Process evaluation of a mobile phone-based intervention to support post-abortion contraception in Cambodia

Abstract

BackgroundThe MObile Technology for Improved Family Planning (MOTIF) trial assessed a mobile phone-based intervention comprising voice messages and counsellor support to increase post-abortion contraception at four Marie Stopes International clinics in Cambodia. The aim of this process evaluation was to assess participants’ interaction with the intervention from a service provider perspective.Methods(1) We conducted a descriptive analysis to assess participants’ interaction with the intervention. (2) In order to explore how the intervention might work, we assessed associations between interaction with the intervention and contraception use using logistic regression analysis. (3) We undertook a logistic regression analysis to assess associations between baseline socio-demographic factors and ever requesting to speak to a counsellor (pressing ‘1’), a variable found to be associated with contraception use.ResultsAmongst 249 women that received six interactive voice messages +/− counsellor support for contraception, around half actively requested to speak to a counsellor (pressed ‘1’) and over 90% spoke to a counsellor at some stage. Women who spoke to the counsellor having requested to (by pressing ‘1’) were more than four times as likely to be using effective contraception at four months compared to women who didn’t request or speak to the counsellor (Odds Ratio 4.39; 95% CI: 1.15-16.71). There was a small, non-statistically significant increase in contraception use amongst women that spoke to the counsellor without requesting a call. Increased parity, a history of >2 previous induced abortions, lower socio-economic status, and medical abortion (after adjusting for age, socio-economic status and residence) were associated with requesting to speak to a counsellor.ConclusionsThe interactive message can identify a subgroup of women in whom counselling will be more effective and appears to be equitable in terms of engaging those most in-need. The intervention could be adapted based on the findings of this study.

Women’s views and experiences of a mobile phone-based intervention to support post-abortion contraception in Cambodia

“…Our previous analysis found that the proportion of women that requested to speak to a counsellor (pressing ‘1’) decreased from message one to six [12], which is consistent with reports from the interviews that health issues often resolved over time.…”

Unintended Consequences of mHealth Interactive Voice Messages Promoting Contraceptive Use After Menstrual Regulation in Bangladesh: Intimate Partner Violence Results From a Randomized Controlled Trial

“…The intervention comprised automated interactive voice messages sent to women's mobile phones in the 4 months after MR. The Cambodia intervention relied heavily on call center counseling, and the cost of this component has been cited as a possible barrier to scale-up 43 . We explored whether an intervention containing more detailed automated content about contraception could be effective.…”

The Impact of a Maternal Education Program Through Text Messaging in Rural China: Cluster Randomized Controlled Trial (Preprint)

“…Between October 2011 and August 2012, a total of 25,236 pregnant women were recruited into the study (13,332 in the intervention arm and 11,904 in the placebo arm). Of these, 13,937 (55.2%) completed the follow up and included in the final analysis.…”

“…Attempts have also been made to use mobile phone text messaging to address issues related to maternal and child health including interventions to support post-abortion contraception (13), infertility treatment (14), lactation management (15), and infant feeding (16). While the overarching goal of mobile phone text messaging seeks to promote behavioural changes in both health care providers and the target population of interest, text messaging intervention evaluated to date have met with varying degrees of success (11,12).…”