{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T21:46:23Z","timestamp":1790718383371,"version":"4.1.0"},"update-to":[{"DOI":"10.12688\/gatesopenres.13008.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2019,10,23]],"date-time":"2019-10-23T00:00:00Z","timestamp":1571788800000}}],"reference-count":31,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2019,10,23]],"date-time":"2019-10-23T00:00:00Z","timestamp":1571788800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1181398"],"award-info":[{"award-number":["OPP1181398"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","award":["AID-306-A-15-00002"],"award-info":[{"award-number":["AID-306-A-15-00002"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["gatesopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Gates Open Res"],"abstract":"<ns4:p>\n                    <ns4:bold>Background:<\/ns4:bold>\n                    Afghanistan ranks among the most disadvantaged globally for many key reproductive, maternal, newborn and child health (RMNCH) indicators, despite important gains in the past decade. Youth (15 to 24 years) are a key audience for RMNCH information as they enter adulthood, marry and begin families; however, reaching Afghan youth with health information is challenging. Internally displaced persons (IDPs), including youth, experience additional challenges to obtaining health-related information and services. This study measured current and preferred RMNCH information channels to explore the feasibility of using mobile phone technology to provide RMNCH information to IDP youth in Afghanistan.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Methods:<\/ns4:bold>\n                    We conducted a sub-group analysis of survey data from a mixed-methods, cross-sectional, formative assessment to understand current access to RMNCH information. The target population for this analysis includes 15-25-year-old male and female IDP youth from three Afghan Provinces. Survey data were collected using a structured questionnaire administered through face-to-face interviews. Data were analyzed descriptively.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Results:<\/ns4:bold>\n                    A total of 450 IDP youth were surveyed in the three provinces (225 male and 225 female). Access to RMNCH information outside of health facilities was limited. Mobile phone ownership was nearly universal among male participants, yet considerably lower among females; nearly all participants without personal phones reported access to phones when needed. Although few participants spontaneously mentioned mobile phones as a preferred source of RMNCH information, most male and female respondents reported they would be very or somewhat likely to use a free, mobile-phone-based system to access such information if offered.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Conclusions:<\/ns4:bold>\n                    Given widespread access and considerable interest voiced by participants, mobile phones may be a viable way to reach IDP youth with important RMNCH health information in this fragile setting. Interventions should be designed and pilot-tested to identify the most appropriate platforms and information content and to further document feasibility and acceptability.\n                  <\/ns4:p>","DOI":"10.12688\/gatesopenres.13008.2","type":"journal-article","created":{"date-parts":[[2019,10,23]],"date-time":"2019-10-23T09:53:57Z","timestamp":1571824437000},"page":"1483","update-policy":"https:\/\/doi.org\/10.12688\/gatesopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Getting health information to internally displaced youth in Afghanistan: can mobile phone technology bridge the gap?"],"prefix":"10.12688","volume":"3","author":[{"given":"Sayed Omar","family":"Alami","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3987-8932","authenticated-orcid":false,"given":"Lisa","family":"Dulli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leila","family":"Dal Santo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sayed Haroon","family":"Rastagar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sediq","family":"Seddiqi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shafiqullah","family":"Hemat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Machlin Burke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3899-5173","authenticated-orcid":false,"given":"Catherine S.","family":"Todd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2019,10,23]]},"reference":[{"key":"ref-1","article-title":"Country Profiles: Afghanistan","year":"2018"},{"key":"ref-2","article-title":"World health statistics 2018: monitoring health for the SDGs, sustainable development goals"},{"key":"ref-3","article-title":"Afghanistan Demographic and Health Survey 2015","year":"2017"},{"key":"ref-4","doi-asserted-by":"publisher","first-page":"3120854","DOI":"10.1155\/2017\/3120854","article-title":"Ending Preventable Child Deaths from Pneumonia and Diarrhoea in Afghanistan: An Analysis of Intervention Coverage Scenarios Using the Lives Saved Tool.","volume":"2017","author":"A Higgins-Steele","year":"2017","journal-title":"J Trop Med."