Busting contraception myths and misconceptions among youth in Kwale County, Kenya: results of a digital health randomised control trial

Abstract

ObjectivesThe objective of this randomised controlled trial in Kenya was to assess the effect of delivering sexual and reproductive health (SRH) information via text message to young people on their ability to reject contraception-related myths and misconceptions.Design and settingA three-arm, unblinded randomised controlled trial with a ratio of 1:1:1 in Kwale County, Kenya.Participants and interventionsA total of 740 youth aged 18–24 years were randomised. Intervention arm participants could access informational SRH text messages on-demand. Contact arm participants received once weekly texts instructing them to study on an SRH topic on their own. Control arm participants received standard care. The intervention period was 7 weeks.Primary outcomeWe assessed change myths believed at baseline and endline using an index of 10 contraception-related myths. We assessed change across arms using difference of difference analysis.ResultsAcross arms, <5% of participants did not have any formal education, <10% were living alone, about 50% were single and >80% had never given birth. Between baseline and endline, there was a statistically significant drop in the average absolute number of myths and misconceptions believed by intervention arm (11.1%, 95% CI 17.1% to 5.2%), contact arm (14.4%, 95% CI 20.5% to 8.4%) and control arm (11.3%, 95% CI 17.4% to 5.2%) participants. However, we observed no statistically significant difference in the magnitude of change across arms.ConclusionsWe are unable to conclusively state that the text message intervention was better than text message ‘contact’ or no intervention at all. Digital health likely has potential for improving SRH-related outcomes when used as part of multifaceted interventions. Additional studies with physical and geographical separation of different arms is warranted.Trial registration numberISRCTN85156148.

Impact of sexual and reproductive health interventions among young people in sub-Saharan Africa: a scoping review

“…The risk of bias results for RCT studies ( n = 20) are summarised in Figures 2 , 3 . Reporting on the overall risk of bias domain, six studies had low risk bias, one study each from articles by Yakubu and colleagues, Wondimagege and colleagues and Gichangi and colleagues ( 31 – 33 ), and three studies from an article by Silverman and colleagues ( 34 ). Most of the studies 45% ( n = 9) had some concerns in the overall risk of bias domain.…”

“…With the increasing popularity of mobile based interventions with young people, they promise to improve SRH services utilisation young people. In the present review, four studies utilised mHealth interventions to improve SRH outcomes ( 33 , 35 , 61 , 62 ). Nuwamanya and colleagues, 2020, used an internet based mobile phone application to improve the use of modern contraceptive methods ( 35 ).…”

“…Nuwamanya and colleagues, 2020, used an internet based mobile phone application to improve the use of modern contraceptive methods ( 35 ). Gichangi and colleague, 2022, reported that there was a statistically significant drop in the average absolute number of contraceptives myths and misconceptions believed by the mHealth intervention arm between baseline and endline ( 33 ). Sharma and colleagues 2022, reported that at the endline, an mHealth intervention resulted in higher level of knowledge related to condoms and on wearing condoms correctly ( 61 ).…”

“…Practice of medicine and public health interventions supported by mobile devices are effective strategies for improving reproductive health outcomes among young people as they promote SRH services utilization ( 33 , 35 , 61 , 62 ). This is partly due to their popularity among young people, privacy, and ability to reach populations with restricted access to direct SRH services ( 58 – 60 ).…”