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Cycle 7 (2018 Deadline)

Reproductive Health Empowerment through Telehealth (REHEAT)

PI: Agnes Kiragga (, Makerere University
U.S. Partner: Keith Horvath, University of Minnesota
Dates: February 2019 - January 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.

Summary of Recent Events

In the quarter ending March 2020, the PI and her team worked on study protocol approval. As per the Ugandan national guidelines, the study protocol is supposed to be approved by the institutional Scientific Research Committee (SRC), and fortunately approval was granted. This was followed by seeking approval from an accredited Research Ethics Committee (REC), which the study sought from the Mildmay Research Ethics Committee (MUREC). The study also sought final protocol approval from the Uganda National Council for Science and Technology (UNCST), a body mandated to register all research conducted within Uganda. In addition, the study also required administrative clearance from the Kampala Capital City Authority (KCCA) Public Health and Environment Directorate.

With administrative clearance from the Director of Public Health and Environment of the Kampala Capital City Authority (KCCA), the study team had to identify venues with an open space and then discuss with the owners they would allow use of their space for erecting mobile tents to provide shelter for participant recruitment. Some owners denied the team’s requests, but others agreed to offer the study team space to carry out their intended activities. Participant recruitment commenced, and by the end of March 2020 the study had recruited more than 100 participants. The PI and her colleagues are following up with them at the one-month mark past the date of recruitment, as stated in the protocol.

A team of four medical doctors from TMCG embarked on the development of content/messages in English that would be sent to recruited study participants periodically, giving more details on the different family planning methods and benefits of family planning. These message fall into three categories: informational, behavioral, and motivational. The developed message content was then translated from English into the local language by Anable Resource Centre to ensure that the targeted study participants (not all of whom know English) understand the texts they will receive on a regular basis.
After completion of protocol training, the study team embarked on recruitment of 25 men and their spouses to test how the study tools would generate the desired study data and determined the feasibility of the different message content that had been developed. They successfully recruited 25 men and followed up for two weeks. The experiences were discussed in the second CAB meeting informing the main study site identification and recruitments.

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