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TitleTelemedicine for contraceptive counseling: An exploratory survey of US family planning providers following rapid adoption of services during the COVID-19 pandemic.
AuthorsStifani, BM; Avila, K; Levi, EE
Publication Date1 Mar 2021
Date Added to PubMed20 Nov 2020
AbstractDuring the COVID-19 pandemic, many clinicians started offering telemedicine services. The objective of this study is to describe the experience of US family planning providers with the rapid adoption of telemedicine for contraceptive counseling during this period. This is a cross-sectional web-based survey of family planning providers practicing in the United States. A total of 172 providers completed the survey (34% response rate). Of these, 156 (91%) provided telemedicine services in the 2 months preceding the survey. Most (78%) were new to telemedicine. About half (54%) referred less than a quarter of contraception patients for in-person visits, and 53% stated that the most common referral reason was long-acting reversible contraceptive (LARC) insertion. A majority of providers strongly agree that telemedicine visits are an effective way to provide contraceptive counseling (80%), and that this service should be expanded after the pandemic (84%). If asked to provide telemedicine visits after the pandemic, 64% of providers would be very happy about it. Many providers used personal phones or smartphones to conduct telemedicine visits but stated that ideal devices would be work-issued computers, tablets, or phones. More than half (59%) of providers prefer video over phone visits. Family planning clinicians in the United States reported a positive experience with telemedicine for contraceptive counseling during the early stage of the COVID-19 pandemic and believe that this service should be expanded. Clinicians seem to prefer using work-issued devices and conducting video rather than phone visits. Telemedicine is a promising option for providing contraceptive counseling even beyond the COVID-19 pandemic. An investment in hospital or clinic-issued devices that allow for video conferencing may optimize clinicians' telemedicine experience.
TitleTelemedicine for Family Planning: A Scoping Review.
AuthorsThompson, TA; Sonalkar, S; Butler, JL; Grossman, D
JournalObstetrics and gynecology clinics of North America
Publication Date1 Jun 2020
Date Added to PubMed27 May 2020
AbstractTelemedicine has the potential to increase access to family planning. The most common application involved the use of text message reminders and mobile apps. Text messaging increased knowledge in a variety of settings, but had no effect on contraceptive uptake and use. Two randomized studies found that text messaging improved continuation of oral contraceptives and injectables. Telemedicine provision of medication abortion included both clinic-to-clinic and direct-to-patient models of care. Telemedicine provision of medication abortion has been found to be equally safe and effective as in-person provision. Some measures of satisfaction are higher with telemedicine. Telemedicine may improve access to early abortion.
TitleAddition of mHealth (mobile health) for family planning support in Kenya: disparities in access to mobile phones and associations with contraceptive knowledge and use.
AuthorsLee, S; Begley, CE; Morgan, R; Chan, W; Kim, SY
JournalInternational health
Publication Date13 Nov 2019
Date Added to PubMed24 Dec 2018
AbstractRecently mobile health (mHealth) has been implemented in Kenya to support family planning. Our objectives were to investigate disparities in mobile phone ownership and to examine the associations between exposure to family planning messages through mHealth (stand-alone or combined with other channels such as public forums, informational materials, health workers, social media and political/religious/community leaders' advocacy) and contraceptive knowledge and use. Logistic and Poisson regression models were used to analyze the 2014 Kenya Demographic and Health Survey. Among 31 059 women, 86.7% had mobile phones and were more likely to have received higher education, have children ≤5 y of age and tended to be wealthier or married. Among 7397 women who were sexually active, owned a mobile phone and received family planning messages through at least one channel, 89.8% had no exposure to mHealth. mHealth alone was limited in improving contraceptive knowledge and use but led to intended outcomes when used together with four other channels compared with other channels only (knowledge: incidence rate ratio 1.084 [95% confidence interval {CI} 1.063-1.106]; use: odds ratio 1.429 [95% CI 1.026-1.989]). Socio-economic disparities existed in mobile phone ownership, and mHealth alone did not improve contraceptive knowledge and use among Kenyan women. However, mHealth still has potential for family planning when used with existing channels.
TitleEngaging men in an mHealth approach to support postpartum family planning among couples in Kenya: a qualitative study.
