Acceptability, feasibility and utility of a Mobile health family planning decision aid for postpartum women in Kenya

Rubee Dev,Nancy F Woods,Pamela Kohler,Daniel Matemo,Shiza Farid,John Kinuthia,Emily R Begnel,Alison L Drake,Jennifer A Unger

doi:10.1186/s12978-019-0767-9

Abstract

BackgroundUnmet need for contraception is high during the postpartum period, increasing the risk of unintended subsequent pregnancy. We developed a client facing mobile phone-based family planning (FP) decision aid and assessed acceptability, feasibility, and utility of the tool among health care providers and postpartum women.MethodsSemi-structured in-depth interviews (IDIs) were conducted among postpartum women (n = 25) and FP providers (n = 17) at 4 Kenyan maternal and child health clinics, 2 in the Nyanza region (Kisumu and Siaya Counties) and 2 in Nairobi. Stratified purposive sampling was used to enroll postpartum women and FP providers. Data were analyzed using an inductive content analysis approach by 3 independent coders, with consensual validation.ResultsFP providers stated that the Interactive Mobile Application for Contraceptive Choice (iMACC) tool contained the necessary information about contraceptive methods for postpartum women and believed that it would be a useful tool to help women make informed, voluntary decisions. Most women valued the decision aid content, and described it as being useful in helping to dispel myths and misconceptions, setting realistic expectations about potential side effects and maintaining confidentiality. Both women and providers expressed concerns about literacy and lack of familiarity with smart phones or tablets and suggested inclusion of interactive multimedia such as audio or videos to optimize the effectiveness of the tool.ConclusionsThe iMACC decision aid was perceived to be an acceptable tool to deliver client-centered FP counseling by both women and providers. Counseling tools that can support FP providers to help postpartum women make informed and individualized FP decisions in resource-limited settings may help improve FP counseling and contraceptive use in the postpartum period.

Highlights

Unmet need for contraception is high during the postpartum period, increasing the risk of unintended subsequent pregnancy
Plain English summary We explored feasibility, acceptability and utility of an Interactive Mobile Application for Contraceptive Choice client focused decision aid designed to support family planning (FP) counseling and uptake
Women and providers felt that the decision aid was easy to use and had all the necessary information on different contraceptive methods that would help them in decision making

Summary

Introduction

Unmet need for contraception is high during the postpartum period, increasing the risk of unintended subsequent pregnancy. Addressing unmet need for family planning (FP) to prevent unintended pregnancies is a high priority for women’s health, and is an effective strategy to reduce both maternal and infant morbidity and mortality [1]. Efforts focused on reducing unmet need for contraception and unintended pregnancy rates among postpartum adolescents and young women, may be strategic. The postpartum period provides a unique opportunity to address women’s contraceptive needs and provide high quality information on contraceptive options while women are engaged in care. While 91% of postpartum women in LMICs report a desire to delay subsequent pregnancies for at least a year [4], women are often discharged from health care facilities without a plan to initiate contraception or a contraceptive method to use. In Kenya 59% of women reported using modern contraception by 9 months postpartum, while only 12% used long-acting reversible contraception (LARC) [6]

Methods

Results

Discussion

Conclusion