Effectiveness of a mobile phone application to increase access to sexual and reproductive health information, goods, and services among university students in Uganda: A randomized controlled trial

Abstract

Background: University students are one of the most vulnerable groups to sexual reproductive health [SRH] threats like sexually transmitted infections [STIs], unwanted pregnancies, and unsafe abortions and often have limited access to SRH information, goods, and services. This study assessed the effectiveness of using a mobile phone application (APP) to increase access to SRH information, goods, and services among university students in Uganda.Methods: Using data from a double-blinded randomized controlled trial, participants were randomly assigned to both the intervention (APP) and control (standard of care) arms. We executed descriptive analyses for baseline demographic characteristics by intervention, difference in difference (DID), and quantile regression analyses for both primary and secondary outcomes.Results: The median age of participants was 21 years of age, and the majority were female (over 60%), unemployed (over 85%) and Christian (90%). Over 50% were resident in off-campus hostels and in a relationship. Between baseline and end-line, there was a significant increase in SRH knowledge score (DID=2, P<0.001), contraceptive use (DID=6.6%, P<0.001), HIV Voluntary testing and counselling (DID=17.2%, P<0.001), STI diagnosis and treatment (DID=12.9%, P<0.001), and condom use at last sex (DID=4%,P=0.02) among students who used the APP. There was a significant 0.98 unit increase in knowledge score (adjusted coefficient= 0.98, P<0.001), a significant 1.6-fold increase in odds of contraceptive use (adjusted coefficient= 1.6, P=0.04), a significant 3.5-fold increase in HIV VCT (adjusted coefficient=3.5, P<0.001), and a significant 2-fold increase in odds of STI testing and treatment (adjusted coefficient =1.9, P<0.001) after adjusting for demographic characteristics among APP users compared to the control group.Conclusion: A mobile phone application increased sexual and reproductive health information (knowledge score), access to goods (contraceptives), and services (HIV voluntary testing and counseling and sexually transmitted infection diagnosis and management) among sexually active university students in Uganda. Further technical development, including the refinement of youth-friendly attributes, extending access to the app with other platforms besides android which was pilot tested, as well as further research into potential economic impact and paths to sustainability, is needed before the app is deployed to the general youth population in Uganda and other low-income settings. Trial registration: MUREC1/7 No. 07/05–18. Registered on June 29, 2018.

Utilization of a mobile phone application to increase access to sexual and reproductive health information, goods, and services among university students in Uganda

“…This allowed access to information, goods, and services while assuring privacy and confidentiality, and enabling convenience by easing transportation and payment. For the section of the population with internet-enabled mobile phones that can download and use apps, our intervention has the potential to improve SRH care delivery in Uganda and other low-income settings [27].…”

“…This study demonstrates that university students in Uganda find a mobile phone application to increase access to SRH information, goods, and services acceptable and usable. Given the effectiveness of the MPA in increasing access to SRH information, goods, and services (27), this study provides the basis for further improvement of both the evidence base (economic efficiency and scalability) and technical features of the app for use in this population, and potentially, for scale up to other populations with access to internet-enabled mobile phones, to improve SRH in Uganda and other low-income settings.…”

“…The study was a one-year pilot project with two complementary sub-studies; (1) a randomized control trial (RCT) to evaluate the effectiveness of the MPA to increasing access to SRH information, goods, and services among KYU students [27], (2) a cross-sectional study to assess the acceptability and usability of MPA. The acceptability study was part of the baseline survey used during data collection.…”

“…The acceptability study was part of the baseline survey used during data collection. The inclusion criteria for the extensive study (RCT) were KYU students 18 to 30 years of age, self-reported sexual activity in the last six months, more than 12 months to graduation, consent, and access to an internet-enabled Android smartphone [27]. The utilization study used data collected from MPA users over the 6-month period of the RCT from in-app data collection and data provided by the healthcare providers.…”

Demand creation for HIV testing services: A systematic review and meta-analysis

“…There were 39 RCTs that reported on the effect of digital interventions: 12 were video-or audio-based [54,81,[107][108][109][110][111][112][113][114][115][116], 8 used social media [51,52,59,64,75,[117][118][119], 5 used websites [54,55,94,120,121], 13 used SMS messaging [65,90,95,[122][123][124][125][126][127][128][129][130][131], and 1 used gamification [132].…”