An Intervention Delivered by App Instant Messaging to Increase Acceptability and Use of Effective Contraception Among Young Women in Bolivia: Protocol of a Randomized Controlled Trial.

Ona L Mccarthy,Shelly Makleff,Caroline Free,Jhonny Lopez Gallardo,Baptiste Leurent,Silvia Huaynoca,Veronica Osorio Calderon,Phil Edwards

doi:10.2196/resprot.8679

Abstract

BackgroundUnintended pregnancy is associated with numerous poorer health outcomes for both women and their children. Fulfilling unmet need for contraception is essential in avoiding unintended pregnancies, yet millions of women in low- and middle-income countries continue to face obstacles in realizing their fertility desires. In Bolivia, family planning progress has improved in recent decades but lags behind other countries in the region. Unmet need for contraception among women aged 15 to 19 years is estimated to be 38%, with the adolescent fertility rate at 70 per 1000 women. Mobile phones are an established and popular mode in which to deliver health behavior support. The London School of Hygiene & Tropical Medicine and the Centro de Investigación, Educación y Servicios in Bolivia have partnered to develop and evaluate a contraceptive behavioral intervention for Bolivian young women delivered by mobile phone. The intervention was developed guided by behavioral science and consists of short instant messages sent through an app over 4 months.ObjectiveThe objective of this study is to evaluate the effect of the intervention on young women’s use of and attitudes toward the most effective contraceptive methods.MethodsWe will allocate 1310 women aged 16 to 24 years with an unmet need for contraception in a 1:1 ratio to receive the intervention messages or the control messages about trial participation. The messages are sent through the Tú decides app, which contains standard family planning information. Coprimary outcomes are use and acceptability of at least one effective contraceptive method, both measured at 4 months.ResultsRecruitment commenced on March 1, 2017 and was completed on July 29, 2017. We estimate that the follow-up period will end in January 2018.ConclusionsThis trial will evaluate the effect of the intervention on young women’s use of and attitudes toward the (nonpermanent) effective contraception methods available in Bolivia.Trial RegistrationClinicalTrials.gov NCT02905526; https://clinicaltrials.gov/ct2/show/NCT02905526 (Archived by WebCite at http://www.webcitation.org/6vT0yIFfN)

Highlights

The desire to limit and space childbirth has increased in recent decades, yet many women continue to face obstacles in avoiding unintended pregnancies [1]
Satisfying unmet need for contraception is essential in avoiding unintended pregnancy, which requires an understanding of the reasons for nonuse in particular contexts [20]
The estimated completion date for the final participant recruited is January 2018. Because this trial is being conducted among young women with an unmet need for contraception in a context where information about contraception is low, it is reasonable to assume that enrolling in the trial will be popular

Summary

Introduction

The desire to limit and space childbirth has increased in recent decades, yet many women continue to face obstacles in avoiding unintended pregnancies [1]. Fulfilling unmet need for contraception is essential in avoiding unintended pregnancies, yet millions of women in low- and middle-income countries continue to face obstacles in realizing their fertility desires. The London School of Hygiene & Tropical Medicine and the Centro de Investigación, Educación y Servicios in Bolivia have partnered to develop and evaluate a contraceptive behavioral intervention for Bolivian young women delivered by mobile phone. Methods: We will allocate 1310 women aged 16 to 24 years with an unmet need for contraception in a 1:1 ratio to receive the intervention messages or the control messages about trial participation. Conclusions: This trial will evaluate the effect of the intervention on young women’s use of and attitudes toward the (nonpermanent) effective contraception methods available in Bolivia. Trial Registration: ClinicalTrials.gov NCT02905526; https://clinicaltrials.gov/ct2/show/NCT02905526 (Archived by WebCite at http://www.webcitation.org/6vT0yIFfN)

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