Evaluation of an mHealth SMS Dialogue Strategy to Meet Women's and Couples' Postpartum Contraceptive Needs in Kenya
Condition: Contraception; Postpartum Period
Study type: Interventional

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.
    


Intervention name(s): Two-way SMS
Intervention type(s): Behavioral
Intervention description(s): SMS messages will provide tailored and actionable education, counseling, and reminders specific to antenatal/postpartum timing and partner track. Messages will include questions and prompts; women and their male partners have the option of writing back to a nurse with questions or concerns, who will provide real-time responses via text and/or make referrals to a clinic. Message content will be tailored to women and couples, and will range from health benefits of child spacing and an emphasis on contraceptive options, to the hierarchy of effectiveness and information on specific methods, to simple reminders about postpartum visits.
Prior to randomization, each enrolled woman will be asked if she has a male partner, and whether she would like to refer her male partner for recruitment and enrollment into the study. The partner tracks are as follows:
Male partner invited to enroll/enrolled
Male partner not invited to enroll
Unpartnered
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Other
Keywords: contraception; postpartum period; mobile health; mHealth; Kenya; couples