Family Planning Digital Tools: A Comprehensive Evaluation

By Eden Demise, Research Associate, Strategy & Insights, PSI; Alexis Coppola, Sr. Program Manager, SRH, PSI; Alexandra Angel, Technical Advisor, SRH, PSI; and Kristen Little, Sr. Research Advisor, Strategy & Insights, PSI

In 2020, for the first time, over half of the world’s population were using mobile internet. Three-quarters of these users lived in low-and middle-income countries. Given the increase in internet connectivity globally, the use of digital technologies is one of several promising High Impact Practices (HIPs) in family planning, providing new opportunities to advance digital self-care, and make headway towards achieving universal health coverage.

The Problem

Currently, there is a growing range of resources available on effective digital interventions, including the HIP brief on Digital Health for Social and Behavioral Change and the HIP enhancement briefs on Digital Health for Systems and Digital Health to Support Family Planning Providers (linked below). However, these resources are limited in helping governments, implementers, and donors identify which family planning and reproductive health tools have high-quality content.

Analyzing the Resources

To fill this evidence gap, FHI 360, under the USAID-funded Research for Scalable Solutions (R4S) project, conducted a digital family planning and reproductive health  tools landscape and content analysis to review and identify high-quality tools for adoption, adaptation, and scale-up.

The full analysis – as well as the nine recommended tools, are summarized in this brief (published December 2021), with more details available in this PowerPoint deck.

The recommended tools were highlighted in a webinar at the 2021 Global Digital Health Forum: So Many Tools: Which Ones to Choose? on December 8th, 2021. Register for the 2021 Global Digital Health Forum for free here to watch the webinar. You can also listen to a fire-side chat with some of the recommended tool owners here. These resources are designed for those interested in developing, funding, or implementing client-facing digital interventions and are intended to fill in the evidence gap on high quality family planning and reproductive health digital platforms.

Tools With High Quality Content

Among the nine short-listed digital tools, three were developed by Population Services International (PSI): Adolecent 360 (A360’s)’s 9Ja Girls Love, Life, and Health (LLH) Guidebook, 9Ja Girls Big Sista Chatbot, and Counseling for Choice (C4C) Chatbot. Taking advantage of mobile phone and internet access as an entry point, each of these three tools bring consumers a ‘click’ away from health information curated in a manner that makes it easy for them to access, digest, understand and apply to make informed health choices.

9Ja Girls LLH Guidebook

Snapshot of 9ja Girls Facebook Messenger

The LLH guidebook, developed under the A360 Nigeria project, is used to facilitate in-person and virtual classes and conversations via Facebook Messenger and WhatsApp, related to love, relationships, family planning and reproductive health.

This tool scored highest in six areas: complete list of modern methods, method effectiveness, duration of protection, dual method use (i.e., offers protection against HIV and sexually transmitted infections), discreteness, and menstrual health.
 
The 9ja Girls program currently has 40 LLH WhatsApp groups with 20-40 students in each group, facilitated using the LLH guidebook. The 9ja Girls Facebook Messenger, also facilitated by the LLH guidebook, receives an average of 1,300 messages per month and provided 159 referrals to in-network providers in 2021. The Facebook Messenger provides a safe space for girls to have private and confidential conversations with a provider, receive personalized on-demand  family planning and reproductive health  information and linkages to quality products and services.

9Ja Girls Big Sista Chatbot

A second A360 Nigeria tool, the Big Sista Chatbot, is an automated menu-based information tool developed via Facebook in 2020.

This tool scored highest in five areas: complete list of modern methods, duration of protection, dual method use (i.e., offers protection against HIV and STIs), discreteness, and menstrual health.

In 2021, the Big Sista Chatbot reached 849 unique users with personalized and actionable family planning and reproductive health information by linking clients to clinics and Facebook Direct Messenger, where clients receive referrals to 9ja Girls Centres. 

Snapshot of 9Ja Girls Big Sista Chatbot

C4C Chatbot
C4C places the consumer at the center of care and the experience, from provider-led interactions to conversations a user has with a digital chatbot​.

The C4C chatbot launched in 2020 is an interactive, user-facing tool designed to provide family planning and reproductive health information, including menstrual health to people where and when they want it, privately and securely. The C4C chatbot is a dynamic tool; users respond to questions about their unique preferences and needs in terms of FP, and the tool recommends 2-3 methods that best fit their stated preferences. The tool is accessible to users via Facebook and WhatsApp.

This tool scored highest in the following four areas: complete list of modern methods, duration of protection, return to fertility, and dual method (i.e., offers protection against HIV and STIs).

Since August 2020, over 10,000 individuals in Cote d’Ivoire have accessed this tool, and nearly 40% of those living in the capital city of Abidjan were referred to a clinic within the PSI network. To further contribute to a growing body of evidence on use of digital tools, R4S is currently conducting a mixed-method study evaluating why people use the chatbot, barriers and facilitators to the use of the chatbot and if users intend to seek family planning and reproductive health methods and services after interacting with the tool. Findings from this study will be used to refine the digital tool and scale-up to other countries.

Leveraging What Works

PSI has successfully utilized mobile technology to provide personalized, actionable information on family planning and reproductive health. Making use of popular messaging platforms such as WhatsApp, Facebook Messenger and microsites is part of PSI’s consumer-powered digital health approach – placing cultural context and accessibility at the forefront. One of our priority areas is to re-position PSI’s in-house learnings and digital solutions, including the A360 tools and C4C chatbot, as global goods to support and encourage all initiatives that bring us closer to universal health coverage.

If you are interested in adapting the A360 tools, contact: [email protected].  

If you are interested in adopting the C4C chatbot, contact: Alexandra Angel: [email protected].

Reference here the High Impact Practice Briefs mentioned in this article: 

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