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      Women’s views and experiences of a mobile phone-based intervention to support post-abortion contraception in Cambodia

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          Abstract

          Background

          The MObile Technology for Improved Family Planning (MOTIF) trial assessed a mobile phone-based intervention comprising voice messages and counsellor support to increase post-abortion contraception at four Marie Stopes International clinics in Cambodia. The aim of this process evaluation was to assess women’s views and experiences of receiving the MOTIF intervention, gain insights into the mechanism of action of the intervention and seek recommendations for improvements.

          Methods

          We conducted a qualitative study comprising15 semi-structured interviews with women who had received the intervention and undertook a simple thematic analysis.

          Results

          We identified themes relating to communication via mobile phone, supporting contraception use, broader post-abortion care, interaction with family and friends and suggestions for improvement. The majority of women were positive about the mobile phone-based intervention to support contraception use and reported it to be a convenient way to ask questions or get advice without going to a health centre, although a few women found the voice messages intrusive.

          The intervention supported contraception use by provision of information, encouragement, reminders to return to clinic, reassurance and advice for problems and had a positive effect on contraceptive uptake and continuation. Women reported a sense of being cared for and received support for additional physical and emotional issues. Most women thought that the duration of the intervention and frequency of messages were acceptable.

          Conclusions

          The majority of women were positive about the mobile phone-based intervention which provided support for contraception use as well as additional physical and emotional issues. The study provides some insights into how the intervention might have worked and considers how the intervention could be improved.

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          Most cited references21

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          Effectiveness of mHealth behavior change communication interventions in developing countries: a systematic review of the literature.

          Mobile health (mHealth) technologies and telecommunication have rapidly been integrated into the health care delivery system, particularly in developing countries. Resources have been allocated to developing mHealth interventions, including those that use mobile technology for behavior change communication (BCC). Although the majority of mobile phone users worldwide live in the developing world, most research evaluating BCC mHealth interventions has taken place in developed countries. The purpose of this study was to conduct a systematic review of the literature to determine how much evidence currently exists for mHealth BCC interventions. In addition to analyzing available research for methodological rigor and strength of evidence, the authors assessed interventions for quality, applying a set of 9 standards recommended by mHealth experts. The authors reviewed 44 articles; 16 (36%) reported evaluation data from BCC mHealth interventions in a developing country. The majority of BCC mHealth interventions were implemented in Africa (n = 10) and Asia (n = 4). HIV/AIDS (n = 10) and family planning/pregnancy (n = 4) were the health topics most frequently addressed by interventions. Studies did not consistently demonstrate significant effects of exposure to BCC mHealth interventions on the intended audience. The majority of publications (n = 12) described interventions that used two-way communication in their message delivery design. Although most publications described interventions that conducted formative research about the intended audience (n = 10), less than half (n = 6) described targeting or tailoring the content. Although mHealth is viewed as a promising tool with the ability to foster behavior change, more evaluations of current interventions need to be conducted to establish stronger evidence.
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            Researchers’ perceptions of ethical challenges in cluster randomized trials: a qualitative analysis

            Background Cluster randomized trials (CRTs) pose ethical challenges for investigators and ethics committees. This study describes the views and experiences of CRT researchers with respect to: (1) ethical challenges in CRTs; (2) the ethics review process for CRTs; and (3) the need for comprehensive ethics guidelines for CRTs. Methods Descriptive qualitative analysis of interviews conducted with a purposive sample of 20 experienced CRT researchers. Results Informants expressed concern over the potential for bias that may result from requirements to obtain informed consent from research participants in CRTs. Informants suggested that the need for informed consent ought to be related to the type of intervention under study in a CRT. Informants rarely expressed concern regarding risks to research participants in CRTs, other than risks to privacy. Important issues identified in the research ethics literature, including fair subject selection and other justice issues, were not mentioned by informants. The ethics review process has had positive and negative impacts on CRT conduct. Informants stated that variability in ethics review between jurisdictions, and increasingly stringent ethics review in recent years, have hampered their ability to conduct CRTs. Many informants said that comprehensive ethics guidelines for CRTs would be helpful to researchers and research ethics committees. Conclusions Informants identified key ethical challenges in the conduct of CRTs, specifically relating to identifying subjects, seeking informed consent, and the use of gatekeepers. These data have since been used to identify topics for in-depth ethical analysis and to guide the development of comprehensive ethics guidelines for CRTs.
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              Mobile phone text messaging to promote healthy behaviors and weight loss maintenance: a feasibility study.

              There is a need to investigate newer strategies pertaining to the maintenance of healthy behaviors and weight. We investigated the feasibility of mobile phone text messaging to enable ongoing communication with African-American women participating in a weight management program. Ninety-five African-American women participated in this pilot study and received regularly scheduled text messages. Forty-two of these women chose to create 165 personal text messages that included tips on healthy eating and physical activity, as well as reminders to drink water and expressions of encouragement. A commercially available client-based application transmitted these personal messages and general health messages at least three times per week. The software transmitted over 4500 text messages during the first 4 months with 114 returned as undeliverable. Participants expressed generally positive attitudes toward incoming text messages, with only one participant declining to continue after enrollment. This study demonstrated early feasibility and acceptability of text messaging as a method for promoting healthy behaviors for weight maintenance.
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                Author and article information

                Contributors
                christopher.smith@lshtm.ac.uk
                Sokhey.ly@mariestopes.org.uk
                ukvannak1@gmail.com
                ruby.warnock@ucsf.edu , ruby.warnock@gmail.com
                caroline.free@lshtm.ac.uk
                Journal
                Reprod Health
                Reprod Health
                Reproductive Health
                BioMed Central (London )
                1742-4755
                12 June 2017
                12 June 2017
                2017
                : 14
                : 72
                Affiliations
                [1 ]ISNI 0000 0004 0425 469X, GRID grid.8991.9, Department of Population Health, , London School of Hygiene and Tropical Medicine, ; Room 150, Keppel Street, London, WC1E 7HT UK
                [2 ]Marie Stopes International, Phnom Penh, Cambodia
                [3 ]ISNI 0000 0001 2297 6811, GRID grid.266102.1, Department of Obstetrics, Gynecology and Reproductive Sciences, , University of California, ; San Francisco, USA
                Author information
                http://orcid.org/0000-0001-9238-3202
                Article
                329
                10.1186/s12978-017-0329-y
                5469016
                28606181
                91100a7c-4d69-4818-898b-ad41be498022
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 10 September 2016
                : 24 May 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000265, Medical Research Council;
                Award ID: MR/L012251/1
                Award Recipient :
                Categories
                Research
                Custom metadata
                © The Author(s) 2017

                Obstetrics & Gynecology
                Obstetrics & Gynecology

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