The design, development and evaluation of an SMS contraceptive behaviour change intervention : a case study in Chikwawa, Malawi

• Main Author: Laidlaw, Rebecca
• Published: University of Strathclyde 2018
• Subjects: 624
• Online Access: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.759453

This thesis aimed to determine the feasibility, acceptability and effectiveness of a behaviour change intervention delivered via mHealth in Chikwawa, Malawi. Three qualitative studies were executed to identify health needs in the area and to understand cultural practices which may influence intervention effectiveness. The Behaviour Change Wheel was then used to design an SMS intervention delivering contraceptive education to adolescents. This intervention was tested in two studies; a feasibility study and larger quasi-experimental study, to identify effectiveness in regards to contraceptive knowledge, attitudes to condoms and contraceptive behaviour. The SMS intervention was found to be feasible in terms of infrastructure, accessibility and participant acceptability. Intention-to-treat analysis found significant increases in attitudes at six months in the intervention group. However, 39% of the control group had access to the intervention, affecting results. Post-hoc analysis revealed significantly higher contraceptive knowledge and attitudes in those who received access to the intervention compared to those who did not, and this was sustained for six months. Additionally, contraceptive behaviour was more frequent in those who received access to the intervention at six months follow up. This thesis demonstrates the feasibility and acceptability of an SMS behaviour change intervention delivering contraceptive education to adolescents in Chikwawa and provides evidence of positive impact on contraceptive knowledge, attitudes and behaviour change. This thesis is the first to implement an mHealth intervention in a community setting in Malawi, and highlights the advantage it has in delivering health education in a relatively quick, simple and easy to access way, without negatively impacting health sector services. However study replication is required to build on the foundations of this research and conduct a large scale evaluation of intervention effectiveness, cost effectiveness and gender equality in mobile access to ensure it can be delivered across the country to those who need it most.