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Table 3 Implications of key formative research findings for intervention design

From: Mobile Technology for Improved Family Planning (MOTIF): the development of a mobile phone-based (mHealth) intervention to support post-abortion family planning (PAFP) in Cambodia

Formative research component Key findings Implication for intervention design
Insights from contraception literature • Health concerns identified as major reason for non-use. Other reasons include factors related to access, cost, autonomy • Intervention needs to address health concerns as well as factors related to access, cost (by nforming clients where they can access contraception near their home) and autonomy
  • Limited evidence for interventions to improve adherence to specific contraceptive methods or uptake of PAFP • The intervention needs to anticipate some discontinuation and aim to facilitate safe method switching and well as support continuation with existing method
  • Most discontinuation occurs within the first few months • Decided to provide intervention for three-months
Insights from mHealth intervention and behaviour change literature •Uni-facteted* adherence interventions have at best modest effects • Developed a multi-faceted intervention providing information reminders and support to boost motivation to use PAFP
  • A semi-automated mHealth intervention increased adherence to HIV treatment in Kenya • A similar intervention could be adapted for PAFP in Cambodia
Case note review • 40 % uptake of effective PAFP at the time of seeking abortion services • An mHealth intervention is an opportunity to maintain contact with clients that don’t return to the clinic for contraception after seeking abortion services
•Over 50 % clients did not return to the clinic within 12-months
Interviews • Side-effects with contraception common • Re-enforced findings from literature that intervention should address health concerns
  • Clients can find it difficult to make decisions about PAFP at time of seeking abortion services • The mHealth intervention is an opportunity to maintain contact and remind clients about available methods
  • Women sometimes have to discuss with their husband/partner before using contraception • Re-enforced findings from literature review that the intervention take into account women’s lack of autonomy, facilitating a discussion with husband/partner if appropriate
Focus group discussions • Preference for voice rather than text-based intervention • Intervention used voice messages sent to clients phone instead of text-messages
  • Many clients preferred direct phone call to automated message • Developed a semi-automated intervention as fully counsellor delivered intervention would be costly to scale up
  • Clients preferred that the messages mentioned the terms ‘Marie Stopes’ and ‘contraception’ • Voice message mentioned ‘contraception’ and ‘Marie Stopes’, but not the name of the client
Consultation with MSIC staff and other organisations • Text-message interventions likely to have limited success in Cambodia • Re-enforced findings from clients that intervention should use voice rather than text
  • A fully counsellor delivered intervention would be costly and hence harder to scale-up • Intervention was semi-automated aiming to identify clients most in need of additional support
  1. *A unifaceted interventions refers to single-component intervention. A multi-faceted intervention refers to a complex intervention using a range of behaviour change techniques