},{"key":"ref-5","doi-asserted-by":"publisher","first-page":"271-282","DOI":"10.1093\/heapol\/czx136","article-title":"Scaling up newborn care in Afghanistan: opportunities and challenges for the health sector.","volume":"33","author":"M Naziri","year":"2018","journal-title":"Health Policy Plan."},{"key":"ref-6","article-title":"Afghanistan Age Structure"},{"key":"ref-7","doi-asserted-by":"publisher","first-page":"e545-e555","DOI":"10.1016\/S2214-109X(17)30139-0","article-title":"Progress and inequities in maternal mortality in Afghanistan (RAMOS-II): a retrospective observational study.","volume":"5","author":"L Bartlett","year":"2017","journal-title":"Lancet Glob Health."},{"key":"ref-8","doi-asserted-by":"publisher","first-page":"1088-1094","DOI":"10.1016\/j.midw.2013.07.021","article-title":"Midwifery retention and coverage and impact on service utilisation in Afghanistan.","volume":"29","author":"G Mansoor","year":"2013","journal-title":"Midwifery."},{"key":"ref-9","article-title":"Internally Displaced Persons (IDPs) in Afghanistan","year":"2019"},{"key":"ref-10","article-title":"Afghanistan","year":"2019"},{"key":"ref-11","article-title":"Research Study on IDPs in urban settings - Afghanistan","author":"S Redaelli","year":"2011"},{"key":"ref-12","article-title":"Returnee and Internally Displaced Persons Monitoring Report","year":"2018"},{"key":"ref-13","doi-asserted-by":"publisher","first-page":"130-142","DOI":"10.1177\/0141076812472620","article-title":"Mobile health use in low- and high-income countries: an overview of the peer-reviewed literature.","volume":"106","author":"A Bastawrous","year":"2013","journal-title":"J R Soc Med."},{"key":"ref-14","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1186\/s12978-016-0276-z","article-title":"Meet us on the phone: mobile phone programs for adolescent sexual and reproductive health in low-to-middle income countries.","volume":"14","author":"N Ippoliti","year":"2017","journal-title":"Reprod Health."},{"key":"ref-15","doi-asserted-by":"publisher","first-page":"e17","DOI":"10.2196\/jmir.2130","article-title":"Mobile health (mHealth) approaches and lessons for increased performance and retention of community health workers in low- and middle-income countries: a review.","volume":"15","author":"K Kallander","year":"2013","journal-title":"J Med Internet Res."},{"key":"ref-16","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016-0884","article-title":"Mobile Phone Interventions for Adolescent Sexual and Reproductive Health: A Systematic Review.","volume":"138","author":"K L'Engle","year":"2016","journal-title":"Pediatrics."},{"key":"ref-17","doi-asserted-by":"publisher","first-page":"e11244","DOI":"10.2196\/11244","article-title":"The Comparative Effectiveness of Mobile Phone Interventions in Improving Health Outcomes: Meta-Analytic Review.","volume":"7","author":"Q Yang","year":"2019","journal-title":"JMIR Mhealth Uhealth."},{"key":"ref-18","article-title":"Number of mobile cellular subscriptions in Afghanistan From 2002 to 2017","year":"2019"},{"key":"ref-19","article-title":"Feasibility Assessment for the Development of a Mobile Applications Sector in Afghanistan","year":"2014"},{"key":"ref-20","article-title":"Connecting to Opportunity: A Survey of Afghan Women's Access to Mobile Technology","year":"2013"},{"key":"ref-21","article-title":"Formative Assessment of Knowledge, Attitudes, and Preferred Media for Reproductive Health Engagement among Selected Groups of Youth and Men in Afghanistan","author":"Jhpiego","year":"2018"},{"key":"ref-22","first-page":"98-106","article-title":"A simplified general method for cluster-sample surveys of health in developing countries.","volume":"44","author":"S Bennett","year":"1991","journal-title":"World Health Stat Q."},{"key":"ref-23","article-title":"Protecting Internally Displaced Persons: A Manual for Law and Policymakers.","author":"R Williams","year":"2008"},{"key":"ref-24","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1186\/1752-1505-8-26","article-title":"Community health workers of Afghanistan: a qualitative study of a national program.","volume":"8","author":"S Najafizada","year":"2014","journal-title":"Confl Health."},{"key":"ref-25","doi-asserted-by":"publisher","first-page":"CD000389","DOI":"10.1002\/14651858.CD000389","article-title":"Mass media interventions: effects on health services utilisation.","author":"R Grilli","year":"2000","journal-title":"Cochrane Database Syst Rev."