The effectiveness and characteristics of mHealth interventions to increase adolescent’s use of Sexual and Reproductive Health services in Sub-Saharan Africa: A systematic review

Abstract

Background mHealth innovations have been proposed as an effective solution to improving adolescent access to and use of Sexual and Reproductive Health (SRH) services; particularly in regions with deeply entrenched traditional social norms. However, research demonstrating the effectiveness and theoretical basis of the interventions is lacking. Aim Our aim was to describe mHealth intervention components, assesses their effectiveness, acceptability, and cost in improving adolescent’s uptake of SRH services in Sub-Saharan Africa (SSA). Methods This paper is based on a systematic review. Twenty bibliographic databases and repositories including MEDLINE, EMBASE, and CINAHL, were searched using pre-defined search terms. Of the 10, 990 records screened, only 10 studies met the inclusion criteria. The mERA checklist was used to critically assess the transparency and completeness in reporting of mHealth intervention studies. The behaviour change components of mHealth interventions were coded using the taxonomy of Behaviour Change Techniques (BCTs). The protocol was registered in the ‘International Prospective Register for Systematic Reviews’ (PROSPERO-CRD42020179051). Results The results showed that mHealth interventions were effective and improved adolescent’s uptake of SRH services across a wide range of services. The evidence was strongest for contraceptive use. Interventions with two-way interactive functions and more behaviour change techniques embedded in the interventions improved adolescent uptake of SRH services to greater extent. Findings suggest that mHealth interventions promoting prevention or treatment adherence for HIV for individuals at risk of or living with HIV are acceptable to adolescents, and are feasible to deliver in SSA. Limited data from two studies reported interventions were inexpensive, however, none of the studies evaluated cost-effectiveness. Conclusion There is a need to develop mHealth interventions tailored for adolescents which are theoretically informed and incorporate effective behaviour change techniques. Such interventions, if low cost, have the potential to be a cost-effective means to improve the sexual and reproductive health outcomes in SSA.

Lack of ownership of mobile phones could hinder the rollout of mHealth interventions in Africa

“…Africa; mHealth interventions have the potential to increase the quality, reduce the cost and extend the reach of healthcare (Ag Ahmed et al, 2017;Manby et al, 2022;Onukwugha et al, 2022;Osei et al, 2020). Those who are most in need of mHealth interventions are those in rural areas who do not live in close proximity to an HC; these individuals will need to own mobile phones to access these mHealth interventions.…”

“…The effectiveness of mobile Health (mHealth) based interventions are currently under investigation in many countries in Africa (Ag Ahmed et al, 2017; Manby et al, 2022; Onukwugha et al, 2022; Osei et al, 2020). The objective of these interventions is to increase access to healthcare resources.…”

“…Currently there are multiple mHealth interventions that are being investigated or being used at a small-scale in almost every African country; the number of mHealth interventions is continuing to increase. Throughout the continent, mHealth interventions are being used for multiple reasons: for disease diagnosis and treatment support by health workers (Anstey Watkins et al, 2018), to increase adolescent’s use of sexual and reproductive health services (Onukwugha et al, 2022), for HIV prevention and management (Manby et al, 2022), to improve maternal and child health (Ag Ahmed et al, 2017), to support the COVID-19 response (Fischer et al, 2021), and to improve surveillance coverage for new outbreaks of infectious diseases (e.g., Ebola) (Tom-Aba et al, 2018).…”

“…for disease diagnosis and treatment support by health workers (Anstey Watkins et al, 2018), to increase adolescent's use of sexual and reproductive health services (Onukwugha et al, 2022), for HIV prevention and management (Manby et al, 2022), to improve maternal and child health (Ag Ahmed et al, 2017), to support the COVID-19 response (Fischer et al, 2021), and to improve surveillance coverage for new outbreaks of infectious diseases (e.g., Ebola) (Tom-Aba et al, 2018).…”

“I am not shy anymore”: A Qualitative Study of the Impact of an Interactive mHealth Intervention on Sexual Health Knowledge, Attitudes, and Behaviors of South African Adolescents with Perinatal HIV

“…Separately, mHealth interventions-such as targeted text-message conversations-have been used across contexts to deliver SRH information (20)(21)(22). However, few mHealth interventions have been targeted for APHIV about their sexual and reproductive health (23).…”