Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland.
Akra-Numero Ltd, Helsinki, Finland.
JMIR Mhealth Uhealth. 2019 Aug 9;7(8):e12672. doi: 10.2196/12672.
Researchers and activists have expressed concerns over the lack of availability and nonuse of reversible, modern, contraceptive methods in India for decades. New attempts to increase access, availability, and acceptance of reversible contraceptives need to be developed, instead of relying solely on female sterilization. Mobile health (mHealth) initiatives may offer one way to serve underprivileged populations who face challenges in sexual and reproductive health (SRH) in countries such as India.
This study aimed to examine the outcome of an mHealth intervention for enhancing knowledge of, and practices related to, reversible contraceptives in rural Western India.
We implemented a nonrandomized controlled trial (before-and-after study in an intervention area and a control area) in the Indian state of Maharashtra. The intervention in this case was a mobile-based SRH helpline provided by a nongovernmental organization (NGO). Baseline and follow-up surveys were carried out in two government-run primary health center areas, one each in the intervention and control area, and 405 respondents were surveyed in the two rounds. An interview-based structured questionnaire suitable for a low-literacy environment was used to collect data. The effect of the intervention was estimated using logistic regression, adjusted for gender, by calculating robust standard errors to take into account the clustering of individuals by the area (intervention or control). In each regression model, the effect of intervention was estimated by including a term for interaction between the intervention area and the period before and after the intervention. The exponent of the regression coefficient of the interaction term corresponding to the period after the intervention, along with the 95% CI, is reported here. The odds ratio for the control village multiplied by this exponent gives the odds ratio for the intervention village. Calls received in the intervention were recorded and their topics analyzed.
The current use of reversible contraception (18% increase in intervention area vs 2% increase in control area; 95% CI) has seen changes. The proportion of respondents who had heard of contraception methods from an NGO rose in the intervention area by 23% whereas it decreased in the control area by 1% (95% CI). However, the general level of awareness of reversible contraception, shown by the first contraceptive method that came to respondents' mind, did not improve. Demand for wider SRH information beyond contraception was high. Men and adolescents, in addition to married women, made use of the helpline.
A mobile helpline that one can confidentially approach at a time most convenient to the client can help provide necessary information and support to those who need reversible contraception or other sexual health information. Services that integrate mHealth in a context-sensitive way to other face-to-face health care services add value to SRH services in rural India.
几十年来，研究人员和活动家一直对印度缺乏可用且未使用的可逆、现代避孕方法表示担忧。需要新的尝试来增加可及性、可用性和接受度，而不仅仅依赖于女性绝育。移动健康 (mHealth) 计划可能是为印度等国家面临性健康和生殖健康 (SRH) 挑战的贫困人群提供服务的一种方式。
本研究旨在探讨在印度西部农村地区实施 mHealth 干预措施以提高对可逆避孕措施的认识和实践的结果。
我们在印度马哈拉施特拉邦进行了一项非随机对照试验（干预区和对照区的前后研究）。该干预措施是由非政府组织提供的基于移动的 SRH 热线服务。在干预区和对照区各有一个政府运营的初级保健中心进行基线和随访调查，两轮调查共调查了 405 名受访者。使用适合低识字环境的基于访谈的结构化问卷收集数据。使用逻辑回归估计干预效果，通过计算稳健标准误差来调整性别，以考虑个体按区域（干预或对照）的聚类。在每个回归模型中，通过包括干预区与干预前后期间的交互项来估计干预的效果。报告对应于干预后期间的交互项的回归系数的指数，以及 95%CI。将对照村的比值乘以该指数即可得到干预村的比值。记录干预区收到的来电，并分析其主题。
目前可逆避孕的使用率（干预区增加 18%，对照区增加 2%；95%CI）发生了变化。受访者从非政府组织听说过避孕方法的比例在干预区增加了 23%，而在对照区则下降了 1%（95%CI）。然而，作为受访者首先想到的可逆避孕措施的一般认识水平并没有提高。对避孕以外的更广泛的 SRH 信息的需求很高。除了已婚妇女外，男性和青少年也使用了热线。
一个可以在客户最方便的时间私下联系的移动热线，可以帮助那些需要可逆避孕或其他性健康信息的人提供必要的信息和支持。以对上下文敏感的方式将 mHealth 整合到其他面对面医疗服务中的服务为印度农村的 SRH 服务增加了价值。
