HIV prevention and teenage pregnancy stories with
reach of 8,964, 16,008 and 4728 followers respectively. The top three most liked stories on the
Sautiplus Facebook page were about: HIV prevention, relationship (cheating partner) and Gender
Based Violence with 206, 43 and 85 likes respectively. Data from the platform observation
showed that sharing of the stories offered on RAHU’s online platforms was limited compared to
liking and commenting on the post. HIV prevention, relationship (personal story) and Hepatitis B
stories were the most shared stories observed with only 28, 6 and 5 followers sharing them
respectively
Programming opportunities identified by the e/mhealth operations research:
We identified several programming opportunities that Reach a Hand Uganda ought to consider.
These include:
•
There is a high appreciation and respect for online platforms by both young people and
RAHU staff, coupled with existing familiarity with online platforms by young people.
•
Existing management support and sound staff technical capacity for e/mhealth programming
plus the untapped strong peer educator network
•
Presence of other RAHU programs that could incorporate online platform promotion.
•
Existence of a big audience base in urban and peri-urban areas.
•
Appreciation of RAHU’s online platform design and trust in content offered by young
people.
xii
•
High ownership and access to gadgets that access internet by young people.
•
Existence of computer laboratories in most secondary schools.
•
High interest of youth in true stories posted online.
OR Implications & Recommendations:
•
RAHU should promote her platforms among young people in addition to strengthening
the platform design efforts in order to maintain or even improve the good impression by
the audience.
•
The online survey showed that young people mainly visited RAHU’s online platforms in
the afternoon and evening. Therefore, RAHU’s message posting and audience
engagement efforts should be capitalized in the afternoon and evening. This may imply
working outside office hours.
•
Data from the online survey showed that majority of the people who used RAHU’s online
platforms were 18 years and above (mean age 22.2 years) and mainly males. RAHU
should therefore tailor its messages to fit profiles of typical users.
•
There is need for RAHU to not only regularly update content on its online platforms but
also create room for innovative ways to make the content more engaging and entertaining
that young people long to always return many more times. Games, real stories, quizzes
and plays are some of the creative ways to make educational content engaging and
entertaining.
•
Since youth are particularly attracted by true stories, RAHU can use true stories to
incorporate learning for youth and embed links within these stories which direct them to
other sources of information. RAHU could also consider developing case vignettes
(sample fictional stories/scenarios) encompass multiple SRHR issues and can be used
(one scenario at a time) to stimulate learning and discussions on their available platforms.
•
Data from on-line interviews and observation revealed that that majority of young
accessed mainly reproductive health information from RAHU’s Sautiplus website
platforms. During FGDs, young people revealed need for information on other topics
such life skills, success stories, integration of sports into SRHR information, career
guidance, business and job interview tips and drug abuse. Therefore, RAHU should
xiii
incorporate other types of information other than health which could to draw those
passionate about it to the platform and hence also accessing SRHR information.
•
There was high appreciation and commitment to e/mhealth programming by both
RAHU’s top managers and implementing staff. Hence RAHU should focus more on
tailoring capacity building to specific needs identified other than using generalized
trainings
•
RAHU has a big peer educators’ network which needed to be fully utilized. RAHU
should put in place structures to involve these peer educators.
•
Contrary to reports from the online survey that claimed that referral information was
readily available, observation findings showed that referral information was minimal and
hidden. RAHU should strengthen its efforts to provide referral information additional
SRHR information and services to its audience. For example, having a referral
corner/page on the main page would be an innovative way of offering referral
information on Facebook and website.
xiv
Summary of Indicators
Table 1:
Summary of Key Study Indicators
Number of young researchers trained
Total online responses
Online responses after data cleaning
Characteristics of online respondents
Mean age
Age range
% male
In-school
Urban residents
Have income generating activities
Characteristics of FGD participants (8 non-users groups +1 users)
Total number
Age range
% male
Sources of information about RAHU’s e/mhealth platforms
School outreaches
Peer educators
Facebook adverts
What attracts respondents to online platforms
Message content
Platform design
Being interactive
Frequency of visiting
Weekly
Daily
More than twice per week
Once per week
First time
When visit most
Evening
Afternoon
Duration of visit
<1 hr
<30 minutes
Access to e/mhealth platforms
Ownership/access to gadget
Internet access at school
Internet access at home
Challenges
Poor internet connection
High costs
Don’t own gadget
Limited time
Type of information accessed
SRHR
Entertainment
Training
7
135
85
22.2
18-39
71.4
47.6
95.2
33.3
91
13-19
58.2
% of respondents
25
22.6
17.8
% of respondents
53.5
23.8
22.6
% of respondents
69
16.6
21.4
30.9
17.8
% of respondents
38
27.3
% of respondents
91.6
41.6
% of respondents
>70
66.6
71.4
% of respondents
59.5
54.7
42.8
44
% of respondents
85.7
70.2
82.1
xv
Type of SRHR information accessed
Relationships
Sexual citizenship
Referral for additional information
Condoms
HCT
Reproductive health services
STI treatment
Rating of information provided
Quality
Useful
Youth friendly
Suggestion for improvement
Link to other pages
Routine update
Make more interactive
Improve design
% of respondents
91.6
0
% of respondents
76.1
72.7
72.6
28.5
% of respondents
75
76.2
52
% of respondents
53.5
76.1
70.2
57.1
xvi
CHAPTER ONE
1.0 Background
1.1 Context and Rationale
The application of electronic and mobile solutions for health (eHealth and mHealth) in
developing countries is expanding quickly, including in the field of Sexual and Reproductive
Health (SRH). The Access, Services, Knowledge (ASK) program which is currently being
implemented in Uganda seeks to use e/m health strategies to increase direct access to SRH
information and services to young people. A number of review papers 2 noted that the research
done in e/m health field is limited to short term effectiveness, client- provider assessment of
technologies and cost of small scale pilots. Therefore, evidence is not sufficient to determine
effectiveness or even sustainability of these interventions beyond pilot phases funding. Impact
assessment/ evaluation research is limited by complexity of strategies i.e. rapid technological
change, unfamiliarity of providers and clients and technical complexity of the infrastructure
itself. 3
A survey4 of existing e/m tools at five (5) ASK partner organisations 5 showed that despite
overwhelming interest, integration of these on-line platforms into existing programs i.e.
Sautiplus plus at RAHU is still at its infancy6 and no evaluation of performance, processes or
effectiveness has been done. Additionally, “traditional” communication and information
strategies such as electronic media and face to face communication i.e. television talk shows and
school outreaches were still strongly being used in providing SRH information to young people.
Furthermore, it was not clear under which conditions and how e/mHealth applications perform
compared to the traditional platforms. Additionally, there were concerns over the possibilities of
2
WHO 2011 (mHealth: New horizons for health through mobile technologies: second global survey on eHealth.),
Aranda-Jan et al 2014 (Systematic review on what works, what does not work and why of implementation of mobile
health (mHealth) projects in Africa. BMC Public Health 2014, 14:188
http://www.biomedcentral.com/1471-2458/14/188)
3
Path Outlook 2012 (eHealth, mHealth, reproductive health. December 2012) and WHO 2011.
4
Report on findings of current e/mHealth strategies used by ASK partners in Uganda.
5
Reach a hand Uganda (RAHU), School Net Uganda, Restless development and Straight talk foundation (STF).
6
Reach a hand Uganda (RAHU) is much ahead in using social media but evaluation of effectiveness is not yet done.
1
effectively using modern technologies among youths especially in settings where many don’t
own mobile phones and access to the internet is not guaranteed.
It is against this background that this OR broadly aimed at providing evidence about use of e/m
health strategies for expanding direct access to SRHR information and services among young
people in Uganda by conducting a comprehensive assessment of RAHU’s Sautiplus website and
facebook pages, discussing their effectiveness, facilitating factors, current challenges, gaps,
opportunities and tendencies. Specifically, the research explored the dynamics (actors and
factors) that determine the effectiveness of the e/m health strategies used by RAHU to increase
access to SRH information/services among Ugandan young people.
1.2 Background of ASK Programme and RAHU
The Access, Services and Knowledge (ASK)programme is a 3 year program (2013 to 2015)
funded by the Dutch Ministry of Foreign Affairs with the aim of enhancing uptake of Sexual
Reproductive Health (SRH) services among young people aged between 10-24 years, including
underserved groups. The programme which is a joint effort of 8 organizations comprising of
Rutgers WPF, Simavi, AMREF Flying Doctors, CHOICE for Youth and Sexuality, dance4life,
Stop AIDS Now!, the International Planned Parenthood Federation (IPPF), and Child Helpline
International (CHI) is implemented in 7 countries namely Kenya, Uganda, Ethiopia, Ghana,
Senegal, Pakistan and Indonesia.
In Uganda, the programme is implemented through 12 partners including RAHU. RAHU is a
non-profit youth led organization that aims to address the key issues that leave Ugandan youths
vulnerable to health outcomes like, HIV, Sexual Transmittable Infections (STIs), and unintended
pregnancy. RAHU focuses on changing social norms and values that limit access to Sexual
Reproductive
Health
(SRH)
services
and
information
through
designing
effective
communication strategies and campaigns to create awareness and mitigate sexual health
problems among the young people. RAHU mainly operates in central region districts although
under the ASK programme, Jinja and Iganga are its operational districts.
2
Central in the ASK program is to develop and implement (new technology) innovations in order
to improve access to SRHR information and/or quality of service delivery, with the goal of
increasing information seeking and uptake of services by youth and hard to reach populations.
Under the ASK program, RAHU implements the Sautiplus campaign. The campaign that started
in September 2013 uses multiple platforms such as facebook, website, twitter, television, radio
and google+ among others to distribute comprehensive Sexuality Education (CSE) messages to
young people (10-24 years) both in and out of school.
1.3 How was this e/mhealth operations research implemented?
researchers. This was intended to ensure Meaningful Youth Participation (MYP) and to build
capacity for young people in RAHU’s peer educators’ network in operations research. This team
included; five data collectors and two data entrants. These were selected by RAHU in
consideration of their membership in RAHU’s peer educators’ network. An Organizational-level
Steering Committee (core team) of four members was also established to oversee the process,
provide guidance and prepare for use of results for program improvement. The core team
members were taken through a one day national joint ASK partners’ training to orient them on
e/mhealth operations research, and work planning. (See Annex 1 for a list of RAHU’s research
core team and young researchers.)
Table 1: Summary of RAHU’s e/mhealth operational research implementation.
Step in the
Activity Objective
implementation
National-level
• Discuss further the possibility
Joint Core team
and feasibility of
engagement
implementing the e/mhealth
meeting
operations research
• Assess Organization
readiness to implement the
OR activity
• Assess the readiness of
ASK partners to begin OR
protocol development
• Draw work plans for the OR
What was done/achievement
• The consultancy team met five
different research core teams from the
ASK partners engaged in e/mhealth
programming and established rapport
with them
• The consultancy team successfully
gained the interest of the core teams in
implementing this e/mhealth OR.
• The team was able to establish that
three partners were willing to begin
right way while the other two opted to
3
activity
Stakeholder
engagement
meeting
• Promote the OR and its
benefits to the broader
stakeholders in the district
• To obtain district buy-in into
the activity as well as support
Capacity
building for
young
researchers
• To orient participants on
e/mhealth strategies under
RAHU.
• To orient the young people on
e/mhealth Operations research
under RAHU.
• To train young people as
researchers for the OR.
• To practice for field activities
through role-modeling.
Tool pre-testing
• To pre-test the research tools
developed for the e/mhealth
OR.
In-depth
Interviews
• To generate staffs’
perceptions towards RAHU’s
on-line platforms.
• To observe RAHU’s
Facebook page and website
and asses its design and
content.
Platform
Observation
On-line survey
Focus group
discussions
Dissemination
• To use an on-line tool to
collect the views and opinions
of users of RAHU’s Sautiplus
face book and website in
regards to these platforms.
