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Title: Increasing contraception use with mobile phone-based interventions
Author: Smith, C.
ISNI:       0000 0004 6351 181X
Awarding Body: London School of Hygiene & Tropical Medicine
Current Institution: London School of Hygiene and Tropical Medicine (University of London)
Date of Award: 2017
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Background: Interventions delivered by mobile phone have been demonstrated to be effective in other health areas. This thesis focuses on interventions delivered by mobile phone to increase contraception use. Methods: This thesis comprises a systematic review, development and evaluation of the MObile Technology for Improved Family Planning (MOTIF) intervention to support postabortion contraception in Cambodia with randomised controlled trial, and a mixed methods process evaluation. Results: The systematic review identified five trials, two of which increased self-reported contraception use, one in the USA and the MOTIF trial in Cambodia (four-month data only). A meta-analysis was not possible due to differing interventions and outcome measures. Development of the MOTIF intervention involved literature reviews on determinants of contraceptive use, interviews and focus groups with women seeking abortion services in Cambodia. The intervention comprised six interactive voice messages with counsellor support depending on the response to the message. The intervention was associated with increased self-reported use of effective contraception at four months post-abortion (64% vs. 46%; Risk Ratio (RR): 1.39; 95% Confidence Interval (CI): 1.17–1.66) but not at 12 months (50% versus 43%; RR: 1.16; 95% CI: 0.92–1.47). Long-acting contraception use (intrauterine device, implant, permanent method) was increased at four and 12 months. There was no significant difference in repeat pregnancies or abortions at four or 12 months. The intervention effect was primarily due to increased initiation of long-acting contraception. The majority of women were positive about the intervention which provided support for physical and emotional issues in addition to contraception use. The intervention could be implemented in current form, however cost-effectiveness data is lacking. The intervention could potentially be improved and further evaluated. Conclusions: Interventions delivered by mobile phone can increase contraception use, but the evidence to date is mixed. Further trials of interventions delivered by mobile phone to increase contraception use are required.
Supervisor: Free, C. Sponsor: Marie Stopes International Innovation Fund ; Medical Research Council
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral