Cellphones4HIV - Cell-Life

Report
m-ASSIST: The use of mobile
phones in medical abortion for
support, self-assessment and
family planning information
D Constant, J Harries - Women’s Health Research Unit, UCT
K de Tolly - Cell-Life
FIGO Conference
Rome
8 - 12 October 2012
www.cell-life.org.za
www.uct.ac.za
Early medical abortion in S Africa
• Standard protocols involve a minimum of 2 clinic visits:
• Visit 1: Clinical assessment, ultrasound and counseling; 200mg oral
mifepristone
• 24-48hrs later at home: 800mcg misoprostol buccal and sublingual
• 2 or 3 weeks later: Follow-up clinical assessment, post-abortion FP
• Procedure is 95-99% successful
• Follow-up visit can be onerous and is often unnecessary
• Loss to follow-up is common
Overview: Project m-ASSIST
• Objective: Can mobile phones be used to provide an
alternative to follow-up visits after medical abortion?
• Study design: 2-arm, randomised controlled trial
• ERB approval by WHO, UCT
• Setting: 2 NGO and 2 public sector clinics near Cape Town,
South Africa
• Time frame: October 2011 – May 2012
• Participants: Women in 1st trimester eligible for MA
18 years or older
Own a mobile phone and willing to receive MArelated messages
Methods: Intervention
• SMSs coaching through MA
More SMSs at start (while taking
medication)
• Self-assessment of abortion
completion via mobile
2-5 questions
SMS request to do SA sent on Day 11
• FP mobisite: m.ichoosewhen.org.za
Hi just a note that if
you get a fever more
than a day after you
took the pills at
home, and the fever
lasts over 6 hours,
please call or go to
the clinic.
You may still be
bleeding. That's OK.
It's just a problem if
you soak more than
6 maxi pads in 2
hours - then call or
go to the clinic.
Methods: Study procedures
•
•
Participants recruited, interviewed and randomised at
1st clinic visit
Over next 2 weeks, investigator logs tracked delivery
of SMSs and access and usage of self-assessment
•
2nd interview at follow-up clinic visit
•
3rd interview (telephonic) 4-6 wks later
Study participants
• Baseline: 469 randomised, 1:1 allocation
234 intervention (226)
235 control
• 2nd Interview: 197 intervention (LTF 16%)
184 control (LTF 21%)
• 3rd Interview: 177 intervention (LTF 24%)
173 control (LTF 27%)
Baseline characteristics
Sociodemographic
Int (234)
Control (235)
Mean Age (SD)
26.0 (5.6)
25.6 (5.4)
44.4%
48.9%
36.3%
9.4%
6.8%
34.0%
6.0%
11%
Completed high school
76.9%
79.6%
Full time job/student
78.6%
76.6%
Had previous TOP
14.5%
16.6%
Gestational age: 7-9wks (vs 4-6wks)
44.4%
46.0%
Home language
Xhosa
English
Afrikaans
Other
Reproductive history
Baseline characteristics
Int (234)
Control (235)
Married or in a stable relationship
80%
Support at home during MA process
67%
80%
68%
Very much wanted to have this abortion
88%
89%
Found decision to have this abortion very difficult
39%
34%
Support and decision-making
Baseline emotional state (over last 2 wks)
Negative emotions (Adler)1:
Intervention > Control (p=0.017)
Anxiety (Hospital anxiety and depression screen):
Intervention > Control (p=0.007)
Depression (HADS):
Intervention = Control
1Adler
N. Am J Orthopsychiatry. 1975;45(3):446–54.
Results: SMS support
% of women very well prepared for:
60
40
20
Control
80
Intervention
100
0
Bleeding
Pain
Side effects
Process
• Intervention group: significantly reduced
– Anxiety
– Impact scores for avoidance (adjusted)
• No significant difference in:
– Overall satisfaction
— Negative emotions
— Unadjusted impact scores
Results: SMS support
• Feedback from the intervention group:
• 99% would recommend the SMS support to a friend undergoing MA
• 98% said the SMSs helped them through the MA process
“I always knew what is going to happen so that kept me going because if it
was not for the SMSs I would have come back after 2 days. So they helped
me a lot because I didn't even call the clinic. They were my hope.”
“Sometimes the SMSs comforted me. I felt the SMSs understood what I was
going through. Felt like a friend.”
Results: Self-assessment usage
& outcome
90% attempted
86% reached
SA
an endpoint
146: NO additional
surgery
SA identified 66%
as complete
3: Additional
surgery
SA identified
33% as NOT
complete
Results: Family planning
SMS/mobisite
Currently using family planning
Currently using IUD
Currently using hormonal method
Int
Control
81%
21%
64%
83%
13%
67%
Feedback from intervention group
No recall of FP SMSs / mobisite information
General recall
Accurate and correct recall of information
Inaccurate or incorrect recall of information
30%
24%
24%
1%
Conclusions
• Timed SMS support was greatly appreciated and was effective as a
•
•
•
•
•
support mechanism for women undergoing MA.
This support was moderate in scale, and effectiveness was
dependant on content and tone of the messages.
If given a demonstration, most women were able to conduct a
mobile-based self assessment to evaluate their MA outcome.
Design of the self assessment requires careful wording and routing to
ensure adequate sensitivity.
Timed SMS information may be a preferred and safer mechanism to
a self assessment.
Mobile-based family planning information has great potential but
needs to be reinforced to commit the information to memory.
Thank you
•
Cell Life
•
Katherine de Tolly
•
Women’s Health Research
Unit, UCT
Deborah Constant
[email protected]
• World Health Organization
• Study participants
[email protected]
-
-
Jane Harries
Ntombomzi Mcanjana
Tembeka Fikizolo
Beverley Arendse
Joanna Romell
Sarah Crede

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