Frances H Ampt 1 2, Collins Mudogo 3, Peter Gichangi 3 4 5, Megan S C Lim 1 2, Griffins Manguro 3, Matthew Chersich 6, Walter Jaoko 4, Marleen Temmerman 3 5 7, Marilyn Laini 3, Liz Comrie-Thomson 1, Mark Stoové 1, Paul A Agius 1 2 8, Margaret Hellard 1, Kelly L’Engle 9, Stanley Luchters 1 2 5
Affiliations
- 1Burnet Institute, Melbourne, Australia.
- 2Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
- 3International Centre for Reproductive Health (ICRH), Mombasa, Kenya.
- 4University of Nairobi, Mombasa, Kenya.
- 5Department of Obstetrics and Gynaecology, International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium.
- 6Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa.
- 7Aga Khan University, Nairobi, Kenya.
- 8Judith Lumley Centre, La Trobe University, Melbourne, Australia.
- 9University of San Francisco, San Francisco, California, USA.
PMID: 28821530 PMCID: PMC5724193
DOI: 10.1136/bmjopen-2017-017388
Abstract
Introduction: New interventions are required to reduce unintended pregnancies among female sex workers (FSWs) in low- and middle-income countries and to improve their nutritional health. Given sex workers’ high mobile phone usage, repeated exposure to short messaging service (SMS) messages could address individual and interpersonal barriers to contraceptive uptake and better nutrition.
Methods: In this two-arm cluster randomised trial, each arm constitutes an equal-attention control group for the other. SMS messages were developed systematically, participatory and theory-driven and cover either sexual and reproductive health (WHISPER) or nutrition (SHOUT). Messages are sent to participants 2-3 times/week for 12 months and include fact-based and motivational content as well as role model stories. Participants can send reply texts to obtain additional information. Sex work venues (clusters) in Mombasa, Kenya, were randomly sampled with a probability proportionate to venue size. Up to 10 women were recruited from each venue to enrol 860 women. FSWs aged 16-35 years, who owned a mobile phone and were not pregnant at enrolment were eligible. Structured questionnaires, pregnancy tests, HIV and syphilis rapid tests and full blood counts were performed at enrolment, with subsequent visits at 6 and 12 months.
Analysis: The primary outcomes of WHISPER and SHOUT are unintended pregnancy incidence and prevalence of anaemia at 12 months, respectively. Each will be compared between study groups using discrete-time survival analysis.
Potential limitations: Contamination may occur if participants discuss their intervention with those in the other trial arm. This is mitigated by cluster recruitment and only sampling a small proportion of sex work venues from the sampling frame.
Conclusions: The design allows for the simultaneous testing of two independent mHealth interventions for which messaging frequency and study procedures are identical. This trial may guide future mHealth initiatives and provide methodological insights into use of reciprocal control groups.
Trial registration number: ACTRN12616000852459; Pre-results.
Keywords: Anaemia; Community Gynaecology; International Health Services; Public Health.
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Conflict of interest statement
Competing interests: None declared.
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