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Reproductive Health
Published in: Reproductive Health 1/2018

Open Access 01-12-2018 | Research

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

Authors: Ona McCarthy, Irrfan Ahamed, Firuza Kulaeva, Ravshan Tokhirov, Salokhiddin Saibov, Marieka Vandewiele, Sarah Standaert, Baptiste Leurent, Phil Edwards, Melissa Palmer, Caroline Free

Published in: Reproductive Health | Issue 1/2018

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Abstract

Background

Unintended pregnancy is associated with poorer health outcomes for women and their families. In Tajikistan, around 26% of married 15–24 year old women have an unmet need for contraception. There is some evidence that interventions delivered by mobile phone can affect contraceptive-related behaviour and knowledge. We developed an intervention delivered by mobile phone app instant messaging to improve acceptability of effective contraceptive methods among young people in Tajikistan.

Methods

This was a randomized controlled trial among Tajik people aged 16–24. Participants allocated to the intervention arm had access to an app plus intervention messages. Participants allocated to the control arm had access to the app plus control messages. The primary outcome was acceptability of at least one method of effective contraception at 4 months. Secondary outcomes were use of effective contraception at 4 months and during the study, acceptability of individual methods, service uptake, unintended pregnancy and induced abortion. Process outcomes were knowledge, perceived norms, personal agency and intention. Outcomes were analysed using logistic and linear regression. We conducted a pre-specified subgroup analysis and a post-hoc analysis of change in acceptability from baseline to follow-up.

Results

Five hundred and seventy-three participants were enrolled. Intervention content was included on the app, causing contamination. Four hundred and seventy-two (82%) completed follow-up for the primary outcome. There was no evidence of a difference in acceptability of effective contraception between the groups (66% in the intervention arm vs 64% in the control arm, adjusted OR 1.21, 95% CI .80–1.83, p = 0.36). There were no differences in the secondary or process outcomes between groups. There was some evidence that the effect of the intervention was greater among women compared to men (interaction test p = 0.03). There was an increase in acceptability of effective contraception from baseline to follow-up (2% to 65%, p < 0.001).

Conclusions

The whole intervention delivered by instant messaging provided no additional benefit over a portion of the intervention delivered by app pages. The important increase in contraceptive acceptability from baseline to follow-up suggests that the intervention content included on the app may influence attitudes. Further research is needed to establish the effect of the intervention on attitudes towards and use of effective contraception among married/sexually active young people.

