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D Constant, J Harries - Womens Health Research Unit, UCT K de Tolly - Cell-Life FIGO Conference Rome 8 - 12 October 2012

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Presentation on theme: "D Constant, J Harries - Womens Health Research Unit, UCT K de Tolly - Cell-Life FIGO Conference Rome 8 - 12 October 2012"— Presentation transcript:

1 D Constant, J Harries - Womens Health Research Unit, UCT K de Tolly - Cell-Life FIGO Conference Rome 8 - 12 October 2012 m-ASSIST: The use of mobile phones in medical abortion for support, self-assessment and family planning information

2 Early medical abortion in S Africa Standard protocols involve a minimum of 2 clinic visits: Visit 1: Clinical assessment, ultrasound and counseling; 200mg oral mifepristone 24-48hrs later at home: 800mcg misoprostol buccal and sublingual 2 or 3 weeks later: Follow-up clinical assessment, post-abortion FP Procedure is 95-99% successful Follow-up visit can be onerous and is often unnecessary Loss to follow-up is common

3 Overview: Project m-ASSIST Objective: Can mobile phones be used to provide an alternative to follow-up visits after medical abortion? Study design: 2-arm, randomised controlled trial ERB approval by WHO, UCT Setting: 2 NGO and 2 public sector clinics near Cape Town, South Africa Time frame: October 2011 – May 2012 Participants: Women in 1st trimester eligible for MA 18 years or older Own a mobile phone and willing to receive MA- related messages

4 Methods: Intervention SMSs coaching through MA More SMSs at start (while taking medication) Self-assessment of abortion completion via mobile 2-5 questions SMS request to do SA sent on Day 11 FP mobisite: Hi just a note that if you get a fever more than a day after you took the pills at home, and the fever lasts over 6 hours, please call or go to the clinic. You may still be bleeding. That's OK. It's just a problem if you soak more than 6 maxi pads in 2 hours - then call or go to the clinic.

5 Methods: Study procedures Participants recruited, interviewed and randomised at 1 st clinic visit Over next 2 weeks, investigator logs tracked delivery of SMSs and access and usage of self-assessment 2 nd interview at follow-up clinic visit 3 rd interview (telephonic) 4-6 wks later

6 Study participants Baseline: 469 randomised, 1:1 allocation 234 intervention (226) 235 control 2nd Interview: 197 intervention (LTF 16%) 184 control (LTF 21%) 3 rd Interview: 177 intervention (LTF 24%) 173 control (LTF 27%)

7 Baseline characteristics Sociodemographic Int (234)Control (235) Mean Age (SD)26.0 (5.6)25.6 (5.4) Home language Xhosa44.4%48.9% English36.3%34.0% Afrikaans9.4%6.0% Other6.8%11% Completed high school76.9%79.6% Full time job/student78.6%76.6% Reproductive history Had previous TOP14.5%16.6% Gestational age: 7-9wks (vs 4-6wks)44.4%46.0%

8 Baseline characteristics Int (234)Control (235) Support and decision-making Married or in a stable relationship80% Support at home during MA process67%68% Very much wanted to have this abortion88%89% Found decision to have this abortion very difficult39%34% 1 Adler N. Am J Orthopsychiatry. 1975;45(3):446–54. Baseline emotional state (over last 2 wks) Negative emotions (Adler) 1 :Intervention > Control (p=0.017) Anxiety (Hospital anxiety and depression screen):Intervention > Control (p=0.007) Depression (HADS):Intervention = Control

9 Results: SMS support % of women very well prepared for: Intervention Control No significant difference in: – Overall satisfaction Negative emotions Unadjusted impact scores Intervention group: significantly reduced – Anxiety – Impact scores for avoidance (adjusted)

10 Results: SMS support Feedback from the intervention group: 99% would recommend the SMS support to a friend undergoing MA 98% said the SMSs helped them through the MA process I always knew what is going to happen so that kept me going because if it was not for the SMSs I would have come back after 2 days. So they helped me a lot because I didn't even call the clinic. They were my hope. Sometimes the SMSs comforted me. I felt the SMSs understood what I was going through. Felt like a friend.

11 Results: Self-assessment usage & outcome 146: NO additional surgery SA identified 66% as complete 3: Additional surgery SA identified 33% as NOT complete 90% attempted SA

12 Results: Family planning SMS/mobisite IntControl Currently using family planning81%83% Currently using IUD21%13% Currently using hormonal method64%67% Feedback from intervention group No recall of FP SMSs / mobisite information30% General recall24% Accurate and correct recall of information24% Inaccurate or incorrect recall of information1%

13 Conclusions Timed SMS support was greatly appreciated and was effective as a support mechanism for women undergoing MA. This support was moderate in scale, and effectiveness was dependant on content and tone of the messages. If given a demonstration, most women were able to conduct a mobile-based self assessment to evaluate their MA outcome. Design of the self assessment requires careful wording and routing to ensure adequate sensitivity. Timed SMS information may be a preferred and safer mechanism to a self assessment. Mobile-based family planning information has great potential but needs to be reinforced to commit the information to memory.

14 Thank you World Health Organization Study participants Womens Health Research Unit, UCT Deborah Constant - Jane Harries - Ntombomzi Mcanjana - Tembeka Fikizolo - Beverley Arendse - Joanna Romell - Sarah Crede Cell Life Katherine de Tolly

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