As low- and middle-income countries transition from paper to digital systems, family planning programs can benefit from unprecedented opportunities to improve services. Investments in digital health tools have expanded exponentially, but information on what works—and what does not— remains limited and scattered. As investments have increased, digital applications and data fragmentation have proliferated, but stakeholders are moving towards more coordinated efforts to scale digital health solutions, support countries’ digital health infrastructure, and share evidence-based learnings.
This Digital Health Compendium enables users to explore case studies across a range of digital health technologies used to enhance family planning programs mainly in sub-Saharan Africa, but also in other regions of the world. Digital health applications in family planning programs can be broadly classified as those affecting demand generation, service delivery, supply chain management, and the policy and enabling environment. In many low- and middle-income countries, digital health innovations were adopted earlier in other health sectors, including HIV/AIDS, maternal and child health, and noncommunicable disease prevention and response. As a result, much of the impact evidence is likewise restricted to those sectors. To advance greater adoption of digital technology in family planning programs, more data and information on the challenges, opportunities, scalability, and results are needed. This compendium aims to consolidate emerging information and data on applications of digital technology in family planning programs to inform adoption and scale-up of successful approaches.
All of the case studies were submitted by the implementing organizations and include a description of the digital health intervention, program context, and, if available, important findings and lessons learned through rigorous evaluations or program data. The compendium facilitates a quick search for case studies based on the target user for digital health intervention, building block for the digital health enabling environment, family planning program classification, and country location. The case studies give policy and program decisionmakers insights on real-world applications of digital health, promising practices, challenges, and other lessons that can be applied to current and future programs.
Building an immersive decision-making tool for adolescents
Susan Howard, Project Director
Cynthia Hannah, Sr. Advisor, Marketing & Communication
Howard Delafield International, LLP.
Howard Delafield International, LLP (HDI)
Vihara Innovation Network
USAID, Direct-to-Consumer (DTC) Approaches to Fertility Awareness and Adolescent Reproductive Health grant
September 2018 - October 2023
India: Bihar, New Delhi (NCR), and Rajasthan, with plans to expand nationally
Client, Data Services Provider
Services and Applications
Adolescence is a formative time when choices and decisions can chart the course for the rest of a young person’s life. New awareness of their bodies, together with emotional changes and a developing interest in exploring relationships, force adolescents to forge territory they’ve never faced before. However, there is a culture of silence and shame that make these changes taboo and leave adolescents misinformed about correct and safe practices, unaware of risks, and unprepared for the consequences of their behaviors. For many adolescent girls in India, their dreams of education and a career are disrupted by early marriage and pregnancy.
To address adolescents’ need for information, foster improvement in attitudes and agency, and eventually inform behavior towards health relationships and reproductive health, Howard Delafield International has been awarded a multi-year Innovation and Impact Direct to Consumer (DTC) grant from the US Agency for International Development (USAID) to support the creation and testing of a “serious” video game for adolescent girls in India.
The project, Game of Choice, Not Chance, is a pilot program targeting urban and peri-urban adolescents ages 15 to 19 that combines the excitement of an interactive story-based video game and the instruction from reproductive health education e-learning tools with portal features that directly link players to health products and services in real time. Game of Choice, Not Chance is a unique hybrid of interactive story-based video games, comprehensive health education e-learning tools, data analytics tools, and web portals that challenges players to make compelling decisions and choices within a game space based on realistic scenarios.
The game simulation design applies Prensky’s principles of learner engagement, which involves the player in making decisions and choices when confronting specific problems that lead them to reach their desired goals—within a “learning loop” of decision-action-feedback-reflection (Prensky, 2007). The game is being designed to provide a virtual safe space for girls to explore, reflect on, and navigate life choices, learn about things they can’t ask anyone, experience the simulated outcomes of their choices, and connect to information and services they most need.
“Serious” video games can provide a simulated reality for young people to be an active character of their game character’s (avatar’s) life. Studies show a strong correlation between identification of players with the avatars used to represent them, and the consequent real-world decisions (Kapp, 2012). A low bandwidth, low-literacy, scenario-based interactive video game is being developed with the goal of generating substantial impact on fertility knowledge and key reproductive health behaviors—with eventual expansion of scale and reach through government, nongovernmental organizations (NGOs), and social media. The game is in the design and development phase and final testing is scheduled for spring 2021. The game is scheduled for release on the Google Play Store in early summer 2021 and will be free of charge on Android phones.
The Evaluation and Results Data Plan is currently in development.
Users of the game are adolescent girls 15 to 19 years old in the Hindi-speaking belt of India. The states of Rajasthan and Bihar as well as Delhi National Capital Region will be the initial target locations. The game will be available for download from the Google Play store and marketing efforts will be initially targeted at this demographic group in a demonstration pilot.
Links embedded in the game direct users to providers of products and services, such as menstrual hygiene products, contraception, fertility and cycle tracking apps, and safety and skills-building resources. These providers are being identified and partnerships (NGOs, private sector, education, and government) are being established to ensure the inclusion of appropriate links in the game.
Lessons to date are limited to findings from formative research that are currently informing the design of the intervention (the game). Specifically, the formative research findings are being used to develop realistic game characters and scenarios—that the target audience will identify with and relate to—and to select the type of information and services relevant for the target audience.
Formative research efforts included:
Research findings revolved around the adolescent girls’ knowledge gaps related to body literacy; menstruation, the woman’s fertility cycle, contraception, sexually transmitted diseases, and sexual health; perceptions, motivators, and barriers around sex negotiation; contraceptive use; fears, desires, and aspirations about their education, vocational, and career opportunities; and identifying the influencers in their lives. Other findings focused on understanding phone availability, specifications, and usage among the adolescent girls, and product/service preferences.
The project is guided by user design principles and best practices to ensure that the intervention is designed for and with the adolescent girls, and responds to their reproductive health and family planning needs. From formative research to design to pretesting, the target audience is engaged. Co-design efforts during formative research and iterative testing conducted with the engagement of the Technology Enabled Girl Ambassador Network (TEGA) helps to guarantee adherence to those principles.
Other considerations for game design entail a combination of the excitement of an interactive video game with the critical instruction that supports the project’s reproductive health and family planning aims and linkages to essential health products and services in real time.