Efficacy of a Digital Health Tool on Contraceptive Ideation and Use in Nigeria: Results of a Cluster-Randomized Control Trial
Efficacy of a Digital Health Tool on Contraceptive Ideation and Use in Nigeria: Results of a Cluster-Randomized Control Trial
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DOI：
10.9745/ghsp-d-19-00066
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发表时间：
2019-06-01
影响因子：
4
通讯作者：
Mobley, Allison
中科院分区：
文献类型：
--
作者：
Babalola, Stella;Loehr, Caitlin;Mobley, Allison
背景资料：尼日利亚的避孕普及率仍然是世界上最低的国家之一，这在很大程度上造成了该国产妇和儿童死亡率高。移动的电话技术的渗透率在尼日利亚有了很大的提高，打开机会的方案，使用这种媒介达到他们的目标受众与健康保护information.Methods：在2017年，健康沟通能力协作进行了一项群集随机对照试验在卡杜纳市评估数字健康工具智能客户端的概念和行为变量与计划生育相关的疗效。城市的12个病房被随机分配到干预（6个病房）和对照（6个病房）的研究武器。共有565名年龄在18-35岁之间的妇女从研究病房中随机选择并同意参加这项研究。在招聘时，这些妇女完成了一项基线调查。干预组的妇女登记收到1个欢迎电话，13个节目电话，3个问答电话在他们的移动的电话。每一个节目都有几个环节，包括介绍、剧情、朋友聊天。最后一次测验包括评估问题。对照组的妇女没有接受任何干预。干预的有效性进行了评估，使用perprotocol和意向治疗的差异，差异techniques.Results：干预和控制武器的关键社会人口特征方面是等同的，与宗教除外。在这项研究中，atmospheric是一个主要的挑战。平均而言，接受干预的参与者听了7.2集戏剧，但只有2.6个个人故事和1.1个对话样本。符合方案和意向治疗分析的结果表明，干预措施在改善相关的概念和行为结果方面是有效的。例如，意向治疗结果表明，干预措施使妇女认为与提供者讨论计划生育的信心水平提高了27.7个百分点，现代避孕普及率提高了14.8个百分点。这一有效性评估表明，使用交互式语音应答-在尼日利亚，一个包括戏剧的基于数字的工具是一个可行的选择，以促进对计划生育的积极想法和增加避孕药具的使用。从该疗效试验中吸取的重要经验教训包括在招募时告知参与者电话的开头部分听起来像什么，以避免电话被误认为是电话营销电话，以及在扩大规模之前进行密集测试，以避免由于技术问题而导致的潜在流失。
Background: Contraceptive prevalence in Nigeria remains among the lowest in the world, which substantially contributes to the countr/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 perprotocol 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.