An Intervention Delivered by Mobile Phone Instant Messaging to Increase Acceptability and Use of Effective Contraception Among Young Women in Bolivia: Randomized Controlled Trial

Ona L McCarthy, Carolina Aliaga, Maria Eugenia Torrico Palacios, Jhonny López Gallardo, Silvia Huaynoca, Baptiste Leurent, Phil Edwards, Melissa Palmer, Irrfan Ahamed, Caroline Free, Ona L McCarthy, Carolina Aliaga, Maria Eugenia Torrico Palacios, Jhonny López Gallardo, Silvia Huaynoca, Baptiste Leurent, Phil Edwards, Melissa Palmer, Irrfan Ahamed, Caroline Free

Abstract

Background: Although the most effective methods of contraception are available in Bolivia, unmet need for contraception among women aged 15 to 19 years is estimated to be 38% (2008), and the adolescent fertility rate is 71 per 1000 women (2016). Mobile phones are a popular mode to deliver health behavior support. We developed a contraceptive behavioral intervention for young Bolivian women delivered by mobile phone and guided by behavioral science. The intervention consists of short instant messages sent through an app over 4 months.

Objective: This trial aimed to evaluate the effect of the intervention on young Bolivian women's use of and attitudes toward the effective contraceptive methods available in Bolivia.

Methods: This was a parallel group, individually randomized superiority trial with a 1:1 allocation ratio. Women were eligible if they were aged 16 to 24 years, owned a personal Android mobile phone, lived in La Paz or El Alto, reported an unmet need for contraception, and could read Spanish. The target sample size was 1310 participants. Participants allocated to the intervention had access to an app with standard family planning information and intervention messages. Participants allocated to the control group had access to the same app and control messages. Coprimary outcomes were use of effective contraception and acceptability of at least one method of effective contraception at 4 months. Secondary outcomes were use of effective contraception during the study, acceptability of the individual methods, service uptake, unintended pregnancy, and abortion. Process outcomes included knowledge, perceived norms, personal agency, and intention. Outcomes were analyzed using logistic and linear regression. We also asked participants about physical violence.

Results: A total of 640 participants were enrolled, and 67.0% (429) of them contributed follow-up data for the coprimary outcome, the use of effective contraception. There was no evidence that use differed between the groups (33% control vs 37% intervention; adjusted odds ratio [OR] 1.19, 95% CI 0.80 to 1.77; P=.40). There was a borderline significant effect regarding acceptability (63% control vs 72% intervention; adjusted OR 1.49, 95% CI 0.98 to 2.28; P=.06). There were no statistically significant differences in any of the secondary or process outcomes. The intervention dose received was low. In the control group, 2.8% (6/207) reported experiencing physical violence compared with 1.9% (4/202) in the intervention group (Fisher exact test P=.75).

Conclusions: This trial was unable to provide definitive conclusions regarding the effect of the intervention on use and acceptability of effective contraception because of under recruitment. Although we cannot strongly recommend implementation, the results suggest that it would be safe and may increase the acceptability of effective contraception if the intervention messages were offered alongside the download of the app.

Trial registration: ClinicalTrials.gov NCT02905526; https://ichgcp.net/clinical-trials-registry/NCT02905526.

Keywords: Bolivia; cellphone; contraception; mobile phone; reproductive health; young adults.

Conflict of interest statement

Conflicts of Interest: None declared.

©Ona L McCarthy, Carolina Aliaga, Maria Eugenia Torrico Palacios, Jhonny López Gallardo, Silvia Huaynoca, Baptiste Leurent, Phil Edwards, Melissa Palmer, Irrfan Ahamed, Caroline Free. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 22.06.2020.

Figures

Figure 1
Figure 1
Trial flow diagram.
Figure 2
Figure 2
Intervention effect on the use of effective contraception by subgroups.
Figure 3
Figure 3
Intervention effect on the acceptability of effective contraception by subgroups.