},{"key":"ref-26","doi-asserted-by":"publisher","first-page":"CD011683","DOI":"10.1002\/14651858.CD011683.pub2","article-title":"Targeted mass media interventions promoting healthy behaviours to reduce risk of non-communicable diseases in adult, ethnic minorities.","volume":"2","author":"A Mosdol","year":"2017","journal-title":"Cochrane Database Syst Rev."},{"key":"ref-27","doi-asserted-by":"publisher","first-page":"S5","DOI":"10.1186\/1472-698X-9-S1-S5","article-title":"Increasing the demand for childhood vaccination in developing countries: a systematic review.","volume":"9 Suppl1","author":"B Shea","year":"2009","journal-title":"BMC Int Health Hum Rights."},{"key":"ref-28","article-title":"Afghan Media in 2014: Understanding the Audience","author":"H Robinson","year":"2015"},{"key":"ref-29","article-title":"Afghanistan in 2018. A Survey of the Afghan People","author":"T Akseer","year":"2018"},{"key":"ref-30","doi-asserted-by":"publisher","first-page":"e13263","DOI":"10.2196\/13263","article-title":"Barriers to the Use of Mobile Health in Improving Health Outcomes in Developing Countries: Systematic Review.","volume":"21","author":"C Kruse","year":"2019","journal-title":"J Med Internet Res."},{"key":"ref-31","doi-asserted-by":"publisher","first-page":"519-544","DOI":"10.1177\/0049124114521150","article-title":"Selection Errors of Random Route Samples.","volume":"43","author":"J Bauer","year":"2014","journal-title":"Soc Method Res."}],"container-title":["Gates Open Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/gatesopenresearch.org\/articles\/3-1483\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/gatesopenresearch.org\/articles\/3-1483\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/gatesopenresearch.org\/articles\/3-1483\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,8,27]],"date-time":"2020-08-27T08:00:17Z","timestamp":1598515217000},"score":1,"resource":{"primary":{"URL":"https:\/\/gatesopenresearch.org\/articles\/3-1483\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,23]]},"references-count":31,"URL":"https:\/\/doi.org\/10.12688\/gatesopenres.13008.2","relation":{"has-review":[{"id-type":"doi","id":"10.21956\/gatesopenres.14222.r28121","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/gatesopenres.14222.r29363","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/gatesopenres.14222.r29363","asserted-by":"object"},{"id-type":"doi","id":"10.21956\/gatesopenres.14222.r28121","asserted-by":"object"},{"id-type":"doi","id":"10.21956\/gatesopenres.14222.r29387","asserted-by":"object"}]},"ISSN":["2572-4754"],"issn-type":[{"value":"2572-4754","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10,23]]},"assertion":[{"value":"Indexed","URL":"https:\/\/gatesopenresearch.org\/articles\/3-1483\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/gatesopenres.14222.r28121, George C. Patton, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia, 12 Nov 2019, version 2, indexed","URL":"https:\/\/gatesopenresearch.org\/articles\/3-1483\/v2#referee-response-28121","order":0,"name":"referee-response-28121","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/gatesopenres.14116.r27473, Nichole Stetten, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA, 15 Jul 2019, version 1, 2 approved with reservations","URL":"https:\/\/gatesopenresearch.org\/articles\/3-1483\/v1#referee-response-27473","order":1,"name":"referee-response-27473","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Lisa Dulli<\/b>; \n<i>Posted: 21 Oct 2019<\/i>; Thank you for your thoughtful and detailed review. We've tried to address each concern separately below (reviewer comments in italics, responses in normal text):\n<i>This study highlights the need for reproductive, maternal, newborn and child health (RMNCH) interventions in Afghanistan. There is a need for RMNCH interventions to be targeted towards youth, aged 15 to 25 years old, which make up more than half of the Afghani population. Internally displaced persons (IDPs) within this population have even greater barriers to access maternal and child health care. Due to IDPs being a unique population and harder to reach, mobile technology could be used to bridge the access gap in health care. The study aimed to measure the current and preferred RMNCH information channels with an emphasis on exploring the feasibility of using mobile phone technology to reach the IDP youth population.The results of this study are important to the field especially as it covers a hard to reach population. Other strengths of the study are its large sample size over three provinces, with almost equal male and female participants within each province. Additionally, the methods show great cultural competency, which is crucial when conducting a research study within a community. &nbsp;Current recommendations to the authors are listed below:<\/i>  \n<i>Brief mention of where the survey data comes from is needed and the purpose of the overall project should be added. Looking at the references within this section, the data seems to come from the United States Agency for International Development (USAID)-funded Helping Mothers and Children Thrive in Afghanistan (HEMAYAT) project. Further explanation of this project would strengthen the paper and deepen understanding.