Mobile Scenes: An mHealth Program For & By Youth!
Pathfinder’s “mCenas!” is a first for Mozambique—a text message education campaign that provides contraceptive information to youth (15-24 years old). This week, Marion McNabb, Pathfinder’s Senior Project Manager for mHealth, shared why she believes mCenas! is worth the exclamation point.
What are some of the issues young people face in Mozambique?
They face pregnancy at an early age and low uptake of contraception. For two decades, Pathfinder has worked with young people in Mozambique, and we recognize the barriers they face when trying to access contraceptives.
Within our ESD/Family Planning Initiative project, we realized knowledge—about contraceptive methods and where to get them—is one of the major issues. We knew we needed to focus on youth to make sure they not only have information, but that they get it in a way that makes the most sense to them.
So what method of delivering info makes youth most receptive?
Narrative stories. Pathfinder has adapted an approach suggested by FHI 360 to send youth informational messages and engaging narrative stories via text message. We call it “mCenas!” which means “Mobile Scenes” in Portuguese. The stories at the heart of the project are not only targeted for youth. They are shaped by them.
We use a lot of acronyms, a lot of smiley faces; the way the youth talk to each other over text. We’ve piloted this with youth to make sure this is the way they communicate with their peers.How are the stories shaped by youth?
Pathfinder held 15 small group sessions in Inhambane and Maputo with young women and men, using our Pathways to Change methodology. Pathways to Change is a tool—a kind of board game—that helps young people identify barriers they might experience when seeking to use contraception.
What were some of the barriers? Are they different for youth in urban versus rural areas?
Actually, we found out that the biggest differences didn’t have to do with where the youth live, or even their gender, but whether or not young people have children themselves.
Youth who are pregnant or have children said that they felt challenged by in-laws to produce more children quickly. But those without children expressed a very different fear—that if they were seen at a clinic trying to get contraceptives, their families would know they are sexually active. And both groups made it clear that a lack of correct information about contraceptive methods—lots of myths and misconceptions—stood in their way.
So after a team of experts (in adolescent and youth sexual and reproductive health) analyzed these results, our team in Mozambique hired a scriptwriter who specializes in local youth texting slang. This writer crafted two different stories, designed to address the needs of these two target youth groups.
How do young women and men opt in to mCenas? How do they actually see these stories on their phones?
That’s where the activistas come in. Activistas are young peer educators, trained through Pathfinder’s ESD/FPI project to do interpersonal communication at different health fairs and events. Their job is to raise awareness among youth. Activistas also link young people to youth-friendly sexual and reproductive health services. Now we are training these activistas to introduce their peers to mCenas! and ask them if they want to receive stories and health information via text message on their phone.
Once they opt in, how often will youth receive these text messages?
Every three days—Wednesday, Friday, and Saturday evenings—the client will receive a new installment about the story, written in short-hand youth vernacular they are used to, like “LOL.” We use a lot of acronyms, a lot of smiley faces; the way the youth talk to each other over text. We’ve piloted this with youth to make sure this is the way they communicate with their peers.
Is there an interactive element to this, or do they simply receive texts?
Definitely interactive. At some points in the story, we want to assess their engagement. So a couple of weeks in, we will send them a message that says “Hey, do you like this story? Reply ‘1’ if you find it interesting, ‘2’ if you find it boring.”
There are other ways they can interact with the system. When a character in the story starts talking about IUDs, the client will receive a message that says, “OK, if you’d like to learn more about IUD, reply ‘1.’” If they do, they will receive an informational message about IUD. The same goes for a variety of other methods and topics.
Also, at any time, they will have the ability to access a menu, which basically says, “Hey, if you’d like to learn more about family planning, reply ‘1.’ If you’d like to learn more about other sexual and reproductive health, reply ‘2.’” They can continue to learn more at any time.
OK, that is interactive. But what if youth want to interact with an actual person?
While mCenas! is an automated text messaging system, we frequently send youth a phone number to a call-in center—a government-run hotline—where live people answer questions related to contraception, HIV, and more. Pathfinder actually trained the hotline operators on contraception (previously, they only provided info on HIV and AIDS). We worked with them to establish a full list of facilities that provide youth-friendly services, so if someone asks, “Where can I get contraception services?” the operator is able to guide them.
So it sounds like mCenas! is not a standalone service.
Pathfinder is not interested in doing mobile health interventions as a silo. We understand text messages alone cannot change behaviors. So in Mozambique, we make sure the activistas know key messages and plots from the stories to use in their interpersonal one-on-one conversations with clients. And we are even thinking about how they can develop dramas based around the narratives for youth to perform.
It sounds like there is a lot to look forward to.
We are carefully documenting this process. It’s been a year in the making, and we are very excited!