Figures & Tables
Figures
- FIGURE 1.
PRISMA Flow Diagram for the Systematic Review of Experimental Studies Evaluating the Effectiveness of mHealth Interventions on Contraceptive Uptake in Low- and Middle-Income Countries
Abbreviation: PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Protocols.
- FIGURE 2.
Risk of Bias in Studies of mHealth Interventions to Increase Contraceptive Uptake in Low- and Middle-Income Countries, N=8
- FIGURE 3.
Summary of Risk of Bias of Studies of mHealth Interventions to Increase Contraceptive Uptake in Low- and Middle-Income Countries, N=8
Tables
- TABLE 1.
Summary of Studies Included in Systematic Review of mHealth Interventions Assessing Contraceptive Uptake in Low- and Middle-Income Countries, N=8
Authors Country mHealth Delivery Mode Target Population Study Design Sample Sizea (Intervention/Control) Frequency and Duration Posttest and Follow-Up Johnson et al.18 Kenya HE via text messaging, “role model” stories, clinic database General public RCT (probably unblinded)b 13,629 (6,817/6,812) Over 3 months 24 hours, 6 days, 3 months postenrollment Maslowsky et al.19 Ecuador Telephone-delivered HE and telephone access to a nurse Postpartum women Unblinded RCT 178 (102/76) Within 48 hours of hospital discharge. Access to a nurse on-call during the first 30 days of the newborn’s life 3 months after delivery McCarthy et al.20 Tajikistan HE via app instant messaging Young people (16–24), both genders Single-blinded RCT 543 (275/298) 0–3 messages per day over 4 months 4 months after baseline McCarthy et al.21 Palestine HE via text messaging Young women (18–24) Single-blinded RCT 578 (289/289) 0–3 messages per day over 4 months 4 months after baseline Smith et al.22 Cambodia Voice messages and phone calls Women, postabortion Single-blinded RCT 300 (249/251) 6 automated voice messages ± telephone counseling within 3-month period 4 and 12 months postabortion Unger et al.23 Kenya HE via text messaging Postpartum women 3-arm, unblinded RCT 300 (100/100/100) Weekly until 12 weeks postpartum From antenatal care attendance and followed through 10, 16, 24 weeks postpartum Biswas et al.24 Bangladesh HE via text messaging Women, postabortion RCT
(probably unblinded)b120 (60 /60) Method-specific reminders/intervals (daily/weekly) 4 months postabortion Harrington et al.25 Kenya HE via text messaging Postpartum women Unblinded RCT 254 (125/129) Weekly from enrollment to 6 months postpartum 6 months postpartum - TABLE 2.
mHealth Features and Behavior Change Communication Intervention Components Used in Studies Reviewed to Assess Effectiveness of Interventions on Contraceptive Uptake, N=8
Authors Communication Pathway Family Planning Information Delivery Additional Intervention Components Theory Framework Used Frequency and Duration Evidence of Effect (Improved Contraceptive Use) Unidirectional Interactive “Push” via Telephone “Push” via Messaging “Pull” via Messaging Motivational Message Tailored Information Partner Involvement Searching for Nearest Service Provider Role Model Stories Johnson et al.18 ✓ ✓ ✓ ✓ Once Noa Maslowsky et al.19 ✓ ✓ ✓ ✓ Once Nob McCarthy et al.20 ✓ ✓ ✓ ✓ ✓ 0–3 messages per day for 4 months Noc McCarthy et al.21 ✓ ✓ ✓ ✓ ✓ 0–3 messages per day for 4 months Nod Smith et al.22 ✓ ✓ ✓ ✓ ✓ ✓ ✓ 2 times per month for 3 months Yese Unger et al.23 ✓ ✓ ✓ ✓ ✓ Weekly Yesf Biswas et al.24 ✓ ✓ ✓* Method-specific reminders (daily/weekly) Nog,h Harrington et al.25 ✓ ✓ ✓ ✓ ✓ ✓ Weekly Yesi ↵a Application was installed, and consumer received surveys for outcome measurement but had to search app for intervention materials. Recipients of full app showed increased knowledge over recipients of the limited app but no difference in contraceptive use.
↵b Participants received 1 phone-based educational session and were invited to call back for more education and counseling, but only 3 did. Intervention participants reported higher rates of breastfeeding and use of implants, but no differences were seen in overall contraceptive use.
↵c No statistically significant difference in contraceptive use and acceptability between intervention and control. Serious contamination occurred, and both the intervention and control participants received intervention messages.
↵d No statistically significant difference between the intervention and control groups in the use of effective contraception at 4 months. Intervention participants were more likely to find at least 1 method of effective contraception acceptable and had a higher mean knowledge score.
↵e Participants received 6 automated, interactive voice messages with counselor phone support, if they opted, and outcome was measured at 4 months and 12 months postabortion. Intervention group showed higher contraceptive use than the control group at both 4 months and 12 months, but the difference was only significant at 4 months.
↵f Both unidirectional and interactive short message service (SMS) interventions improved early postpartum contraceptive use over the control condition.
↵g Simple SMS reminder intervention did not improve contraceptive use at 4 months postabortion.
↵h Method-specific text message reminders to use method selected by participants, in their preferred language for the messages, including Bangla (Unicode), English, or phonetic Bangla in English fonts.
↵i The primary outcome of highly effective contractive (with less than 10% of failure rate) use at 6 months postpartum was significantly higher among women in the 2-way SMS group (69.9%) than in the control group (57.4%). Automated SMS text contained health education message and ended with actionable advice or a question to promote engagement.
- TABLE 3.
Quality of Evidence of the Contraceptive Uptake Outcome Using the GRADE Approach in Studies Included in the Review, N=8
Study Limitations of Detailed Design and Execution (Risk of Bias) Unexplained Heterogeneity or Inconsistency of Results Indirectness of Evidence Imprecisions of Results Publication Bias Quality of Evidence Smith et al.22 −1 ⊕⊕⊕⊝Moderate Maslowsky et al.19 −2 −1 ⊕⊝⊝⊝Very low McCarthy et al.20 −2 ⊕⊕⊝⊝ Low Johnson et al.18 −1 ⊕⊕⊕⊝
ModerateUnger et al.23 −1 ⊕⊕⊕⊝
ModerateMcCarthy et al.21 −2 ⊕⊕⊝⊝
LowBiswas et al.24 −1 −1 ⊕⊕⊝⊝
LowHarrington et al.25 −1 ⊕⊕⊕⊝
ModerateRandomized controlled trials were considered to be high quality, but were downgraded by 1 level (serious) or 2 levels (very serious) for each of the following: limitations of detailed design and execution (risk of bias) (e.g., limitations in randomization, deviations from intended interventions), unexplained heterogeneity or inconsistency of results, indirectness of evidence, imprecision of results, and presence of publication bias.
