MObile Technology for Improved Family Planning Services (MOTIF): study protocol for a randomised controlled trial

Abstract

BackgroundProviding women with contraceptive methods following abortion is important to reduce repeat abortion rates, yet evidence for effective post-abortion family planning interventions are limited. This protocol outlines the evaluation of a mobile phone-based intervention using voice messages to support post-abortion family planning in Cambodia.Methods/DesignA single blind randomised controlled trial of 500 participants. Clients aged 18 or over, attending for abortion at four Marie Stopes International clinics in Cambodia, owning a mobile phone and not wishing to have a child at the current time are randomised to the mobile phone-based intervention or control (standard care) with a 1:1 allocation ratio.The intervention comprises a series of six automated voice messages to remind clients about available family planning methods and provide a conduit for additional support. Clients can respond to message prompts to request a phone call from a counsellor, or alternatively to state they have no problems. Clients requesting to talk to a counsellor, or who do not respond to the message prompts, receive a call from a Marie Stopes International Cambodia counsellor who provides individualised advice and support regarding family planning. The duration of the intervention is 3 months. The control group receive existing standard of care without the additional mobile phone-based support.We hypothesise that the intervention will remind clients about contraceptive methods available, identify problems with side effects early and provide support, and therefore increase use of post-abortion family planning, while reducing discontinuation and unsafe method switching.Participants are assessed at baseline and at 4 months. The primary outcome measure is use of an effective modern contraceptive method at 4 months post abortion. Secondary outcome measures include contraception use, pregnancy and repeat abortion over the 4-month post-abortion period.Risk ratios will be used as the measure of effect of the intervention on the outcomes, and these will be estimated with 95% confidence intervals. All analyses will be based on the ‘intention to treat’ principle.DiscussionThis study will provide evidence on the effectiveness of a mobile phone-based intervention using voice messages to support contraception use in a population with limited literacy. Findings could be generalisable to similar populations in different settings.Trial registrationClinicalTrials.gov Identifier: NCT01823861

Sexual health promotion for young people delivered via digital media: a scoping review

“…[79][80][81] Text messages or voice messages via mobile phone can be used to support contraceptive choice, uptake and adherence. [82][83][84] Shared online clinical records and online medical consultation or therapy have not so far been widely available within the NHS, partly because of concerns about confidentiality, data security and medical indemnity for services provided outside routine NHS pathways of care. In contrast, the private sector offers many paid-for services online, including medical advice by e-mail and diagnosis, although these services may disclaim responsibility for the accuracy of information or diagnoses.…”

“…Multimedia formats such as audio and graphics may facilitate access to content for populations with low literacy. 83,127 Many of the currently available interventions could be adapted for internet, CD-ROM or mobile phone use, maximising their reach. 127 Selection of the modality for use should be guided by understanding the technology usage of the target population.…”

“…Audio and digital graphics can improve accessibility among individuals with limited literacy, 83,241 and in resource-poor settings with limited access to the internet, mobile phones may have much better reach and can be used to collect survey data. 242 …”

“…via health-care settings 83,88 ), at community events 249 or entirely online. 66,119 Online trial procedures can be completely self-directed/automated, for example accessing trial information, establishing eligibility, obtaining informed consent and randomisation to experimental arms.…”

“…239 In a trial of an IDI delivered by automated voice message, 86% follow-up was achieved for self-reported data at 4 months. 83 A trial of a digital intervention delivered by text message to increase safer sex behaviours achieved 93% follow-up for self-reported data at 1 month and 86% follow-up for chlamydia tests at 3 months. 88 Eysenbach has hypothesised that dropout from a trial usually follows the pattern of non-usage of an intervention, 254 although this was not substantiated in a trial of a website for alcohol harm reduction, in which greater adherence to the intervention was not necessarily associated with greater retention, especially in the intervention arm, and factors associated with intervention usage and retention in the trial were not similar.…”