JMIR Publications

ABSTRACT

Background:

Adolescents transitioning from childhood to adulthood need to be equipped with sexual reproductive health (SRH) knowledge, skills, attitudes and values that empower them. Accessible, reliable, appropriate, and friendly SRH information can be provided through mobile phone-based health interventions.

Objective:

This study investigated the effectiveness and impact of an Unstructured Supplementary Service Data (USSD)-based mobile phone app in: i) increasing adolescents’ knowledge about contraceptives, gender-based stereotypes, sexually-transmitted infections (STIs), abstinence, and perceived vulnerability; and ii) helping adolescents make informed decisions about their sexual reproductive health.

Methods:

A randomized control trial (RCT) methodology was applied to investigate the potential of a USSD-based app to provide on-demand SRH information to adolescents. To be eligible, adolescents 15 to 19 years old residing in Kibra had to have access to a phone and be available for the three-month follow-up visit. Participants were randomly assigned to intervention (146) and control (154). The primary outcome was improved knowledge on SRH. The secondary outcome was improved decision-making on SRH. Outcomes were measured using validated tools on adolescent SRH and user perceptions administered by study staff during the 3-month follow-up visit. The Wilcoxon signed rank test was used to compare change in knowledge score in both groups. The control group did not receive any information on SRH from the study.

Results:

During the RCT, 62 (54.9%) adolescents used the USSD-based app at least once. The mean age by randomization group was control 17.3 (1.23) and intervention 17.3 (1.12). Although non statistically significant, the intervention contributed to improve knowledge scores. Increase in the control group was 0.3 compared to 0.5 increase in intervention group (P-value = 0.42). On contraceptives knowledge scores, increase in the control group was 0.1 compared to the intervention group 0.4 (P-value = 0.11). Information on STIs was of particular interest, with 27.0% (20) of the adolescents seeking information in this area; 55% (11) of these were female. In relation to improved decision making, 21.6% (29) of the adolescents were able to identify STIs and likely to seek treatment; 51.7% (15) of these were female. Ease of use was the most important feature of the app for 28.3% (54) of the participants.

Conclusions:

Adolescents require accurate and up-to-date SRH information to guide their decision making and improve health outcomes. As adolescents already use mobile phones in their day-to-day life, mobile phone apps could provide an ideal platform for SRH information. A USSD-based app could be an appropriate tool to increase SRH knowledge among adolescents in low-resource settings. Adolescents in the study valued the information provided in the app as it helped them identify SRH topics they needed more information on.