“Tu Decides” App and the Increase of Effective Contraceptive Use Among Adolescents in Bolivia
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The document discusses the development and evaluation of the 'tú decides' app aimed at increasing effective contraceptive use among young women in Bolivia, highlighting collaboration between various organizations. It outlines the mobile health intervention's design, implementation, and the significant unmet contraceptive needs observed in the target demographic. Additionally, it stresses the importance of understanding young people's perspectives on contraceptive methods and their information preferences to enhance intervention effectiveness.
“Tu Decides” App and the Increase of Effective Contraceptive Use Among Adolescents in Bolivia
- 1. The development of the ‘Tú decides’ app and an intervention to increase the acceptability and use of effective contraceptive use among young women in Bolivia Silvia Huaynoca: Program Officer – Technical Advisor, IPPFWHR Ona McCarthy: Research Fellow LSHTM Maria Eugenia Torrico and Carolina Aliaga: CIES, Bolivia
- 2. Collaboration between the International Planned Parenthood Federation (Western Hemisphere Region), the London School of Hygiene and Tropical Medicine and the Centro de Investigacion, Educacion y Servicios
- 3. IPPF - Innovation Program Projects to broaden the contraceptive method mix to young people Research project to know the impact of a m-health intervention its acceptability and contraceptive service uptake Partnership with LSHTM Bolivia Tajikistan Palestine
- 4. The project Phase 1: Formative work that contributed to: – the development of the ‘Tu Decides’ app and – an intervention sent by short instant messages through the app Phase 2: Evaluation of the intervention
- 5. Research Partnership CIES and the research partner developed the intervention Integrate evaluation component in the project Implement cost- effectiveness analysis of the project
- 6. IT Partnership A local and London- based company worked together to identify the best mode to deliver the intervention through the mobile phone. Reviewed the tech capabilities and young people’s use of mobile phones
- 7. Bolivia- Reproductive Health Progress in family planning has lagged behind Unmet need among women aged 15-19: 38% Effective contraceptive prevalence in women aged 15-19: 4% Adolescent fertility rate: 70 per 1,000 in women aged 15-19 Around 100 illegal abortions are carried out per day 84% unmarried sexually active women 15-19 want to avoid pregnancy but only 49% report using any method Main reasons for not using contraceptives: stigma regarding premarital sex, lack of accurate information regarding the most effective methods
- 8. Mobile phone-based health interventions Many mobile phone-based health interventions globally Growing evidence that ‘mHealth’ interventions can be effective in improving a range of health behaviors In sexual and reproductive health, they are advantageous as users can receive information in private at any time and in any place. Capable of reaching many people Support can be non-judgemental Once developed, often more convenient and cheaper to deliver than face-to-face support
- 9. Mobile phone-based contraceptive interventions: evidence from trials Evidence for improving self-reported contraceptive-related behaviours: o Daily educational messages can improve pill continuation, knowledge and injection appointment attendance o Post abortion voice messages + counselling in Cambodia increased effective contraception at 4 months and 12 months LARC *But all trials did not have low-risk of bias and only 1 not in the US
- 10. Youth- Centered Design CIES Bolivia worked with their young leaders: • To gain their feedback on the design and the content of the Tu Decides app • To complement its routine services in an innovative way.