AuthorsHarrington, EK; McCoy, EE; Drake, AL; Matemo, D; John-Stewart, G; Kinuthia, J; Unger, JA
JournalReproductive health
Publication Date11 Feb 2019
Date Added to PubMed13 Feb 2019
AbstractInvolving male partners in family planning (FP) education and counseling may improve FP utilization and help meet couples' reproductive health needs in the postpartum period. We aimed to explore Kenyan men's and women's perspectives on an interactive short message service (SMS) approach to support postpartum FP decision-making, and inform intervention content for a randomized controlled trial (RCT). We conducted four focus group discussions (FGD) among men (n = 35) and two among pregnant/postpartum women (n = 15) in western Kenya. Female participants were recruited at antenatal clinics; male participants were referred by antenatal attendees. FGDs included participant critique of pilot theory-based SMS messages. FGD transcripts were coded by two investigators and analyzed using an iterative, modified grounded theory approach. These data informed the intervention and RCT design, in which women had the option to refer male partners for trial enrollment. Men strongly desired inclusion in FP programs, and frequently discussed negative relationship consequences of women's covert contraceptive use. Female and male participants voiced a variety of concerns about contraceptive side effects and potential harms, which were central to narratives of community influence on personal contraceptive choices. Most participants felt that receiving FP-focused SMS and including men would be beneficial. They perceived that SMS dialogue with a nurse about FP could reduce misperceptions and may stimulate communication within couples, thereby improving contraceptive access and continuation. Shared decision-making around FP within couple relationships, in consultation with clinicians, was highly valued. Health concerns about FP and limited couple communication are perceived contributors to postpartum unmet contraceptive need. With women's consent, the inclusion of male partners in FP services, and specifically in an mHealth SMS intervention, is acceptable and desired. Receiving SMS may trigger communication about postpartum FP within couples. SMS content should address contraceptive knowledge gaps, anticipated side effects and FP misperceptions, and allow for real-time method choice assistance.
TitleEffects of the COVID-19 pandemic on family planning services.
AuthorsStanton, T; Bateson, D
JournalCurrent opinion in obstetrics & gynecology
Publication Date1 Oct 2021
Date Added to PubMed23 Aug 2021
AbstractThe COVID-19 pandemic has highlighted existing healthcare disparities worldwide and has challenged access to family planning (FP) services. Research has identified ways in which government regulations and healthcare programs have inhibited or increased access to FP services, as well as how the pandemic has changed individuals' sexual and reproductive health behaviors and intentions. The pandemic has had both positive and negative effects on access to FP services. Innovations in various delivery services, extended use of contraception, telehealth for medication abortion, and a no-test medication abortion protocol have decreased the need for in-person visits and improved access to FP services.
TitleMobile phone ownership, text messages, and contraceptive use: Is there a digital revolution in family planning?
AuthorsJadhav, A; Weis, J
Publication Date1 Feb 2020
Date Added to PubMed30 Nov 2019
AbstractThis study aims to clarify the associations between mobile phone ownership use on family planning outcomes. Secondary analysis of DHS data finds that in certain contexts, mobile phone ownership may be related to increased FP uptake. Using recent data for women 15-49 from the Demographic and Health Surveys for six countries - Ethiopia (2016), Uganda (2016), Tanzania (2015-16), Nepal (2016), Philippines (2017), and Haiti (2016-17) - we conduct multivariate logistic regression analysis to assess FP outcomes (contraceptive prevalence (CPR), modern contraceptive prevalence (mCPR), and unmet need for family planning) for mobile phone ownership and source of exposure to FP messaging. We use STATA14 for our analyses, and all results presented are weighted. We find that in Uganda, Tanzania, and Haiti, owning a mobile phone is significantly associated with overall contraceptive use (OR = 1.38, 1.38, 1.23 respectively), modern contraceptive use (OR = 1.34, 1.30, 1.24 respectively) net of socioeconomic factors. Further, our analysis demonstrated that receiving FP information via text message was significantly associated with contraceptive uptake only in Haiti (OR = 1.62 for overall contraceptive use and OR = 1.53 for modern contraceptive use), where SMS systems have more robust connections to clinic services. Our results indicate that in certain contexts, mobile phone ownership may be related to increased FP uptake. These findings help inform investments in mHealth programming for family planning and reproductive health. They help clarify the potential significance of demographic patterns of mobile ownership and health outcomes, and also demonstrate the limitations of SMS services in relationship to contraceptive behaviors, reinforcing the need to connect mHealth to clinic services.