&nbsp;<\/i>  Information on the project is added to the first sentence of the methods section with new content in italicized font on pp. 2-3:\u201cWe conducted a sub-group analysis of survey data collected in a mixed-methods, cross-sectional, formative assessment \n<i>to inform programming for the United States Agency for International Development-funded Helping Mothers and Children Thrive in Afghanistan project<\/i>.\n<sup>21<\/sup> The assessment was designed to gather information from youth \n<i>15-25 years<\/i> and adult men \n<i>&gt; 25 years of age<\/i> \n<i>to identify health information and service gaps related to RMNCH outcomes<\/i> \n<i>and inform content and channel selection to segments of these populations, including IDPs, for targeted programming<\/i>. For these analyses, we include data \n<i>from a convenience sample<\/i> of female and male IDP youth, ages 15 to 25 years. Youth \n<i>who self-identified as IDP<\/i> were recruited from households located in areas with large IDP populations in Kandahar, Nangarhar, and Takhar Provinces, selected based on their geographic and ethnic diversity. Survey data were collected March-July 2017 using a structured questionnaire administered through face-to-face interviews conducted by trained research assistants. Data used for these analyses include participant background information, household possession of media devices (i.e. television, radio and mobile phones), exposure to health information from various channels, desires for various types of health information and \n<i>preferred<\/i> channels of communication, as well as likelihood to use a free mobile phone-based system to receive health information.\u201d&nbsp;&nbsp;  \n<i>Formative research is primarily used for developing intervention strategies, materials and instruments. Commonly formative research approaches are developed using a theoretical framework. Methods should be expanded to include how this formative approach was developed.&nbsp;<\/i>  While we agree that formative research can be driven by theory, it can also be driven by empirical evidence (or both) or practical need in the absence of empirical evidence. In this case, the project had a number of predetermined objectives (based on project design) and this assessment was used to identify gaps that needed to be addressed for those objectives in order to target interventions to improve health outcomes. We have added this content on pp. 2-3:\u201cWe conducted a sub-group analysis of survey data collected in a mixed-methods, cross-sectional, formative assessment to inform programming for the United States Agency for International Development-funded Helping Mothers and Children Thrive in Afghanistan project. The assessment was designed to gather information from youth 15-25 years and adult men &gt; 25 years of age to identify health information and service gaps related to RMNCH outcomes and inform content and channel selection to segments of these populations, including IDPs, for targeted programming.\u201d&nbsp;  \n<i>The random walk technique used for sampling should be explained in further detail, including why this method was chosen over other methods. How does this method reduce bias?&nbsp;<\/i>  The method was selected as an attempt to reduce sampling bias as compared to simple convenience sampling, although we acknowledge that it does not necessarily do so to a measurable extent; thus, we describe and treat these data as a convenience sample. Community mapping to generate a true probability sample is a time-intensive and costly endeavor, one that the project was unable to afford. Therefore, the option to enroll a convenience sample was chosen. However, random-walk sampling can help to reduce (though we do not know to what extent) sampling bias introduced by a non-random sampling method. Reference is given to the primary source that describes the method and we have provided further details on p. 3:\u201cHouseholds in these communities were sampled using a random walk technique.