- 11. Tu Decides Development • We reviewed the content of the application with CIES young leaders • We incorporated the CIES’ brand in the design of the app • The local tech partner developed the app based on the preferences of the young leaders • We tested the usability of the app with the young leaders
- 12. App Specifications • Feature to monitor page views and user demographics (gender, city, age) • Application available in play store • Linked to CIES’s server • Must be light (not use much data)
- 13. Tú decides
- 14. Intervention development Systematic approach for the development of health behaviour change interventions which involves: 1. Understanding the health problem (unintended pregnancy) 2. Specifying behavioural change 3. Behaviour change methods and their practical applications 4. Producing and refining intervention content 5. Planning for implementation 6. Planning the evaluation
- 15. Brief results from focus group discussions and interviews
- 16. Focus group discussions and interviews: objective and participants Objective: To identify determinants and beliefs that influence effective contraceptive use in young people aged 18-24 in El Alto Participants: • CIES El Alto • 5 female, 3 male groups • 2 user interviews, 5 provider interviews • 69 total participants
- 17. Mobile Phone Use • All owned phones, most smart phones (android) • Majority don’t share phones • Very enthusiastic about contraceptive information delivered by phone • Buy data packages (3-7 times a week) enough for FB and WhatsApp • Main internet use is through mobile phone • WhatsApp nearly ubiquitous
- 18. Content and Privacy • Advantages & disadvantages of methods (strong theme) • Real stories about other people’s experiences, quotes, curiosities (women) • Straightforward, brief information about how to use methods • 1-2 messages a day, (some 2-3) • No privacy concerns, if can password protect, & prevent pop-ups • Addresses misconceptions • Some liked the idea of a call centre so they can talk to a real person • Directions to services
- 19. Knowledge • Good level of awareness of different methods However, most did not know: - efficacy of different methods - advantages & disadvantages - how much they cost - how they are used - where to get them - how they work • Very strong expressed need for more information about contraception • Comprehensive information should start around puberty
- 20. Attitudes Some examples: • Carrying condoms means that you are ‘promiscuous’ • Applies to men and women, but stigma stronger for women • IUD can rust inside the uterus if it’s not checked • IUD can implant into a fetus’s head • It’s a crime for unmarried people to have sex • IUD causes cancer
- 21. Barriers • Services are very busy • Won’t access services unless there is a problem (pregnancy, STI) b/c • Assumption is that methods (besides condoms) are expensive • Providers judge them according to their age • Worried about what people in general will think
- 22. Communication • Not confident talking to providers • Most parents don’t talk to their children directly • Some talk to extended family members • Most are confident talking to close friends • Most not confident talking to partners unless they know them very well • Talk about contraception usually happens after beginning a sexual relationship • Initiating discussion about contraception too early with a partner might make them judge you as promiscuous
- 23. Writing, testing and refining messages • Messages written based on behavioural theory, behaviour change methods and what was found from consulting with the target group • Tested with the target group • Refined the messages based on the feedback • Tested again etc.
- 24. The intervention • Short mobile phone instant messages sent through Tú decides • 0-3 messages per day for 120 days • The messages: o Provide information about contraception o Target beliefs identified in the development phase that influence contraceptive use and o Support young women in feeling that they can influence their reproductive health • Contains 10 behaviour change methods, adapted for delivery by mobile phone
- 26. Do messages delivered by mobile phone increase use and acceptability of effective contraception among young women in Bolivia?
- 27. Evaluation • Randomised controlled trial and interviews • Aim: to evaluate the effect of the intervention on women’s use and acceptability of effective contraceptive methods • Participants: 1310 women aged 16-24 with an unmet need for contraception • Co-primary outcomes: use & acceptability of effective contraception • Self-reported data collected by questionnaire at 4 months • Secondary outcomes: acceptability of individual methods, discontinuation, service uptake, unintended pregnancy, induced abortion • Process outcomes: knowledge of effective contraception, perceived norms and personal agency in using and communicating with partners about contraception, intention to use and intervention dose received • Current recruitment = 350 (recruitment closes 31 July 2017)
- 28. Thank you: Marcos Mayta Maria Elena Villarroel CIES Young volunteers Cristian Montes Jose Orosco Alison McKinley
- 29. Silvia Huaynoca Program Officer, Technical Officer IPPF/WHR shuaynoca@ippfwhr Skype: shuaynoca.ippfwhr Ona McCarthy Research Fellow, London School of Hygiene and Tropical Medicine [email protected] Carolina Aliaga Research Assistant CIES Bolivia [email protected] Skype: caroaliagac