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Randomized Controlled Trial
. 2017 Feb;107(2):298-305.
doi: 10.2105/AJPH.2016.303562. Epub 2016 Dec 20.

Impact of a Text-Messaging Program on Adolescent Reproductive Health: A Cluster-Randomized Trial in Ghana

Slawa Rokicki  1 , Jessica Cohen  1 , Joshua A Salomon  1 , Günther Fink  1
Affiliations
Randomized Controlled Trial

Impact of a Text-Messaging Program on Adolescent Reproductive Health: A Cluster-Randomized Trial in Ghana

Slawa Rokicki et al. Am J Public Health. 2017 Feb.

Abstract

Objectives: To evaluate whether text-messaging programs can improve reproductive health among adolescent girls in low- and middle-income countries.

Methods: We conducted a cluster-randomized controlled trial among 756 female students aged 14 to 24 years in Accra, Ghana, in 2014. We randomized 38 schools to unidirectional intervention (n = 12), interactive intervention (n = 12), and control (n = 14). The unidirectional intervention sent participants text messages with reproductive health information. The interactive intervention engaged adolescents in text-messaging reproductive health quizzes. The primary study outcome was reproductive health knowledge at 3 and 15 months. Additional outcomes included self-reported pregnancy and sexual behavior. Analysis was by intent-to-treat.

Results: From baseline to 3 months, the unidirectional intervention increased knowledge by 11 percentage points (95% confidence interval [CI] = 7, 15) and the interactive intervention by 24 percentage points (95% CI = 19, 28), from a control baseline of 26%. Although we found no changes in reproductive health outcomes overall, both unidirectional (odds ratio [OR] = 0.14; 95% CI = 0.03, 0.71) and interactive interventions (OR = 0.15; 95% CI = 0.03, 0.86) lowered odds of self-reported pregnancy for sexually active participants.

Conclusions: Text-messaging programs can lead to large improvements in reproductive health knowledge and have the potential to lower pregnancy risk for sexually active adolescent girls.

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Figures

FIGURE 1—
FIGURE 1—
Profile of Cluster–Randomized Controlled Trial of Text-Messaging Programs and Reproductive Health Among Adolescent Girls in Ghana, 2014
FIGURE 2—
FIGURE 2—
Adjusted Mean and 95% Confidence Intervals of Knowledge Score at 0 (Baseline), 3 Months, and 15 Months for Interactive, Unidirectional, and Control Groups in Cluster–Randomized Controlled Trial on the Impact of Text-Messaging Programs on Reproductive Health Among Adolescent Girls in Ghana, 2014 Note. Estimates are predicted scores obtained from a linear regression of knowledge score on intervention group and adjusted for presence of home economics class, school category, age, religion, ethnicity, mother’s education, father’s education, school size, and baseline knowledge.
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