• To generate users’ and nonusers’ perceptions towards
RAHU’s on-line platforms.
• Use findings to inform
start three months down the road.
• Each team drew a draft work plan for
the activity.
• The Consultancy team together with a
core team member successfully
introduced the OR to the district
stakeholders in Jinja and Iganga.
• The district stakeholders endorsed the
activity and appreciated the need for
evidence based programming.
• Successfully trained seven young
people from RAHU’s peer education
network in; research basics, operations
research, oriented them on OR tools
and had hands on experience in
collecting data in Jinja and Iganga.
• The data collection i.e. the FGD
discussion guide was pre-tested at
Hana Mixed School in Kampala.
• Whereas the on-line tool was pretested
until five records were got.
• The pretest informed tool improvement
before actual data collection.
• Eight in-depth interviews were held
with RAHU’s staff; three from top
management and five implementers.
• An observation of Sautiplus Facebook
page and website was done. The
observation focused on a period of
three months that preceded the
observation exercise.
• 135 records were attained through the
on-line tool from Dec 2014 to April
2015
• Eight Focus Group Discussions were
held with non-users of RAHU’s
Sautiplus website and face book pages.
• The consultancy team will share the
4
and use of
findings
interventions
OR findings with the OR working
group in the Netherlands for their input
before sharing it with RAHU.
• The Consultancy team will discuss
with RAHU the strength and gaps
identified by the OR and action points.
• District and National level
dissemination meeting will be held.
1.4 Ethical Review and Approval
This OR protocol was reviewed and approved by the Makerere University School of Public
Health Higher Degrees, Research and Ethics Committee and National Council of Science and
Technology (See annex 4. Copy of approval letters)
Other ethical considerations:
Research assistants informed all study participants of their rights and risks of participating in the
study. Written consent was obtained from all study participants (online, FGD & IDI) after
explaining the purpose of the study. Participation in the study was voluntary.
Throughout this study, privacy and confidentiality was emphasized. All data was collected in a
private setting. Confidentiality was assured by removal of identifiers and restriction of raw data
to only those who were directly involved in the study.
5
CHAPTER TWO
2.0 Young peoples’ perceptions and attitudes towards RAHU’s
Sautiplus Facebook page and website
2.1 Methods of data collection from young people
Both quantitative and qualitative study methods i.e. online semi structured survey and Focus
Group Discussions (FGDs) were used to examine and report detailed views of young participants
(10-24 years) in response to the research questions.
On-line survey:
A sample size of 400 young people was targeted for the online survey to assess aspects related to
RAHU’s Sautiplus Facebook page and website. The sample size was calculated using a webbased sample size calculator (http://www.openepi.com/OE2.3/SampleSize/SSPropor.htm), based
on three factors: the estimated population of young people who may have accessed e/m health
platform by RAHU (in this case not known, maximum variability proportion of 0.5 has been
used); the confidence level at 95%; and the margin of error at 5%.The response rate of 15-20%
was also considered given that this was the first time this population (young people accessing
social media/website information by ASK partners) was surveyed online.
The online survey tool was posted on RAHU’s Sautiplus website and Facebook pages in
December 2014. Automated daily reminders of the survey were put on the studied pages
throughout the study period to promote response. Only 135 responses were generated and
downloaded in excel sheet by April 2015. After data cleaning, 85 recorded remained. Data was
analyzed using SPSS XBM version 17 statistical package. The analysis was mainly descriptive,
frequency/percentage distribution tables, graphs and cross-tabulations were the main form of
presentation and analysis for the study.
It was not possible to restrict age and geographical coverage of this web-based data collection
method. Slow response and multiple submissions were the biggest challenges of this process.
6
Focus Group Discussions:
A total of eight focus group discussions were conducted with in-school non-users of RAHU’s
e/mhealth platforms. Efforts to find users in the study schools were futile. The FGDs were
conducted in the five schools covered by RAHU in the ASK districts; three in Jinja district (Jinja
SS, Kiira College Butiki and PMM Girls school) and two in Iganga district (King of Kings S.S
and Iganga S.S). Each FGD comprised of 8-12 participants. FGDs explored youths’ perceptions
and attitudes towards aspects of e/mhealth strategies (such as access, design and implementation)
and how the young people used the provided SRHR information. A pre-test Focus Group
Discussion of users at Hana Mixed School in Kampala was included in the analysis to provide
some in-depth insights from users. School authorities were used to mobilize FGD respondents.
Data from the FGDs were analyzed using a thematic framework approach based on key themes,
concepts and emergent categories. Quotes from the respondents were used to illustrate and
emphasize the voices and points made by respondents.
All in-school students (boys and girls) aged 10 or older were eligible to participate and all those
above the age of 24 were excluded.
Training of young researchers:
researchers. The content was adapted to suit the Operations research. The young people were
trained to ensure Meaningful Youth Participation (MYP) and to build capacity for young people
in RAHU’s peer educators’ network in operations research. This team included; five data
collectors and two data entrants. These were selected by RAHU in consideration of their
membership in RAHU’s peer educators’ network. The research assistants were trained for four
days, on research basics, e/mhealth OR objectives, quality control, record taking and research
ethics prior to the beginning of data collection process. The training involved face to face talk
and mock interviews and fieldwork to familiarize with the data collection tools. Use of various
training approaches was aimed at ensuring accuracy, consistent, uniformity and validity of the
dialogues. More about the training can be seen in the photos below.
7
2.2 What kind of young people currently use RAHU’s website and Sautiplus Facebook
pages
2.2.1 Online Respondents
The mean age of the respondents was 22.2 years, age range was 18-39, and 74% of the
respondents were young people while 16.4% were outside the age range of RAHU’s target
audience of 10-24 years. Male respondents constituted the biggest proportion (71.4%) of the online respondents while 47.6% of the study respondents were still in school. Majority of the online respondents (95.2%) resided in urban areas while 33.3% reported engaging in Income
Generating Activities (IGA). This showed that youths in urban areas mainly accessed RAHU’s
Sautiplus Facebook page and website. The details can be seen in the table below.
Table 2: Socio-demographic characteristics of online respondent.
Frequency
Percent
10-14
15-19
20-24
25-30
30 +
Missing
0
16
47
11
03
07
0
19
55.9
13
3.5
8.3
Female
24
28.5
Variable
Age
Sex
8
Male
60
71.4
In-school
Out of school
40
44
47.6
52.3
None
Primary school
Secondary school
Tertiary education
Residence
Urban
Peri-urban
Rural
Engaged in IGA
Yes
No
0
0
24
60
0
0
28.5
71.4
80
02
02
95.2
2.3
2.3
28
56
33.3
66.6
Schooling status
Education level
2.2.2 Focus Group Discussion Participants
A total of 91 in-school young people were engaged in the eight (8) focus group discussions
conducted. The age range of participants was 13-19. Male participants constituted the biggest
proportion (58.2%) of the FGD participants. The details can be seen in the table below.
Table 3: Socio-demographic characteristics of FGD participants
FGD Identifier
FGD 1- Jinja
FGD 2- Jinja
FGD 3- Jinja
FGD 4- Jinja
FGD 5- Jinja
FGD 1- Iganga
FGD 2- Iganga
FGD 1- Hana
FGD Type
Non-user
Non-user
Non-user
Non-user
Non-user
Non-user
Non-user
User
Composition
Female
0
0
12
7
7
3
5
4
Male
12
12
0
5
4
8
5
7
Mean Age of
Respondents
16.2
14.5
16.7
15
16
15.5
16
15.5
2.3 Sources of information about RAHU’s on-line Platforms and Reasons for access
School outreaches, peer educators, friends and Facebook adverts were the main sources of
information about RAHU’s on-line Platforms with 25%, 22.6%, 22.6% and 17.8% respectively
9
reporting them. Teachers and RAHU’s IEC materials were the least sources of information about
RAHU’s on-line platforms with only 5.9% and 3.5% of the on-line respondents respectively
reporting having known RAHU’s Sautiplus website and Facebook pages through these sources.
30
25,0
Percentage of respondents
25
22,6
22,6
20
17,8
15
10
5,9
5
3,5
2,3
0
Peer Educator
Academy
Peer Educator
Facebook Advert
RAHU's IEC
Materials
School Outreach
Teacher
Friend
Figure 1: Sources of information about RAHU's platforms
Most of the on-line respondents (53.5%) reported that they were attracted to RAHU’s Sautiplus
Facebook page and website because of the messages shared on these platforms. According to
them, messages are informative, educative and beneficial. However, much as majority were
attracted by content, 23.8% and 22.6% of the respondents were attracted by the platform design
and friendship making/interaction respectively. This can be seen in the pie-chart below.
10
Reasons for A ccess
Making/Interracting
with Friends
23%
Platform Design
24%
Educative/Informati
ve Messages
53%
Figure 2: Reasons for accessing Sautiplus Facebook and website as reported by On-line
respondents
2.4 How Frequent and Extensive Do Young People Visit Sautiplus on-line pages
Many people (69%) visit the Sautiplus Facebook page and website every week. Specifically,
16.6% of the respondents visited these pages every day; 21.4%, 2 or more times a week and
30.9% visit the pages once a week. Some people had visited Sautiplus on-line pages for more
than 6 months (19%); in fact, 10.7% of respondents had visited these pages for over a year.
Only 17.8% reported that this was their first visit to the page (see Figure 3). The visits were
mainly done in the evening and afternoons with 38% and 27.3% of respondents reporting often
visiting RAHU’s online pages at those times respectively. Most of the people stayed on the page
not more than an hour (91.6%) and 41.6% particularly spent less than 30 minutes. These were
mainly respondents who reported secondary level of education. These findings matched with the
focus group discussions where majority of the participants mentioned that they were mostly
allowed to access the computer laboratories in the afternoons. One participant remarked:
11
“……yes it’s easy to access internet because every after lunch we have a provision for
those who want to have the internet, we have a good number of computers there so we
can access them” Male Participant, FGD 1-Jinja.
Frequency of Platform Visits
2 or more times a
month
9%
First time visit
23%
Once a month
8%
Everyday
21%
Once a week
39%
Figure 3: Frequency of visits at Sautiplus and website
2.5 Young People Perceptions towards Access and the Design of RAHU’s on-line Platforms
Over 70% of the respondents reported ownership and/or access to another person’s gadget
(phone or computer) which they used to access the on-line platforms and many (66.6% & 71.4%)
reported being allowed to access internet at School and home respectively. On the other hand,
only 33.3% and 28.5% were not allowed to access internet at School and home respectively.
Over a half of the respondents (59.5% and 54.7%) reported that poor connections and the cost of
internet were the biggest challenges limiting their access to the on-line platforms (See Figure 4).
This finding matched with the FGD findings were one participant remarked:
“At school it may be a little easier for me to access internet because at home, my parents
do not allow me to have a phone. I have to get some money and move to the internet
12
café. I cannot get money every day so maybe in a week if am lucky I may go to a café
twice because at home getting money is a challenge”. Male Participant, FGD 1-Jinja
Other participants had this to say about internet access:
“It’s difficult for me at school to use the internet or the phone because they do not allow
us to possess phones at school but at home I can access it”. Male Participant, FGD 3Jinja
“Much as we are allowed to use the computer lab but time given is limited. You are
given 20 minutes to surf and do everything you want on the computer as other people will
be waiting for their turn, they push you out before you surf whatever you wanted”. Male
Participant, FGD 2-Jinja
“It’s too hard at school, sometimes the internet is too slow and time given is limited”.
Male Participants, FGD 2-Jinja
Majority of the online respondents reported that it was either very easy or easy to find the
information needed whenever they visited RAHU’s on-line Platforms (See Figure 5).
