Interventions delivered by mobile phone to support client use of family planning/contraception

Contraception - methods or devices used to prevent pregnancy – has significant benefits for women's and children's health. Despite these benefits, an estimated 225 million women in developing countries were not using a modern contraceptive method in 2014 despite wanting to avoid pregnancy. Expansion of mobile phone use in recent years has led to increased interest in healthcare delivery via mobile phone and the potential to deliver support wherever the person is located, whenever it is needed, and to reach populations with restricted access to services. Mobile phone-based interventions have been demonstrated to be effective in other health areas, but not yet in the field of contraception.

In 2014, we undertook computer searches for randomised trials evaluating mobile phone-based interventions to increase contraception use. We found five trials. Three trials used text messaging to support women in continuing to use a specific method of contraception. Two trials aimed to improve both uptake and continued use of contraception - one with voice and one with text messaging. Our review provides limited evidence that interventions delivered by mobile phone improve contraception use. One trial in the USA reported that women were more likely to continue to take the contraceptive pill from an intervention comprising a range of educational text messages. One trial in Cambodia reported increased use of contraception at four months post abortion from an intervention comprising voice messages and phone counsellor support. Another trial in the USA reported improved attendance for the first but not subsequent contraceptive injection appointments from an intervention comprising reminders and healthy self management text messages. Simple text message contraceptive pill reminders did not reduce missed pills in a small trial in the USA. No difference in contraception use was reported amongst users of isotretinoin (a drug used for acne) from an intervention that provided health information via text messages and mail.

In conclusion, evidence indicates that a series of voice messages and counsellor support can improve contraception amongst women seeking abortion services not wanting to get pregnant again at the current time, and data suggest that daily educational text messages can improve continued use of the contraceptive pill. However, the cost value and long-term effectiveness of these interventions remain unknown. More good quality trials are needed to establish the effectiveness of interventions delivered by mobile phone to increase contraception use.

Authors' conclusions: 

Our review provides limited evidence that interventions delivered by mobile phone can improve contraception use. Whilst evidence suggests that a series of interactive voice messages and counsellor support can improve post-abortion contraception, and that a mixture of uni-directional and interactive daily educational text messages can improve OC adherence, the cost-effectiveness and long-term effects of these interventions remain unknown. Further high-quality trials are required to robustly establish the effects of interventions delivered by mobile phone to improve contraception use.

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Background: 

Contraception provides significant benefits for women's and children's health, yet an estimated 225 million women had an unmet need for modern contraceptive methods in 2014. Interventions delivered by mobile phone have been demonstrated to be effective in other health areas, but their effects on use of contraception have not been established.

Objectives: 

To assess the effects of mobile phone-based interventions for improving contraception use.

Search strategy: 

We searched for randomised controlled trials (RCTs) of client-provider interventions delivered by mobile phone to improve contraception use compared with standard care or another intervention. We searched the electronic databases Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Global Health, PsycINFO, POPLINE, Africa-Wide Information and Latin American Caribbean Health Sciences Literature (LILACS) from January 1993 to October 2014, as well as clinical trials registries, online mHealth resources and abstracts from key conferences.

Selection criteria: 

Randomised controlled trials of mobile phone-based interventions to improve any form of contraception use amongst users or potential users of contraception. Outcome measures included uptake of contraception, measures of adherence, pregnancy and abortion.

Data collection and analysis: 

Two review authors independently screened titles and abstracts of studies retrieved using the search strategy and extracted data from the included studies. We calculated the Mantel-Haenszel risk ratio (RR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes, together with 95% confidence intervals (CIs). Differences in interventions and outcome measures did not permit us to undertake meta-analysis.

Main results: 

Five RCTs met our inclusion criteria. Three trials aimed to improve adherence to a specific method of contraception amongst existing or new contraception users by comparing automated text message interventions versus standard care. Two trials aimed to improve both uptake and adherence, not limited to one method, in both users and non-users of contraception. No trials were at low risk of bias in all areas assessed.

One trial in the USA reported improved self reported oral contraceptive (OC) continuation at six months from an intervention comprising a range of uni-directional and interactive text messages (RR 1.19, 95% CI 1.05 to 1.35). One trial in Cambodia reported increased self reported use of effective contraception at four months post abortion from an intervention comprising automated interactive voice messages and phone counsellor support (RR 1.39, 95% CI 1.17 to 1.66).

One feasibility trial in the USA reported a lower mean number of days between scheduled and completed attendance for the first but not subsequent Depo-Provera appointments using clinic records from an intervention comprising reminders and healthy self management text messages (mean difference (MD) -8.60 days, 95% CI -16.74 to -0.46). Simple text message OC reminders had no effect on missed pills as assessed by electronic medication monitoring in a small trial in the USA (MD 0.5 missed pills, 95% CI -1.08 to 2.08). No effect on self reported contraception use was noted amongst isotretinoin users from an intervention that provided health information via two uni-directional text messages and mail (RR 1.26, 95% CI 0.84 to 1.89). One trial assessed potential adverse effects of the intervention and reported no evidence of road traffic accidents or domestic abuse.

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