Increasing Effectiveness of Family Planning Promoters in Mozambique through an SMS Intervention

Last registered on October 25, 2023
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Pre-Trial

Trial Information

General Information

Title
Increasing Effectiveness of Family Planning Promoters in Mozambique through an SMS Intervention
RCT ID
AEARCTR-0005383
Initial registration date
February 18, 2020

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
February 19, 2020, 3:17 PM EST

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Last updated
October 25, 2023, 3:56 PM EDT

Last updated is the most recent time when changes to the trial's registration were published.

Locations

Country
Mozambique
Region
Sofala and Nampula provinces

Primary Investigator

Name
Jessica Leight
Affiliation
IFPRI
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Other Primary Investigator(s)

PI Name
Julian Jamison
PI Affiliation
University of Exeter
Contact Investigator
PI Name
Catherine Hensly
PI Affiliation
American University
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PI Name
Elana Safran
PI Affiliation
OES
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Additional Trial Information

Status
Completed
Start date
2020-02-03
End date
2021-05-01
Keywords
Health
Additional Keywords
JEL code(s)
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
The objective of this evaluation is to use a randomized design to evaluate the effect of sending a series of mobile SMS follow-ups to beneficiaries who have received referrals for family planning services from a family planning promoter in urban and peri-urban Mozambique (Nampula and Sofala provinces). Currently, only about 50% of beneficiaries who receive referrals ever redeem them by visiting a family planning clinic. This evaluation seeks to understand whether behaviorally informed SMS messages can be a cost-effective means of increasing the referral redemption rate among beneficiaries. The project is implemented by the Office of Evaluation Sciences, supporting the USAID-funded Integrated Family Planning Program (IFPP) in Mozambique led by Pathfinder International; the component of the IFPP that will be evaluated in this project is led by Population Services International (PSI).
External Link(s)

Registration Citation

Citation
Hensly, Catherine et al. 2023. "Increasing Effectiveness of Family Planning Promoters in Mozambique through an SMS Intervention." AEA RCT Registry. October 25. https://doi.org/10.1257/rct.5383-3.0
Sponsors & Partners
Experimental Details

Interventions

Intervention(s)
The proposed intervention is a series of mobile message follow-ups for beneficiaries who have received referrals to encourage them to redeem their referral. The reminders will include basic information about when the referral was received, a reminder to redeem it, and encouragement to contact the promoter. Six substantive messages will be sent within the first month following the promoter's visit, on the following schedule: one day post-visit (or as soon as the respondent's consent can be verified), three days post-visit, and at one week, two weeks, three weeks, and four weeks. These messages will be supplemented by an additional introductory message and a thank-you message at the end of the month.

Intervention Start Date
2020-02-03
Intervention End Date
2020-12-20

Primary Outcomes

Primary Outcomes (end points)
Redemption of voucher for family planning services
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
Beneficiaries will be randomized at the individual level into the following conditions.

Control (status quo) — Promoters will follow up as normal, according to the schedule laid out above based on each woman’s segment type.

Treatment — Beneficiaries will receive a series of electronic follow-ups reminding them to redeem their referrals or follow up with their promoter, as described above.

Enrollment will be conducted on an ongoing basis as promoters visit new beneficiaries; eligible beneficiaries who provide consent will be enrolled into the sample, and randomization will be conducted at least twice weekly.
Experimental Design Details
Randomization Method
Randomization will be conducted at least bi-weekly in Stata.
Randomization Unit
Individual
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
The projected sample size is between 3700 and 5100; the numbers will vary based on the promoters' ability to rapidly verify consent for beneficiaries in the field. These projections reflect estimates constructed post-piloting.
Sample size: planned number of observations
As above
Sample size (or number of clusters) by treatment arms
The sample size per treatment arm is between 1850 and 2550.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
The minimum detectable effect ranges between 3.9 and 4.6 percentage points, relative to a base redemption rate of vouchers of 50%.
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
Republica de Mozambique Comite National de Bioetica para a Saude
IRB Approval Date
2019-10-02
IRB Approval Number
477/CNBS/19
Analysis Plan

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Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
Yes
Intervention Completion Date
January 31, 2021, 12:00 +00:00
Data Collection Complete
Yes
Data Collection Completion Date
January 31, 2021, 12:00 +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
Individually randomized trial
Was attrition correlated with treatment status?
No
Final Sample Size: Total Number of Observations
3623 women
Final Sample Size (or Number of Clusters) by Treatment Arms
Data Publication

Data Publication

Is public data available?
No

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Program Files

Program Files
No
Reports, Papers & Other Materials

Relevant Paper(s)

Abstract
Abstract
Introduction Reduction of unmet need for contraception is associated with enhanced health outcomes. We conducted a randomised controlled trial in Mozambique analysing the effects of text messages encouraging use of family planning services.

Methods This trial was conducted within a sample of women served by the Integrated Family Planning Program implemented by Population Services International, in which community health workers provide clinic referrals for family planning services. The evaluation enrolled 5370 women between 20 January and 18 December 2020 who received a referral, reported access to a mobile phone and provided consent. Women were randomly assigned to a treatment group that received a series of text message reminders encouraging them to visit a clinic or to a control arm. An intention-to-treat analysis was conducted to analyse the effect of reminders on the probability of a clinic visit and contraceptive uptake. The final analysis includes 3623 women; 1747 women were lost to follow-up.

Results Women assigned to receive the text reminders are weakly more likely to visit a clinic (risk difference 2.3 percentage points, p=0.081) and to receive a contraceptive method at a clinic (2.2 percentage points, p=0.091), relative to a base rate of 48.0% and 46.9%, respectively. The effect on clinic visits is larger and statistically significant in the prespecified subsample of women enrolled prior to the COVID-19-related state of emergency (3.2 percentage points, p=0.042).

Conclusion Evidence from this trial suggests that text message reminders are a promising nudge that increases the probability that women receive contraception.
Citation
Leight J, Hensly C, Chissano M, et al. The effects of text reminders on the use of family planning services: evidence from a randomised controlled trial in urban Mozambique. BMJ Global Health 2022;7:e007862. doi:10.1136/ bmjgh-2021-007862
URL
http://dx.doi.org/10.1136/bmjgh-2021-007862

Reports & Other Materials