Grand Challenges is a family of initiatives fostering innovation to solve key global health and development problems. Each initiative is an experiment in the use of challenges to focus innovation on making an impact. Individual challenges address some of the same problems, but from differing perspectives.
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Takudzwa Sayi of the University of South Florida in the U.S. will use journey mapping to discover women's experiences and responses to hormonal contraceptives, as well as their interaction with providers, in Zimbabwe to help design new contraceptives. They will also hold focus group discussions with family planning providers to find out their views on the uptake of specific methods. They will enroll women and providers in rural and urban areas across Zimbabwe. The journey mapping will involve a series of six sessions and will document from the time a woman chooses a contraceptive through her experience of side effects and how she interacts with the providers. They will validate their approach by comparing it to results from standard survey methods.
Christine Valente of the University of Bristol in the United Kingdom will collect data on quantitative beliefs of women in Mozambique on contraceptive use to measure the relative importance of factors such as fear of side effects that inhibit use in order to help implement more effective methods. Many women in Mozambique avoid contraceptives, but the reasons, and importantly how women value those different reasons, remain unclear. They will design and conduct a survey to quantify key beliefs on contraceptives among around 700 women who do not want to become pregnant within two years from three provinces in Mozambique. This will enable them to identify ways to correct any false beliefs, such as by providing specific information on the risk of pregnancy in the absence of contraception, to increase contraceptive use.
Maria Gallo of Ohio State University in the U.S. will adapt a validated computer-based psychological test known as the Implicit Association Test to measure the true opinions of women in Vietnam on hormonal contraceptives in order to encourage use. Vietnam has one of the highest rates of abortion worldwide. Although hormonal contraceptives are available, it is thought that many women are worried about using them and instead use alternative methods that are generally less effective. Finding out exactly what these women think about hormonal contraceptives in order to dispel any myths is challenging because many people either don't say or don't realize what they think for a variety of social and psychological reasons. The Implicit Association Test overcomes this challenge by measuring the strength of the associations an individual makes between two pairs of contrasting concepts based on speed. They will adapt the test to determine opinions about the intrauterine device and oral contraception by measuring the strength of their associations with good or bad, and natural or unnatural. This will be tested using a cross-sectional study of 500 non-pregnant females.
Zoe Dibb of Girl Effect in the United Kingdom will train a network of girl researchers to use their custom-built mobile phone research application to find out why 99% of married girls aged 15-19 years old in Northern Nigeria do not use modern contraceptives. This peer-to-peer approach should help encourage young girls to speak more openly about their needs and experiences. Their network of seventeen girl researchers will be trained to use the application to ask 120 young girls, both married and unmarried, quantitative and qualitative questions, and capture their responses using different visual and numerical formats as well as photos and videos to provide greater insight into their views. They will also work with adolescent co-designers to explore desirable attributes of contraceptives with a view towards building and testing prototypes with partners in the future.
Alison Drake of the University of Washington Foundation, Global WACh in the U.S. will conduct an automated SMS-based survey to gather the opinions of women and adolescents on family planning methods in Kenya in order to characterize contraceptive use, reasons for discontinuation, and experience with side effects over a 6-month period that can help develop more acceptable methods. Current surveys capture only a single impression, whereas experiences can change over time. Using a mobile platform requires minimal personnel, and participants can register their opinions remotely. Adolescents will also be included. They will recruit 1,000 women and adolescents at five family planning clinics in Kenya and send them automated SMS messages weekly for six months that ask them to choose from numbered options regarding, for example, if and what side effects they are experiencing from their current family planning method. A monetary incentive will be offered for each SMS response.
Hope Neighbor of Camber Collective in the U.S. will use applied behavioral research to better understand how and why young, sexually active women who are approaching marriage in West Africa make decisions on family planning products. Women appear to regulate their fertility differently based on their specific situation and needs. Young women who are not yet married tend to use unsafe or ineffective practices such as herbal remedies and abortion. They will recruit women in this group to fill out journals to generate evidence on the nature of their fertility planning needs and identify specific attributes of contraceptives that would fit better into their daily lives. They will also develop hypothetical prototype contraceptives by involving the participants in a card game to identify ways of modifying existing contraceptives, such as enabling over-the-counter availability, and key attributes for future contraceptives that better suit their needs.
Bvudzai Magadzire of VillageReach in the U.S. will use a mixed methods approach including in person and electronic focus discussion groups with adolescents in Malawi to discover their experiences and opinions of contraceptives to help inform the development of more tailored options. Adolescents as a group face unique challenges when considering contraception, but their specific needs and concerns are mostly unknown. They will use a free telephone hotline to solicit feedback from adolescent callers on contraceptives, and engage them to lead art-enhanced discussion groups and take part in workshops to design modern contraceptive prototypes that overcome the identified barriers and better suit their needs.
Sarah Rominski of the University of Michigan in the U.S. will conduct longitudinal surveys of women who seek contraception to identify factors associated with satisfaction and particularly with discontinuation, which is common in Ghana. Understanding the reasons women stop using specific contraceptives is important for developing more effective new methods. These reasons may include whether a woman's preference for a specific contraceptive led to them being offered that at the family planning clinic. They will recruit women who attended three clinics in two large cities in Ghana for the survey, which will be conducted at three, six, nine and twelve months post contraceptive selection. Participants will be sent reminders and offered incentives for taking part.
Fiona Gannon of GOAL in Ireland will use mobile technology to conduct surveys of young people aged between 18 and 20 years old in urban regions of Sierra Leone to find out their opinions on contraceptives in order to promote more widespread use. They will develop the survey and advertise and deliver it directly on Facebook to encourage participation. Mobile phone airtime will be offered via mobile money agents as incentive to complete the survey, which will also ensure participants are the right age and from the right area. Participants will also be invited to be part of a collaborative brainstorming event - a hackathon - involving fun and interactive activities to help develop new family planning solutions that work better for their age group.
Francis Eremutha of the Women Friendly Initiative in Nigeria will develop and conduct surveys to identify the reasons why Nigerian men prefer certain contraceptives to help design new ones that men are more likely to use. Currently, there are limited male contraceptive options available, and they suffer from being ineffective, undesirable, or irreversible. The surveys will be both field-based and online, and will be designed to capture the opinions of married and unmarried Nigerian men between the ages of 15 and 60 across six states. They will develop the research protocol in collaboration with the Federal and State Ministries of Health, and train field workers, develop collection tools, and perform quantitative and qualitative analyses of the data.