mHealth for Girls: “Hanging” with Choma

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by Jenn Warren

CHOMA Magazine is your best friend and big sister – inspiring, supporting and motivating you to make informed positive life choices to live healthily and HIV free [1].

Embracing technology in an effort to reach adolescent and teenage girls, CHOMA Magazine exists exclusively online and on mobile. Meaning hanging in Zulu, CHOMA focusses on young girls and women between the ages of 15 and 25 years, whether they are at school, unemployed or employed, or single, in a relationship, or married.

‘Adolescence is a time when girls’ and boys’ lives begin to differ dramatically in terms of schooling, spatial mobility, domestic responsibilities, and sexual and reproductive health. It is also a time when gender disparities in access to resources and opportunities begin to emerge. In most settings, including in South Africa, girls’ status is inferior to that of boys across almost all domains; girls have less social and economic power, and face disproportionate risks that are rooted in gender inequality.

Evidence shows that the health of adolescents is affected by a variety of social factors at the individual, family, community and national levels [2],[3]. South Africa has one of the world’s highest rates of sexual and gender-based violence (SGBV) against adolescent girls [4], with more than a third of girls experiencing sexual violence before the age of 18 [5].

The timing of transition as adolescent girls enter secondary schooling is particularly precarious; girls’ exposure to physical and emotional threats increases as they age. As girls mature, they become increasingly vulnerable to various threats in their environment that put them at risk for HIV, pregnancy and SGBV. This significantly affects their physical, mental and educational outcomes; ultimately affecting their life trajectories.

These young girls and women bear the brunt of gender-based violence executed in many forms, thereby limiting their ability take their rightful place in South Africa’s workplace and marketplace [6].

Adolescence is developmentally a critical period in which to introduce programmes that explore normative behaviours around gender and power [7],[8] that are youth-friendly, approachable and non-threatening. There is the need to share evidence-based sexuality education that addresses gender and power in effective and fresh ways’ [9].

CHOMA is certainly a strong example of a young-friendly, approachable and fresh initiative to address gender equality and health issues for adolescent girls and young women. In a Choma article about gender equality, the author highlights the importance of freedom of choice for her teen readers:

“Being a certain sex or gender should not dictate the choices you are allowed to make. Just because you are a female, doesn’t mean you are not allowed to pursue things like engineering or play sports such as soccer. In saying that, being male doesn’t mean you are not allowed to be a stay-at-home dad or study to be a nurse. Being able to decide what you want regardless of what gender you are is what gender equality is all about. Gender equality is achieved when men and women, boys and girls, enjoy the same rights and opportunities.”

CHOMA magazine and its accompanying virtual community are accessible through a number of online platforms, and include an Ask Choma page where users can anonymously seek support for any issue they may be facing. Below is a powerful example of a Choma user who is in an abusive relationship and needs help; CHOMA Magazine reminds the user that she has the power to choose a healthy relationship that is happy and safe, and tells her to reach out to friends and family for support.

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In South Africa, reaching adolescent girls and young women through mobile platforms is a strategic approach. CHOMA reports, “85% of 15–24 year olds have a mobile phone so it is not surprising that South Africans lead as one of the highest users of mobile technology and mobile social networking on the continent. Advances in social media applications, including mobile phone usage and uptake, provide us with an unrivaled opportunity to engage with and invest in the future of young people in South Africa” [6].

CHOMA’s overall mission is to contribute to an HIV free generation, achieved by developing and supporting an active community that’s informed, self-aware, empowered and inspired to take responsibility for their own SRH choices and who are willing and able to influence others positively through the use of social media [10].

