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. 2023 Oct 4:5:1224429.
doi: 10.3389/fdgth.2023.1224429. eCollection 2023.

Adaptation of the Gabby conversational agent system to improve the sexual and reproductive health of young women in Lesotho

Elizabeth Nkabane-Nkholongo  1 , Mathildah Mokgatle  1 , Timothy Bickmore  2 , Clevanne Julce  3 , Brian W Jack  3
Affiliations

Adaptation of the Gabby conversational agent system to improve the sexual and reproductive health of young women in Lesotho

Elizabeth Nkabane-Nkholongo et al. Front Digit Health. .

Abstract

Introduction: Young women from the low-middle-income country of Lesotho in southern Africa frequently report limited knowledge regarding sexual and reproductive health issues and engage in risky sexual behaviors. The purpose of this study is to describe the adaptation of an evidence-based conversational agent system for implementation in Lesotho and provide qualitative data pertaining to the success of the said adaptation.

Methods: An embodied conversational agent system used to provide preconception health advice in the United States was clinically and culturally adapted for use in the rural country of Lesotho in southern Africa. Inputs from potential end users, health leaders, and district nurses guided the adaptations. Focus group discussions with young women aged 18-28 years who had used the newly adapted system renamed "Nthabi" for 3-4 weeks and key informant interviews with Ministry of Health leadership were conducted to explore their views of the acceptability of the said adaptation. Data were analyzed using NVivo software, and a thematic content analysis approach was employed in the study.

Results: A total of 33 women aged 18-28 years used Nthabi for 3-4 weeks; eight (24.2%) of them were able to download and use the app on their mobile phones and 25 (75.8%) of them used the app on a tablet provided to them. Focus group participants (n = 33) reported that adaptations were culturally appropriate and provided relevant clinical information. The participants emphasized that the physical characteristics, personal and non-verbal behaviors, utilization of Sesotho words and idioms, and sensitively delivered clinical content were culturally appropriate for Lesotho. The key informants from the Ministry leadership (n = 10) agreed that the adaptation was successful, and that the system holds great potential to improve the delivery of health education in Lesotho. Both groups suggested modifications, such as using the local language and adapting Nthabi for use by boys and young men.

Conclusions: Clinically tailored, culturally sensitive, and trustworthy content provided by Nthabi has the potential to improve accessibility of sexual and reproductive health information to young women in the low-middle-income country of Lesotho.

Keywords: conversational agent technology; health education in global health; mHealth adaptation; preconception care; women’s health education.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Gabby was developed in the United States to deliver health education that women could access on desktop computers.
Figure 2
Figure 2
Lesotho version of Gabby (Nthabi) for use on mobile phones.
See this image and copyright information in PMC

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