Designing for two: How enhancing human-centered design with behavioral nudges unlocked breakthroughs to promote young women's psychological safety and access to reproductive care in Tanzania. (March 2023)

• Record Type: Journal Article
• Authors: Liu, Jenny X.; Vallin, Janelli; Chiu, Calvin; Cabrera, F. Abigail; Hunter, Lauren A.; Rao, Aarthi; Njau, Prosper; McCoy, Sandra I.
• Is Part Of: Social science & medicine. Volume 320(2023)
• Publication Date: 2023-03
• Subjects: Adolescent girls and young women -- HIV -- Contraception -- Sexual and reproductive health -- Behavioral economics -- Human-centered design -- Tanzania -- Drug shops; AGYW adolescent girl and young women -- HCD human-centered design -- HIVST HIV self-testing -- IDI in-depth interview -- SRH sexual and reproductive health; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2023.115683
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: Adolescent girls and young women (AGYW; ages 15–24) in sub-Saharan Africa face many barriers to accessing preventive sexual and reproductive health (SRH) services. We drew upon the strengths of two complementary approaches, human-centered design and behavioral economics, to craft a holistic, highly-tailored, and empathetic intervention to motivate AGYW to seek contraception and HIV self-test kits at community drug shops. To encourage engagement, we embedded "nudge" strategies at different opportunity points (uncovered during our design research) along the care-seeking and service delivery journey. Our Malkia Klabu intervention is a loyalty program designed to enhance drug shops' role as SRH providers through which AGYW earned punches for shop purchases redeemable for small prizes; free SRH products could be requested at any time. From our 4-month pilot in Shinyanga, Tanzania, we assess the extent to which different behavioral nudge strategies motivated behaviors as predicted by synthesizing findings from (1) in-depth interviews with AGYW and shopkeepers, (2) shop program records, (3) shop observations, and (4) customer exit surveys. Overall, we find that AGYW and shopkeepers were motivated by many intervention features as intended and consistent with hypothesized mechanisms. We found strong evidence of social norms for helping to spread awareness of Malkia Klabu among peers, prize incentives for drawing AGYW back to shops, and the opt-out default membership gift of an HIV self-test kit for encouraging testing uptake and exploration of contraceptives. Shopkeepers in both arms noted increased community status from distributing HIV self-testing kits ( ego ). Malkia Klabu shopkeepers experienced increased customer traffic and business revenues ( incentives ), which reduced shopkeepers' gatekeeping tendencies and earned them additional recognition as champions of AGYW well-being. Integrating human-centered design and behavioral economics was effective for developing an innovative and effective intervention that simultaneously met the different needs of economic actors in support of public health priorities. Highlights: We crafted our holistic intervention using behavioral economics and human-centered design. Multiple nudges were used to motivate behaviors along a continuum of actions. Young women were influenced by social norms, incentives, defaults, and positive affect. Shopkeepers felt financially and socially rewarded, the result of aligning two key needs. Making drug shops girl-friendly requires attention to physical, emotional, and social contexts.