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Cycle 7 (2018 Deadline)
Reproductive Health Empowerment through Telehealth (REHEAT)
PI: Agnes Kiragga (akiragga@idi.co.ug), Makerere University
U.S. Partner: Keith Horvath, San Diego State University
Dates: February 2019 - May 2021
Project Overview:
This initiative is built on an existing and well tested theory of change—the Information, Motivation, and Behavioral Skills (IMB) model—as well as a novel information dissemination method using telehealth. The IMB model proposes that health behavior and behavior change results from being well and accurately informed, having the personal and social motivation to engage in the behavior, and having the appropriate behavioral skills and self-efficacy to use them. The PI and her team will develop a Family Planning (FP) information package using a human-centered approach involving end users and subject matter experts in the design. This will allow the study team to develop and pilot content that is both culturally and scientifically appropriate. The telehealth services for the project will leverage an existing telehealth contact center and platform run by The Medical Concierge Group (TMCG), a local digital health company in Uganda. The contact center presently provides telehealth and mobile health services through voice calls, SMS, Whatsapp, email, and social media. It has been widely adopted over the last five years and supports voluntary family planning, among other health areas, across national programs for the Ministry of Health, UNICEF, USAID, and clinical research organizations.
To evaluate the impact of their work, the researchers will assess users’ level of knowledge before and after implementation of the FP intervention. With input from a community advisory board, they will design an information pack to be implemented through the already existing telehealth platform and assess its impact on FP uptake among men. In addition, their evaluation of the platform will provide informed guidance to future implementing teams to design FP or other sexual and reproductive health interventions using similar platforms. Given the barriers that men face in accessing traditional FP services, telehealth services have the potential to increase young men’s access to reproductive health information and offer a model for their delivery and other health services countrywide. Given that more than 70% of the population in Uganda are youth, the project is timely as it uses platforms that are youth-friendly (e.g., SMS and social media) to deliver important information on family and reproductive health to change behavior and increase voluntary uptake and use of services.
Final Summary of Project Activities
Dr. Kiragga and her team developed a fully detailed study protocol and study tools with the objective of assessing the feasibility and acceptability of using a Telehealth platform for men involved in family planning. The study was also designed to assess if Mobile Telephone Information Packages (mTIP) increase knowledge, attitudes, and uptake of family planning and to determine the impact of mTIP on couple communications about family planning. These objectives were achieved through the formation of a Community Advisory Board (CAB) consisting of members from different backgrounds who helped in the development of message content (mTIP) about family planning, which subsequently was sent out to study participants. The content was categorized into Motivational, Behavioral, and Informational messages. Motivational messages were meant to inform about, attract to, and demystify any information surrounding family planning. Behavioral messages were meant to check the attitudes of men towards family planning, and Informational messages were meant to give more educational information about family planning.
A total of 461 men were screened, of whom 450 were enrolled into the study. Of that total, 415 (92.9%) were followed up at one month after enrollment, 404 (89.8%) at four months after enrollment, and 432 (96.0%) at six months after enrollment. A total of 399 (88.7%) completed the one-month, four-month, and six-month follow-ups. The study also enrolled 100 spouses of the 450 enrolled men to help assess couples communication about family planning and decision making on family planning. A total of 26,988 short mobile messages (SMS) were sent out over the six months, with an average of 66 messages received by each study participant. Out of the 450 males (primary study participants) onboarded onto the SMS program, 426 (95%) successfully received the messages and only 24 reported not to receiveing the mobile health content. The average response (participation) rate to the weekly quizzes was 23% for periodic quizzes.
The research team also conducted qualitative in-depth interviews to assess knowledge and attitudes towards family planning and evaluate couples communication as a result of the mTIP intervention. The study established that there was a 58% increase in knowledge about family planning after six months of follow up from baseline, an 18% increase in family planning uptake after six months of follow up from baseline, and an improvement in couples communication and information sharing. The male participants and their spouses admitted to having candid conversations about family planning, unlike before, when such discussions were not possible and women were afraid to talk about family planning. Following the couples communication, women felt supported and keen to use family planning services without fear of spousal violence. The study reduced poor attitudes toward family planning among men. For example, at the beginning of the study, 25% of men believed that family planning and contraception is solely a woman's business. At the end the study this was reduced to 2%. Similarly, at the start before receipt of the family planning messages, 10% believed that women who use family planning are promiscuous. At study end, none of the men still had this misconception, and this underscores the effect of the intervention on men’s attitudes. Additionally, one of the greatest achievements that was highlighted from the qualitative in-depth interview was the delineation of decision making with regard to family planning. Prior to the study, men preferred to make the final decision on when and whether their spouse should use any family planning method. At the end of the six-month study period, men preferred a joint decision model that allows a couple to decide together regarding the preferred method of family planning. This is a step towards women’s empowerment and increased and supported use of family planning services.
As a result of the mTIP intervention, it was also established that men preferred interventions and modes of communication that gave them privacy, as opposed to the traditional way of seeking health services. Educating men would enable them to act as agents to champion the use of family planning, and using a clear, precise language enabled them to comprehend all the information presented. Although the PEER project has ended, the study team has continued to work on publishing their results in scientific journals, as well as disseminating the results in other formats to different stakeholders in order to attract more funding. The ultimate aim would be to ensure that the study objectives are rolled out countrywide to include perceptions of people in rural settings.
Publication
Kamulegeya LH, Bwanika J, Banonya J, Atuhaire J, Musinguzi D, Nakate V, Kyenkya J, Namatende L, Horvath KJ, Kiragga A. 2022. Feasibility and Acceptability of a Ugandan Telehealth Engagement Platform for Informational Messaging on Modern Contraception: Pilot Cross-sectional Study. JMIR Formative Research 2022;6(6):e34424. https://formative.jmir.org/2022/6/e34424 doi: 10.2196/34424
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