Evaluation of an mHealth SMS Dialogue Strategy to Meet Women's and Couples' Postpartum Contraceptive Needs in Kenya
- Conditions
- Postpartum PeriodContraception
- Interventions
- Behavioral: Two-way SMS
- Registration Number
- NCT02781714
- Lead Sponsor
- University of Washington
- Brief Summary
Meeting women's need for postpartum family planning is has been acknowledged as a global priority in maternal and child health. The prevention of unintended pregnancies in sub-Saharan African countries, which carry the highest global burdens of maternal mortality and HIV infection, is projected to substantially decrease maternal and neonatal morbidity and mortality. Many barriers to contraceptive uptake exist, both within and outside of the postpartum time period, and include socio-cultural, economic, and supply-side factors. Furthermore, while the importance of engaging men in family planning programs has been acknowledged for decades, few interventions have succeeded in increasing male involvement in family planning while maintaining a focus on women's empowerment. Innovative approaches to meeting the family planning needs of women and couples are urgently needed.
Public health interventions are increasingly incorporating mobile health (mHealth) approaches using short message service (SMS) technology in low-income countries, approaches that have demonstrated benefit among various reproductive health outcomes. The investigators hypothesize that personalized, bidirectional SMS dialogue with individual women and couples will increase postpartum contraceptive uptake, thereby decreasing unmet need for family planning in Kenya. The investigators have collaborated with the University of Washington (UW) Department of Computer Science and Engineering (CSE) along with Kenyan telecommunication providers to develop a hybrid messaging system that allows for innovative bidirectional SMS messaging. This system has been used successfully in maternal child health (MCH) clinics in Kenya. In qualitative research, women in Kenya have expressed a strong desire for mHealth support to provide additional education, counseling and reminders to supplement counseling by health workers.
The investigators propose a randomized controlled trial (RCT) comparing the effects of bidirectional SMS dialogue vs. control on highly effective contraceptive use at 6 months postpartum among HIV negative women and couples in Nyanza Province, Kenya. Data from this RCT and accompanying qualitative study will contribute to innovative, scale-able strategies to address unmet need for contraception and increase male involvement in family planning.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Female
- Target Recruitment
- 260
- Pregnant; at least 28 weeks gestation
- HIV negative
- Daily access to a mobile phone
- Planning to stay in area for 6 months postpartum
- Able to read/write or has trusted person to help
- Does not meet above criteria
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Two-way SMS Two-way SMS Pre-programmed SMS messages by partner track will be delivered twice weekly to participants in participants' preferred languages from enrollment to 6 months postpartum. They will include a question soliciting a response from the participant(s). Interactive SMS communication will be responded to and managed by the study nurse at each site. Content themes will include: general support/encouragement, postpartum visit reminders, postpartum pregnancy risk and benefits of birth spacing, postpartum contraceptive options and side effects, family planning misconceptions, and couple communication.
- Primary Outcome Measures
Name Time Method Highly-effective contraceptive use 6 months postpartum Proportion of participants self-reporting use of oral contraceptive pills, injectable contraception, contraceptive implant, intrauterine device, or male/female sterilization at 6 months postpartum will be compared between arms. Questionnaires will be used to assess this outcome.
- Secondary Outcome Measures
Name Time Method Time to contraceptive use Through study completion (6 months postpartum) Time postpartum at which contraceptive use was initiated
Dual contraceptive use 6 weeks, 14 weeks, and 6 months postpartum Percentage of sexual acts in which a condom was used among contraceptive users
Any contraceptive use 6 weeks, 14 weeks, and 6 months postpartum Proportion of participants self-reporting use of any contraceptive method will be compared between arms. This outcome will be assessed with a questionnaire.
Family planning satisfaction questionnaire 6 weeks, 14 weeks, and 6 months postpartum Satisfaction with chosen contraceptive method
Exclusive breastfeeding questionnaire 6 weeks, 14 weeks, and 6 months postpartum Self-reported exclusive breastfeeding
Trial Locations
- Locations (2)
Bondo County Hospital
🇰🇪Bondo, Siaya County, Kenya
Ahero sub-County Hospital
🇰🇪Ahero, Kisumu County, Kenya