Supporting Contraceptive Decision-Making in the Intermediated Pharmacy Setting in Kenya

TL;DR

This study develops and tests the Mara Divas tablet app to support AGYW in Kenya's pharmacy-based contraceptive counseling, addressing barriers such as stigma, confidentiality concerns, and literacy gaps. By embedding the app in a private pharmacy counseling room and using co-design workshops with AGYW and pharmacists, the researchers examine intermediation as a mechanism to augment counseling and tailor method choices to user needs. Findings show generally positive reception, with important insights on how pharmacist beliefs shape interactions, and how differences in language, digital, and health literacy influence app use. The work highlights the potential and challenges of implementing tech-enabled decision-support in LMIC, emphasizing the pharmacist’s central role, the need for targeted design to hard-to-reach populations, and the importance of context-aware integration in complex healthcare ecosystems.

Abstract

Adolescent girls and young women (AGYW) in sub-Saharan Africa face unique barriers to contraceptive access and lack AGYW-centered contraceptive decision-support resources. To empower AGYW to make informed choices and improve reproductive health outcomes, we developed a tablet-based application to provide contraceptive education and decision-making support in the pharmacy setting - a key source of contraceptive services for AGYW - in Kenya. We conducted workshops with AGYW and pharmacy providers in Kenya to gather app feedback and understand how to integrate the intervention into the pharmacy setting. Our analysis highlights how intermediated interactions - a multiuser, cooperative effort to enable technology use and information access - could inform a successful contraceptive intervention in Kenya. The potential strengths of intermediation in our setting inform implications for technological health interventions in intermediated scenarios in \lrem{LMICs}\ladd{low- and middle-income countries}, including challenges and opportunities for extending impact to different populations and integrating technology into resource-constrained healthcare settings.

Figures (12)

• Figure 1: Mara Divas app configuration. Enlarged images of each screen are in Appendix \ref{['big_images']}. (a) Main screen with questions and topics that are of most interest and importance to AGYW. (b) Short explanations of each contraceptive method and where it is administered on a female body. (c) Information presented with text, audio, and videos (provider and peer). (d) Survey where users can indicate preferences for method characteristics. (e) Recommendations for contraceptive methods based on survey results.
• Figure 2: Flow of workshop activities.
• Figure 3: Workshop activities. Enlarged images are in Appendix \ref{['big_images']}. (a) AGYW journey mapping where AGYW and facilitators wrote actions, thoughts, goals, and emotions before a pharmacy visit on post-it notes. (b) AGYW journey mapping with role-play, led by the facilitator. (c) Pharmacy staff journey mapping with role-play. (d) App feedback documented by AGYW on post-it notes using the "I Like, I Wish, What If” method.
• Figure 4: Main screen with questions and topics that are of most interest and importance to AGYW.
• Figure 5: Short explanations of each contraceptive method and where it is administered on a female body.