JMIR Publications

ABSTRACT

Background:

Indian National Family Health Survey Data from 2021 suggests that 9.4% of women of reproductive age had an unmet need for spacing or limiting future pregnancies (1). Randomised controlled trials evaluating mHealth interventions (programmes delivered via mobile phones) provide evidence of their potential benefit to addressing the determinants of misconceptions and lack of knowledge regarding postpartum family planning (PPFP) methods. The mMitra programme has been implemented since 2014 and uses automated voice-messaging to deliver pregnancy and postpartum care information to socioeconomically vulnerable women in the Mumbai metropolitan area. However, the mMitra programme has not been adequately evaluated to understand its impact on postpartum family planning knowledge and outcomes (2, 3).

Objective:

To assess whether, how, why, for whom, and in what contexts the mMitra programme affects postpartum family planning knowledge by analysing cohort follow-up survey data, call duration and attendance to measure the impact of listenership, and by refining context–mechanism–outcome configurations through testing effect modification in logistic regression and structural equation models.

Methods:

This study presents the quantitative findings from the realist evaluation of the mMitra programme. Moderator analysis (through testing for effect modification in a logistic regression model) and structural equation models (SEMs) were used to test context-mechanism-outcome configurations (CMOCs) from an accompanying realist review.

Results:

After adjusting for religion as a potential confounder and including phone access as an effect modifier in the logistic regression model, mMitra call duration, a proxy measure for programme engagement, did not have an effect on knowledge of one or more highly effect contraceptive (HEC) methods (OR=1.012, p=0.02, 95%CI 1.002-1.021). SEMs show some evidence of an association between shared phone ownership and mMitra programme engagement, potentially via the mechanism of women’s ability to negotiate phone access.

Conclusions:

This study adds to the growing body of evidence on the usefulness of SEM to test CMOCs in realist evaluations. Issues with data collection and management and the absence of survey data from locations outside of Mumbai limit the generalisability of the conclusions from this study.