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. 2015 Jun 26;2015(6):CD011159.
doi: 10.1002/14651858.CD011159.pub2.

Mobile phone-based interventions for improving contraception use

Affiliations

Mobile phone-based interventions for improving contraception use

Chris Smith et al. Cochrane Database Syst Rev. .

Update in

Abstract

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 methods: 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.

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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Conflict of interest statement

None known.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 Daily educational text messages vs no messages, Outcome 1 OC use (continuation) at 6 months.
1.2
1.2. Analysis
Comparison 1 Daily educational text messages vs no messages, Outcome 2 OC use (continuation) : follow up 187 d or less.
1.3
1.3. Analysis
Comparison 1 Daily educational text messages vs no messages, Outcome 3 OC use (continuation): follow up 188 d or more.
1.4
1.4. Analysis
Comparison 1 Daily educational text messages vs no messages, Outcome 4 No OC interruptions > 7 days at 6 months.
1.5
1.5. Analysis
Comparison 1 Daily educational text messages vs no messages, Outcome 5 Missed no pills in last month.
1.6
1.6. Analysis
Comparison 1 Daily educational text messages vs no messages, Outcome 6 OC use at last intercourse.
2.1
2.1. Analysis
Comparison 2 Daily text message reminders vs no reminders, Outcome 1 Mean number of missed pills (cycle 1).
2.2
2.2. Analysis
Comparison 2 Daily text message reminders vs no reminders, Outcome 2 Mean number of missed pills (cycle 3).
2.3
2.3. Analysis
Comparison 2 Daily text message reminders vs no reminders, Outcome 3 Condom use for at least 50% of coital activity during the study (self report).
2.4
2.4. Analysis
Comparison 2 Daily text message reminders vs no reminders, Outcome 4 Emergency contraception use during the study.
2.5
2.5. Analysis
Comparison 2 Daily text message reminders vs no reminders, Outcome 5 Pregnancy reported during the study.
3.1
3.1. Analysis
Comparison 3 Daily text message appointment reminders 72 hours before appointment + healthy self management messages vs standard care, Outcome 1 Mean number of days between scheduled appointment and completed visit: first visit.
3.2
3.2. Analysis
Comparison 3 Daily text message appointment reminders 72 hours before appointment + healthy self management messages vs standard care, Outcome 2 Mean number of days between scheduled appointment and completed visit: third visit.
4.1
4.1. Analysis
Comparison 4 Voice messages and counsellor support vs standard care, Outcome 1 Effective contraception use at 4 months.
4.2
4.2. Analysis
Comparison 4 Voice messages and counsellor support vs standard care, Outcome 2 Long‐acting contraception use at 4 months.
4.3
4.3. Analysis
Comparison 4 Voice messages and counsellor support vs standard care, Outcome 3 Effective contraception use over 4 month post‐abortion period.
4.4
4.4. Analysis
Comparison 4 Voice messages and counsellor support vs standard care, Outcome 4 Repeat pregnancy at 4 months.
4.5
4.5. Analysis
Comparison 4 Voice messages and counsellor support vs standard care, Outcome 5 Repeat abortion at 4 months.
4.6
4.6. Analysis
Comparison 4 Voice messages and counsellor support vs standard care, Outcome 6 Road traffic accident.
4.7
4.7. Analysis
Comparison 4 Voice messages and counsellor support vs standard care, Outcome 7 Domestic abuse.
5.1
5.1. Analysis
Comparison 5 Contraceptive information via text messages and mail at 1 and 2 months vs standard care, Outcome 1 Contraceptive use during treatment with isotretinoin.
5.2
5.2. Analysis
Comparison 5 Contraceptive information via text messages and mail at 1 and 2 months vs standard care, Outcome 2 Use of 2 contraceptives.
5.3
5.3. Analysis
Comparison 5 Contraceptive information via text messages and mail at 1 and 2 months vs standard care, Outcome 3 Sexually active and not using contraceptive.

References

References to studies included in this review

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References to ongoing studies

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NCT01401816 {published data only}
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