Effect of a mobile phone-based intervention on post-abortion contraception: a randomized controlled trial in Cambodia

Chris Smith, Thoai D Ngo, Judy Gold, Phil Edwards, Uk Vannak, Ly Sokhey, Kazuyo Machiyama, Emma Slaymaker, Ruby Warnock, Ona McCarthy, Caroline Free, Chris Smith, Thoai D Ngo, Judy Gold, Phil Edwards, Uk Vannak, Ly Sokhey, Kazuyo Machiyama, Emma Slaymaker, Ruby Warnock, Ona McCarthy, Caroline Free

Abstract

Objective: To assess the effect of a mobile phone-based intervention (mHealth) on post-abortion contraception use by women in Cambodia.

Methods: The Mobile Technology for Improved Family Planning (MOTIF) study involved women who sought safe abortion services at four Marie Stopes International clinics in Cambodia. We randomly allocated 249 women to a mobile phone-based intervention, which comprised six automated, interactive voice messages with counsellor phone support, as required, whereas 251 women were allocated to a control group receiving standard care. The primary outcome was the self-reported use of an effective contraceptive method, 4 and 12 months after an abortion.

Findings: Data on effective contraceptive use were available for 431 (86%) participants at 4 months and 328 (66%) at 12 months. Significantly more women in the intervention than the control group reported effective contraception use at 4 months (64% versus 46%, respectively; relative risk, RR: 1.39; 95% confidence interval, CI: 1.17-1.66) but not at 12 months (50% versus 43%, respectively; RR: 1.16; 95% CI: 0.92-1.47). However, significantly more women in the intervention group reported using a long-acting contraceptive method at both follow-up times. There was no significant difference between the groups in repeat pregnancies or abortions at 4 or 12 months.

Conclusion: Adding a mobile phone-based intervention to abortion care services in Cambodia had a short-term effect on the overall use of any effective contraception, while the use of long-acting contraceptive methods lasted throughout the study period.

Figures

Fig. 1
Fig. 1
Flowchart of participants in a mobile phone-based intervention for post-abortion contraception, Cambodia, 2013–2014
Fig. 2
Fig. 2
Kaplan–Meier survival curves for contraceptive discontinuation, in a mobile phone-based intervention for post-abortion contraception, Cambodia, 2013–2014
Fig. 3
Fig. 3
Contraceptive use in different subgroups after a mobile phone-based intervention for post-abortion contraception, Cambodia, 2013–2014