References

    1. Hardee K, Eggleston E, Wong EL, Irwanto. Hull TH. Unintended pregnancy and women's psychological well-being in Indonesia. J Biosoc Sci. 2004 Sep;36(5):617–26. doi: 10.1017/s0021932003006321.
    1. Gipson JD, Koenig MA, Hindin MJ. The effects of unintended pregnancy on infant, child, and parental health: a review of the literature. Stud Fam Plann. 2008 Mar;39(1):18–38. doi: 10.1111/j.1728-4465.2008.00148.x.
    1. Marston C, Cleland J. Do unintended pregnancies carried to term lead to adverse outcomes for mother and child? An assessment in five developing countries. Popul Stud (Camb) 2003;57(1):77–93. doi: 10.1080/0032472032000061749.
    1. Shah PS, Balkhair T, Ohlsson A, Beyene J, Scott F, Frick C. Intention to become pregnant and low birth weight and preterm birth: a systematic review. Matern Child Health J. 2011 Feb;15(2):205–16. doi: 10.1007/s10995-009-0546-2.
    1. Mohllajee AP, Curtis KM, Morrow B, Marchbanks PA. Pregnancy intention and its relationship to birth and maternal outcomes. Obstet Gynecol. 2007 Mar;109(3):678–86. doi: 10.1097/01.AOG.0000255666.78427.c5.
    1. Sedgh G, Ashford LS, Hussain R. Guttmacher Institute. New York, NY: Guttmacher Institute; 2016. Jun, [2020-03-13]. Unmet Need for Contraception in Developing Countries: Examining Women's Reasons for Not Using a Method .
    1. World Health Organization. 2018. Feb 8, [2020-03-13]. Family Planning/Contraception Fact Sheet
    1. Cleland J, Ali MM. Reproductive consequences of contraceptive failure in 19 developing countries. Obstet Gynecol. 2004 Aug;104(2):314–20. doi: 10.1097/01.AOG.0000134789.73663.fd.
    1. Trussell J. Contraceptive efficacy. In: Hatcher R, Trussell J, Nelson A, Cates W, Kowal D, Policar M, editors. Contraceptive Technology. New York, NY: Ardent Media; 2011.
    1. The DHS Program. 2008. [2017-10-20]. 2008 National Demography and Health Survey. In Spanish. Encuesta Nacional de Demografía y Salud 2008 .
    1. Ministerio de Salud. 2017. [2019-03-21]. Demographia and Health Survey - EDSA 2016. In Spanish. Encuesta de Demographia y Salud - EDSA 2016 .
    1. UNFPA - United Nations Population Fund. 2012. Jan, [2017-10-20]. Independent Country Programme Evaluation-Bolivia 2008-2011 .
    1. Free C, Knight R, Robertson S, Whittaker R, Edwards P, Zhou W, Rodgers A, Cairns J, Kenward MG, Roberts I. Smoking cessation support delivered via mobile phone text messaging (txt2stop): a single-blind, randomised trial. Lancet. 2011 Jul 2;378(9785):49–55. doi: 10.1016/S0140-6736(11)60701-0.
    1. Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, Jack W, Habyarimana J, Sadatsafavi M, Najafzadeh M, Marra CA, Estambale B, Ngugi E, Ball TB, Thabane L, Gelmon LJ, Kimani J, Ackers M, Plummer FA. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. Lancet. 2010 Nov 27;376(9755):1838–45. doi: 10.1016/S0140-6736(10)61997-6.
    1. Pop-Eleches C, Thirumurthy H, Habyarimana JP, Zivin JG, Goldstein MP, de Walque D, MacKeen L, Haberer J, Kimaiyo S, Sidle J, Ngare D, Bangsberg DR. Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders. AIDS. 2011 Mar 27;25(6):825–34. doi: 10.1097/QAD.0b013e32834380c1.
    1. Zurovac D, Sudoi RK, Akhwale WS, Ndiritu M, Hamer DH, Rowe AK, Snow RW. The effect of mobile phone text-message reminders on Kenyan health workers' adherence to malaria treatment guidelines: a cluster randomised trial. Lancet. 2011 Aug 27;378(9793):795–803. doi: 10.1016/S0140-6736(11)60783-6.
    1. Orr JA, King RJ. Mobile phone SMS messages can enhance healthy behaviour: a meta-analysis of randomised controlled trials. Health Psychol Rev. 2015;9(4):397–416. doi: 10.1080/17437199.2015.1022847.
    1. Hall AK, Cole-Lewis H, Bernhardt JM. Mobile text messaging for health: a systematic review of reviews. Annu Rev Public Health. 2015 Mar 18;36:393–415. doi: 10.1146/annurev-publhealth-031914-122855.
    1. Hall CS, Fottrell E, Wilkinson S, Byass P. Assessing the impact of mHealth interventions in low- and middle-income countries--what has been shown to work? Glob Health Action. 2014;7:25606. doi: 10.3402/gha.v7.25606.
