Parents of students at Rising Academy School in Kilifi County, Kenya, expressed concern when the school management allowed the local department of health to set a Human Papilloma Virus (HPV) vaccination schedule for 10–14-year-old girls at the school. Misinformation about the HPV vaccine was common, and the parents felt they didn’t know enough about the vaccine and wondered why only girls of a certain age would get the vaccine when they met with school management. With little information, many were unsure about letting their daughters get vaccinated.
They didn’t know that cervical cancer is one of the leading causes of cancer deaths in women in Kenya, and that the HPV vaccine, when administered before sexual activity, has close to a 90% rate of success in preventing cervical cancer. In Kenya, HPV is the number one cause of cancer in women between the ages of 15 and 44, and approximately 5,250 new cases are diagnosed annually.
In coastal Kenya, only 18.8% of women 25-49 years had ever had cervical cancer screening1, and HPV vaccination coverage and cancer screening rates are lower than the national average. That’s why Pathfinder, with the Kenyan Ministry of Health, the STOP Cervical Cancer Initiative, and local stakeholders, including county governments, community health volunteers, and peer educators, started using the askNivi digital chatbot platform to build awareness of cervical cancer, prevent infections, and increase screenings and treatments.
AskNivi is a digital ‘marketplace’ where individuals can access a wide range of health information and services via a chatbot on Facebook Messenger, WhatsApp, and SMS text, making it widely accessible to most users. Providers, governments, and suppliers can understand what information and goods users are seeking, and they can offer health products and services based on users’ interactions.
Pathfinder piloted askNivi in Kilifi, Mombasa, and Kwale counties, with a focus on building awareness about cervical cancer prevention and HPV vaccination. Over four months, the campaign reached 160,800 people. The platform was extremely well received, and after interacting with the app, users demonstrated significant knowledge about HPV (65.6%), readiness to get HPV screenings (91.6%), and vaccination (56.2%). The cost of the HPV vaccine, as well as a lack of information on where to get the service, proved to be the largest deterrents to vaccination. Pathfinder worked to solve the latter problem by integrating geo-targeted referral information and links to 150+ public and private clinics, dispensaries, and hospitals that provide cervical cancer screening and HPV vaccinations in Kilifi and Mombasa counties.
An Integrated Approach
Pathfinder staff worked with peer educators and community health volunteers across communities in the three counties, distributing posters and 10,000 visiting cards, and building awareness about HPV and the askNivi platform. They held community awareness sessions, answering questions from community members, and promoting the interactive platform. Pathfinder deployed 180 peer educators to reach young people and adolescents. Over the four months, 4,592 users were onboarded to the platform, and 2,670 of them engaged with the interactive content about the HPV vaccine.
At the Rising Academy School, parents attended an education session with Pathfinder, and then used the app to learn about HPV and the vaccine to prevent it. “We want all women and girls to take advantage of the advancements made around HPV, cervical cancer screening, and treatment. (I know now that) cervical cancer is preventable, and to get screened early,” said one parent who had used askNivi.
After rolling out the app among parents, all of the eligible girls at Rising Academy received their HPV vaccine and some of their mothers started receiving cervical cancer screenings after learning more from Nivi and Pathfinder staff.
Hassan Ngellesa, a peer educator with the pilot project, noted that this is just the beginning. “The askNivi platform has informed many young people. This is the beginning of a journey of self-discovery and learning for adolescents and youth in Kilifi, Kenya.”
The pilot program demonstrated the capability of the digital platform to provide comprehensive information, interactive engagement with real-time responses, and the potential to incorporate additional outreach approaches, like community-awareness conversations, to reach communities with cervical cancer prevention information and referrals.