Trial registration

Clinicaltrial.gov NCT02905513. Date of registration: 14 September 2016.
Appendix
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Literature
1.
Sedgh G, Singh S, Hussain R. Intended and unintended pregnancies worldwide in 2012 and recent trends. Stud Fam Plan. 2014;45(3):301–14.CrossRef
2.
3.
Logan C, Holcombe E, Manlove J, Ryan S. The consequences of unintended childbearing: a white paper. Washington, DC: Child Trends; 2007.
4.
Khajehpour M, Simbar M, Jannesari S, Ramezani-Tehrani F, Majd HA. Health status of women with intended and unintended pregnancies. Public Health. 2013;127(1):58–64.CrossRefPubMed
5.
Gipson JD, Koenig MA, Hindin MJ. The effects of unintended pregnancy on infant, child, and parental health: a review of the literature. Stud Fam Plan. 2008;39(1):18–38.CrossRef
6.
Nakku JEM, Nakasi G, Mirembe F. Postpartum major depression at six weeks in primary health care: prevalence and associated factors. Afr Health Sci. 2006;6(4):207–14.PubMedCentralPubMed
7.
Cheng D, Schwarz EB, Douglas E, Horon I. Unintended pregnancy and associated maternal preconception, prenatal and postpartum behaviors. Contraception. 2009;79(3):194–8.CrossRefPubMed
8.
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. 2003;57(1):77–93.CrossRef
9.
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;15(2):205–16.CrossRefPubMed
10.
Mohllajee AP, Curtis KM, Morrow B, Marchbanks PA. Pregnancy intention and its relationship to birth and maternal outcomes. Obstet Gynecol. 2007;109(3):678–86.CrossRefPubMed
11.
Brown SS, Eisenberg L, editors. The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. Washington D.C.: National Academies Press; 1995.
12.
Darroch JE, Audam S, Biddlecom A, Kopplin G, Riley T, Singh S, et al. Adding it up: the costs and benefits of investing in sexual and reproductive health 2017 (Investing in contraception and maternal and newborn health fact sheet): Guttmacher Institute; 2017.
13.
Singh S, Darroch J, Ashford L. Adding it up: the costs and benefits of investing in sexual and reproductive health 2014. New York: Guttmacher Institute; 2014.
14.
UNFPA Tajikistan country Programme 2010–2015 evaluation report. United Nations Population Fund; 2014.
15.
Country programme document for Tajikistan. United Nations Population Fund; 2015.
16.
Tajikistan Demographic and Health Survey 2012. Dushanbe, Tajikistan, and Calverton, Maryland, USA: SA, MOH, and ICF International.: Statistical Agency under the President of the Republic of Tajikistan (SA), Ministry of Health [Tajikistan], and ICF International., 2013.
17.
Cleland J, Ali MM. Reproductive consequences of contraceptive failure in 19 developing countries. Obstet Gynecol. 2004;104(2):314–20.CrossRefPubMed
18.
Trussell J. Contraceptive efficacy. In: Hatcher R, Trussell J, Nelson A, Cates W, Kowal D, Policar M, editors. Contraceptive technology: twentieth revised edition. 20th ed. New York: Ardent Media; 2011.
19.
20.
Sedgh G, Ashford L, Hussain R. Unmet need for contraception in developing countries: examining Women’s reasons for not using a method. New York: Guttmacher Institute; 2016.
21.
Free C, Knight R, Robertson S, Whittaker R, Edwards P, Zhou W, et al. Smoking cessation support delivered via mobile phone text messaging (txt2stop): a single-blind, randomised trial. Lancet. 2011;378(9785):49–55.CrossRefPubMedCentralPubMed
22.
Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, et al. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. Lancet. 2010;376(9755):1838–45.CrossRefPubMed
23.
Pop-Eleches C, Thirumurthy H, Habyarimana JP, Zivin JG, Goldstein MP, de Walque D, et al. Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders. AIDS. 2011;25(6):825–34.CrossRefPubMedCentralPubMed
24.
Zurovac D, Sudoi RK, Akhwale WS, Ndiritu M, Hamer DH, Rowe AK, et al. The effect of mobile phone text-message reminders on Kenyan health workers’ adherence to malaria treatment guidelines: a cluster randomised trial. Lancet. 2011;378(9793):795–803.CrossRefPubMedCentralPubMed
25.
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.CrossRefPubMed
26.
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.CrossRefPubMed
27.
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;14:188.CrossRefPubMedCentralPubMed
28.
Free C, Phillips G, Galli L, Watson L, Felix L, Edwards P, et al. 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.CrossRefPubMedCentralPubMed
29.
Head KJ, Noar SM, Iannarino NT, Grant Harrington N. Efficacy of text messaging-based interventions for health promotion: a meta-analysis. Soc Sci Med. 2013;97:41–8.CrossRefPubMed
30.
31.
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;138(3):e20160884.CrossRefPubMed
32.
Ippoliti NB, L'Engle KL. Meet us on the phone: mobile phone programs for adolescent sexual and reproductive health in low-to-middle income countries. Reprod Health. 2017;14(1):11.CrossRefPubMedCentralPubMed
33.
Berenson AB, Rahman M. A randomized controlled study of two educational interventions on adherence with oral contraceptives and condoms. Contraception. 2012;86(6):716–24.CrossRefPubMedCentralPubMed
34.
Castaño PM, Bynum JY, Andres R, Lara M, Westhoff C. Effect of daily text messages on oral contraceptive continuation: a randomized controlled trial. Obstet Gynecol. 2012;119(1):14–20.CrossRefPubMed