References

    1. Cleland J, Conde-Agudelo A, Peterson H, Ross J, Tsui A. Contraception and health. Lancet. 2012. July 14;380(9837):149–56. 10.1016/S0140-6736(12)60609-6
    1. Singh S, Darroch J, Ashford L. Adding it up: the costs and benefits of investing in sexual and reproductive health 2014. New York: Guttmacher Institute; 2014. Available from: [cited 2015 Oct 3].
    1. Postabortion family planning: strengthening the family planning component of postabortion care. Baltimore: John Hopkins University; 2012. Available from: [cited 2015 Sep 21].
    1. Curtis C, Huber D, Moss-Knight T. Postabortion family planning: addressing the cycle of repeat unintended pregnancy and abortion. Int Perspect Sex Reprod Health. 2010. March;36(1):44–8. 10.1363/3604410
    1. Tripney J, Kwan I, Bird KS. Postabortion family planning counseling and services for women in low-income countries: a systematic review. Contraception. 2013. January;87(1):17–25. 10.1016/j.contraception.2012.07.014
    1. Ferreira AL, Lemos A, Figueiroa JN, de Souza AI. Effectiveness of contraceptive counselling of women following an abortion: a systematic review and meta-analysis. Eur J Contracept Reprod Health Care. 2009. February;14(1):1–9. 10.1080/13625180802549970
    1. Cambodia Demographic and Health Survey 2010. Calverton & Phnom Penh: ICF Macro & National Institute of Statistics and Directorate General for Health of Cambodia; 2010. Available from: [cited 2015 Sept 21].
    1. Fetters T, Samandari G. An estimate of safe and unsafely induced abortion in Cambodia. In: Proceedings of XXVI International Population Conference of the IUSSP; 2009 Sep 27–Oct 2; Marrakech, Morocco. Princeton: Princeton University; 2009.
    1. Kimchhoy P, Sola J. Mobile phones in Cambodia 2014. Phnom Penh: Open Institute; 2014. Available from: [cited 2015 Oct 2].
    1. Källander K, Tibenderana JK, Akpogheneta OJ, Strachan DL, Hill Z, ten Asbroek AH, et al. Mobile health (mHealth) approaches and lessons for increased performance and retention of community health workers in low- and middle-income countries: a review. J Med Internet Res. 2013;15(1):e17. 10.2196/jmir.2130
    1. Smith C, Vannak U, Sokhey L, Ngo T, Gold J, Free C. Mobile technology for improved family planning (MOTIF): the development of a mobile phone-based (mHealth) intervention to support post-abortion family planning (PAFP) in Cambodia. Reprod Health. 2015. Forthcoming.
    1. Free C, Phillips G, Galli L, Watson L, Felix L, Edwards P, et al. The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: a systematic review. PLoS Med. 2013;10(1):e1001362. 10.1371/journal.pmed.1001362
    1. Free C, Knight R, Robertson S, Whittaker R, Edwards P, Zhou W, et al. Smoking cessation support delivered via mobile phone text messaging (txt2stop): a single-blind, randomised trial. Lancet. 2011. July 2;378(9785):49–55. 10.1016/S0140-6736(11)60701-0
    1. Horvath T, Azman H, Kennedy GE, Rutherford GW. Mobile phone text messaging for promoting adherence to antiretroviral therapy in patients with HIV infection. Cochrane Database Syst Rev. 2012;3:CD009756.
    1. Castaño PM, Bynum JY, Andrés R, Lara M, Westhoff C. Effect of daily text messages on oral contraceptive continuation: a randomized controlled trial. Obstet Gynecol. 2012. January;119(1):14–20. 10.1097/AOG.0b013e31823d4167
    1. Hou MY, Hurwitz S, Kavanagh E, Fortin J, Goldberg AB. Using daily text-message reminders to improve adherence with oral contraceptives: a randomized controlled trial. Obstet Gynecol. 2010. September;116(3):633–40. 10.1097/AOG.0b013e3181eb6b0f
    1. Tsur L, Kozer E, Berkovitch M. The effect of drug consultation center guidance on contraceptive use among women using isotretinoin: a randomized, controlled study. J Womens Health (Larchmt). 2008. May;17(4):579–84. 10.1089/jwh.2007.0623
    1. Smith C, Vannak U, Sokhey L, Ngo TD, Gold J, Khut K, et al. MObile Technology for Improved Family Planning Services (MOTIF): study protocol for a randomised controlled trial. Trials. 2013 Dec 12;14(427):427. 10.1186/1745-6215-14-427
    1. Smith C, Ngo TD, Edwards P, Free C. MObile Technology for Improved Family Planning: update to randomised controlled trial protocol. Trials. 2014;15(1):440. 10.1186/1745-6215-15-440
    1. Cleland J, Ali MM. Reproductive consequences of contraceptive failure in 19 developing countries. Obstet Gynecol. 2004. August;104(2):314–20. 10.1097/01.AOG.0000134789.73663.fd
    1. Knowledge for Health Project. Family planning: a global handbook for providers (2011 update). Baltimore & Geneva: Johns Hopkins Bloomberg School of Public Health & World Health Organization; 2011.
    1. Bullen P. Operational challenges in the Cambodian mHealth revolution. J Mob Technol Med. 2013;2(2):20–3. 10.7309/jmtm.2.2.5
    1. Stuart GS, Grimes DA. Social desirability bias in family planning studies: a neglected problem. Contraception. 2009. August;80(2):108–12. 10.1016/j.contraception.2009.02.009
    1. Potter L, Oakley D, de Leon-Wong E, Cañamar R. Measuring compliance among oral contraceptive users. Fam Plann Perspect. 1996. Jul-Aug;28(4):154–8. 10.2307/2136191
    1. Hall KS, White KO, Reame N, Westhoff C. Studying the use of oral contraception: a review of measurement approaches. J Womens Health (Larchmt). 2010. December;19(12):2203–10. 10.1089/jwh.2010.1963
    1. Morineau G, Neilsen G, Heng S, Phimpachan C, Mustikawati DE. Falling through the cracks: contraceptive needs of female sex workers in Cambodia and Laos. Contraception. 2011. August;84(2):194–8. 10.1016/j.contraception.2010.11.003
    1. Ali MM, Cleland J. Contraceptive switching after method-related discontinuation: levels and differentials. Stud Fam Plann. 2010. June;41(2):129–33. 10.1111/j.1728-4465.2010.00234.x
    1. Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2008; (2):CD000011.
    1. Ali MM, Park MH, Ngo TD. Levels and determinants of switching following intrauterine device discontinuation in 14 developing countries. Contraception. 2014. July;90(1):47–53. 10.1016/j.contraception.2014.03.008
    1. Johnson BR, Ndhlovu S, Farr SL, Chipato T. Reducing unplanned pregnancy and abortion in Zimbabwe through postabortion contraception. Stud Fam Plann. 2002. June;33(2):195–202. 10.1111/j.1728-4465.2002.00195.x

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit