May 15, 2018

The mCUBE study, funded by Grand Challenges Explorations, seeks to understand women’s contraceptive preferences and behaviors in Kenya

Written by Alison Drake, Assistant Professor of Global Health, and Claire Rothschild, Epidemiology PhD student and mCUBE Research Assistant

As mobile phone ownership is rapidly growing around the world, crowdsourcing – asking questions to solicit information from large groups of people – is an increasingly attractive way to conduct global health research. In Kenya, nearly 90% of the population has access to a mobile phone,[1] and capturing data through mobile phones may provide a low-cost and effective solution for tracking health outcomes over time.

In 2017, Global WACh’s Dr. Alison Drake, Assistant Professor of Global Health, was awarded a Gates Grand Challenges Explorations grant to explore this idea – how mobile phones might be used to understand Kenyan women’s experience using family planning over time. Women and girls face major challenges using family planning, including side effects, stigma, cost, and barriers to access. Overall, 1 in 3 women starting a modern method of contraception stop using it within 1 year, and over half stop within 2 years.[2] This phenomenon is called the “leaking bucket”[3]  in family planning coverage, making efforts to achieve universal access to family planning worldwide extremely difficult.

In partnership with PATH-Kenya, the Mobile Data Collection of Contraceptive Use, Behaviors, and Experiences (mCUBE) study is collecting information from Kenyan women using family planning in real-time through surveys distributed directly to their phone via short message system (SMS). The survey technology, developed by the Kenya-based mobile technology firm mSurvey, allows SMS questions to be personalized based on language, family planning method, and prior SMS responses.

The team developed short and simple SMS surveys in four languages (English, Swahili, Luo, and Kisii) that could easily be completed in 5-10 minutes, and could capture important information on women’s experiences and challenges using family planning methods. This task was challenging, as SMS questions need to be clear and straightforward enough to ensure women can complete surveys on their own, but within a 160 character count limit. In some instances, when text is translated from one language to another, the length of the translated text can differ. The team consulted with members of the Global WACh Family Planning Working Group and staff from Global WACh’s collaborating institution, UW-Kenya, to further simplify questions as much as possible.  The mCUBE study team enrolled participants from February 2018 to April 2018 from 10 public facilities across 5 counties in Western Kenya. A total of 1,270 women were enrolled, including 12% who didn’t have their phones at the time of enrollment and completed SMS registration remotely.

Once enrolled in the study and the SMS system, women receive weekly SMS surveys about their experience using family planning over the next 6 months.  mCUBE is also using SMS to collect information about the health facilities where women and girls are seeking their family planning care. Together, this information can be connected to individual participants, providing insight into the quality of family planning services and the impact quality may have on family planning use and satisfaction.

We look forward to seeing the results of the study, with completion of follow-up anticipated in October 2018!

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[1] http://www.ca.go.ke/index.php/what-we-do/94-news/366-kenya-s-mobile-penetration-hits-88-per-cent

[2] Castle S, Askew I. Contraceptive discontinuation: reasons, challenges, and solutions. FP2020, Population Council. 2016 [cited 12 September 2017]. Available from: <http://www.familyplanning2020.org/microsite/contraceptivediscontinuation>

[3] Jain AK. Fertility reduction and the quality of family planning services. Stud Fam Plann. 1989;20(1):1-16.