Abstract
BackgroundData on contraceptive needs and use among young unmarried men are limited. Conventional ways of data collection may lead to limited and unreliable information on contraceptive use due to sensitivity of the topic, as many young men feel ashamed to discuss their behavior of using contraceptives. As short message service (SMS) is anonymous and a commonly used means of communication, we believe that if deployed, it will create a promising user-friendly method of data collection.ObjectiveThe objective was to investigate the feasibility of using SMS to collect data on sexually active, young, unmarried men’s sexual behavior and contraceptive preferences, practices, and needs in Addis Ababa, Ethiopia, and Moshi, Tanzania.MethodsWe enrolled men aged 18-30 years who were students (in Ethiopia and Tanzania), taxi or local bus drivers/assistants (Ethiopia and Tanzania), Kilimanjaro porters (Tanzania), or construction workers (Ethiopia). Young men were interviewed using a topic list on contraceptive use. They were followed up for 6 months by sending fortnightly SMS texts with questions about contraceptive use. If the young men indicated that they needed contraceptives during the reporting period or were not satisfied with the method they used, they were invited for a follow-up interview. At the end of the study, we conducted exit interviews telephonically using a semistructured questionnaire to explore the feasibility, acceptability, and accuracy of using SMS to validate the study findings in both countries.ResultsWe enrolled 71 young unmarried men—35 in Tanzania and 36 in Ethiopia. In Moshi, 1908 messages were delivered to participants and 1119 SMS responses were obtained. In Ethiopia, however, only 525 messages were sent to participants and 248 replies were received. The question on dating a girl in the past weeks was asked 438 times in Tanzania and received 252 (58%) replies, of which 148 (59%) were “YES.” In Ethiopia, this question was asked 314 times and received 64 (20%) replies, of which 52 (81%) were “YES” (P=.02 for difference in replies between Tanzania and Ethiopia). In Tanzania, the question on contraceptive use was sent successfully 112 times and received 108 (96%) replies, of which 105 (94%) were “YES.” In Ethiopia, the question on contraceptive use was asked 17 times and received only 2 (11%) replies. Exit interviews in Tanzania showed that SMS was accepted as a means of data collection by 22 (88%) of the 25 interviewed participants.ConclusionsDespite network and individual challenges, the SMS system was found to be feasible in Moshi, but not in Addis Ababa. We recommend more research to scale up the method in different groups and regions.
Highlights
Data on contraceptive use is limited overall and often limited to use among girls or couples only
Despite network and individual challenges, the short message service (SMS) system was found to be feasible in Moshi, but not in Addis Ababa
In order to determine the reason for nonuse of contraception for the past 2 weeks, we invited the participants to a follow-up in-depth interview, wherein we focused on the need of contraceptives for the specific sexual encounter and discomfort with the used contraceptive method, as reported by SMS texts
Summary
Data on contraceptive use is limited overall and often limited to use among girls or couples only. According to the latest Demographics and Health Surveys, in both Tanzania and Ethiopia, just over half of sexually active, unmarried women use a contraceptive method (54% in Tanzania and 55% in Ethiopia). In both countries, contraception is driven by the use of condoms, injectables, and oral contraceptive pills. In a study in an urban area in Northern Ethiopia, it was quite common among young men to frequent sex workers, and many expected their girlfriends to be virgins [7] These studies rarely touched upon the contraceptive needs and practices of these young men [8]. As short message service (SMS) is anonymous and a commonly used means of communication, we believe that if deployed, it will create a promising user-friendly method of data collection
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