Barriers and facilitators to the implementation of cell phone interventions to improve the use of family planning services among women in Sub-Saharan Africa: A systematic review

Abstract

Background: Mobile health (mHealth) interventions are being tested to improve contraceptive uptake in Sub-Saharan Africa (SSA). However, few attempts have systematically reviewed the mHealth programs to enhance family planning (FP) services among women in SSA. At the same time, more than half of low-income countries’ population have a cell phone. This review identifies and highlights facilitators and barriers to implementing cell phone interventions designed to target women FP services.

Methods: Databases including PubMed, CINAHL, Epistemonikos, Embase, and Global Health were systematically searched for studies from January 1, 2010, to December 31, 2020, to identify various mHealth interventions used to improve the use of FP services among women in SSA. Two authors independently selected eligible publications based on inclusion/exclusion criteria, assessed study quality and extracted data using a pre-defined data extraction sheet. In addition, a content analysis was conducted using a validated extraction grid with a pre-established categorization of barriers and facilitators.

Results: The search strategy led to 8,188 potentially relevant papers, of which 16 met the inclusion criteria. Most included studies evaluated the impact of mHealth interventions on FP services, access (n = 9), and use of FP outcomes (n = 6). At the same time, only one article was interested in implementing a mHealth intervention. The most-reported cell phone use was for women reproductive health education, contraceptive knowledge and use. Barriers and facilitators of the use of mhealth were categorized into three main outcomes: behavioral outcomes, data collection and reporting, and health outcomes. mHealth interventions addressed barriers to provider prejudice, stigmatization, discrimination, lack of privacy, and confidentiality. The studies also identified barriers to uptake of mHealth interventions for FP services, including decreased technological literacy and lower linguistic competency.

Conclusions: The review provides detailed information about implementing mobile phones at different healthcare system levels to improve FP service outcomes. Barriers to uptake mHealth interventions must be adequately addressed to increase the potential use of mobile phones to improve access to Sexual and Reproductive Health (SRH) awareness and FP services.