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Efficacy of a Digital Health Tool on Contraceptive Ideation and Use in Nigeria: Results of a Cluster-Randomized Control Trial

BACKGROUND: Contraceptive prevalence in Nigeria remains among the lowest in the world, which substantially contributes to the country's high maternal and child mortality. Mobile phone technology penetration has increased considerably in Nigeria, opening opportunities for programs to use this me...

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Autores principales: Babalola, Stella, Loehr, Caitlin, Oyenubi, Olamide, Akiode, Akinsewa, Mobley, Allison
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Global Health: Science and Practice 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6641804/
https://www.ncbi.nlm.nih.gov/pubmed/31249023
http://dx.doi.org/10.9745/GHSP-D-19-00066
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author Babalola, Stella
Loehr, Caitlin
Oyenubi, Olamide
Akiode, Akinsewa
Mobley, Allison
author_facet Babalola, Stella
Loehr, Caitlin
Oyenubi, Olamide
Akiode, Akinsewa
Mobley, Allison
author_sort Babalola, Stella
collection PubMed
description BACKGROUND: Contraceptive prevalence in Nigeria remains among the lowest in the world, which substantially contributes to the country's high maternal and child mortality. Mobile phone technology penetration has increased considerably in Nigeria, opening opportunities for programs to use this medium for reaching their intended audience with health-protective information. METHODS: In 2017, the Health Communication Capacity Collaborative conducted a cluster-randomized control trial in Kaduna City to assess the efficacy of the digital health tool Smart Client on ideational and behavioral variables related to family planning. Twelve wards in the city were randomly assigned to intervention (6 wards) and control (6 wards) arms of the study. A total of 565 women aged 18–35 years were randomly selected from study wards and consented to participate in the study. At recruitment, the women completed a baseline survey. The women in the intervention group were registered to receive 1 welcome call, 13 program calls, and 3 quiz calls on their mobile phones. Each of the program calls had several segments, including introduction, drama episode, and friend-to-friend chat. The last quiz call included evaluation questions. Women in the control arm received no intervention. The efficacy of the intervention was assessed using both per-protocol and intent-to-treat differences-in-differences techniques. RESULTS: The intervention and control arms were equivalent in terms of key sociodemographic characteristics, with the exception of religion. Attrition was a major challenge in the study. On average, participants receiving the intervention listened to 7.2 drama episodes but only 2.6 personal stories and 1.1 sample dialogues. The results of both per-protocol and intent-to-treat analyses show that the intervention was efficacious in improving relevant ideational and behavioral outcomes. For example, the intent-to-treat results show that the intervention increased women's perceived level of confidence to discuss family planning with a provider by 27.7 percentage points and modern contraceptive prevalence by 14.8 percentage points. CONCLUSION: This efficacy assessment showed that using an interactive voice response-based digital tool that includes drama is a viable option for promoting positive ideation about family planning and increasing contraceptive use in Nigeria. Significant lessons learned from this efficacy trial include informing participants at the time of recruitment of what the opening segment of the calls will sound like to avoid the calls being mistaken for telemarketing calls and intensive testing prior to scale-up to avoid potential attrition due to technical issues.
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spelling pubmed-66418042019-07-29 Efficacy of a Digital Health Tool on Contraceptive Ideation and Use in Nigeria: Results of a Cluster-Randomized Control Trial Babalola, Stella Loehr, Caitlin Oyenubi, Olamide Akiode, Akinsewa Mobley, Allison Glob Health Sci Pract Original Articles BACKGROUND: Contraceptive prevalence in Nigeria remains among the lowest in the world, which substantially contributes to the country's high maternal and child mortality. Mobile phone technology penetration has increased considerably in Nigeria, opening opportunities for programs to use this medium for reaching their intended audience with health-protective information. METHODS: In 2017, the Health Communication Capacity Collaborative conducted a cluster-randomized control trial in Kaduna City to assess the efficacy of the digital health tool Smart Client on ideational and behavioral variables related to family planning. Twelve wards in the city were randomly assigned to intervention (6 wards) and control (6 wards) arms of the study. A total of 565 women aged 18–35 years were randomly selected from study wards and consented to participate in the study. At recruitment, the women completed a baseline survey. The women in the intervention group were registered to receive 1 welcome call, 13 program calls, and 3 quiz calls on their mobile phones. Each of the program calls had several segments, including introduction, drama episode, and friend-to-friend chat. The last quiz call included evaluation questions. Women in the control arm received no intervention. The efficacy of the intervention was assessed using both per-protocol and intent-to-treat differences-in-differences techniques. RESULTS: The intervention and control arms were equivalent in terms of key sociodemographic characteristics, with the exception of religion. Attrition was a major challenge in the study. On average, participants receiving the intervention listened to 7.2 drama episodes but only 2.6 personal stories and 1.1 sample dialogues. The results of both per-protocol and intent-to-treat analyses show that the intervention was efficacious in improving relevant ideational and behavioral outcomes. For example, the intent-to-treat results show that the intervention increased women's perceived level of confidence to discuss family planning with a provider by 27.7 percentage points and modern contraceptive prevalence by 14.8 percentage points. CONCLUSION: This efficacy assessment showed that using an interactive voice response-based digital tool that includes drama is a viable option for promoting positive ideation about family planning and increasing contraceptive use in Nigeria. Significant lessons learned from this efficacy trial include informing participants at the time of recruitment of what the opening segment of the calls will sound like to avoid the calls being mistaken for telemarketing calls and intensive testing prior to scale-up to avoid potential attrition due to technical issues. Global Health: Science and Practice 2019-06-24 /pmc/articles/PMC6641804/ /pubmed/31249023 http://dx.doi.org/10.9745/GHSP-D-19-00066 Text en © Babalola et al. http://creativecommons.org/licenses/by/4.0/ 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-19-00066
spellingShingle Original Articles
Babalola, Stella
Loehr, Caitlin
Oyenubi, Olamide
Akiode, Akinsewa
Mobley, Allison
Efficacy of a Digital Health Tool on Contraceptive Ideation and Use in Nigeria: Results of a Cluster-Randomized Control Trial
title Efficacy of a Digital Health Tool on Contraceptive Ideation and Use in Nigeria: Results of a Cluster-Randomized Control Trial
title_full Efficacy of a Digital Health Tool on Contraceptive Ideation and Use in Nigeria: Results of a Cluster-Randomized Control Trial
title_fullStr Efficacy of a Digital Health Tool on Contraceptive Ideation and Use in Nigeria: Results of a Cluster-Randomized Control Trial
title_full_unstemmed Efficacy of a Digital Health Tool on Contraceptive Ideation and Use in Nigeria: Results of a Cluster-Randomized Control Trial
title_short Efficacy of a Digital Health Tool on Contraceptive Ideation and Use in Nigeria: Results of a Cluster-Randomized Control Trial
title_sort efficacy of a digital health tool on contraceptive ideation and use in nigeria: results of a cluster-randomized control trial
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6641804/
https://www.ncbi.nlm.nih.gov/pubmed/31249023
http://dx.doi.org/10.9745/GHSP-D-19-00066
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