Formative Study of Mobile Phone Use for Family Planning Among Young People in Sierra Leone: Global Systematic Survey

Abstract

Background Teenage pregnancy remains high with low contraceptive prevalence among adolescents (aged 15-19 years) in Sierra Leone. Stakeholders leverage multiple strategies to address the challenge. Mobile technology is pervasive and presents an opportunity to reach young people with critical sexual reproductive health and family planning messages. Objective The objectives of this research study are to understand how mobile health (mHealth) is used for family planning, understand phone use habits among young people in Sierra Leone, and recommend strategies for mobile-enabled dissemination of family planning information at scale. Methods This formative research study was conducted using a systematic literature review and focus group discussions (FGDs). The literature survey assessed similar but existing interventions through a systematic search of 6 scholarly databases. Cross-sections of young people of both sexes and their support groups were engaged in 9 FGDs in an urban and a rural district in Sierra Leone. The FGD data were qualitatively analyzed using MAXQDA software (VERBI Software GmbH) to determine appropriate technology channels, content, and format for different user segments. Results Our systematic search results were categorized using Grading of Recommended Assessment and Evaluation (GRADE) into communication channels, audiovisual messaging format, purpose of the intervention, and message direction. The majority of reviewed articles report on SMS-based interventions. At the same time, most intervention purposes are for awareness and as helpful resources. Our survey did not find documented use of custom mHealth apps for family planning information dissemination. From the FGDs, more young people in Sierra Leone own basic mobile phones than those that have feature capablilities or are smartphone. Young people with smartphones use them mostly for WhatsApp and Facebook. Young people widely subscribe to the social media–only internet bundle, with the cost ranging from 1000 leones (US $0.11) to 1500 leones (US $0.16) daily. Pupils in both districts top-up their voice call and SMS credit every day between 1000 leones (US $0.11) and 5000 leones (US $0.52). Conclusions mHealth has facilitated family planning information dissemination for demand creation around the world. Despite the widespread use of social and new media, SMS is the scalable channel to reach literate and semiliterate young people. We have cataloged mHealth for contraceptive research to show SMS followed by call center as widely used channels. Jingles are popular for audiovisual message formats, mostly delivered as either push or pull only message directions (not both). Interactive voice response and automated calls are best suited to reach nonliterate young people at scale.

Association between exposure to family planning messages on different mass media channels and the utilization of modern contraceptives among young women in Sierra Leone: insights from the 2019 Sierra Leone Demographic Health Survey

“…The increasing penetration of mobile phones or digital media platforms are an emerging opportunity to engage young audiences in most need [39]. Mobile phones also represent the most rapid expansion as a medium for mass media messaging globally and in Sierra Leone [40].…”

Project design and technology trade-offs for implementing a large-scale sexual and reproductive health mHealth intervention: Lessons from Sierra Leone

“…In 2019, UNFPA conducted formative research to understand how young people use mobile phones and the best strategy for reaching young people using mobile technology with SRH messages. The report showed that phone ownership and phone type increased with education and income ( 20 ). Young people, out of school, generally used basic phones and often could not read or write.…”

“…Multichannel here refers to the use of several media channels for spreading marketing and health promotion and education messages to consumers and service users, including via social media, print, mobile, television, etc. ( 20 , 21 ). The multiple channels adopted in this project were automated voice calls, SMS, radio jingles, and social media.…”

“…The multiple channels adopted in this project were automated voice calls, SMS, radio jingles, and social media. The campaign followed earlier formative research studies with school counselors, community learning centers, and youth advisory panels ( 20 ). The campaign helped to communicate the following: continuity of sexual reproductive health; how to seek help for gender-based-violence-related issues; and staying safe during the COVID-19 restrictions and countermeasures.…”

The Impact of Technology on Adolescent Sexual and Reproductive Needs

“…The 4 Youth by Youth mHealth photo verification app for self-texting was found to be feasible by Nigerian youth [ 15 ]. Text messaging was recommended to provide family planning information to adolescent and young adult women in Sierra Leone [ 16 ]. In Zambia, the Insake mobile phone app provided support to pregnant women living with HIV [ 17 ].…”