Last December, Lauren Hunter, a fourth-year doctoral student at the University of California Berkley School of Public Health, was listed as one of 13 Students Who Rocked Public Health in 2019 for her work in delivering sexual and reproductive health services to adolescent girls and young women in Tanzania. Here, she describes her efforts in more detail. Follow along each month as we profile all 13 Students Who Rocked Public Health 2019.

As my first year of doctoral studies came to a close in 2017, my focus abruptly shifted away from epidemiology and biostatistics, and I began a crash course in human-centered design. This unexpected detour came about when I was given the opportunity to coordinate a research project spearheaded by Drs. Sandra McCoy (UC Berkeley), Jenny Liu (UC San Francisco), and Prosper Njau (Health for a Prosperous Nation [HPON]). Our aim was to develop an easily accessible, community-based platform for delivering sexual and reproductive health services to adolescent girls and young women in Tanzania, with the ultimate goal of reducing HIV incidence and unintended pregnancy.

In the formative phase of the project, I collaborated with a multidisciplinary team of Tanzania- and US-based researchers to design a “girl-friendly” intervention to bolster uptake of HIV self-testing and contraception among young women at privately owned drug shops. To achieve this, we followed the human-centered design process. Human-centered design is a creative, empathic approach to developing innovative programs and interventions, grounded in the needs and preferences of their intended users. First, we sought to deeply understand the experiences and perspectives of young women and shopkeepers. We focused on building community partnerships, creating a Youth Advisory Board, and conducting diverse research activities including in-depth interviews, shadowing, and shop observations. Next, we synthesized what we had learned and used our findings as a starting point from which to creatively brainstorm and prototype intervention elements. Finally, we iteratively tested our ideas for acceptability and feasibility, refining them through focus groups and debriefs with our Youth Advisory Board and other community stakeholders.

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Thanks to the collective efforts and creativity of HPON researchers Agatha Mnyippembe, Atuganile Kalinjila, Kassim Hassan, and Moza Chitela and the mentorship of experienced design thinker Aarthi Rao, our team converged on a promising intervention. The intervention, “Malkia Klabu” (“Queen Club”), is a multifaceted loyalty program through which young women can earn mystery prizes by shopping at drug shops and can discreetly request free sexual and reproductive health products by pointing at symbols on the loyalty card.^1-2 In a preliminary test implementation, the program earned high marks from our Youth Advisory Board and partnering shopkeepers. With the design process complete, we were finally ready to begin a rigorous evaluation and move back into the more familiar territory of epidemiologic methods.

In the next phase of the project, we implemented a randomized trial of the intervention in 20 drug shops. We aimed to determine its preliminary impact on young women’s patronage and the distribution of HIV self-test kits and contraception to young women at these shops. After a year spent developing the idea from the ground up, we were all excited to see the program come to life. Our excitement continued as it quickly became apparent that Malkia Klabu was a hit with young women and shopkeepers alike. Over the study period, we found that shops with the intervention had significantly higher patronage and sexual and reproductive health product distribution to young women in comparison to shops without the program.³ Although the trial has ended, we hope to build on these promising results through a future effectiveness and sustainability study.

By merging human-centered design with established epidemiologic methods, this project offered me the best of both worlds as a student researcher. The human-centered design process challenged me to let go of textbook research practices and surrender to a more creative and immersive approach, while the evaluation allowed me to hone my skills in intervention trial design. Across both phases, the experience cemented the importance of deep collaboration with young women, shopkeepers, and other community stakeholders to ensure that the intervention truly addressed their needs and fit seamlessly within their routines. It also taught me the value of stepping out of my methodologic comfort zone, thinking outside the box, and investing creative energy into every detail of a program. I am grateful to have had the rare opportunity to follow an idea all the way from inception to implementation to evaluation alongside an amazing team.

References

¹ Hunter LA, McCoy SI, Rao A, Mnyippembe A, Hassan K, Njau P, Mfaume R, Liu JX. Designing “girl-friendly” drug shops in Tanzania: An application of human-centered design to facilitate access to HIV self-testing and contraception. Poster presentation at UC Global Health Day. May 2020. https://bit.ly/2zFTcDb

² Rao A, McCoy S, Liu J, Hunter L. Marrying empathy and science to spread impact. Stanford Social Innovation Review. 2019. https://ssir.org/articles/entry/marrying_empathy_and_science_to_spread_impact

³ Hunter LA, Liu JX, Rao A, Napierala S, Kalinjila A, Mnyippembe A, Hassan K, Mfaume R, Njfau P, McCoy SI. Drug shops are an effective strategy to reach adolescent girls and young women with HIV self-testing and contraception: A randomized trial in Tanzania. Oral presentation at AIDS 2020. July 2020. http://programme.aids2020.org/Programme/Session/80

Read About More Students Who Rock:

• Students Who Rocked Public Health 2019
• Students Who Rocked Public Health 2018
• Students Who Rocked Public Health 2017
• Students Who Rocked Public Health 2016
• Students of Public Health: Student Voices and Profiles