Percentage of Respondents
70
60
50
40
30
59,5
54,7
44
42,8
20
30,9
10
28,5
20,2
0
Its
expensive
Don't own
gadget
Limited Limited time Poor internet Restriction Distance to
Computer
connection from elders internet point
Skills
Internet Access Challenges
13
Figure 4 : Factors influencing access to internet as reported by Respondents
Ease of Finding Information on the Platform
Very Difficult
0%
Difficult
2%
Easy
38%
Very Easy
60%
Figure 5 : ease of finding information at Sautiplus Facebook page and website
2.6 SRHR Information Accessed by Young People from Sautiplus on-line Platforms
Among the on-line respondents, the biggest proportion (85.7%) reported accessing reproductive
health information from Sautiplus online platforms. The other type of information accessed on
Sautiplus platforms were training opportunities and entertainment information with 82.1%and
70.2% respectively. Majority (91.6%) of those who had sought reproductive health information
had specifically sought information do with relationships (See Table 2).
Table 4: Information Sought from Sautiplus Online Platforms by Young People.
Responses from the Online Survey, RAHU, e/mhealth Operations Research, 2015
Respondents
Percentage of Respondents Who:
Mean age
Male
(n=60)
Female
(n=24)
22.5
22
80
100
Type of Information Accessed from Sautiplus on-line platform (%)
Reproductive Health Information
14
Responses from the Online Survey, RAHU, e/mhealth Operations Research, 2015
Respondents
Entertainment
75
58.3
Job Opportunities
48.3
41.6
Entertainment Opportunities
93.3
54.1
News
83.3
62.5
Specific SRHR information accessed from Sautiplus on-line platform (%)
(n=48
Gender
89.5
Sexual and Reproductive Health
(n=24)
62.5
95.8
79.1
0
0
Pleasure
60.4
20.1
Violence
68.7
79.1
Diversity
51.4
45.8
Relationships
91.6
95.8
Sexual Citizenship
Further investigations on additional information needed by young people showed that, 47.6% of
the online respondents felt some information was missing on the platforms. The following types
of information were reported as additional information needed on the platforms; life skills,
success stories, integration of sports into SRHR information, career guidance, business and job
interview tips, drug abuse and homosexuality information. When asked which type of
information embarrassed them to access from on-line platforms, all those who attempted to
answer this question (only seven people) mentioned information related to sexual intercourse.
One FGD participant reported finding sexual pleasure information embarrassing to access from
on-line platforms. She remarked:
“….I may not be at ease reading information on sex in a computer lab”. Female
Participant, FGD 3-Jinja
2.7 Young People’s Usage of the Information Offered on Sautiplus on-line Platforms
Understanding the content is an important step to information usage. From the online survey, the
majority of the respondents (94%) reported that they found the information provided on
Sautiplus online platforms easy enough to understand to their satisfaction. Only 6% of the online respondents felt the information provided on Sautiplus online platforms was not
15
satisfactorily easy to understand. Over a half of the respondents (51%) reported that the
information provided on Sautiplus online channels was very helpful. Other 35.7% of the
respondents felt the information provided was helpful whereas some 13% of respondents were
not sure whether the information provided was helpful or not (see Figure 5). These findings
matched with the FGD findings although the FGD participants further noted that much as the
information shared was helpful, it was too brief. One participant remarked:
“…….they talk about useful topics but they don’t bring out everything that you need to
know”. Female Participant, FGD 1-Hana
60
51,1
50
40
35,7
30
20
13
10
0
Very helpful
Helpful
Not Sure
Table 5: Rating of information offered on Sautiplus platforms
2.8 Sautiplus on-line Platforms Contribution to Increased Uptake of RH services
Over 80% of the online respondents reported finding referral information for additional SRHR
information and services on the Sautiplus website and Facebook page. Condoms, HCT services
and reproductive health services were the main services referred for on RAHU’s on-line Platforms
with 76.1%, 72.7%, and 72.6% respectively reporting them. Pregnancy care and delivery as well as STI
counseling and treatment were the least services referred for on RAHU’s on-line platforms with
only 33.3% and 28.5% of the on-line respondents respectively reporting having referred for these
services on Sautiplus Facebook page and or website. More than half of the respondents (64.2%)
16
reported having seen referral services for Post Abortion Care on Sautiplus Facebook page and or
website. Discussions with RAHU’s online platform users during the focus group discussions also
revealed that young people were referred for additional information and services. Two
participants remarked:
“Yes, we are referred for reproductive health services like Reproductive Health
Uganda”. Female Participant, FGD 1-Hana
“They gave me a telephone helpline that I can all for more information”. Male
Participant, FGD 1-Hana
80
70
60
50
40
76,1
72,7
64,2
30
20
76,1
72,6
33,3
33,3
10
0
Reproductive
Health
HCT
STI Treatment
PAC
FP services
Pregnancy
Care &
Delivery
Condoms
Referral Services
Figure 6: SRHR information and services which are usually referred.
2.7 Appreciation, Perceived Advantages and Recommendations for Platform Improvement
by Young People
2.7.1 Young People’s Appreciation of the Platforms
Willingness of the on-line respondents to recommend RAHU’s online platforms to their friend
was extremely high at 100%. Similarly, over 80% of the online respondents felt RAHU’s online
platforms allowed them to share ideas openly. However, discussions with users of RAHU’s
17
online platforms during the FGD expressed some reservation on sharing their ideas on the
platform. One participant remarked:
“RAHU itself is an organization and many people have access to the information posted
on its pages. You can’t tell how many people access your information, if posted.
Sometimes you fear to write your private things (concerns)”. Male Participant, FGD 1Hana
Findings on the general perceptions of young people towards the information offered on
RAHU’s online platforms showed that; 75% of respondents approved that the information
offered was of high quality. Further still, 76.2% of respondents approved that the information
offered on RAHU’s online platforms was useful. Over half of the respondents (52.3%) felt the
information offered was youth friendly and 44.4% felt it was understandable. Thirty six percent
of the respondents felt the information offered was not understandable and the language used
was inappropriate (see figure 7).
Information Rating by Young People
50
45
40
44
41,6
39,2
35
30
Completely Agree
33,3
Agree
27,3
25
20
29,7
29,7
Disagree
22,6
21,4
19
15
13
10,7
10
5
0
1,1
Completely Disagree
13
5,9 4,7
14,2
0 1,11,1
13
Don’t Know
13
Neutral
2,3
0
High Quality
Understable
Useful
Youth Friendly
Figure 7: Young people's rating of the information offered on RAHU's online platforms.
18
Discussions with non-users of RAHU’s online platforms during the focus group discussions also
revealed high appreciation of online platforms. Young people felt it was cool and fashionable to
have a Face book page. Some participants remarked:
“I think Facebook is easy because I have many friends now when you send me the
message, say RAHU sends me a message on FB, I will share it with Paul, Calvin so they
will all have a chance to comment. If I suggested to him (Paul) a page, we shall all be
sharing the same information rather than a newspaper where he will ask for a copy. So
face book becomes even easier and faster?” Male respondent, FGD 1-Jinja
“……because right now in this generation a person without a Face book account is
totally a real villager. So now days as you use Face book, I think in butikino everybody
has a facebook account accept those who are staunch Christians”. Male Participant,
FGD 2-Jinja
About the design and layout of RAHU’s online platforms, findings showed that; 81.7% of
respondents trusted the content offered on the website. Further still, 55.9% of respondents
approved that it was easy to navigate through RAHU’s online platforms to find the information
needed. About 43% of the respondents agreed or completely agreed that the videos shared on
RAHU’s online platforms were attractive to watch while 42.4% agreed or completely agreed that
believed that the language used was appropriate (see figure 8).
19
Rating of Platform Design by Young Peaople
60
54,7
50
40
Completely Agree
32,1
30,9
29,7
30
20,2
20
13
10,7
10
2,3
25 26,1
21,4
13
9,5
4,7
5,9
0 0
Agree
27,3
22,6
20,2
11,9
15,4
2,3
0
Completely Disagree
Disagree
Don’t Know
Neutral
0
Trust Website
Messages
Easy to Navigate
Appropriate
Language
Attractive Videos
Figure 8: Young people's Opinion of RAHU's online design and lay-out.
Focus Group Discussions on the design and layout of RAHU’s online platforms indicated that
majority of young people appreciated RAHU’s platform design and layout. Some young people
believed the videos shared were of good quality while others thought it was easy to navigate
through the platforms:
“I like the videos. They are of high quality but when the internet is slow, you cannot play
them”. Male Participant, FGD 1-Hana
“It’s easy to find the posts, to comment on the posts and ask about what I didn’t
understand”. Male Participant, FGD 1-Hana
“Its youth friendly because the posts are about young people’s problems which at times
help others young people to solve their own issues or even get courage and hope”.
Female Participant, FGD 1-Hana
2.7.2 Young People’s Perceived Advantages of online Platforms
Focus group discussions on the advantages of using online platforms to disseminate SRHR
information to young people indicated that some young people were in support of online
20
channels while others thought not all young people could access online platforms. Some young
people thought online platforms were effortless as compared to face-to-face means, others said
online channels are quick/faster while others highlighted the navigation challenges:
“It’s very easy to pass on sex information using online platforms other than getting it
orally because people shy away from giving sex information”. Female respondent, FGD
1-Iganga
“It’s easy to ask a burning sexual problem on face book since our parents are not on
face, so they will not get to know our sexual problems”. Male respondent, FGD 4- Jinja
“…….. but someone who didn’t log in like the morning may not know what was there if
he/she logged in the evening especially, if they don’t have the skill to navigate through
the page”. Female respondent, FGD 4- Jinja
2.7.3 Young People’s Suggestions for RAHU’s online Platforms Improvement
Findings on young people’s suggestions for platform improvement showed that; majority of the
online respondents wished-for more routine update of messages and making the platforms more
interactive (76.1% and 70.1% respectively) (see figure 9).
21
Young People's Suggestions for Platform Improvement
76,1
80
70,2
70
60
57,1
53,5
50
40
30
20
10
0
Link to other pages
Routine update of
messages
Make it more
interractive
Improve design
Figure 9 : Young respondents' suggestions for improvement.
The above finding matched with the findings from FGDs where young people suggested making
the platform more interactive. One participant had this to say:
“I think concerning Face book, daily posting is good. If you post information on a daily
or even after every one hour for instance, you post in something about cleanliness and
then the next hour you post maybe on sexual morals, guys are going to get interested and
they will love it”. Male Participant, FGD 1- Jinja.
“Quick response, like when I send a message sometimes it takes long to get feedback, at
least it should be done in one day”. Female Participant, FGD 1-Hana
Other participants wished for offline or free content search:
“They should not charge us for searching Reach a Hand information on internet”. Male
Participant, FGD 1- Iganga
Other suggestions from FGDs included; need for additional information other than SRHR, face
to face promotion of the platform especially in rural schools and lengthy posts:
22
“You should get agents who should come and teach us about these platforms in our
schools”. Female Participant, FGD 1-Iganga
“You should talk about real life stories” Male Participant, FGD 2-Iganga
Yes, sometimes it’s clear sometimes it’s not. They post something very educative yes, but
in most cases summarized”. Male Participant, FGD 1-Hana
23
CHAPTER THREE
3.0 Staff perceptions and attitudes towards RAHU’s Sautiplus
Facebook page and website
3.1. Method of Data Collection from Staff
In-depth Interviews (IDI) were used to generate staff views and judgments of RAHU’s Sautiplus
Facebook page and website. An in-depth guide was developed and used to guide face- to-face
in-depth interviews with RAHU staff. The study population consisted of eight (8) staffs; three (3)
at management level and five at the implementation level. The staffs were identified purposively
considering their roles at RAHU. The researcher together with the selected RAHU staffs chose
the ideal time and place for the interviews. The respondents were offered on-front consent before
being included in the study. The consent form was read to the participants to facilitate clear
understanding. The respondents consented by signing the consent forms. Confidentiality was
maintained by use of anonymous identifiers and restriction to raw data to only those who were
directly involved.
In-depth Interviews (IDIs) generated rich and detailed information concerning the staffs’
perceptions towards the studied platforms, current design and maintenance processes, added
value to other information dissemination means by RAHU as well as the needs for program
development. Open ended questions were used to dig deeper into the subject of discussion. The
interview was recorded using a tape recorder. The in-depth interview guide was pre-tested and
feedback used to refine it.
The audio taped in-depth interviews were transcribed by the researcher. The data was analyzed
using a thematic framework approach, following the key themes, concepts and emergent
categories that evolved during data processing. The researcher then manually analyzed the
findings theme by theme.
24
3.2 Characteristics of the Staff Interviewed
Out of the eight RAHU staffs were interviewed; three were from the management while five (5)
were implementers. All the staffs interviewed were below 30 years, indicating a youth-led
organization. One of the managers had worked in SRHR field for 14 years. The average working
experience of the implementing staff in SRHR field was 2.7 years. A Peer Educator engaged in
managing RAHU’s on-line platforms was also one of the study’s five implementers. He had
three years’ experience working in SRHR field.
Table 6 : Socio-demographic Characteristics of the Staff Interviewed
Key
Identifier
informant
Sex of
Respondent
Age of Respondent
No. of years in
working in SRHR
field
Manager 1
Manager 2
Manager 3
Implementer 1
Male
Male
Male
Female
25
25
25
25
7
14
2
4
Implementer 2
Implementer 3
Male
Male
23
25
3
1
Implementer 4
Implementer 5
Female
Female
28
23
0.5
3
3.3 RAHU’s Readiness for E&MHealth Programming
3.3.1 On-line Programming Needs Assessment
Findings on whether RAHU had conducted a needs assessment in regards to on-line
programming showed that a needs assessment had been conducted and among some of the key
insights from the assessment reported included; the need for capacity building for staff and peer
educators, the need for more computers and staffs, and the increasing appreciation of on-line
media by young people e.t.c. One respondent remarked:
25
“Yes we did some needs assessment and we realized that there are different
challenges……. The overwhelming questions from young people require additional
manpower”. Implementer
However, some respondents were not certain as to whether the needs assessment for e/mhealth
programming was done. This was mainly common among the implementers.
“I am not sure but I think they did a needs assessment”. Implementer
3.3.2 Presence of Infrastructure
There was an overall agreement among the respondents that the available infrastructure was
adequate. Findings on the state of infrastructure pointed out that; there was unlimited internet
access, each staff had access to a computer and had a smart phone. Respondents mentioned that
may be in future as RAHU grow more infrastructure will be needed.
“At the moment I think our infrastructure is adequate but like I said RAHU is growing
there is time to get even much better”. Manager
“……….at the moment every member of the team can at least access internet, they can
access a computer, but as we grow, the team will grow and more of these will be needed.
Right now the team has full time access to internet and at least a computer”.
Implementer
3.3.3 Availability of resources (human, time and finances)
Human resources:
Findings on the availability of resources showed that some respondents felt RAHU had enough
human resources with a big peer educators’ network which it could tap into while other
respondents mentioned the need for additional staff. The later was common among
implementers. Some respondents thought that the peer educators’ network had not yet been fully
utilized.
26
“You know with human resource we have because we train these peer educators and if
each of these peer educators was seated on a computer then we would have a lot of
support”. Manager
I think we need someone else (additional staff) but it will also depend on the expansion of
e/m platforms. It may not be very big so we may not need a big team”. Implementer
“We have enough human resource, but financial resources we are still fundraising…”.
Manager
Further probing on the capacity of RAHU’s human resources revealed that the staff were
competent to do e/mhealth programming and often exposed to continuous training. Respondents
cited; refresher trainings, expert talks, self and team learning as approaches through which their
capacity was build. However, majority of the respondents mentioned need for continuous
capacity building of the e/mhealth team. It was also reported that, e/mhealth staff worked as a
team and each staff had an area of specialty. Further still, majority of the in-depth interviewees
reported no prior e/mhealth working experience besides managing personal online pages. This
showed that this was their first time exposure doing e/mhealth programming at RAHU.
“The staff is competent to use E&M platforms, but as we know this is technology, every day
things change and as they evolve we have these refresher courses for the staff”. Manager
Financing for e/mhealth
Yes currently resources are available but we have also established ourselves in Uganda
as social media ambassadors, in order to compete favorably. We have also sent out
funding proposals and we hope they will get some funding especially the youth hub”.
Manager
Another respondent noted that e/mhealth financing has picked up and should be given funding
priority.
27
“……..it would be very unfortunate if they are no funds for e/mhealth programming. This
should be what everyone wants to fund”. Manager
3.3.3 Management Support for e/mhealth programming
Findings on management support for e/mhealth programming showed that there was a lot of
support received from the management. Respondents reported that RAHU management highly
appreciated e/mhealth programming and actively solicited for its funding. Further discussions on
the types of support received from management revealed both technical and financial support.
Among the support mentioned included; mentorship and guidance, training opportunities,
internet provision, and fostering collaboration with other organizations that doing well in
e/mhealth programming. One respondent remarked:
“There is a lot of support that comes from management for online communication
channels because they are our core business. There is room for trainings, management at
least solicits for these trainings, there has been presence of full internet access at office,
and the peer educators who use their smart phones at least are facilitated with airtime to
buy data bundles..........”. Implementer
3.4 Staff Perceptions of e/mhealth Programming
3.3.1 Perceived advantages of e/mhealth programming by staff
Discussions on the use of internet and mobile technology supported platforms to pass on SRHR
information to young people in Uganda revealed that the interviewed staffs were in support of
e/mhealth programming. They reported that e/mhealth programming was fast growing and direct
to the audience:
“Since internet use is a first growing trend among young people, it’s a tool we can adopt
and use to pass on information and young people can easily adopt to it and easily get to
it”. Manager
28
“I think it’s an easier way to get to young people without intermediaries; they are getting
the information straight off the internet and straight off their social media pages. I think
it’s the way to go if we want to easily reach them (young people) because this is what
they do every day, so if you put the information there then they will get it”. Implementer
Furthermore, majority of the respondents mentioned that use of internet and mobile technology
supported platforms to disseminate health information was now the trend. One respondent
remarked:
“It’s now becoming more of a fashion to access information through internet. I have been
to Jinja and I have met young people asking each other if they are on Facebook and if not
then what you are waiting for. So for me I think it’s the way to go”. Implementer
Further discussions showed that the respondents believed that access to devices that accessed
online platforms like phones, computers among others was on increase in Uganda including in
local schools. One respondent said:
“I think the current generation is so much more into social media, even the young
adolescents; our target audience the 12 to 24 years. In fact the biggest percentage of
people in the urban and peri-urban can access devices like phones, computers and even
simple schools now have computer labs where by students can access internet”.
Implementer
3.3.2 Perceived challenges of e/mhealth programming by staff
Further probing on what the respondents thought about use of internet and mobile supported
channels highlighted a major concern over the cost of accessing these platforms by young
people. According to the concern respondents, much as online communication channels are the
latest thing in Uganda, the cost of internet bundles is still on a high side especially for the young
ones to afford. One respondent remarked:
“In Uganda it’s still challenging where you find that it’s a bit expensive for young people
to access internet. Much as there internet subsidizing campaigns like Face book zero and
29
another one that MTN launched recently of loading 500 UGX then you access whatsup,
face book and tweeter at a lower price, but young people still find it a little expensive”.
Implementer
Another concern expressed by the respondents was that of the national policies that limit certain
content for instance the anti homosexuality and anti pornography bills. According to some
respondents, there was demand for information on homosexuality and yet it’s would be violating
the law if you provided such information. One respondent remarked:
“…..you know that sexuality is also somehow like pornography, there are some pictures
that are explicit, some communication that is explicit. But we try to balance because we
do not want to be tagged on as those who support pornography in this country”.
Manager
Similarly strict school policies were also reported by respondents as a limitation to e/mhealth
programming. Respondents reported policies like; restriction of phones in school, limited access
to computer laboratories and restriction of sexuality education especially in Muslims schools.
“……if you are going to a Muslim school you need to know that these people view
sexuality information in a certain way, you need to be in line with their policy”.
Implementer
Further probing on the limitations of e/mhealth programming revealed some cultural and social
restrictions. Respondents reported the following cultural and social limitations respectively;
shying away from open discussion of some sexuality topics, and boys being friendlier to use of
technology than girls. In addition to the above, respondents noted that rural youths in particular
had limited access to internet. Unanimously respondents reported the slow internet connections
in the country as an access limitation and also pointed out that at organization level, they had no
limitations to e/mhealth programming. One respondent remarked:
30
“At RAHU there are no limitations. We are going without any limitations. For the
country, the biggest limitation that we have is the slow internet connections that we keep
facing”. Manager
3.5 Current Platform Design and Maintenance
Discussions on how the RAHU’s online platforms are designed and maintained revealed varying
responses from the interviewed staff. Some respondents mentioned that the design of RAHU’s
online platforms was done by specific people after team discussion while other respondents
reported that that the design and maintenance of the platforms was done by a number of people.
This was common with the Facebook page where it seemed there was no clear cut on the
responsibility of platform designing and maintenance across managers and implementers. One
respondent remarked:
“With the process of designing we have someone who is doing our design work, we sit
with them they understand the concept, we tell them we need something to go out, it has
to be like this, they understand it and they sit and design it. So we all get involved”.
Manager
3.6 Staff Perceived Added Value of Online Platforms to other RAHU’s Information
Dissemination Channels
Discussions on the added value of online platforms revealed that the interviewed staffs believed
that online platforms complemented the face to face strategies. They noted that online and face to
face platforms promoted each other and supplemented the information disseminated on the other.
Further probing also showed that the respondents believed that online platforms enabled them to
reach a wider coverage even where they couldn’t easily reach physically. One respondent
remarked:
“When you are going to have an outreach you share about it online and you keep the
young people updated with what is happening at the outreach on social media. During
the outreaches you encourage them to continue the discussion you have had with them on
the social media platforms”. Implementer
31
3.7 Needs for program improvement and sustainability as reported by staff
Discussions on what is needed for emhealth program improvement and sustainability showed
that all the in-depth interviewees pointed at three conditions, which they perceived to enhance
program improvement. These conditions included; continuous training of the implementing
staffs such that they are regularly updated with the technological advances, proper planning, and
training and involvement of the peer educators in content development and regular platform
message posting:
“We need a lot of improvement in planning, because planning is normally haphazard if
the team decides then it’s left to the implementing person and you find that there is a big
gap between the two; the top management and the person that is implementing”.
Implementer
“I think more planning will make our work easy because when you plan, you can easily
schedule the posts and just keep pushing them out. And the people you are trying to
target with this information will get correct and consistent information”. Manager
Another respondent said what is needed is more youth involvement in implementation of the
platforms.
“Lets remove the beaucracy and involve the young people themselves in content
development, ask them what they think and use the feedback”. Implementer
32
CHAPTER FOUR
4.0 Expert observation of RAHU’s Sautiplus Facebook page and
website
4.1 Observation methods
A structured observational assessment of RAHU’s Sautiplus Facebook page and website was
conducted. An observation checklist was developed and used to guide the observation of the two
platforms to produce information on the nature, operations and information offered on the
platforms. The observation assessment generated rich and detailed information which included;
user engagement i.e. likes, shares, comments; the platform design; the type content shared; and
content generation.
The observation focused on the platform activities for the period of three months that preceded
the observation exercise. The observation forms were completed during and immediately
following an observation. Written notes, listing ideas or relationships were noted during the
observation.
Data from the observation was analyzed manually, following the key themes, concepts and
emergent categories that evolved during data processing. The researcher then manually analyzed
the findings theme by theme.
4.2 What kind of information is offered on RAHU’s Sautiplus Facebook page
and website
Observation findings showed that gender, sexual and reproductive health, pleasure, violence,
diversity and relationships were the common comprehensive sexuality education topics offered
on RAHU’s Sautiplus Facebook page and website. Sexual citizenship related topics were not
offered on the platforms during the three months study period. Other types of information shared
other than SRHR information included; training and some news.
33
About the common questions asked by the young people, the observation noted that the design of
the website did not allow the audience to share feedback or ask any questions. In otherwords the
website was not interractive. Observation on the facebook page, showed that there were a few
questions coming in from the audience. The questions were mainly inboxed and not posted on
the page. The common questions observed were asking about the physical address of the
organization and relationship issues. It was observed that on average it took two days to respond
to the followers questions/concerns.
Further observation of the referral information offered on RAHU’s online platforms revealed that
referral information for additional information and services was barely on the platforms. The
little that the observers noted were hidden within stories and not easily seen.
4.3 Expert observation of the platform design and content generation
Data from the observation assessment of RAHU’s Sautiplus website and facebook page showed
that the design and layout of the observed platforms was good but there was still room for
improvement. Information was shared mainly in text, pictures and video formats.
Further observation of content generation on the platforms revealed that for the facebook page,
on average a message was posted on a daily basis while for the website, content was not
regularly updated. During the three months observed, no content update was done on the
Sautiplus website. The observation findings further showed that content was mainly generated by
the organization. The messages shared on the platforms were precise.
4.4 Observation of the audience engagement on RAHU’s on-line Platforms
Observation findings showed that RAHU’s Sautiplus facebook page had over 31,000 followers.
The followers were mainly engaged through, post stories, comments, share links and likes. The
other forms of engagements noted were pictures and videos that were uploaded. Questions were
asked but this happened on a small scale. Feedback from the audience was only observed on the
facebook page and not the website.
34
The observation findings also showed that the top three most reached stories on the Sautiplus
Facebook page during the study period were; relationship (personal story), HIV prevention and
teenage pregnancy stories with 8,964, 16,008 and 4728 followers reaching them through either
reading, liking, sharing respectively.
In relation to the above, the observation findings further showed that the top three most liked
stories on the Sautiplus Facebook page during the study period were; HIV prevention,
relationship (cheating partner) and Gender Based Violence with 206, 43 and 85 likes
respectively.
Data from the platform observation showed that sharing of the stories offered on RAHU’s online
platforms was limited compared to liking and commenting on the post. HIV prevention,
relationship (personal story) and Hepatitis B stories were the most shared stories observed with
only 28, 6 and 5 followers sharing them respectively.
The Sautiplus Facebook page in-built analytical features revealed the following information;
there were more visits in the first week of February 2015 (227 visitors) with an average post
likes of 25900 in the month of February, the least visitors during the study period visited during
the first week of April 2015 (02 visitors); Photo views were quite high; and the highest reach was
attained during paid reach at 20,366 compared to 15,775 highest during unpaid reach. Reach
refers to all people reached by the platform information through the various ways i.e. post view,
photo/video view, comment, share, like e.t.c.
35
CHAPTER FIVE
5.0 Use of Results to Improve RAHU’s Online Platforms
5.1 Programming opportunities identified by the e/mhealth operations research
We identified several programming opportunities that Reach a Hand Uganda ought to consider.
These include:
•
High appreciation and respect for online platforms by both young people and RAHU staff,
coupled with existing familiarity of online platforms by young people.
•
Management support and sound staff technical capacity for e/mhealth programming plus the
untapped strong peer educator network
•
Presence of other RAHU programs that could incorporate online platform promotion
•
Existence of a big audience base in urban and peri-urban areas.
•
Appreciation of RAHU’s online platform design and trust in content offered by young people
•
High ownership and access to gadgets that access internet by young people
•
Existence of computer laboratories in most secondary schools
5.2 Program gaps identified by the operations research
The following gaps were identified by the operations research and observations during the
operations research implementation:
•
Low awareness of RAHU’s online platforms among in school young people
•
Irregular update of content on RAHU’s online platforms (especially on Sautiplus website)
•
Unclear structures for platform design and maintenance.
•
Minimal and hidden referral information for additional SRHR information and services
•
Limited staff capacity specifically on content development (current practices not systematic).
•
Fewer formats and functionalities used to disseminate SRHR information via online platform
•
Minimal integration of online platforms with other current offline programs i.e. face to face
programs
36
•
Low usage of platform inbuilt statistical information and other research findings to inform
programming
5.3 Implications of the e/mhealth OR findings and observations to RAHU
The study findings showed a high appreciation of online platforms both by users of RAHU’s
online platforms as well as the in-school non users. In fact discussions with non-users of
RAHU’s platforms during the focus group discussions revealed that young people believed that
having a Face book page was cool and fashionable. Similarly, FGDs on the design and layout of
RAHU’s online platforms indicated that majority of the users appreciated RAHU’s platform
design and layout. In particular young people believed that the videos shared were of good
quality and it was easy to navigate through the platforms. Over 80% of online respondents
trusted the content offered on the website. This implies that RAHU should take advantage of this
positive situation to promote her platforms among young people in addition to strengthening the
platform design efforts in order to maintain or even improve the good impression by the
audience.
The online survey showed that young people mainly visited RAHU’s online platforms in the
afternoon and evening. In fact 38% and 27.3% of online respondents reported often visiting
RAHU’s online pages in the afternoon and evening times respectively. The average stay on the
page was less than an hour. These findings give a clue on the proper timing and frequency of
online information posting. Burnam et al (2012) emphasized that the timing of communication
messages (i.e., time of day, frequency, and sequencing) is vital in ensuring convenience and
receptivity of the end user. Therefore RAHU’s message posting and audience engagement efforts
should be capitalized in the afternoon and evening. RAHU should also create room for overtime
dedication to online audience engagement beyond office hours.
Data from the online survey showed that majority of the people who used RAHU’s online
platforms were 18 years and above (mean age 22.2 years) and mainly males. The survey findings
also showed that a big proportion of young people (95.2%) who used RAHU’s platforms were
mainly urban and peri-urban residents. These findings provide a sound understanding of the
situational context which is a fundamental pre-condition for e/mhealth programming. The
37
implication of this finding is that RAHU should be mindful of the information needs of this older
group of young people who dominates its audience. It also highlights the need for concentrated
promotion of the online platforms among the very young young people (10-17 years) and other
hard to reach groups. Teachers, in particular in-school clubs’ patrons are a good resource for inschool promotion of online platforms. In addition, previous research has noted that to increase
uptake of online information, one may have to provide incentives. 7
The survey showed that young people often visited RAHU’s Sautiplus website and Facebook
pages. In fact 69% of the respondents reported visiting these pages at least every week. Some
respondents had visited the platforms for more than 6 months (19%) while 10.7% of respondents
had visited the platforms for over a year. These finding imply that there is need for regular
updates of messages offered on the online platforms such that the regular visitors do not feel
tired of same messages. The observation findings showed that the messages on the platforms
were not regularly updated and not “sticky”. For example, the Sautiplus website messages had
not been updated for the last three months. This implies that regular visitors of this page went
through the same content over and over again. Therefore there is need for RAHU to regularly
update content on its online platforms but also create room for innovative ways to make the
content more engaging and entertaining that young people long to always return many more
times. Games, real stories, quizzes and plays are some of the creative ways to make educational
content engaging and entertaining.
The survey showed high ownership and easy access to personal or another person’s gadget i.e.
phone or computer. Over 70% of the online respondents reported ownership and/or access to
another person’s gadget (phone or computer) which they used to access the on-line platforms.
This finding is similar to the findings one study 8 that looked at actual and potential access to
SRHR information through various platforms in Uganda in 2010, which reported that 27% of
about 1500 secondary school students in Mbarara district (south-western Uganda) owned a
7
. Sheila Kinkade and Katrin Verclas: Wireless Technology for Social Change. Washington, DC and Berkshire, UK:
UN Foundation–Vodafone Group Foundation Partnership, 2008
8
. Mitchell KJ, Bull S, Kiwanuka J, Ybarra ML. Cell phone usage among adolescents in Uganda: acceptability for
relaying health information. Health Educ Res. 2011 Oct;26(5):770–81. doi: 10.1093/her/cyr022
38
phone. Easy access to gadgets that access internet is a facilitating factor for making SRHR
content directly available and accessible for youths through online platforms. Therefore it is a
positive indicator for e/mhealth programming in Uganda. Related to the above, the survey
showed that 66.6% and 71.4% of respondents were allowed to access internet at School and
home respectively. This implies that there is opportunity for RAHU to negotiate with other
school administrations (those that restrict internet access) to allow internet access and may be put
restrictions on the access timing.
Data from on-line interviews showed that majority of young people (85.7%) accessed
reproductive health information from RAHU’s Sautiplus website platforms. Observation of the
RAHU’s online platforms revealed that comprehensive sexuality education topics were the major
topics offered compared to any other type of information. In fact, sexual and reproductive health
as well as relationship topics i.e. HIV prevention, Cheating, GBV among others drew more
comments, sharing, and likes from the Face book audience. This could be partly because
RAHU’s online platforms were mainly accessed by older young people 18 years and above yet
in Uganda young people typically become sexually active at an early age. By 15 years of age,
11% of Ugandan adolescents have initiated sex and by 18 years 64% of young people have had
their first sexual encounter. 9 This implies that during content development RAHU should
priorities the information needs of this sub age group who dominates its audience. Related to the
above, discussions on additional information needs highlighted the following information topics
needed by young people; life skills, success stories, integration of sports into SRHR information,
career guidance, business and job interview tips, drug abuse and homosexuality information. The
implication of this finding is that there need to incorporate other types of information other than
health. This is information is likely to draw those passionate about it to the platform and hence
also accessing SRHR information.
In-depth discussions on the organizational capacity, showed high appreciation and commitment
to e/mhealth programming by both RAHU’s top managers and implementing staff. Further
probing revealed that the staff were competent to do e/mhealth programming and but mentioned
9
.Uganda Bureau of Statistics (UBOS) and ICF International Inc:Uganda Demographic and Health Survey
2011.UBOS and Calverton, Maryland: ICF International Inc 2012.
39
need for continuous capacity building of the e/mhealth team. This implies that RAHU should
focus more on bridging the current capacity gaps rather than having generalized trainings since
the staff are generally competent but have minor gaps that need to be filled with specialized
trainings. About the resources, the findings showed that RAHU had enough human resources
with big peer educators’ network which needed to be fully utilized. The implication of this
finding is that RAHU needs to put in place structures for proper online platforms design and
maintenance including clearly stipulated peer educator responsibilities. Trained peer educators
could be a good resource for regular tracking of the follow of information on the platforms as
well us message updates.
In relation to the above, findings showed that RAHU had adequate infrastructure for e/mhealth
programming. Data from staff interviews also showed that there was funding assurance of the
current e/mhealth programs but uncertainty for future funding existed among staff. The
implication of these findings is that RAHU need not to spend more on infrastructure but rather
use the available funds for other pressing program needs like promotion of the online platforms.
There is also need to advance current fundraising efforts for e/mhealth programming.
Furthermore, although the online survey showed that over 80% of the respondents reported
finding referral information for additional SRHR information and services on the Sautiplus
website and Facebook pages, on the contrary observation findings showed that referral
information was minimal and hidden. This implies that RAHU should strengthen its efforts to
provide referral information additional SRHR information and services to its audience. For
example, having a referral corner/page on the main page would be an innovative way of offering
referral information on Facebook and website.
Lastly, findings on whether RAHU had conducted a needs assessment in regards to e/mhealth
programming revealed mixed answers; according to the managers interviewed a needs
assessment had been conducted while some implementers were not aware of this. The
implication of this finding is that the dissemination and use of research finding is still lacking.
Therefore RAHU should develop measures to disseminate research findings across the all
stakeholders and use the findings to inform programming.