&nbsp;\n<sup>22<\/sup> The approach used for this random-walk sample involved selecting a central community landmark, such as a mosque, then selecting one house at random to be the starting point. From there households were approached at regular intervals (e.g. every 3rd) Household selection continued in each area until reaching the requisite sample size.\u201d&nbsp;&lt; &gt;\n<i>In the methods the authors state that they were specifically targeting youth and adult men, but when looking in the recruitment section it appears, they are targeting men and women equally.<\/i>Looking at the demographics of the study it looks as if there are significant differences in men in the Takhar province than the other two. While women were similar in demographics across the three provinces, men in the Takhar province had lower levels of educational attainment and low levels of literacy. This difference should be noted within the paper. Noting these differences not only with demographics but in the other sections of the analysis is important as certain provinces may have different wants\/needs. If these populations are significantly different from each other then they may also have different needs within an intervention.\n<i>The authors conclude that an RMNCH intervention is \u201cpotentially feasible\u201d and \u201clikely accessible to more IDP youth\u201d than other forms of communication. The results appear to show low feasibility for this type of intervention, due to low literacy rates, smart phones being owned and controlled predominantly by males, and overall preferred sources of RMNCH coming directly from health care providers. Although many IDP youth own mobile phones there would be many barriers to overcome to implement a successful mobile intervention. A majority of participants reported being \u201clikely to use a free mobile phone-based intervention,\u201d this high rate of \u201cintention to use\u201d does not always translate into a behavior change. Actual feasibility conclusions should be drawn from a pilot study using an RMNCH intervention.<\/i>We appreciate the reviewer\u2019s comments; however, as noted in the discussion, if the intervention used voice messaging (either through live persons or voice recordings) then the literacy challenge would be addressed. Smartphones would not be needed for either a voice- or a text-based intervention, and we hope we have not given the impression that they would be required.We agree that face-to-face client-provider interactions are ideal based on the preferred source of health information for most participants; however, access to such interactions is limited, for multiple reasons, which is why alternative, complementary strategies are required.In terms of self-reported likelihood to use a hypothetical intervention, we absolutely agree. We\u2019ve revised the text in the last paragraph to more explicitly support the need for documenting the actual feasibility of the approach on p. 9:\u201cAlthough findings from this study \n<i>are <\/i>exploratory, we believe that mobile phone-based programming, if appropriately marketed, presents a promising channel to reach IDP youth. Further research is needed to \n<i>more thoroughly document feasibility, as well as to understand the most cost-effective mobile phone platforms to use.<\/i> It will also be important to refine content for various RMNCH topics and channel selection to target specific segments of these sub-populations. We recommend that mobile phone-based RMNCH programming be developed and tested specifically for youth, with purposive inclusion of IDP populations in multiple settings to ensure cultural congruence and acceptability. The resulting interventions should be rigorously tested for cost-effectiveness to help guide national policy for youth programming amidst budgetary limitations and increasing insecurity.\u201d","URL":"https:\/\/gatesopenresearch.org\/articles\/3-1483\/v2#referee-comment-3226","order":2,"name":"referee-comment-3226","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/gatesopenres.14222.r29363, Lianne Gonsalves, Department of Sexual and Reproductive Health and Research including UNDP\/UNFPA\/UNICEF\/WHO\/World Bank Special Programme of Research, World Health Organization, Geneva, Switzerland, 27 Aug 2020, version 2, indexed","URL":"https:\/\/gatesopenresearch.org\/articles\/3-1483\/v2#referee-response-29363","order":3,"name":"referee-response-29363","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Publication of this study was supported by the Bill & Melinda Gates Foundation (OPP1181398).\nThis assessment was supported as part of the HEMAYAT project by the United States Agency for International Development Afghanistan FP\/MNCH Project (AID-306-A-15-00002). The contents of this manuscript are the responsibility of the authors and do not necessarily reflect the views of Jhpiego, FHI 360 or USAID. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}