ECInfo: Text Messaging Intervention to Increase Correct and Effective Contraceptive Use Among Emergency Contraceptive Users.

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ECInfo: Text Messaging Intervention to Increase Correct and Effective Contraceptive Use Among Emergency Contraceptive Users.
Kelly L'Engle PHD MPH, Heather Vahdat, MPH.

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  • 1. ECINFO: Text Messaging Intervention to Increase Correct and Effective Contraceptive Use among Emergency Contraceptive Users Kelly L’Engle, PhD, MPH Heather Vahdat, MPH SHOPS e-conference series May 5, 2010
  • 2. Overview • Background • Formative Research • Research Design • Challenges
  • 3. Background • High mobile phone use in developing countries • Reported popularity of texting programs and promotions BUT: • Few family planning programs • Lack of research and evaluation • Research with EC users in Ghana in 2008 and 2009 found lack of contraceptive knowledge, everyone had a mobile phone Photos courtesy:,
  • 4. Formative Research • Focus group discussions in Accra, Ghana • Explored themes related to mobile phone use, ownership, and texting • Tested the concept of providing FP information via mobile phone • Tested contraceptive message content for comprehension and trust
  • 5. Formative Research Results: Text Messaging • Text messaging is very common among mobile phone users. • Respondents frequently participated in promotions that were advertised by text message. • Respondents suggested promoting ECINFO via unsolicited text messages to their mobile phones, since they pay attention to each and every message they receive. • Clinics, pharmacies, and mass media also were frequently mentioned as good points for service promotion.
  • 6. Formative Research Results: Accra Focus Groups When asked about how the information provided will be useful: • “I have two babies and my husband doesn’t like using condoms and I am not conversant with my menstrual cycle …because I don’t want to have anymore babies I would [use the service] so that they can refer me to a particular clinic…so that I can go there immediately and take control” (female, Ghana) • “With my girl after she took the emergency contraceptive pills she asked me a lot of questions about whether or not she may be able to bear children in future so I think that she may want to know more [about the service]” (male, Ghana) • They are making us aware that there are other birth control methods that are more effective so I’ll text for more [information]” (female, Ghana)
  • 7. Formative Research Results: Accra Focus Groups When asked about others potentially seeing the messages on their phone: • “When [my partner] asks me that what’s the meaning; like if he sees other birth control methods are more effective, he will call my attention to it and I’ll tell him that I’ve read it already” (female, Ghana) • “My dad sees you; he will tease you and will go like “Eh! W’ahye aseέ sua mu more yie”, is good, is good, keep on. Meaning eh! You started learning , is good keep on” (female, Ghana) When asked about if the service provides new information: • “[No one] has ever done something like this before; it’s always about sports, texting bible, love and ringer tones …but when it comes to this program it will encourage people to [use the system] because they know that they can get new information about having unprotected sex…” (female, Ghana)
  • 8. Formative Research Results: Sharing Participants said they would share the messages with friends, partners, and family members: •“You meet in a group, girls talk then l will tell them [about the service], then l will explain things to them or you even send them the messages if you saved it” (female, Ghana)
  • 9. ECINFO Research Design: Randomized Trial Pharmacy promotion of ECINFO service Interested pharmacy clients contact ECINFO Screener to define eligibility Non-EC Users EC Users Ineligibile Electronic Consent Consent not provided Baseline questions Ineligibile Randomization Intervention Control (n=1450) (n=1450) Access to EC Plus Access to EC Basic 30-day follow-up 30-day follow-up
  • 10. Study Goals To investigate whether text messaging is a feasible and effective means of providing EC users with contraceptive information and increasing their uptake of highly effective, longer-term methods To investigate the feasibility of using text messaging on mobile phones to conduct a randomized research study that relies exclusively on text for data collection
  • 11. Study Implementation •Study promotion in pharmacies in Accra, Ghana •Intervention group will receive messages about proper EC use as well as persuasive messages promoting the benefits of OCPs and DMPA; Control group will receive information about EC use only •Role model stories will be available to each group •Analyses based on: (1) text questions and (2) system use data such as screens accessed, repeat access
  • 12. ECINFO: Role Model Stories •Role model stories provide basic information about contraception and the ability to address perceived norms for contraceptive use •Utilize a personal tone (i.e., delivered in the first person) to maximize identification with model, relevance, and salience of messages •Incorporate concepts of behavior change to maximize impact •Intervention group will access role model stories that address motivators and barriers to use of longer-term methods •Control group will access EC role model stories that demonstrates proper use of EC
  • 13. ECINFO: Control Group Content •Basic EC information •For example: Take EC pills up to 5 days after sex. Take first pill immediately, second pill 12 hours later. Safe for all women. Not recommended for regular use. Will not affect existing pregnancy. •In addition, role model stories demonstrating correct use of EC
  • 14. ECINFO: Intervention Group Content Introduction to Role Model Stories Hi, my name is Beth. Congratulations on using EC and taking control of your health. Since preventing pregnancy is important to you, I want to tell you about other contraception that is less expensive and longer lasting. These methods are great for single and married women. I know because my friends and I use them. To hear Sandra talk about daily birth control pills (OCPs), reply J. To learn about OCPs from Ruth and Isaac, reply R. For my experience with Depo, reply B. Heighten sense of personal control over health and pregnancy prevention Make salient value on pregnancy prevention Address normative barriers to contraceptive use Accessible to women and men Interactive and personal
  • 15. Data Collection Exclusively Via Text •Contraceptive behavior. For example: How many times have you used EC in the past 6 months? Reply A for 1 time, B for 2-3 times, C for 4 or more times, D if you have not used EC in past 6 months. (159 characters) Contraceptive knowledge and attitudes. For example: EC only should be used for emergencies and not for ongoing pregnancy prevention. Reply A if you agree, B if you are not sure, and C if you disagree. (150 characters) Changes in bleeding are common and normal with birth control pills and injectables. Reply A if true, B if false, C if you are not sure. (139 characters)
  • 16. Analysis of Research Process • Data collection and enrollment via text message – What % of people who contact ECINFO answer eligibility question and are eligible? – What % of people who are eligible answer baseline questions? – What % of people who contact ECINFO participate all the way through follow-up? • Administering consent via text message – What % of eligible participants respond to and accept consent? • Follow-up response on mobile phones – What % answer follow-up questions after 30 days?
  • 17. Current Status and Timeline • Protocol development and ethical review (current) • Programming and testing of system (April – June 2010) • Message and usability testing (May-June 2010) • System refinement and final preparations (June 2010) • System launch (July 2010)
  • 18. Challenges 1. Platform - literacy, reach, character limits, limits 2. Persuasion - behavior change on mobile phone 3. Programming and Presentation - usability, technical partner(s) 4. Evaluation—research design, randomization, follow-up, data collection via text 5. Scale up—sustainability, cost
  • 19. Partners • The William and Flora Hewlett Foundation • Text to Change • Marie Stopes International • Sliced Bread Design