Effectiveness of mHealth Interventions for Improving Contraceptive Use in Low- and Middle-Income Countries: A Systematic Review

Banyar Aung; Jason W. Mitchell; Kathryn L. Braun

doi:10.9745/GHSP-D-20-00069

Key Findings

Of the 8 mHealth family planning interventions that met inclusion criteria, 3 studies improved family planning outcomes and 4 studies experienced implementation issues.
Further research is needed to encourage robust program fidelity of mHealth family planning interventions, along with a more thorough understanding of what mHealth and behavior change components are needed to improve family planning outcomes in low- and middle-income countries.

Key Implications

A “push” approach, interactive communication, information tailored to participants, motivational messaging, and male partner involvement appear to be tied to better family planning outcomes.
Program managers and researchers should consider improvements in protocols and fidelity that are needed to more accurately assess how well mHealth family planning interventions impact outcomes in low- and middle-income countries.

ABSTRACT

Background:

mHealth interventions are being tested to improve contraceptive uptake in low- and middle-income countries (LMICs); however, the effectiveness of these interventions has not been systematically reviewed.

Objectives:

The primary objective of this systematic review was to assess the effectiveness of mHealth interventions to improve contraceptive uptake and adherence in LMICs. A second objective was to identify mHealth features and behavior change communication components used in these mHealth interventions.

Methods:

A systematic search was conducted of online databases for peer-reviewed articles that reported on intervention studies with men and women from LMICs and measured mHealth intervention impact on contraceptive uptake and/or adherence. Key search terms included “mHealth” or “mobile health,” “contraception” or “family planning,” and “low- and middle-income countries.” PRISMA guidelines were followed for reporting review methods and findings. The Cochrane risk-of-bias 2 tool for randomized trials was used to assess the risk of bias of the included studies. The GRADE approach was used to determine the quality of evidence.

Results:

Eight randomized controlled trial studies met the inclusion criteria. Four studies experienced implementation challenges (e.g., intervention components were not utilized fully by participants, intervention participants did not receive the full intervention content, contamination, low response rate, and/or missing data). Only 3 interventions were found to be effective, and these included a “push” approach, interactive communication, information tailored to participants, motivational messaging, and male partner involvement.

Conclusion:

To date, the delivery of mHealth interventions for improving family planning in LMICs has met with implementation challenges that have reduced the researcher’s ability to test intervention effectiveness. Although 3 of 8 studies found improved contraceptive use in the intervention group, the review cannot draw concrete conclusions on the overall effectiveness of mHealth interventions to increase contraceptive use in LMICs. Further research with robust program fidelity is recommended.

Received: February 14, 2020.
Accepted: September 22, 2020.
Published: December 23, 2020.

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-20-00069

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