Organizations involved
International Planned Parenthood Federation; London School of Hygiene and Tropical Medicine
Summary
In 2015, the London School of Hygiene and Tropical Medicine (LSHTM) started a collaboration with the International Planned Parenthood Federation’s (IPPF) Member Associations in Tajikistan, Bolivia and Palestine to develop and evaluate an intervention delivered by mobile phone to enhance contraceptive choice among young people in each country. This project involved the development and evaluation of a contraceptive behavioral intervention delivered by mobile phone for young people in Tajikistan, Palestine, and Bolivia. The intervention was developed using behavioral science and evaluated by randomized controlled trials in each country.
Social norms of interest
Perceived norms in relation to using and communicating with partners about contraception
Behaviors of interest
Acceptability of at least one method of effective contraception; use of effective contraception
Project components
Intervention Mapping (IM) guided the development of the interventions. IM is a cumulative process that often necessitates moving back and forth through the following steps: (1) needs assessment; (2) specifying behavioral change to result from the intervention; (3) designing the intervention components by selecting behavior change methods; (4) producing and refining the intervention content; (5) planning intervention implementation and (6) planning intervention evaluation. This project encompassed steps 1-4. The needs assessment aimed to understand unintended pregnancy and contraceptive use in each context. Activities included 1) establishing a project planning group 2) a literature search 3) focus group discussions (FGDs) and interviews with the target group and 4) interviews with local service providers. The needs assessment led to the specification of the desired behaviors for the target group to accomplish as a result of the intervention (behavioral outcomes): improvement in acceptability of effective contraception methods.
After the needs assessment, the project planning groups decided that the intervention would be delivered through short, one-way messages. The initial message sets were largely similar across the countries given similar results of the needs assessment. In general, feedback across the countries was that the messages were helpful, and they were enthusiastic about the intervention. There were no clear differences in acceptability of the messages by gender. For the final intervention, the fundamental structure of the intervention was the same across countries. Each intervention is designed to target the belief-based constructs identified in the needs assessment (instrumental attitude, self-efficacy and perceived control) in relation to contraception use, access to services and communication with partners about contraception. Each intervention provides accurate information about the effective contraceptive methods available in the country and aims to support young people in believing that they can influence their reproductive health. The interventions contain the same ten behavior change methods and similar content, with minor contextual variations resulting from the testing.
Social norms measurement
The intervention development work explored perceived norms among young people in each country through focus group discussions and interviews. Among the trial participants in each country, data was collected on perceived norms through the follow-up questionnaire at 4 months post randomization.
Key findings to date
The development of the intervention resulted in a specific theory-based intervention, tailored to each country. The Palestine trial demonstrated a clear benefit of the intervention on attitudes towards effective contraception. The trials in Tajikistan and Bolivia suggest that providing accurate, comprehensive information that addresses the beliefs of the target groups, delivered from a trustworthy source, may be enough to change attitudes about effective contraception in contexts where young people have little accurate information.
Attribution statement
McCarthy, O. L. (2019) Changing young people’s attitudes towards effective contraception using mobile phone messaging. PhD (research paper style) thesis, London School of Hygiene & Tropical Medicine.
