The MOSEXY trial: mobile phone intervention for sexual health in youth—a pragmatic randomised controlled trial to evaluate the effect of a smartphone application on sexual health in youth in Stockholm, Sweden

Abstract

An estimated 350 million cases of STIs occur globally each year. In Sweden, Chlamydia is the most common STI with approximately 30 000 cases annually, disproportionally affecting youth. National surveys report low condom use among youth. Smartphone coverage is high among this tech-savvy group. In collaboration with youth, we developed an interactive smartphone application comprising games, peer experiences and information snippets to promote condom use.ObjectivesTo evaluate in a randomised controlled trial, the effectiveness of this smartphone application to improve condom use among youth in Stockholm, Sweden.MethodsThis two-arm, individually randomised controlled trial was implemented through the Youth Health Clinics (YHC) in Stockholm, Sweden. Youth aged 18–23 years, who owned a smartphone and had ≥2 sexual partners during the past 6 months were eligible. The intervention delivered the interactive elements described above over 180 days. The control group received a ‘dummy’ application. Both groups received standard of care at the YHC. The primary outcome was proportion of consistent (100%) self-reported condom use at 6 months. Secondary outcomes included self-reported number of partners, occurrence of STIs/pregnancy and STI tests during the study period. An intention-to-treat approach was used.Results214 and 219 youth were randomised to the intervention and control groups, respectively. Consistent condom use was reported for 32/214 (15.0%) in the intervention group and for 35/219 (16.0%) in the control group (OR 0.9, 95% CI 0.5 to 1.6). No significant differences in secondary outcomes were seen.ConclusionWe were unable to detect an effect of the intervention. Future research should focus on targeting different subgroups within the overall risk group, with tailored mHealth interventions. The potential for such interventions in settings where sexual health services are unavailable should be evaluated.Trial registration numberISRCTN13212899.

Increasing uptake of long‐acting reversible contraception with structured contraceptive counselling: cluster randomised controlled trial (the LOWE trial)

“…The aim to complete recruitment within 6 months from study start was not reached at all clinics, which resulted in some clinics accepting to recruit more participants or to continue recruitment over a longer period. Although loss to follow‐up was minimal for the main outcome and for pregnancy, we had missing data, loss to follow‐up, withdrawal and the exclusion of participants of nearly 21% at 3 months for the secondary outcome of the contraceptive initiation rate, which is similar to the rate previously noted for trials conducted among young participants and at abortion clinics 19,20 …”

“…While loss to follow-up was minimal for the main outcome and for pregnancy, we had missing data, loss to follow-up, withdrawal, and exclusion of participants of close to 21% at three months for secondary outcome of the contraceptive initiation rate, which is similar to that previously noted for trials conducted among young participants and at abortion clinics. (19,20) This is the first randomised controlled trial in a real-life setting showing increased uptake of LARC after structured contraceptive counselling resulting in significantly reduced rate of pregnancy post abortion. A previous randomised trial could not show any reduction in pregnancy in abortion clinics.…”

The Effect of the Commander Application (Gender Equality-Based Adolescent Reproductive Health Education) on Knowledge, Attitudes, and Self-efficacy of High School Students in Yogyakarta City

“…The effect of the use of mobile phone intervention for adolescent sexual health did not show the same good results in the research of Nielsen et al, where the outcome measured in this study was the behavior of using condoms. The comparison between the group given mobile intervention and the control group did not show a significant difference in the behavior change of the two groups [22]. Suggestions from this study for the future researchers include selecting groups from groups that are more at risk for experiencing sexual problems and using more adapted media.…”

“…Providing education using an application or mobile phone intervention about sexual health actually depends on the consistent use of this application, since among teenagers, this method is still considered interesting and in accordance with the characteristics of adolescents, namely, understanding the use of technology. The choice of using media applications or mobile phone interventions is also considering that reproductive health and adolescent sexuality education services have not been routinely provided in public health services [22]. In the study of Manlove et al, giving a pulse reproductive health application could also increase adolescent self-confidence in using contraception [18].…”

“…Mobile applications are recommended for the development of health promotion programs in developing countries. The use of applications to promote sexual health in adolescents is still important, since they are familiar with technology and sexual problems are a very sensitive issue [22]. Accordingly, further research is still needed to develop more interesting applications for sexual and reproductive health education for adolescents.…”