TitleAnother voice in the crowd: the challenge of changing family planning and child feeding practices through mHealth messaging in rural central India.
AuthorsScott, K; Ummer, O; Shinde, A; Sharma, M; Yadav, S; Jairath, A; Purty, N; Shah, N; Mohan, D; Chamberlain, S; LeFevre, AE; Agarwal, S; Arora, S; Bashingwa, J; Bhatanagar, A; Chamberlain, S; Chandra, R; Chakraborty, A; Dumke, N; Dutt, P; Godfrey, A; Gopalakrishnan, S; Indurkar, M; Jairath, A; Kumar, N; Honikman, S; Labrique, A; LeFevre, A; Mendiratta, J; Miller, M; Mitra, R; Mohan, D; Moodley, D; Mulder, N; Ng, A; Parida, D; Penugonda, N; Purty, N; Rahul, S; Rajput, S; Sahore, A; Shah, N; Scott, K; Sharma, M; Shinde, A; Singh, A; Tiffin, N; Ummer, O; Ved, R; Weiss, F; Whitehead, S; Yadav, S
JournalBMJ global health
Publication Date1 Jul 2021
Date Added to PubMed28 Jul 2021
AbstractKilkari is one of the world's largest mobile phone-based health messaging programmes. Developed by BBC Media Action, it provides weekly stage-based information to pregnant and postpartum women and their families, including on infant and young child feeding (IYCF) and family planning, to compliment the efforts of frontline health workers. The quantitative component of a randomised controlled trial (RCT) in the Indian state of Madhya Pradesh found that exposure to Kilkari increased modern contraceptive uptake but did not change IYCF practices. This qualitative research complements the RCT to explore why these findings may have emerged. We used system generated data to identify households within the RCT with very high to medium Kilkari listenership. Mothers (n=29), as well as husbands and extended family members (n=25 interviews/family group discussions) were interviewed about IYCF and family planning, including their reactions to Kilkari's calls on these topics. Analysis was informed by the theory of reciprocal determinism, which positions behaviour change within the interacting domains of individual attributes, social and environmental determinants, and existing practices. While women who owned and controlled their own phones were the Kilkari listeners, among women who did not own their own phones, it was often their husbands who listened. Spouses did not discuss Kilkari messages. Respondents retained and appreciated Kilkari messages that aligned with their pre-existing worldviews, social norms, and existing practices. However, they overlooked or de-emphasised content that did not. In this way, they reported agreeing with and trusting Kilkari while persisting with practices that went against Kilkari's recommendations, particularly non-exclusive breastfeeding and inappropriate complementary feeding. To deepen impact, digital direct to beneficiary services need to be complimented by wider communication efforts (e.g., sustained face-to-face, media, community engagement) to change social norms, taking into account the role of socio-environmental, behavioural, and individual determinants.
TitleA randomized controlled trial of the impact of a family planning mHealth service on knowledge and use of contraception.
AuthorsJohnson, D; Juras, R; Riley, P; Chatterji, M; Sloane, P; Choi, SK; Johns, B
Publication Date1 Jan 2017
Date Added to PubMed17 Jul 2016
AbstractmHealth, or the use of mobile phones for health, is a promising but largely untested method for increasing family planning knowledge in developing countries. This study estimates the effect of m4RH, an mHealth service in Kenya that provides family planning information via text message, on consumers' knowledge and use of contraception. We randomly assigned new consumers of the m4RH service to receive either full access or limited access to m4RH. We collected data on outcomes by sending questions directly to consumers via text message. Response rates to the text message surveys ranged from 51.8% to 13.5%. Despite relatively low response rates, response rates were very similar across the full-access and limited-access groups. We find that full access to m4RH increased consumers' scores on a test of contraceptive knowledge by 14% (95% confidence interval: 9.9%-18.2%) compared to a control group with limited access to m4RH. m4RH did not increase consumers' use of contraception, likelihood of discussing family planning with their partners, or likelihood of visiting a clinic to discuss family planning. Text messages may increase family planning knowledge but do not, by themselves, lead to behavior change. Text messages can be an effective method of increasing family planning knowledge but may be insufficient on their own to cause behavior change.
