Effect of mobile health application interventions on modern contraceptive use among women of reproductive age in sub-Saharan Africa: a systematic review

Introduction

Sustainable Development Goal 3, target seven, aims to ensure universal access to sexual and reproductive health care services, including family planning information and education. Mobile health interventions may be an effective means to achieve this target. Mobile health (mhealth) involves the use of mobile phone applications (MPAs) and text messages (SMS) on devices such as cell phones to provide relevant information to improve well-being and health. Given the growing interest in the use of mobile health to improve healthcare delivery, especially in sub-Saharan Africa (SSA), up-to-date information must be available to guide practice.

Objectives

To provide up-to-date evidence on the effectiveness of mhealth interventions in enhancing contraceptive use among women of reproductive age in SSA.

Methods

We conducted a systematic review of the literature in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The review was guided by a protocol registered in PROSPERO and aimed to provide up-to-date evidence on the effectiveness of mhealth interventions in enhancing contraceptive use. The PICO framework guided the literature search, and the review was conducted with an information specialist. The literature search covered studies published from 1994 to 2022 in the following databases: Medline, CINAHL, PubMed CENTRAL, the Cochrane Library, and EMBASE. Two independent reviewers conducted the screening in three stages. The title, abstract, and full-text were screened to identify studies that met the inclusion criteria. Data were extracted using a standardised data extraction form, synthesised, and assessed for quality. The quality of randomised controlled trials (RCTs) was evaluated using the JBI critical appraisal tool for RCTs. The JBI critical appraisal tool for cross-sectional studies was used to assess the non-randomised studies. A meta-analysis was conducted for studies that met the meta-analysis criteria.

Results

A total of 9,768 records were retrieved following the searches. Eight (8) studies were included in the final review: 6 RCTs, and 2 cross-sectional studies. A positive effect of mhealth on modern contraceptive use was reported in 4 out of the 8 studies, while the remaining 4 did not report any significant effect. A meta-analysis of data pooled from the 6 RCTs demonstrated a statistically significant effect of the intervention on contraceptive use (OR = 1.46, 95% CI: 1.11–1.92), indicating a meaningful increase in the likelihood of use among participants exposed to mhealth interventions.

Conclusions

The effect of mhealth applications on modern contraceptive use was inconclusive based on vote counting among the 8 selected studies. However, findings from the meta-analysis of 6 RCT studies appear to suggest that mobile health interventions can significantly improve contraceptive use among women of reproductive age.