CHOMA’s specific behaviour change goals are [10]:

  1. Delay sexual debut
  2. Increase positive self-esteem and ability to make better choices
  3. Know your status and increase demand for HCT
  4. Increase and negotiate condom use
  5. Increase STI care-seeking behaviour
  6. Reduce number of sexual partners
  7. Increase perception of risk
  8. Increase safe sex behaviour and reduce risk
  9. Increase demand of SRH services including contraception
  10. Create demand for information on HIV and AIDS and increasing dialogue and discussions on related topics

When reviewing CHOMA’s Annual Report for the period 1 May 2014 to 30 April 2015 [10], a significant finding that stood out for me was a look at the magazine’s top performing Facebook posts from the channel’s beginning to present. Starting with an entry point post about tips for teenage girls interested in going natural, CHOMA eased their audience to more hard-hitting conversations about the importance of always carrying a condom, and other taboo discussions in South Africa such as sugar daddies and sexually transmitted diseases.

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Technical Officer for Research Utilisation at FHI360, Kate Plourde, states “Given the high penetration of mobile phone use among young people, targeting them with mobile health (mHealth) interventions seems like a ‘no-brainer.’ Yet, it has taken some time for the global health and development community to realise that young people represent interested consumers and early adopters of mHealth tools. To date, there are still only a limited number of programmes that directly target youth. […] While the evidence about mHealth is still growing, the success of these youth programmes and the rapid scale which they have achieved demonstrate the potential of mHealth to empower millions of young people with essential health information” [11].

With over 22,000 followers on Facebook, 615 followers on Twitter, and virtual communities on Mobi and Mxit, CHOMA is certainly on its way to becoming the South African girl’s go-to source for relationship, sexual reproductive health and HIV prevention information.

[1] http://twitter.com/Chomamag

[2] Viner, R. M., E. M. Ozer, S. Denny, M. Marmot, M. Resnick, A. Fatusi and C. Currie (2012). “Adolescence and the social determinants of health.” Lancet 379 (9826): 1641-1652.

[3] Bonell, C., H. Wells, a. Harden, F. Jamal, a. Fletcher, J. Thomas, R. Campbell, M. Petticrew, M. Whitehead, S. Murphy and L. Moore (2013). “The effects on student health of interventions modifying the school environment: systematic review.” Journal of epidemiology and community health. 67: 677-681.

[4] Peterson, I., Bhana, A., & McKay, M. (2005). Sexual violence and youth in South Africa: The need for community-based prevention interventions. Child Abuse & Neglect, 29 (11), 1238-1248.

[5] Jewkes, R., Abrahams, N., & Mathews, S. (2009). Preventing rape and violence in South Africa: Call for leadership in a new agenda for action. Tygerberg: Medical Research Council.

[6] http://hivsa.com/?q=content/choma-mobile-magazine

[7] Wolfe, D. A., C. Wekerle, D. Reitzel-Jaffe and L. Lefebvre (1998). “Factors associated with abusive relationships among maltreated and non-maltreated youth.” Development and Psychopathology 10: 61-85.

[8] Temple, J. R., R. C. Shorey, S. R. Tortolero, D. A. Wolfe and G. L. Stuart (2013). “Importance of gender and attitudes about violence in the relationship between exposure to interparental violence and the perpetration of teen dating violence.” Child Abuse & Neglect, 37 (5): 343-352.

[9] Grassroot Soccer South Africa, www.grassrootsoccer.org

[10] Armstrong, Jean (2015). CTAOP Annual Report for the period 1 May 2014 to 30 April 2015. HIVSA

[11] Plourde, Kate (20 January 2015). “mHealth for Youth—A No-Brainer”.
K4HEALTH: Knowledge for Health Blog. http://www.k4health.org/blog/post/mhealth-youth-no-brainer

About Jenn

Jenn provides photography, communications and Communication for Development services for a range of humanitarian and development clients, and leads photography and communications workshops for youth and professionals. These days, she spends much of her time with the Sport for Development organisation, Grassroot Soccer.
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6 Comments

  1. Adriano Pedrana

    This is a very interesting example of activism through new media, with a specific target. Choma mixes light topics along with serious ones, all with a simple, direct language. I think that this is the best way to impersonate ‘your best friend’, ‘your big sister’, as they write in the About Choma page.

    I have a few questions, though. First of all, the name. You write that Choma comes from Zulu. Does choosing a word in a specific language run the risk of excluding other linguistic groups in South Africa? Would a different, neutral name be more inclusive?

    Take Belgium, a three-language country. The government’s official website address uses the neutral, English name (www.belgium.be). And the English name is overwhelmingly used in all language pages: here are some search results divided per language:

    French
    Belgique 649
    Belgium 3335

    Dutch
    Belgie 595
    Belgium2995

    German
    Belgien 152
    Belgium 255

    English
    Belgium 310

    That, I feel, is a way to include all the countries language communities, but also to appear politically correct and not being involved in the clash among communities.

    Something similar seems to happen in Switzerland, where many companies choose a neutral, often Latin-sounding name (take Novartis, Syngenta, Implenia).

    By reading some posts I have realized that “choma/s” is also used as a way to address to the readers (“Hey, chomas”, “So there you have it chomas”. See also the screenshots in your post). This could override the origin of this word – or maybe it is already being used in other languages as well.

    I have also briefly analysed the pictures of people published in Choma. Of about 120 of them (harvested through google), just a dozen depict white people (and at least four of them are adverts or singers), and one only has a group with people of different races. Does this reflect the target of the website? And would it make sense to have more groups with black and white persons, though ethnic conflicts is not the target of this action?

    And is there any parallel initiative targeting boys?

    • Thanks for your thoughts and comments, Adriano. Agreed that Choma Magazine is a clever way to reach adolescent girls, and bridge the gap between casual conversation and those taboo or hard-to-hold conversations about sex, HIV, intimate partner violence and gender-based violence.

      Regarding the use of language, while it is true that South Africa has 11 national languages, there is a good deal of overlap between certain main languages due to linguistic and geographic origin. Also, many South Africans know more than their own origin language – and are fluent or at least conversational in 3-4 languages! The main points of potential exclusion in South Africa, in terms of language, remain with the use of Afrikaans and English when communicating with African communities. I personally believe – although this is a valid question to follow up with some of my organisation’s female adolescent participants and older role models – that audiences seeing a word that is known to be of African origin, and in this case Zulu, would give a sense of inclusion no matter which community the audience member is from (with exception to *some* British and Afrikaans teenage girls, possibly, although not necessarily – as South African becomes more and more diverse as time goes on).

      Also as you mention, Choma Magazine has decided to re-purpose the word “choma” to give a more casual and “in” feel, calling the magazine’s readers and participants “chomas”, and also signing off from support letters as “Choma”. I believe this approach helps to level the playing field – demonstrating that not all the support requests appear or feel to be FROM a girl who needs help, written TO an “expert”. We are all “chomas” 🙂 because we all face the same challenges in life.

      To this point of audience, the “we”, and your observation of the selected photos throughout Choma’s online magazine, Twitter and Facebook pages – the target population for this initiative is South African adolescent females who are at higher risk of contracting HIV, and therefore more likely living in impoverished communities and townships. This is due to a number of complicated and unfortunate (although I would personally use a stronger term!) factors, including South Africa’s apartheid history, continued segregation and economic and educational exclusion of the majority of citizens. Adolescent girls’ increased risk of contracting HIV is also due to South Africa’s pervasive harmful gender norms, that are more prevalent amongst African communities due to traditional practices and religious beliefs. That said, I personally feel that South African culture across the board is misogynistic and contributes to more “traditional” or harmful practices when it comes to gender equality.

      There are parallel activities for others, including adolescent boys. On the tech/ICT4D-side, the folks behind Choma Magazine also have Hi4Life which is for boys, and families. Sonke Gender Justice is behind Brothers for Life, created for young men. Not using tech, Grassroot Soccer (where I work) reaches adolescent boys (and girls, and young men and women) using the language of soccer and community role models.

      The lesson for me here is that there is no ONE intervention/programme/curriculum/game/website that will work. The key is to use as many communication channels as possible to reach the same audiences with the same messages, so that the message will slowly take root and lead to sustained social change on a wider level.

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