TitleEffects of mHealth intervention on sexual and reproductive health in emerging adulthood: A systematic review and meta-analysis of randomized controlled trials.
AuthorsInhae, C; Jiwon, K
JournalInternational journal of nursing studies
Publication Date1 Jul 2021
Date Added to PubMed19 May 2021
AbstractSexual and reproductive health of young people is an international concern with the increasing interest in healthy pregnancy and childbirth. mHealth interventions involve the use of mobile technologies for health support, have wide applications in clinical nursing practice, and play an increasingly important role in disseminating sexual and reproductive health-related information in emerging adulthood. However, there is a lack of evidence on the effects of mHealth intervention programs. This meta-analysis systematically assessed the effects of mHealth interventions on contraceptive use and pregnancy occurrence in emerging adulthood to identify the characteristics of a successful mHealth intervention program. We conducted a systematic review and meta-analysis of randomized controlled trials. Four central electronic databases (PubMed, Embase, CINAHL complete, and the Cochrane Library) were searched for relevant articles published from inception to May 2020. Data extraction and quality appraisal were performed independently by two reviewers. Eleven papers on the effects of mHealth interventions on sexual and reproductive health in emerging adulthood were selected. The included studies were assessed for the risk of bias with the Risk of Bias 2 (RoB 2) tool. Overall and subgroup meta-analyses were conducted using STATA 16.0. Heterogeneity within studies was calculated using I2. We tested the effect of mHealth interventions on contraceptive use and pregnancy occurrence to identify the impact of sexual and reproductive health. mHealth interventions improved the use of contraception (OR 1.21; 95% CI: 1.02-1.43, I2 = 20.7%; p = 0.234) although the effect on pregnancy occurrence was not significant (OR 0.80, 95% CI: 0.61-1.05, I2 = 0.0%, p = 0.950). In subgroup analysis, mHealth interventions especially improved oral contraceptive use (OR 1.43, 95% CI: 1.15-1.77, I2 = 0.0%, p = 0.784). Regarding the communication type, two-way communication showed statistically significant results with the mHealth intervention in the experimental group (OR 1.28, 95% CI: 1.06-1.54, I2 = 0.0%, p = 0.872). This meta-analysis found a positive effect of mHealth intervention on contraception, whereas the impact on pregnancy occurrences was limited. We also confirmed the factors underlying effective mHealth interventions from the results of our review. Our findings demonstrate that mHealth interventions may be suggested as a useful strategy to promote sexual and reproductive health in emerging adulthood.
TitleFamily planning and abortion services in COVID 19 pandemic.
AuthorsSharma, KA; Zangmo, R; Kumari, A; Roy, KK; Bharti, J
JournalTaiwanese journal of obstetrics & gynecology
Publication Date1 Nov 2020
Date Added to PubMed22 Nov 2020
AbstractMany routine and elective services have already been postponed or suspended by both Government and private setups in most parts of the world because of the unprecedented pandemic of COVID-19. Healthcare systems everywhere in the world are under pressure. Being a component of essential health services, family planning and abortion services should continue to cater the population in order to prevent the complications arising from unintended pregnancies and sudden rise in STIs. Due to airborne nature of transmission of the virus, it is advisable for all consultations relating to family planning services to be done remotely unless and until visit is absolutely necessary. Contraception initiation and continuation can be done by telemedicine in most individuals. Post partum contraception can be advised before discharge from hospital. In an individual planning for pregnancy, currently it is not advisable to discontinue contraceptive and plan for pregnancy as not much is known about the effect of the virus on foetal development. Also, pregnancy requires routine antenatal and peripartum care and complications arising from pregnancy may necessitate frequent hospital visits, exposing the individual to the risk of infection. Abortion services are time sensitive therefore should not be denied or delayed beyond legal limit. We need to change from real to virtual consultation to prevent the rise in unplanned pregnancies, sexually transmitted infections and unsafe abortions.
MNCHFPRHHIV/AIDSMalariaNoncommunicable diseaseCOVID-19Decision-makingEducation & trainingBehavior changeGovernancePrivacy & securityEquityCHWsYouth & adolescentsSystematic reviewsProtocols & research designMedical RecordsLaboratoryPharmacyHuman ResourcesmHealthSMSChatbotsAI