    1. Aranda-Jan CB, Mohutsiwa-Dibe N, Loukanova S. Systematic review on what works, what does not work and why of implementation of mobile health (mHealth) projects in Africa. BMC Public Health. 2014 Feb 21;14:188. doi: 10.1186/1471-2458-14-188.
    1. Free C, Phillips G, Galli L, Watson L, Felix L, Edwards P, Patel V, Haines A. 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. doi: 10.1371/journal.pmed.1001362.
    1. Head KJ, Noar SM, Iannarino NT, Harrington NG. Efficacy of text messaging-based interventions for health promotion: a meta-analysis. Soc Sci Med. 2013 Nov;97:41–8. doi: 10.1016/j.socscimed.2013.08.003.
    1. World Health Organization . mHealth: New Horizons for Health Through Mobile Technologies: Second Global Survey on eHealth. Geneva, Switzerland: World Health Organization; 2011.
    1. L'Engle KL, Mangone ER, Parcesepe AM, Agarwal S, Ippoliti NB. Mobile phone interventions for adolescent sexual and reproductive health: a systematic review. Pediatrics. 2016 Sep;138(3):pii: e20160884. doi: 10.1542/peds.2016-0884.
    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 Jan;119(1):14–20. doi: 10.1097/AOG.0b013e31823d4167.
    1. Harrington EK. ResearchWorks. [2019-03-21]. Evaluation of an mHealth SMS dialogue strategy to meet women’s and couples’ postpartum contraceptive needs in Kenya (Mobile WACh XY): A randomized controlled trial .
    1. Smith C, Ngo TD, Gold J, Edwards P, Vannak U, Sokhey L, Machiyama K, Slaymaker E, Warnock R, McCarthy O, Free C. Effect of a mobile phone-based intervention on post-abortion contraception: a randomized controlled trial in Cambodia. Bull World Health Organ. 2015 Dec 1;93(12):842–50A. doi: 10.2471/BLT.15.160267.
    1. Hebert LE, Hill BJ, Quinn M, Holl JL, Whitaker AK, Gilliam ML. Mobile contraceptive application use in a clinical setting in addition to standard contraceptive counseling: A randomized controlled trial. Contraception. 2018 Oct;98(4):281–7. doi: 10.1016/j.contraception.2018.07.001.
    1. Johnson D, Juras R, Riley P, Chatterji M, Sloane P, Choi SK, Johns B. A randomized controlled trial of the impact of a family planning mHealth service on knowledge and use of contraception. Contraception. 2017 Jan;95(1):90–7. doi: 10.1016/j.contraception.2016.07.009.
    1. Rokicki S, Cohen J, Salomon JA, Fink G. Impact of a text-messaging program on adolescent reproductive health: a cluster-randomized trial in Ghana. Am J Public Health. 2017 Feb;107(2):298–305. doi: 10.2105/AJPH.2016.303562.
    1. Bull S, Devine S, Schmiege SJ, Pickard L, Campbell J, Shlay JC. Text messaging, teen outreach program, and sexual health behavior: a cluster randomized trial. Am J Public Health. 2016 Sep;106(S1):S117–24. doi: 10.2105/AJPH.2016.303363.
    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 Sep;116(3):633–40. doi: 10.1097/AOG.0b013e3181eb6b0f.
    1. Trent M, Thompson C, Tomaszewski K. Text messaging support for urban adolescents and young adults using injectable contraception: outcomes of the DepoText Pilot Trial. J Adolesc Health. 2015 Jul;57(1):100–6. doi: 10.1016/j.jadohealth.2015.03.008.
    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. doi: 10.1089/jwh.2007.0623.
    1. Sridhar A, Chen A, Forbes ER, Glik D. Mobile application for information on reversible contraception: a randomized controlled trial. Am J Obstet Gynecol. 2015 Jun;212(6):774.e1–7. doi: 10.1016/j.ajog.2015.01.011.
    1. McCarthy OL, Wazwaz O, Calderon VO, Jado I, Saibov S, Stavridis A, Gallardo JL, Tokhirov R, Adada S, Huaynoca S, Makleff S, Vandewiele M, Standaert S, Free C. Development of an intervention delivered by mobile phone aimed at decreasing unintended pregnancy among young people in three lower middle income countries. BMC Public Health. 2018 May 2;18(1):576. doi: 10.1186/s12889-018-5477-7.
    1. Bartholomew EL, Markham C, Ruiter R, Fernandez M, Kok G, Parcel G. Planning Health Promotion Programs: An Intervention Mapping Approach. Fourth Edition. San Francisco, CA: John Wiley & Sons; 2016.
    1. Montaño D, Kasprzyk D. Theory of reasoned action, theory of planned behavior, and the integrated behavioral model. In: Glanz K, Rimer BK, Viswanath K, editors. Health Behaviour: Theory, Research and Practice. Fifth Edition. San Francisco, CA: Jossey-Bass; 2015.