40
6.3 Recommendations
1. Considerable effort is needed to promote RAHU’s online platforms in schools. Special effort
is needed for the upcountry schools. RAHU should intensify the current platform promotion
efforts as well as employ other sustainable promotion strategies such as use of in-school club
patrons, computer laboratory in-charges to continuously give information to students about
RAHU’s online platforms. These can be supplemented by the usual school visits by RAHU
staff.
2. Generally overall capacity of RAHU to implement e/mhealth programs is adequate.
However, small gaps in the staff capacity do exist which require specialized trainings.
Specifically, RAHU should conduct a staff capacity assessment in regards to e/mhealth
implementation in order to identify the precise staff knowledge and skill gaps that need to be
filled. This research noted a gap in content development and packaging capacity.
3. There is need for RAHU to focus its efforts to a few online platforms and then expand little
by little. From the findings and observations during the OR implementation processes, it was
evident that currently RAHU operates many online platforms, some of which are well-known
to some staff. This situation tends to scatter RAHU’s efforts and limits the performance of all
the platforms. A few platforms i.e. Facebook and website could be prioritized and given
targeted efforts to great platform improvement.
4. There is need to explore measures to enable young people access online content at a
subsidized cost or no cost. Offline content access strategies can be explored to supplement
direct online information access. These will address the issue cost of access that was raised
by both the young people and RAHU staff.
5. Considerable effort is needed to make RAHU’s online platforms interactive and entertaining.
RAHU should explore innovative strategies like live stream on the website, quizzes, and
games among others. Regular update of information on the platforms should also be
emphasized. All these approaches could stimulate young people’s engagement and
motivation for revisits. Further still small incentives i.e. promotional materials to regular
visitors or winners could also be a good strategy to promote the platforms and a motivating
factor for revisiting the platforms. Peer educators (if well trained and guided) could be a
good resource to regularly update the platforms. Related to the above, RAHU should invite
41
stories (true or fictional) from young people with content relevance. These can be used to
stimulate participation. In addition, RAHU can annually request youth to give their thoughts
on what content they want to see and even solicit for content from followers in order to have
regular content updates for the site.
6. There is critical need for RAHU to make its planning for emhealth implementation more
efficient. Efforts to redefine the implementation structures for emhealth platforms are need.
7. Further research is needed on; 1) the quality of content offered on RAHU’s online platforms
is needed, and 2) the information needs of the young people 10-14 years old. In addition,
RAHU should develop a culture to use data to guide programming. For example, the online
platforms’ in-built statistics are a rich source of data which could inform implementation
decision making.
6.4 Results Dissemination and action planning
After data analysis, a dissemination and action planning workshop was organized at organization
level before the joint national stakeholders’ dissemination meeting. The objective of this
workshop was to share the e/mhealth operations research (2015) findings and use the findings to
initiate evidence-based e/mhealth programming at RAHU. At the action planning workshop, the
results of the e/mhealth operations research (2015) were disseminated by the consultant to
RAHU staff. The participants discussed the findings of the e/mhealth operations research (2015)
and through participant engagement, obtained recommendations for improvement of RAHU’s
online platforms. The initial action plan is appended to this research report.
42
Main findings/problem
description
1. Low awareness of
RAHU’s online
platforms among in
school young people.
Which actions can be undertaken by RAHU to bridge the gaps
identified by the OR
•
•
•
•
•
•
•
2. Irregular update of
content on RAHU’s
online platforms
(especially on
Sautiplus website)
•
•
•
•
•
•
•
3. Unclear structures for
platform design and
maintenance.
•
4. Minimal and hidden
referral information
for additional SRHR
information and
services.
•
5. Limited staff capacity
specifically on content
development (current
•
•
•
•
•
Strengthen the promotion of the platforms during school outreaches.
Display the platforms during school outreaches and encourage
students to like the pages for easy follow up.
Encourage peer educators to promote online platforms during school
visits.
Print IEC materials specifically for online platforms i.e. fliers, posters,
small cards e.t.c
Restrict online platform promotions to the target age group.
Liaise with in-school club patrons to promote RAHU’s online
platforms
Pinning platform promotion posters on school and computer
laboratory notice boards.
Redesign the Sautiplus website to make it more user friendly for
easy content posting.
Assigning multiple people to do content update rather than one
person.
Encourage peer educators to record materials i.e. videos and
testimonies during school visits.
Share content from the other platforms i.e. the Facebook pages
Revamp the Sauti radio on the website
Empower peer educators to become content developers.
Have a schedule for content development and posting
Include peer educators in the structures for platform design and
maintenance.
Clarify roles and responsibilities for the people working on the
online platforms.
Identify and map youth friendly service points and sign MOUs
with them.
Design online referral posters, banners for referrals and have a
regular schedule for updates.
Create a pop-up with different referral centers.
Continuous capacity development of staffs in areas of content
development
Use of evidence to inform content generation
43
practices not
systematic).
•
Provide materials i.e. books, online resources to facilitate the
content development process.
6. Fewer formats and
functionalities used to
disseminate SRHR
information via online
platform
Try out new formats and functionaries i.e.
•
•
•
Puzzles and quizzes
Online games
Competitive posting
7. Minimal integration of
online platforms with
other current offline
programs i.e. face to
face programs
•
Train peer educators on the integration of online platforms with
existing RAHU offline programs
8. Low usage of platform
inbuilt statistical
information and other
research findings to
inform programming.
•
•
•
•
Encourage peer educators to promote online platforms during school
visits.
Include a platform promotion moment in every RAHU activity
Conduct regular review of in-built data
Use platform in-built data for fundraising
44
Appendices
Appendix 1: List of RAHU’s Young People trained in Research
No.
1.
2.
3.
4.
5.
6.
7.
8.
Name
Nakayima Beatrice
NaluzzePreeme Sharon
AkamutuhaCoviirene
KintuKeneth
Kisekka Edward
Mubiru Alex K
Bamulanzeki Samuel
AtukundaAthibert
Responsibility
Peer Educator
Peer Educator
Peer Educator
Peer Educator
Peer Educator
Peer Educator
Peer Educator
Program Officer
Appendix 2: List of RAHU’s Core Team for this Operational Research
No.
1.
2.
3.
4.
Name
Humphrey Nabimanya
Bakshi Khan
Atukunda Athibert
KintuKeneth
Responsibility
Executive Director
Programs Manager
Program Officer
Peer Educator
45
Appendix 3: RAHU Staff In-depth Interview Guide
ASK E&M HEALTH OPERATIONAL RESEARCH – IDI GUIDE (SYSTEM FACTORS)
INTERVIEWER COMPLETES A1 – A5 BEFORE INTERVIEW
A1
Organisation name:
A2
E/M health platforms used by Organisation
A3
District(s) covered by Organisation under ASK
A4
Name of interviewer
A5
Interview Date
THE INTERVIEWER IDENTIFIES KEY INFORMANT(IMPLEMENTING STAFF OR MANAGEMENT
TEAM MEMBER) INVOLVED IN E&MHEALTH AND FILLS IN THE REST OF THE QUESTIONNAIRE
Hello. My name is _______ and I am working with ASK program_______________ on a study exploring the
factors and actors that determine the effectiveness of RAHU’s e/m health platform to improve access to SRHR
information and services among young people in Uganda. We appreciate that you play an important role is
shaping these platforms and that is why we want to hear from you about your involvement and interaction with
these e&mhealth channels. This is your chance to let ASK program and your organization (RAHU) know your
views concerning the e/mhealth platforms i.e. the design, content, operational processes and the changes you
would wish to be made on them.
I would like to read you a description of the study and then you can decide if you want to participate. If you
choose to participate in the study, it is important that you answer each question as thoughtfully and honestly as
possible. Please be patient if some questions don’t apply to you: we need to ask everyone the same questions. Be
sure to understand the instructions below before you begin to answer. Thank you very much for being an
important part of this survey.
I'd like to start by recording your briefsocio-demographic characteristics.
RESPONDENT CHARACTERISTICS
1
GENDER OF RESPONDENT
MALE
1
FEMALE
2
46
2
How old are you?
AGE:
3
What is your role here?
BOARD MEMBER1
TOP MANAGEMENT2
PROGRAM MANAGER3
PROGRAM OFFICER4
PEER EDUCATOR5
TEMPORARY VOLUNTEER
OTHER (SPECIFY) :
_________________96
4
How long have you worked in SRHR field?
5
How long have you worked at this organisation?
KNOWLEDGE, SKILLS & ATTITUDE TOWARDS E/MHEALTH PLATFORMS
1.
2.
3.
4.
5.
6.
7.
8.
9.
What do you think about use of internet and mobile technology supported platformsi.e. social media,
SMS or telephone helpline to pass on SRHR information to young people in Uganda?
I heard that <name organization> usese/m health platformsin sharing SRRH information.
What are these platforms that you are currently using?
What is your role in the planning, implementation and evaluation of the ASK program and specifically
the e/m health platforms?
What is your experience in using internet and mobile technology supported platforms to increase access
to SRHR information to young people?
What is the experience and background of your organizations team members working on e/m health
platforms?
Has your organization ever supported implementing staff to acquire technical skills related to use of
e/m technology supported platforms?
Any kind of support given by management in preparation for your work?
Are there any environmental (social structures, organizational norms, policy& regulations) limitations
for e/m health programming in your organization and country at large?
ORGANIZATIONAL READINESS FORE/MHEALTH PROGRAMMING
1.
Is your organization ready to expand/take on e/m health programming?
a. Has your organization done any needs assessment in regard to this subject?
b. Do you have adequate ICT infrastructurein place? I.e. internet connections, computers etc.
c. Do you have adequate resources (human, finance & time) for internet and mobile technology
supported communication platforms?
d. Is the staff competenceenough to use e/m health platforms?
e. Is it easy to access funds for e/m health programming? Are the funds available?
47
IMPLEMENTATION PROCESSES, MANAGEMENT SUPPORT& IT COMPETENCES
1.
2.
3.
How easy do you find using e/mhealth platforms compared to traditional communication modes?
What is your opinion on the process of page or site design (social media, website etc.)?
How is the process of content development? Do you have enough resources? Is it systematic?Do feel
involved in making decisions on the content?
4. How do you rate the management support?
5. How are the staffs working on these platforms motivated?
6. To what extent do you feel involved in making decisions regarding changing or adopting e/mhealth
strategies at your organization?
7. Mention some of the challenges encountered while trying to use these new technologies to promote
behavior change among the youth?
8. How can they be overcome?
9. How can ICTs be effectively integrated into traditional medium of delivery of SRHR information to
young people?
10. What implementation process improvements would you recommend to easy your work or to better
serve your audience?
CONTENT &M&E
1.
What factors do you consider when designing, implementing and evaluating e/mhealth platforms to
increase access to SRHR information?
2. What kind of SRHR information is currently being provided by <name organization>through
e/mhealth channels?
3. How actively are you involved in content generation on e/mhealth platforms at you organization?
4. Are there any materials/training provided for that role?
5. How do you rate the above?
6. How often is content changed?
7. What factors explain the content updating patterns reported above?
8. What kind of SRHR information should be provided by <name organization>through e/mhealth
channels?
9. What are the reasons for your answers?
10. In your opinion, how does e/mhealth compare with traditional communication channels effectively
deliver SRHR information to young people in ASK district?
11. What are the reasons for your response?
12. Does your organization have a laid plan to evaluate these e/m health programs?
If yes, has any evaluation been done and how were the findings used?
FINAL WORDS
1.
2.
3.
4.
5.
6.
What do you think about your current e/m health platforms at this time?
Overall, how appropriative do you feel it is touse e/m health strategies to increase access to SRHR
among young people in the ASK project districts and Uganda in general?
What are your biggest concerns about e/m health programming in your organization?
What do you think is the best option to improve e/m health programming in your organization?
What information or services could encourage more young people access information through e/m
health platforms?
Do you have any final questions or recommendations to make?
READ OUT LOUD: Thank you for your participation!
48
Appendix 4: IDI Consent Form
Reach a Hand Uganda (RAHU)
IDI Consent Form– Implementing / Management staff
Title:Exploring the dynamics (factors and actors) that determine the effectiveness of e/m health strategies used
by Reach a Hand Uganda to improve access to SRHR information and services among young people in Uganda.
Sponsor:WPF Rutgers
Principal Investigator:Babirye Susan,ASK Project-Reach a Hand Uganda, Kampala
Introduction
Good morning/afternoon. My name is _____________. We are working on an operational research study
exploring the factors and actors that determine the effectiveness of e/m health strategies used by RAHU to
improve access to SRHR information and services among young people.
Purpose of the study
The purpose of this study is to learn about users’ (current & prospective)and providers perceptionsand
experiences using/providing RAHU’s e/m health strategies thereby strengthening evidence based practice and
program development. The other purpose of this study is to generate knowledge on ways to improve program
operations and for strategic dissemination of program results/publication. We want to be sure that you
understand the purpose and your responsibilities in the research before you decide if you want to be in it. Please
ask us to explain any words or information that you may not understand.
Procedures
The interview will last about between 60 and 90 minutes, but you may stop it at any time. I will talk with you
about your role in RAHU’s e/m health programming. I will also ask about your institutional readiness to take on
e/m health programming i.e. culture, infrastructure, financial and content readiness. I will ask you questions
about your support of these strategies, management experiences, staff motivation as well as monitoring and
evaluation of these strategies. If you agree, we would like to record this interview to help us make an exact
record of what you said. We will not write your name on the tape. We will destroy the record when the research
is completed. Staff from the study team will look at the transcripts from this interview but your name will not be
included.
Who will participate in the study
Implementing staff directing working on RAHU’s e/m health platforms and management staff will be
interviewed tobetter understand their experiences and feelings about these strategies. We expect to interview
about 10respondents from this organization. You have been selected as part of this group, and we are asking you
to participate in an interview.
Possible Risks
49
We do not expect that you are at risk of any bad things happening to you by participating in this interview. You
may feel uncomfortable answering some of our questions. You are not obliged to answer them. I will ask you to
respond honestly and to the best of your ability. There is no need to worry if you do not know the answer to a
question. We will not discuss your responses with anyone.
Possible Benefits
The information that you share with us will inform e/m health programming at organizational, program and
other levels of planning.By participating in this interview, you will have a chance to share your experiences with
decision makers.
Confidentiality
We will protect information you share with us to the best of our ability. We will not use your name in any
reports. We will not tell anyone about your participation. We will not tell anyone the answers you give in this
interview.
Compensation for the participant in this study
If you agree to participate, you will receive NO compensate you for your time.
Questions and rights as a participant
The Higher Degrees, Research and Ethics Committee of Makerere University School of Public Health and The
Uganda National Council of Science and Technology approved this study.
If you have any questions about the research or your participation in the research, you may contact Dr. Suzanne
Kiwanuka, the Chair, Higher Degrees, Research and Ethics Committee of Makerere University School of Public
Health P.O BOX 7072, Kampala, Uganda on Tel No: 0701-888 163 or 0312-291 397
Alternatives/Statement of voluntariness
You are free to decide if you want to participate in this interview or not. If you decide not to participate, this will
not be reported to anyone. Your decision will not affect your position and the services you receive from RAHU.
If there is a question you do not feel comfortable answering, you can tell me so, and we can skip over it. You
may also stop the interview at any time.
Confirmation of your consent to participate
Do you understand all I have just told you and do you agree to participate in this study? If you agree to
participate in this study, you will need to sign this form.
PARTICIPANT AGREEMENT
50
PARTICIPANT: I have read the study information / The study information has been read to me. I have been
asked if I have any questions, and these have been answered to my satisfaction. I freely agree to participate.
_____________________________
Name
_____________________________
_____________
Signature or Thumb Print
Date
INTERVIEWER: I certify that the nature and purpose, the potential benefits, and possible risks associated with
participating in this research have been explained to the above individual, and the individual has consented to
participate.
_____________________________
Name
_____________________________
Signature
_____________
Date
51
Appendix 5: Focus Group Discussion Guide
REACH A HAND UGANDA
ASK E&M HEALTH OPERATIONAL RESEARCH - FGD GUIDE
Number of participants 8-12
SECTION 1: Introductions
Note: Welcome everybody and thank them for being part of the discussion. Introduce yourself as
working with a team from Reach a Hand Uganda (RAHU) in collaboration with the district health
office and introduce the subject of discussion. Then give a summary of the verbal consent below and
allow each one of them to introduce them thereafter.
Wekalirize: Sangaza buli mutuntu era omwebaze okwikiriza okwetaba mumusomo guno.
Weyandule ng’akola ni RAHU nga mugemaganiza walala ni offisi ey’obulamu ku
distirikiti.Yandula omulamwa gw’omusomo guno mme oyinhongole ebigemagana ku musomo
guno. Wa buli muntu akasera okweyandula.
Summary of the verbal consent
Dear Participant,
You have been selected to participate in this study “Exploring the dynamics (factors and actors) that
determine the effectiveness of three e/m health strategies by RAHU to improve access to SRHR
information and services among young people in Uganda”. We appreciate that you play an important
role in shapingthe strategies intended to reach you with SRHR information and that is why we want to
have a discussion with you today.The generated data will inform subsequent e/m health programming
through knowledge on what works and what does not work.
Ssebo/nyabo,
Olondeibwa okwetaba mumusomo guno ogugya okwekalirisa ebintu ebiviraku enkola enkalamu
ey’empereza dha RAHU edhiweleza amawulire geby’obulamu eri abavubuka ng’adhibita mu
masiimu n’omutimbagano nkani internet mu Uganda. Twidhi era tusiima nti oliwamugaso inho
mukutumbula empereza dhino edhigendeleirwa okusasanya amawulire geby’obulamu eri
abavubuka, n’ensonga lwaki tugya kuwayamu niwe olwaleero. Byetunawaya biidha kuyamba
okw’ongera omutindo mumpereza dhino nailala by’ogya okutukoba kuki ekirungi kumpereza
dhaife naki kyoyenda okukyusamu.
Taking part in this discussion is voluntary and what we shall discuss today shall be kept confidential
and only used for purposes of improving the e/m health platforms implemented by RAHU and the
52
ASK programme partners.You are free to take part in this discussion but should you feel like you
want to leave at any point, you are also free. If you have any questions about the study, raise it now or
should you need any further information about what we are doing, you can contact Dr. Suzanne
Kiwanuka, the Chair, Higher Degrees, Research and Ethics Committee of Makerere University
School of Public Health on Tel No: 0701-888 163 or 0312-291 397 or Ms. Babirye Susan, the
principal investigator on Tel No: 0712-210 002. We would also like to inform you that you that we
shall be recording the discussion, just for the purposes of us capturing everything that we might miss
out when taking notes.The interview will take about 60-90 minutes and your participation or refusal to
participate in this interview will not affect the services you receive in any way.If you agree to provide
information to the researcher under the conditions of confidentiality set out on this sheet form, please
register on the registration sheet.
Oluwayo
luno
lwakyeyendele
era
byetunawaya
bidha
kukumibwa
nga
byakyama.
Biidhakukozesebwa mukutumbula empereza dhino edha RAHU edhikozesebwa okusasanya
amawulire geby’obulamu eri abavubuka mu pologulamu ya ASK. Oliwayidembe okwetaba
mumusomo guno oba okuloba era w’oyendela okugya wonawona oliwayidembe. Bwoba
n’ekibuuzo kyonakyona ekigemagana kumusomo guno, okobola okukibuuza kati oba okubuuza
Dr. Suzanne Kiwanuka, akulira, Higher Degrees, Research and Ethics Committee eya Makerere
University School of Public Health kwisimu: 0701-888 163 oba 0312-291 397 oba kubiraMs.
Babirye Susan, akulira omusomo guno kwisimu: 0712-210 002. Twenda okukutegeza nti tugya
kugemywa kulutambi byetugya okuwaya okusobola obutelabira byetuwayiya. Oluwayo luno lwidha
kumala wagati wesaawa n’esaawa endala n’ekituntu. Okwetaba oba obutetaba mumusomo guno
tikyidha kukukosa naile. Bwoba oyikiriza okwetaba muluwayo luno, wandika erinayo ilala lyonka
ku kapapulo akokwewandisa ketugya okukuwa.
Note:
1. Make sure the tape recorder is switched on to the start of the interview.
2. Use the demographic log sheet to register the participants (by registering only their first
name)
Ice breaker
1. Shall we start by introducing ourselves? (Let the participants introduce themselves)
2. What do you understand by sexual and reproductive health and rights (SRHR) information?
3. Where have you gotten SRHR information in the past 12 months?
SECTION2: E&M HEALTH PLATFORMS
53
4. Tell me more about the SRHR information sources that use internet and mobile technologies
for instance websites, SMS or telephone helpline and social media etc.
Probe for:
• The different e/m health platforms they have been exposed to
• E&M health platforms by RAHU (website and social media)
• How did you hear about these platforms?
• How they access these platforms?
• How often they access the platforms?
5. Does RAHU’s website/social media platform meet your needs?
Probe:
• When you access the website/social media, do you get the SRHR information
needed?
• Is the information provided on the website/social media comprehensive enough to
your satisfaction?
• What do you like most about the content provided on RAHU’s website/social media
page?
• Is there any information you needed but never found it on RAHU’s website/social
media?
• Are you referred for the SRHR services you would like to receive?
• Are the referral points accessible and affordable for you?
6. Does the cost of accessing these e/m health platforms meet your income and ability to pay:
Probe:
• How easy or difficult is it for you to access SRHR information through e/m health
platforms?
• Is it affordable for you to access the website/social media pages for SRHR
information?(gadget ownership, cost for internet)
• Have you ever failed to access to the website/social media pages for SRHR
information because of money?
7. How accessible are these platforms in relation to the location of service and that of the young
people?
Probe:
a) Is the environment you leave in convenient for you to access these platforms?
8. Does RAHU’s website/social media platform meet your constraints and preferences?
Probe:
a) Are these e/m health platforms easy to operate using your limited IT skills?
b) Does the content and its design meet your expectations?
c) Is the content changed regularly?
d) Are you able to express your concerns and get response too?
e) Are you able to access these platforms any time and at any location?
f) Do you feel your privacy is safeguarded on these platforms?
9. How comfortable are you with the characteristics of RAHU’s website/social media page?
Probe:
54
g) When you access the website/social media page; is it clear for you where to find the
information you need?
h) Describe your experience using these platforms? Are these platforms friendly?
i) Was there anything that made it difficult for you to use RAHU’s website or social
media page or is there any improvement that you can suggest?
SECTION 3: NON USERS
10. Do you know of any e/m health platforms providing SRHR information to young people?
11. Are you aware of any any e/m health platforms providing SRHR information to young people
by RAHU?
12. Are these platforms (website and social media) easily accessed in your community?
13. Why haven’t you accessed these platforms before?
14. What is your preferred source of SRHR information and why?
15. What are benefits of accessing SHRH information through e/m health platforms?
16. How best do you think these platforms can be extended to young people in your community?
Conclusion
17. Would you recommend RAHU’s website/ social media page to a friend? Why?
18. What changes would you like to be made on the current e/m health platforms used by RAHU
to increase access to SRHR information to young people?
Thank you very much once again for taking part in this discussion.
We promise to use the information you have shared to serve you better as RAHU.
55
DEMOGRAPHIC REGISTRATION FORM
District: ______________________________________
Sub county: ___________________________________________
School: _______________________________________
S/N
Name
Date:________________________________________________
Sex
Age
Educational level
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
56
Appendix 6: Observation Checklist
REACH A HAND UGANDA
ASK E&M HEALTH OPERATIONS RESEARCH-observation checklist
Organisation_______________________________________________________________________
Platform observed__________________________________________________________________
Observation number: _______________________________________________________________
Date of platform observation: (dd/mm/yy):____________________________________________
Observer name/signature: _________________________________/_________________________
Supervisor signature/date _______________________________/___________________________
GENERAL INSTRUCTIONS:
1. For Facebook platform consider three months prior the study
2. For website to be done monthly over a period of two months.
3. Liaise with organisation to ensure availability of key persons who manage the platform (e.g.
system administrators).
4. Access the platform and follow the guide below.
5. Further analysis of the platform Insights (inbuilt analytical features) should be summarised and
provided by the system administrator.
INTERVIEW ELEMENT/CODING CATEGORY
CODE
CONTENT
1. What are the common comprehensive sexuality education
(CSE) topics/themes shared on platform and how often?
a. Gender (gender and sex; gender roles; masculinity and
femininity; evolving social norms and values; gender
CIRCLE AND RECORD THE
TIMES EACH TOPIC HAS
APPEARED THE PAST WEEK.
Yes
No
1
1
Appearance:
_________times
Yes
No
1
1
inequality)
b.
Sexual and reproductive health: (understanding STIs and
HIV; pregnancy; sexual response; living with HIV; anatomy;
sexuality).
57
c.
Sexual citizenship (human rights; policies, laws and
structures; services and resources; participation; choice;
Appearance:
_________times
Yes
No
1
1
Appearance:
_________times
Yes
No
1
1
Appearance:
_________times
Yes
No
1
1
Appearance:
_________times
Yes
No
1
1
Appearance:
_________times
Yes
No
1
1
Appearance:
_________times
protection)
d.
Pleasure (sex should be enjoyable and consensual; sex is
more than intercourse; biology and emotions; masturbation;
relationships and communication)
e.
Violence (types; rights and laws; support options;
community norms and myths about power and gender;
prevention; referrals)
f.
Diversity (the range of diversity, e.g., faith, culture,
ethnicity, ability/disability, sexual orientation; gender, sexual
identity, HIV status, discrimination)
g.
Relationships (emotions; intimacy (emotional and physical),
rights and responsibilities; power dynamics; coercion)
2. What other types of information are shared?
1. General news
2.
3.
Training
Job opportunities
CIRCLE AND RECORD THE
TIMES EACH TOPIC HAS
APPEARED THE PAST WEEK.
Yes
No
1
1
Appearance:
________times
Yes
No
1
1
Appearance:
________times
Yes
No
58
4.
Other specify:
____________________________________________________
1
1
Appearance:
________times
Yes
No
1
1
Appearance:
________times
____________________________________________________
__
3. What are the various forms in which information is shared?
4. Who often generates content?
Text only
Mainly Text
Text and picture equally
Mainly pictures
Multimedia videos
1
2
3
4
5
Mainly organization1
Mainly target audience2
Both groups equally 3
Not easy to tell4
5. How often is the content generated?
Daily
1
2-3 times a week
Weekly3
Bi-monthly
4
Monthly
5
Not regularly
6
2
6. What are the top five frequently asked questions by the
followers? (Write in the space provided)
7. How often are the followers concerns/questions responded to?
Instant
Daily
2
2-3 times a week
Weekly4
Bi-monthly
5
Monthly
6
Not regularly
7
1
3
59
8. Are the funs referred for other SRHR information and
services not provided by RAHI?
Yes
No
1
0
USER ENGAGEMENT
Yes
9. How are the platform followers engaged?
No
Post stories1
1
Comment11
Ask questions 11
Share links11
Likes
11
Others
1
1
Specify__________________
______________________
10. What are the top three most liked topics and their total
number of likes?
1st_____________________
2nd____________________
3rd____________________
11. What are the top three most shared topics and their total
number of shares?
1st_____________________
2nd____________________
3rd____________________
12. Which three topics drew the most comments and how many
comments did each drew?
1st_____________________
2nd____________________
3rd____________________
13. Are there links to other organization’s social channels, like
Twitter account and blog provided?
Yes
No
Other FB pages
(not for ASK)
1
1
60
Twitter
1
Website
1
Blog
1
Others
1
1
1
1
1
Specify__________________
______________________
14. Summarise findings from facebook’s inbulit analytical features
15. What is your overall comment on the design and layout of the platform?
61
Appendix 7: RAHU On-line Questionnaire
ASK E&M HEALTH OPERATIONAL RESEARCH – ON-LINE SURVEY QUESTIONNAIRE
Thank you for accepting the invitation to participate in this study exploring the factors and actors
that determine the effectiveness of this e/m health platform to improve access to SRHR information
and services among young people in Uganda. We appreciate that you play an important role is
shaping this platform and that is why we want to hear from you about our services. This is your
chance to let Reach a Hand Uganda (RAHU) know your views concerning this page i.e. the design,
content and the changes you would wish to be made on this page.
This study is completely voluntary, so you may skip any questions you do not wish to answer or stop
the survey at any time. Your answers shall be kept strictly confidential and only used for purposes
of improving the e/m health platforms implemented by RAHU and the other ASK Programme
partners. We do not collect identifying information such as your name, email address or IP address.
If you choose to begin the survey, it is important that you answer each question as thoughtfully and
honestly as possible. Please be patient if some questions don’t apply to you: we need to ask
everyone the same questions. Be sure to read the instructions below before you begin to answer.
Thank you very much for being an important part of this survey.
Electronic Participation consent: Please select your choice below.
Clicking on the “agree” button below indicates that:
• You have read and understood the above information
• You voluntarily agree to participate
If you or your do not wish you to participate in this interview, please decline participation by
clicking on the “disagree” button?
[__]
Agree
[__]
Disagree  END
INSTRUCTIONS:
1. This is not a test, so there is no right or wrong answers; we would like you to freely express
yourself.
62
2. Circle or record only one response to each question, unless otherwise instructed.
SECTION A: Socio demographic characteristics
To start, we would like to ask you some questions about yourself and your background.
NO.
QUESTIONS
A01
Are you:
A02
CODING CATEGORY
CODE
Female
1
Male
0
What is your date of birth?
Enter birthdate
____/____/___
DAY MONTH
YEAR
A03
How old are you?
A04
Where do you live? In which district of
Uganda?
Enter age in years
[___|___]
Enter your current district of
residence
_______________
A05
A06
A07
What is the highest level of school that you
attended?
Are you in school now?
Do you participate in any income
generating activity?
None
1
Primary
2
Secondary
3
Tertiary
4
Yes
1
No
0
Yes
1
No
0
63
SECTION B: ACCESS AND DESIGN OF THE PLATFORM
NO.
QUESTIONS
B01
How did you know about this
Facebook/website page?
CODING CATEGORY
CODE
Friend
1
Peer educator
2
School outreach
3
Teacher
4
Facebook adverts
5
RAHU IEC materials i.e.
6
brochures, files etc.
Other
Specify:
B02
B03
B04
When did you come to this page the first
time?
How often do you visit this
Facebook/website page?
When do you visit this page most?
This is my first visit
7
______________
1
Within past 4 weeks
2
Within past 2 - 6 months
3
Within past 7 - 12 months
4
Over a year ago
5
Everyday
1
4 To 6 Times Per Week
2
2 To 3 Times Per Week
3
One Time Per Week
4
2 To 3 Times Per Month
5
One Time Per Month
6
This Is My First Visit
7
Morning
Afternoon
Evening
Weekend
1
2
3
4
64
NO.
QUESTIONS
B05
How much time do you spend on this page?
CODING CATEGORY
CODE
Less than 30 minutes
Between 30 minutes and 1 hour
More than 1 hour
1
2
3
B06
B07
What gadget do you use to access this
Facebook page? Select all that apply.
Are you allowed to access internet at:
select all that apply
Personal phone
Another person’s phone
Personal computer
Public computers
School
Home
B08
What attracts you to this page?
Its design
Interesting messages
To make friends
Interacting with young people
Others(specify)
Yes
No
1
1
1
1
1
1
1
1
Yes
No
1
1
1
1
1
2
3
4
______________
B09
When you visit this page, how easy is it to
find the information you want?
Very easy
Easy
Difficult
Very difficult
1
2
3
4
B10
What are the challenges with this Facebook
page?
Slow
Restricted access
Not easy to find
Poor design
Not updated regularly
Irrelevant messages
Not interactive
Others (specify)
1
2
3
5
6
7
8
_____________
65
NO.
QUESTIONS
B10
What challenges do you face to access
internet/ this platform?
CODING CATEGORY
CODE
Select all that apply
It is expensive
Yes
No
1
1
1
1
1
1
1
1
Restriction from elders
1
1
Distance to internet points
1
1
1
1
1
1
Do not own gadgets
Limited computer skills
Limited time
Poor internet connection
Restriction from elders
Others (specify)...................
B11
How do you think this page can be
improved?
Routine update of messages
Improve design
Link to other pages with SRHR
information.
Make it interactive
Others (specify)
1
2
3
4
5
______________
SECTION C: CONTENT ON THE PLATFORM
Thank you for sharing that information. Now let’s talk more about the information you access on
RAHU’s website/Facebook pages.
NO.
QUESTIONS
C01
Does this page allow you to share ideas
openly?
CODING CATEGORY
CODE
Yes
No
1
0
Not sure
3
66
NO.
QUESTIONS
C02
What kind of information do you get
through this page?
CODING CATEGORY
Select all that apply:
Reproductive health
information
Entertainment
Job opportunities
Training opportunities
News
Other
Specify:
CODE
Yes
No
1
1
1
1
1
1
1
1
1
1
_______
67
NO.
QUESTIONS
CO3
Specifically, what SRHR information have
you accessed from this platform?
(Select all that applies)
CODING CATEGORY
CODE
Yes
No
1
1
1
1
Pleasure
1
1
Violence
1
1
1
1
1
1
1
1
1
1
Gender
Sexual and reproductive health
Sexual citizenship
Diversity
Relationships
Other
Specify:
_______
C04
C05
Is the information provided on this page
easy enough to understand to your
satisfaction?
Yes
No
Is the information provided on this page
often updated?
Yes
No
1
0
1
0
C06
How helpful is the information got from
this page?
Very helpful
Helpful
Not helpful
Not sure
1
2
3
4
68
NO.
QUESTIONS
C07
Is there any information you feel is missing
on this website?
CODING CATEGORY
CODE
Yes
No
1
0
C08
Are you referred for additional information
and health services?
Yes
No
1
0
C09
Which service(s) were you referred for?
Please tick all that apply.
Yes
No
1
1
HIV counseling & testing
1
1
STI treatment and counseling
1
1
1
1
1
1
1
1
1
1
SRH information
Post-abortion care services
Family planning services
Pregnancy care and delivery
Condoms
Other (specify) ___________
C10
Have ever sought the referral services on
this site?
Yes
No
1
0
C11
Other than the available information, what
other information would you want to get
from this page?
Specify
___________________
___________________
_______
69
NO.
QUESTIONS
C12
What kind of information would you find
embarrassing to access from this page?
C13
If you have a personal
question/concern/problem, would you share
it openly or privately?
CODING CATEGORY
CODE
Specify
___________________
___________________
_______
Openly
Privately
Both
1
2
3
C14
What is the reason for your response
above?
C15
What other communication channels under
Reach a hand Uganda (RAHU) have you
accessed in the last 6 months?
C16
Would you recommend RAHU’s website/
social media page to a friend?
Why?
Specify
___________________
___________________
_______
Facebook
Website
Twitter
Watsup
Print material
School visit
Other
Specify___________
What changes would you like to be made
on the current e/m health platforms used by
RAHU to increase access to SRHR
No
1
1
1
1
1
1
1
1
1
1
1
1
Yes
1
No
0
Specify
C17
Yes
Specify
_________________
___________________
___________________
_______
information to young people?
Thank you for taking the time to respond to this survey. The information you have shared with us is very
helpful. Our study team will make every effort to keep what you have shared confidential. END
Appendix 8: OR Approval Letters (to be attached)
70

Final report

Transcription

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