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D Constant, J Harries - Women’s Health Research Unit, UCT K de Tolly - Cell-Life FIGO Conference Rome 8 - 12 October 2

m-ASSIST: The use of mobile phones in medical abortion for support, self-assessment and family planning information. D Constant, J Harries - Women’s Health Research Unit, UCT K de Tolly - Cell-Life FIGO Conference Rome 8 - 12 October 2012. www.cell-life.org.za. www.uct.ac.za.

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D Constant, J Harries - Women’s Health Research Unit, UCT K de Tolly - Cell-Life FIGO Conference Rome 8 - 12 October 2

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  1. m-ASSIST: The use of mobile phones in medical abortion for support, self-assessment and family planning information D Constant, J Harries - Women’s Health Research Unit, UCT K de Tolly - Cell-Life FIGO Conference Rome 8 - 12 October 2012 www.cell-life.org.za www.uct.ac.za

  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 questionsSMS request to do SA sent on Day 11 • FP mobisite: m.ichoosewhen.org.za 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 randomisedat 1st clinic visit • Over next 2 weeks, investigator logs tracked delivery of SMSs and access and usage of self-assessment • 2nd interview at follow-up clinic visit • 3rd 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%) • 3rd Interview: 177 intervention (LTF 24%) • 173 control (LTF 27%)

  7. Baseline characteristics

  8. Baseline characteristics 1Adler N. Am J Orthopsychiatry. 1975;45(3):446–54.

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

  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 90% attempted SA 146: NO additional surgery SA identified 66% as complete 3: Additional surgery SA identified 33% as NOT complete

  12. Results: Family planning SMS/mobisite

  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 • Cell Life • Katherine de Tolly • katherine@cell-life.org.za • Women’s Health Research Unit, UCT • Deborah Constant • deborah.constant@uct.ac.za • Jane Harries • NtombomziMcanjana • TembekaFikizolo • Beverley Arendse • Joanna Romell • Sarah Crede • World Health Organization • Study participants

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