Co-design of a digital health intervention to provide pharmacy-based, person-centered contraceptive decision support for youth in Kenya
6 affiliations
- 1Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, United States of America
- 2Department of Global Health, University of Washington, Seattle, Washington, United States of America
- 3Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, Washington, United States of America
- 4Independent Design Consultant, Nairobi, Kenya
- 5Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- 6Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, United States of America
Abstract
Adolescent girls and young women (AGYW; age 15–24 years) face intersectional barriers to undesired pregnancy prevention, with profound health consequences. Community pharmacies remain a relatively untapped opportunity to improve the reach and quality of contraceptive care for youth. The purpose of this study was to co-design and prototype a digital health, person-centered contraceptive decision support application (the Mara Divas App) tailored for Kenyan AGYW. We engaged AGYW with recent experience seeking contraception in a pharmacy, and pharmacy providers who dispense contraceptive methods, to participate in full-day human-centered design workshops. The design team analyzed visual artifacts, official written notes, and transcripts to generate insights, which were used by the technical team to modify the prototype between and after workshops. We conducted four co-design workshops among AGYW (n = 33), and pharmacy providers (n = 10). Journey mapping highlighted AGYW anxiety rooted in social stigma throughout their pharmacy experience and limited contraceptive knowledge. Friendly, nonjudgmental providers and respect for privacy were critical to engaging AGYW despite their tendency to avoid interaction and make purchases at “rocket speed.” Emergency contraception seekers need a “hook” motivating them to engage with the app, as they have low motivation to engage in contraceptive counseling due to perceived limited options. All content could be engaged in three languages by screen; AGYW switched languages frequently during app use. AGYW preferred video and visual content to text, though audio narration of text was popular. Additional features were added to enhance navigability, which was initially limited among the youngest participants. AGYW desired the app to project a confident, powerful “diva.” We used human-centered design approaches to generate key design insights related to engaging youth seeking emergency contraception in pharmacies, overcoming literacy challenges with multilingual audiovisual content, and addressing negative contraceptive beliefs. Future research is needed to study the feasibility and determinants of app implementation.
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BibTeX
@article{harrington2026codesign,
title = {{Co-design of a digital health intervention to provide pharmacy-based, person-centered contraceptive decision support for youth in Kenya}},
author = {Elizabeth K. Harrington and Lisa Orii and Nelson K. Cheruiyot and Merceline Awuor and Cellestine Aoko and Dismas C. Ouma and Christine Dehlendorf and Richard Anderson and Elizabeth A. Bukusi and Serah W. Gitome},
journal = {PLOS Global Public Health},
year = {2026},
month = sep,
doi = {10.1371/journal.pgph.0007335},
url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007335},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Co-design of a digital health intervention to provide pharmacy-based, person-centered contraceptive decision support for youth in Kenya
AU - Elizabeth K. Harrington
AU - Lisa Orii
AU - Nelson K. Cheruiyot
AU - Merceline Awuor
AU - Cellestine Aoko
AU - Dismas C. Ouma
AU - Christine Dehlendorf
AU - Richard Anderson
AU - Elizabeth A. Bukusi
AU - Serah W. Gitome
PY - 2026
DA - 2026/09/17
JO - PLOS Global Public Health
DO - 10.1371/journal.pgph.0007335
UR - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007335
AB - Adolescent girls and young women (AGYW; age 15–24 years) face intersectional barriers to undesired pregnancy prevention, with profound health consequences. Community pharmacies remain a relatively untapped opportunity to improve the reach and quality of contraceptive care for youth. The purpose of this study was to co-design and prototype a digital health, person-centered contraceptive decision support application (the Mara Divas App) tailored for Kenyan AGYW. We engaged AGYW with recent experience seeking contraception in a pharmacy, and pharmacy providers who dispense contraceptive methods, to participate in full-day human-centered design workshops. The design team analyzed visual artifacts, official written notes, and transcripts to generate insights, which were used by the technical team to modify the prototype between and after workshops. We conducted four co-design workshops among AGYW (n = 33), and pharmacy providers (n = 10). Journey mapping highlighted AGYW anxiety rooted in social stigma throughout their pharmacy experience and limited contraceptive knowledge. Friendly, nonjudgmental providers and respect for privacy were critical to engaging AGYW despite their tendency to avoid interaction and make purchases at “rocket speed.” Emergency contraception seekers need a “hook” motivating them to engage with the app, as they have low motivation to engage in contraceptive counseling due to perceived limited options. All content could be engaged in three languages by screen; AGYW switched languages frequently during app use. AGYW preferred video and visual content to text, though audio narration of text was popular. Additional features were added to enhance navigability, which was initially limited among the youngest participants. AGYW desired the app to project a confident, powerful “diva.” We used human-centered design approaches to generate key design insights related to engaging youth seeking emergency contraception in pharmacies, overcoming literacy challenges with multilingual audiovisual content, and addressing negative contraceptive beliefs. Future research is needed to study the feasibility and determinants of app implementation.
SN - 2767-3375
ER -