ARV adherence support – there’s an app for that!
29 January 2018
By Lizzie Haycocks and Joe Miller, M&C Saatchi World Services
As we write this, we’re on the long journey back from Mozambique to London after a fantastic trip running workshops with young people living with HIV to test a mobile app designed to help with treatment adherence.
M&C Saatchi World Services is a project partner in READY+, a four-year programme in southern Africa supporting adolescents and young people living with HIV in Mozambique, Swaziland, Tanzania, and Zimbabwe.
During our first visit to Swaziland and Mozambique in July 2017 we ran insight sessions that helped us establish that the biggest impact we, as communication specialists, could have was supporting young people in the challenges they face adhering to antiretroviral treatment.
We also identified that Community Adolescent Treatment Supporters (CATS) would be the most effective way to reach a large number of young people and positively impact on their adherence. CATS have a unique role in supporting young people to adhere to their medication, both building confidence and understanding around why adherence is so important, and providing a trusted relationship and a safe space for young people to talk about their challenges.
CATS are being equipped with mobile phones to help them collect monitoring data for the project. With this knowledge in mind, we spent the following few months developing an adherence app designed to work in a complementary way to this data collection.
Specifically, our idea is designed to help facilitate conversations between CATS and their clients about their adherence, the challenges they are facing in taking their medication regularly and how they’re feeling about their treatment.
In order to make it both appealing and engaging, the app is in the format of a game, asking clients to name and personalise a character and then play along by answering questions relevant to adherence. Each time the CATS meet with their clients they would play the game and have conversations based on the answers given.
The app also allows CATS to easily view this information over time, helping them track and monitor how clients are doing. Playing the game allows clients to win rewards and ‘level-up’ as well as gaining medals every time they use it, acting as positive motivator.
Testing the demo with the target audience
While we were confident that this idea had potential, we wanted to run sessions with both CATS and clients, putting a demo version in front of our target audience to explore how and whether it resonated and to gain information about how it might best be developed.
We ran four days of workshops (two in Swaziland and two in Mozambique) with CATS and their clients to see what they thought of our idea, how it might fit into the day-to-day work of the CATS and whether clients would actually want to play!
We ran these sessions in pairs, speaking with a CATS and one of their clients at a time and talking them through the idea screen by screen, showing them our demo on a mobile phone similar to the devices the CATS will be using. This meant we could explore how well the idea was understood as well as whether they liked it. As many a wise member of the READY+ team has said: “Nothing about us, without us”! Over the course of our trip we spoke to around 20 CATS and 20 clients, allowing us to get a wealth of valuable feedback.
We had no idea what to expect from the workshops and were nervous about how much the CATS and their clients might understand an idea that is so different to what many of them are used to.
However, the sessions really helped us validate the idea. CATS spontaneously mentioned how it will support them in keeping track of what is going on with their clients. They also understood and valued the practical advantages of not having to use pen and paper, making it more convenient and also more confidential (seeming less ‘visible’ than taking notes on paper when out in the community).
On the client side, we could see the levels of engagement through the laughter and smiles in the sessions when seeing their character change and being able to gain rewards and points for playing.
We’ll now go back and work through the feedback provided to us. After another short period of development, we will be in a position to roll out a pilot of the application for CATS in Swaziland and Mozambique to start using with their clients. However, before this can begin we’ll design a training or ‘on-boarding’ process to ensure the CATS using the app have a full understanding of how it works and feel confident and ready to use it. We’re hugely excited about the next phase of our project and want to give a big thank you to the in-country partners in Swaziland and Mozambique for making sure that “We Are READY”!