Assessing the reach and effectiveness of mHealth: evidence from a reproductive health program for adolescent girls in Ghana

Slawa Rokicki, Günther Fink, Slawa Rokicki, Günther Fink

Abstract

Background: While mobile health (mHealth) programs are increasingly used to provide health information and deliver interventions, little is known regarding the relative reach and effectiveness of these programs across sociodemographic characteristics. We use data from a recent trial of a text-messaging intervention on adolescent sexual and reproductive health (SRH) to assess the degree to which mHealth programs reach target adolescent subpopulations who may be at higher risk of poor SRH outcomes.

Methods: The study was conducted among girls aged 14-24 in 22 secondary schools in Accra, Ghana. The mHealth intervention was an interactive mobile phone quiz in which participants could win phone credit for texting correct answers to SRH questions. We use detailed data on individuals' level of engagement with the program, SRH knowledge scores, and self-reported pregnancy collected as part of the original trial to assess the extent to which engagement and program impact vary across parental education, sexual experience, SRH knowledge deficit, and parental support.

Results: Eighty-one percent of participants engaged with the mHealth program, with no evidence that the program disproportionally reached better-off groups. The program was effective at increasing knowledge of SRH across all strata. Higher levels of engagement were associated with higher knowledge scores up to year later. There was no significant impact of the program on self-reported pregnancy within subgroups.

Conclusion: mHealth programs for adolescents have the potential to engage and increase SRH knowledge of adolescent girls across sociodemographic strata, including those who may be at higher risk of poor SRH outcomes.

Trial registration: ClinicalTrials.gov NCT02031575 . Registered 07 Jan 2014.

Keywords: Adolescent health; Health promotion; Mobile health; SMS; Sexual and reproductive health; Text messaging.

Conflict of interest statement

Ethics approval and consent to participate

Participants gave written consent; those aged younger than 18 years obtained parental consent. IRB approval was granted by Harvard University [#FWA00004837] as well as locally by the Ghana Health Service (GHS-ERC:05/09/13).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Average difference in knowledge z-score between intervention and control groups, at 3 months (left) and 15 months (right), as a function of number of responses to text message quiz questions (uses intervention and control groups, N = 498)
Fig. 2
Fig. 2
Difference in knowledge z-score for intervention group compared to the control group at 3 and 15 months, stratified by target subgroups (uses intervention and control groups, N = 498)
Fig. 3
Fig. 3
Distribution of number of responses

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