    1. McCarthy OL, Calderon VO, Makleff S, Huaynoca S, Leurent B, Edwards P, Gallardo JL, Free C. An intervention delivered by app instant messaging to increase acceptability and use of effective contraception among young women in Bolivia: protocol of a randomized controlled trial. JMIR Res Protoc. 2017 Dec 18;6(12):e252. doi: 10.2196/resprot.8679.
    1. McCarthy O. Figshare. 2017. [2019-03-21]. A Randomised Controlled Trial of an Intervention Delivered by App Instant Messaging to Increase Acceptability and Use of Effective Contraception Among Young Women in Bolivia: Statistical Analysis Plan .
    1. Kok G, Gottlieb NH, Peters GY, Mullen PD, Parcel GS, Ruiter RA, Fernández ME, Markham C, Bartholomew LK. A taxonomy of behaviour change methods: an intervention mapping approach. Health Psychol Rev. 2016 Sep;10(3):297–312. doi: 10.1080/17437199.2015.1077155.
    1. Francis J, Eccles M, Johnston M, Walker A, Grimshaw J, Foy R. Constructing Questionnaires Based on the Theory of Planned Behaviour. A Manual for Health Services Researchers. Newcastle upon Tyne, UK: Centre for Health Services Research, University of Newcastle upon Tyne; 2004.
    1. Montaño DE, Kasprzyk D, Hamilton DT, Tshimanga M, Gorn G. Evidence-based identification of key beliefs explaining adult male circumcision motivation in Zimbabwe: targets for behavior change messaging. AIDS Behav. 2014 May;18(5):885–904. doi: 10.1007/s10461-013-0686-7.
    1. Unidad de Análisis de Políticas Sociales y Económicas. 2014. [2020-03-13]. 2012 Health and Nutrition Assessment Survey: Results Report. In Spanish. Encuesta de evaluación de salud y nutrición 2012: informe de resultados .
    1. Pocock SJ, Assmann SE, Enos LE, Kasten LE. Subgroup analysis, covariate adjustment and baseline comparisons in clinical trial reporting: current practice and problems. Stat Med. 2002 Oct 15;21(19):2917–30. doi: 10.1002/sim.1296.
    1. Kasenda B, Schandelmaier S, Sun X, von Elm E, You J, Blümle A, Tomonaga Y, Saccilotto R, Amstutz A, Bengough T, Meerpohl JJ, Stegert M, Olu KK, Tikkinen KA, Neumann I, Carrasco-Labra A, Faulhaber M, Mulla SM, Mertz D, Akl EA, Bassler D, Busse JW, Ferreira-González I, Lamontagne F, Nordmann A, Gloy V, Raatz H, Moja L, Rosenthal R, Ebrahim S, Vandvik PO, Johnston BC, Walter MA, Burnand B, Schwenkglenks M, Hemkens LG, Bucher HC, Guyatt GH, Briel M, DISCO Study Group Subgroup analyses in randomised controlled trials: cohort study on trial protocols and journal publications. Br Med J. 2014 Jul 16;349:g4539. doi: 10.1136/bmj.g4539.
    1. Gabler NB, Duan N, Liao D, Elmore JG, Ganiats TG, Kravitz RL. Dealing with heterogeneity of treatment effects: is the literature up to the challenge? Trials. 2009 Jun 19;10:43. doi: 10.1186/1745-6215-10-43.
    1. Kent DM, Rothwell PM, Ioannidis JP, Altman DG, Hayward RA. Assessing and reporting heterogeneity in treatment effects in clinical trials: a proposal. Trials. 2010 Aug 12;11:85. doi: 10.1186/1745-6215-11-85.
    1. Brookes ST, Whitely E, Egger M, Smith GD, Mulheran PA, Peters TJ. Subgroup analyses in randomized trials: risks of subgroup-specific analyses; power and sample size for the interaction test. J Clin Epidemiol. 2004 Mar;57(3):229–36. doi: 10.1016/j.jclinepi.2003.08.009.
    1. McCarthy O, Ahamed I, Kulaeva F, Tokhirov R, Saibov S, Vandewiele M, Standaert S, Leurent B, Edwards P, Palmer M, Free C. Correction to: A randomized controlled trial of an intervention delivered by mobile phone app instant messaging to increase the acceptability of effective contraception among young people in Tajikistan. Reprod Health. 2018 Mar 26;15(1):52. doi: 10.1186/s12978-018-0496-5.
    1. McCarthy OL, Zghayyer H, Stavridis A, Adada S, Ahamed I, Leurent B, Edwards P, Palmer M, Free C. A randomized controlled trial of an intervention delivered by mobile phone text message to increase the acceptability of effective contraception among young women in Palestine. Trials. 2019 Apr 23;20(1):228. doi: 10.1186/s13063-019-3297-4.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться