Using digital to improve young people’s sexual health

Research with young people finds Be in the Know Zambia, a sexual health app co-created by young people in Zambia by Avert, increased condom knowledge, encouraged HIV and STI testing and doubled resistance to peer pressure.

What is the research about?

Researchers from the Centre for Infectious Disease Research in Zambia (CIDRZ) surveyed and interviewed around 1,600 young people (ages 18-24) in Zambia to assess the impact of Be in the Know Zambia (BITKZ). Around half had used the app and half had not.

BITKZ offers young people different ways to learn about sexual and reproductive health (SRH). Users can choose a character then enter a comic strip to solve dilemmas on condoms, preventing pregnancy and staying healthy. They can also look at simple guides to using condoms and contraceptives, get tips, do quizzes and read answers to common questions.

Why is this research important?

Many young people feel at home in the digital world. So using a mobile app to provide them with SRH information and link them to services can be effective. But only if it is designed in a way that is appealing to young people and meets their needs. Assessing whether an app like BITKZ is having an impact is important for improving it, and for designing similar apps.

What did they find out?

Participants who used BITKZ for five weeks increased their knowledge of condoms and how to use them by 35%, compared with participants who didn’t use the app. They were twice as likely to resist peer pressure than young people who had not used BITKZ.

BITKZ users were more likely to plan to test for sexually transmitted infections (STIs) and HIV. This likelihood was greater among app users who were aged 20 or above. One young man, 22, commented: “Before I used the application, I used to be frustrated that, ‘Ok, I slept with that girl but ah!...maybe I get STIs’... But once I started using the app I…went for HIV testing, STIs…so that I am updated.”

Young women said they often felt uncomfortable and shy to speak openly about sex. But some said BITKZ made them feel more confident to raise issues with their partners, particularly about using condoms.

One young woman said: “I shared it with my boyfriend. I told him that there is this App [Be in the KNOW Zambia] to go through maybe because there are certain things that I am not comfortable telling him. So after reading on his own definitely he had the idea, was also learning here and there and we talk about protection now.”

Many young people who used BITKZ shared information from it with friends. They also encouraged friends to use the app and take notice of what it said.

What does this mean for HIV services?

It shows that well designed, youth-led SRH apps and digital content can increase young people’s knowledge and influence their behaviour. And that young people who engage with such digital resources are likely to influence their peers. This means that apps and digital content like BITKZ can reach a wide number of young people at relatively low cost.

But it is important to ensure that young people who do not have internet access or a mobile phone do not miss out. This can be done in a number of ways, such as providing free data and devices or providing the information in other formats.

The fact that BITKZ led some young people to have more open conversations about SRH with friends and partners is encouraging. But it is also important to support parents, teachers and other influential adults to speak openly, accurately and non-judgementally to young people about sex. This can be done by working with adults and young people together to increase SRH knowledge, challenge myths and stigma, and improve communication skills.

It is also important to make sure that young people can access friendly SRH services, so they can turn their new-found knowledge about things like testing for HIV into action.