Co-producing access to care with young people living in Zambia through digital and vending machine-enabled innovation in sexual and reproductive health: A place-based, human-centred design research approach.

Digital health innovation can fail to move beyond prototype or pilot stages or achieve intended outcomes due to a lack of involvement and attunement to local context. This article shares the potential of place-based co-production to support the development, acceptability and usability of context-attuned, digital health service innovation for young people. To illustrate the approach, we report on a collaborative, interdisciplinary project involving a Zambian public health research partner based in Lusaka, Zambia, three European universities and a not-for-profit digital innovation partner. Our youth-led, co-production process involved 6 stages: recruitment of youth Co-design Leaders; role play-based care pathway co-design; app co-design; digital prototype development; stakeholder consultation; and digital pathway testing. We used a combination of qualitative social science research, community and arts-based, human-centred design and digital innovation methods. Young people traced the digital testing and sampling process from accessing self-testing and sampling kits to laboratory processing of results through to how results should be communicated. They were encouraged to evaluate how these processes would work in the context of their everyday lives. We systematically embedded this ideation work into a technically functional 'eHealth Yabwela' app and clinical or laboratory worker-facing web application which young people user tested. Our place-based focus encouraged elicitation of whole pathway, in situ, logistical feasibility alongside social and technical concerns, enabling us to engage with potential adoption and accessibility barriers during the design process. Youth-led co-production created the conditions for participants to lead discussions, voice requirements and hold the project team accountable. Young people recognised that advocacy, overcoming digital inequalities, and further co-production with healthcare workers already facilitating youth-friendly healthcare provision would be needed to integrate the pathway within local systems.