CyberRwanda's Pathway to Impact: Results From a Cluster-Randomized Trial of Adolescent Family Planning Knowledge, Beliefs, Self-Efficacy, and Behavior

• Published in: Journal of adolescent health 2024-06, Vol.74 (6), p.1239-1248
• Main Authors: Hémono, Rebecca, Gatare, Emmyson, Kayitesi, Laetitia, Packel, Laura, Hunter, Lauren A., Kunesh, Jacqueline, Mwali, Marie Merci, Bertozzi, Stefano, Sayinzoga, Felix, Mugisha, Michael, Hope, Rebecca, McCoy, Sandra I.
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescent Behavior - psychology; Adolescent sexual health; Child; Contraception Behavior - psychology; Digital health; Family planning; Family Planning Services; Female; Health Knowledge, Attitudes, Practice; Humans; Male; Reproductive Health; Rwanda; Self Efficacy; Young Adult; Youth-friendly
• ISSN: 1054-139X; 1879-1972; 1879-1972
• DOI: 10.1016/j.jadohealth.2024.01.035

CyberRwanda is a digital health intervention designed to increase knowledge of family planning and reproductive health (FP/RH) and access to youth-friendly services in Rwanda. Sixty schools in eight districts were randomized 1:1:1 to one of two CyberRwanda implementation models—self-service (tablet-only) or facilitated (tablet, activity booklet, peer facilitators)—or to control. Students aged 12–19 years were randomly selected to participate. Baseline and 12-month midline surveys assessed intermediate (secondary) outcomes of FP/RH and HIV knowledge, attitudes/beliefs, self-efficacy, and behavior. Prevalence differences (PDs) were estimated using generalized linear mixed models. There were 5,767 midline participants (51% female, mean/median age: 16 years, 29.9% sexually active). Those in CyberRwanda schools had higher knowledge of emergency contraception (57.3% vs. 47.5%, PD: 0.09, 95% confidence interval [CI]: 0.05–0.13); greater confidence in providing consent (73.3% vs. 68.1%, PD: 0.05, 95% CI: 0.01–0.08), negotiating partner's contraceptive use (88.3% vs. 85.0%, PD: 0.03, 95% CI: 0.01–0.06), and accessing/using contraceptive services (95.6% vs. 91.8%, PD: 0.03, 95% CI: 0.02–0.05); and more favorable views on FP/RH services (54.5% vs. 48.5%, PD: 0.06, 95% CI: 0.02–0.11) and condoms (76.9% vs. 71.3%, PD: 0.06, 95% CI: 0.03–0.08) compared to control. No significant differences in HIV/fertility knowledge, confidence in accessing HIV testing, or condom use were observed. CyberRwanda increased FP/RH knowledge, supportive attitudes/beliefs, self-efficacy, and behavior at 12 months. The 24-month endline analysis will reveal whether CyberRwanda's benefits on intermediate outcomes result in changes to the primary outcomes, including contraception use and childbearing.