35.
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;57(1):100–6.CrossRefPubMedCentralPubMed
36.
Smith C, Ngo TD, Gold J, Edwards P, Vannak U, Sokhey L, et al. Effect of a mobile phone-based intervention on post-abortion contraception: a randomized controlled trial in Cambodia. Bull World Health Organ. 2015;
37.
Hall KS, Westhoff CL, Castano PM. The impact of an educational text message intervention on young urban women's knowledge of oral contraception. Contraception. 2013;87(4):449–54.CrossRefPubMed
38.
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;107(2):298–305.CrossRefPubMed
39.
Johnson D, Juras R, Riley P, Chatterji M, Sloane P, Choi SK, et al. A randomized controlled trial of the impact of a family planning mHealth service on knowledge and use of contraception. Contraception. 2017;95(1):90–7.CrossRefPubMed
40.
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;17(4):579–84.CrossRef
41.
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.[erratum appears in Obstet Gynecol. 2010 Nov;116(5):1224]. Obstet Gynecol. 2010;116(3):633–40.CrossRefPubMed
42.
Kirby D, Raine T, Thrush G, Yuen C, Sokoloff A, Potter SC. Impact of an intervention to improve contraceptive use through follow-up phone calls to female adolescent clinic patients. Perspect Sex Reprod Health. 2010;42(4):251–7.CrossRefPubMedCentralPubMed
43.
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;106(S1):S117–S24.CrossRefPubMedCentralPubMed
44.
McCarthy OL, Leurent B, Edwards P, Tokhirov R, Free C. A randomised controlled trial of an intervention delivered by app instant messaging to increase the acceptability of effective contraception among young people in Tajikistan: study protocol. BMJ Open. 2017;7(9):e017606.CrossRefPubMedCentralPubMed
45.
46.
Bartholomew Eldredge LK, Markham C, Ruiter R, Fernandez M, Kok G, Parcel G. Planning health promotion programs: an intervention mapping approach. 4th ed. San Francisco: Jossey-Bass; 2016.
47.
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. 5th ed. San Francisco: Jossey-Bass; 2015. p. 168–222.
48.
Kok G, Gottlieb N, Peters G, Mullen P, Parcel G, Ruiter R, et al. A Taxonomy of Behavior Change Methods; an Intervention Mapping Approach. Health Psychol Rev. 2016;10(3):297–12.
49.
Francis JJ, Eccles MP, Johnston M, Walker A, Grimshaw J, Foy R, et al. Constructing questionnaires based on the theory of planned behaviour. A manual for health services researchers 2004; 2010. p. 2–12.
50.
Montano 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;18(5):885–904.CrossRefPubMedCentralPubMed
51.
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;21(19):2917–30.CrossRefPubMed
52.
Kasenda B, Schandelmaier S, Sun X, von Elm E, You J, Blumle A, et al. Subgroup analyses in randomised controlled trials: cohort study on trial protocols and journal publications. BMJ. 2014;349:g4539.CrossRefPubMed
53.
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;10:43.CrossRefPubMedCentralPubMed
54.
Kent DM, Rothwell PM, Ioannidis JPA, Altman DG, Hayward RA. Assessing and reporting heterogeneity in treatment effects in clinical trials: a proposal. Trials. 2010;11:85.CrossRefPubMedCentralPubMed
55.
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;57(3):229–36.CrossRefPubMed
56.
McCarthy OL, Wazwaz O, Jado I, Leurent B, Edwards P, Adada S, et al. An intervention delivered by text message to increase the acceptability of effective contraception among young women in Palestine: study protocol for a randomised controlled trial. Trials. 2017;18(1):454.CrossRefPubMedCentralPubMed
57.
McCarthy OL, Osorio Calderon V, Makleff S, Huaynoca S, Leurent B, Edwards P, et al. 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;6(12):e252.CrossRefPubMedCentralPubMed
58.
Smith C, Gold J, Ngo TD, Sumpter C, Free C. Mobile phone-based interventions for improving contraception use. Cochrane Database Syst Rev. 2015;(6):CD011159.
59.
Reiss K, Andersen K, Barnard S, Ngo TD, Biswas K, Smith C, et al. Using automated voice messages linked to telephone counselling to increase post-menstrual regulation contraceptive uptake and continuation in Bangladesh: study protocol for a randomised controlled trial. BMC Public Health. 2017;17(1):769.CrossRefPubMedCentralPubMed
60.
Bailey JV, Pavlou M, Copas A, McCarthy O, Carswell K, Rait G, et al. The sexunzipped trial: optimizing the design of online randomized controlled trials. J Med Internet Res. 2013;15(12):e278.CrossRefPubMedCentralPubMed
61.
Carswell K, McCarthy O, Murray E, Bailey JV. Integrating psychological theory into the design of an online intervention for sexual health: the sexunzipped website. JMIR Res Protoc. 2012;1(2):e16.CrossRefPubMedCentralPubMed
Metadata
Title
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
Authors
Ona McCarthy
Irrfan Ahamed
Firuza Kulaeva
Ravshan Tokhirov
Salokhiddin Saibov
Marieka Vandewiele
Sarah Standaert
Baptiste Leurent
Phil Edwards
Melissa Palmer
Caroline Free
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Reproductive Health / Issue 1/2018
Electronic ISSN: 1742-4755
DOI
https://doi.org/10.1186/s12978-018-0473-z

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