Kate Lairmore

May 13, 2015

mHealth for Family Planning

Outline

!  Background ! Unmet need & family planning programs ! What is mHealth?

!  Aim !  Methods !  Results !  Key considerations for development &

implementation !  Conclusions

Global Unmet Need for Family Planning (a very brief overview)

!  225 million married women have an unmet need for contraception (+ unmarried women)

" Unwanted pregnancies, unsafe abortions, poorer maternal and reproductive health outcomes, higher maternal mortality

" Highest unmet need typically found in low-income countries, many of them in Africa

!  Access to contraceptives on the global stage: " Overpopulation, women’s rights, international development " Ability to control one’s fertility now considered a basic

human right

Overall FP Program Structure

Funders:)Government,*

donors*

Community)level)Programs:)Clinics,*service*

providers*

Target)Popula7on:)Adults,*

adolescents,*etc*

Family)Planning)Outcomes)

What is mHealth?

!  Mobile Health is the use of mobile and wireless technologies to support the achievement of health objectives.

" Can include SMS, IVR, audio, and/or videos, presented on… " Mobile phones, tablets, or PDAs

!  Including, but not limited to…

1.  

Client education and BCC  

7. Provider-to-provider communication  

2. Sensors and point-of-care diagnostics  

8. Provider work planning & scheduling  

3. Registries and vital events tracking  

9. Provider training and education  

4. Data collection and reporting  

10. Human resource management  

5. Electronic health records  

11. Supply chain management  

6. Electronic decision support  

12. Financial transactions & incentives  

Client Education & Behavior Change Communication (BCC)

!  mHealth strategies focused on the client "  Interacting directly with the intended beneficiary

!  Aims to improve people’s knowledge, modify their attitudes, and change their behavior

" Ex. Encouraging medication adherence or use of health services

My Aim

!  Evaluate the potential of mHealth for client education and BCC in family planning programs

!  Focus areas/inclusion criteria: " Technology: user-owned mobile phones " Health domain: contraception and sexual and reproductive

health " Users:

"  Women (and men) with an unmet need for family planning "  Specific target population for family planning programs

Target Audience of mHealth FP Tools

Methods

!  Compared unmet need to mobile phone coverage !  Assembled an inventory of mHealth interventions

! Three types of searches: " Structured search of PubMed and Web of Science for mHealth

and family planning terms " Online project repositories " Project & paper recommendations

! Exclusions: " General health interventions including FP " MCH… +FP

Results

1. Examining unmet need levels and mobile phone coverage indicates real potential for mHealth tools to be beneficial in most countries

Results, cont.

2. mHealth tools and strategies for client education and BCC have been implemented to increase uptake and awareness of contraceptive methods and services

! Developed an inventory of tools and projects, then narrowed it to a table of illustrative examples

Illustrative Examples

!  Includes information on implementing organizations, locations, technology, available evidence, and current status

!  Developed a set of six illustrative examples: " Hotline: Ligne Verte " SMS-based: Mobile for Reproductive Health (m4RH) " Voice recordings: Mobile Technology for Improved Family

Planning (MOTIF) " Warmline (text-based hotline): BrdsNBz " Text and voice tree: SMS and IVR to Improve Family

Planning Services " Smartphone app: NaturalCyles

Ex. Mobile for Reproductive Health (m4RH), by FHI 360

!  Goal: Improve knowledge and use of long and short acting family planning methods

!  Strategy: Automated SMS tree " Users text in to the m4RH system, receive menu to navigate " Question/answer design "  Includes searchable database of FPSPs

!  Target users: Men & Women of reproductive age !  Location: Kenya & Tanzania !  Evaluation evidence:

" Effectiveness of providing info via text " Especially effective for younger audience

Six Key Implementation Considerations

1.  mHealth is NOT a stand-alone intervention. "  Must be paired with accessible services "  Partnerships and collaboration are essential

"  May include: IT firms, regional FP programs, organizations with similar mHealth experience, governments, local phone services

2.  Formative Research is essential when developing mHealth interventions.

"  Cultural reasons: social norms, accurate translation, effectiveness of messaging

"  Communication reasons: build on established communications norms and pathways

3.  Choose the right technology. "  Apps "  SMS and/or voice

Six Key Implementation Considerations, cont.

4.  Promotion matters. 5.  Content matters.

"  Positive, supportive messaging to empower users "  If significant stigma or partner opposition exists, consider

complementary community-wide approach

6.  Don’t reinvent the wheel. " Highly collaborative field with many online resources

"  Databases "  Toolkits "  Guides "  Online classes

Conclusions

!  mHealth strategies are already at work around the world, and the evidence base is growing…

!  …but technology and partnerships are growing faster, and should be the focus area for developing new tools and strategies.

!  mHealth has great potential to increase awareness and uptake of modern contraceptive methods by:

" Providing medically accurate health information "  Linking individuals to care " Reducing stigma & social barriers

Acknowledgments

Many, many thanks to: Dr. Amy Tsui Dr. Scott Radloff Jamie Haines James Bontempo and Heidi Good-Boncana, JHU-CCP The PopFam staff and faculty And my PopFamily –

you are PopFabulous.

References

1. Darroch JS, G. Ball, H. Contraceptive Technologies: Responding to Women's Needs. New YOrk: Guttmacher Institute;2011.

2. Singh SD, JE. Ashford, LS. Adding It Up: The Costs and Benefits of Investing in Sexual and Reproductive Health - 2014. New York: Guttmacher Institute;2014.

3. Corker J. “Ligne Verte” Toll-Free Hotline: Using Cell Phones to Increase Access to Family Planning Information in the Democratic Republic of Congo. Cases in Public Health Communication & Marketing. 2010;4:23-37.

4. m4RH: Mobile 4 Reproductive Health (booklet). In: 360 F, ed2011.

5. L'Engle KL, Vahdat HL, Ndakidemi E, Lasway C, Zan T. Evaluating feasibility, reach and potential impact of a text message family planning information service in Tanzania. Contraception. 2013;87(2):251-256.

6. Vahdat HL, L'Engle KL, Plourde KF, Magaria L, Olawo A. There are some questions you may not ask in a clinic: providing contraception information to young people in Kenya using SMS. Int J Gynaecol Obstet. 2013;123 Suppl 1:e2-6.

7. Smith C, Vannak U, Sokhey L, et al. MObile Technology for Improved Family Planning Services (MOTIF): study protocol for a randomised controlled trial. Trials. 2013;14:427.

8. Phillips KR. BrdsNBz: a text-messaging forum for improving the sexual health of adolescents in North Carolina. N C Med J. 2010;71(4):368-371.

9. McQueen SK, S. Palmer, N. Morgan, G. Bitrus, S. Okoko, L. mHealth Compendium, Edition One. Arlington, VA.: Management Science for Health; November 30 2012.

10. NaturalCycles, the fertility monitor. 2014; https://itunes.apple.com/us/app/naturalcycles/id765535549?ls=1&mt=8. Accessed May 8, 2015.

11. Berglund Scherwitzl E, Linden Hirschberg A, Scherwitzl R. Identification and prediction of the fertile window using NaturalCycles. Eur J Contracept Reprod Health Care. 2015:1-6.