Mobile 4 Reproductive Health (m4RH) Toolkit

“A randomized controlled trial conducted in Kenya in 2013 demonstrated a 13% improvement in family planning knowledge among m4RH users after three months, compared to a control group.”

This toolkit provides information and tips from FHI 360’s work in developing and expanding the Mobile 4 Reproductive Health (m4RH) project, and is intended to share tips and lessons learned for individuals and organisations who are considering whether and how to implement a simlar mobile phone solution. The toolkit includes an overview of m4RH, recent demographic and use data gathered through routine system use and from several studies, sample messages, cost-analysis insight into financing models for SMS-based services, and a description of the message development and adaptation process.

As explained in the overview section of the toolkit, “The Mobile for Reproductive Health (m4RH) service is an award-winning automated, interactive, and on-demand short message service (SMS, or text message) system that provides simple, accurate and globally relevant information on reproductive health. Developed in 2009 and piloted in Kenya and Tanzania, m4RH was one of the first services to take advantage of the increasing ubiquity of cell phones to put accurate reproductive health information and decision making directly into the hands of those who need it. Since then, m4RH has expanded its content and reach and has been adopted and adapted by organizations around the world.”  (see Related Summaries below for more information)

Following an overview, the toolkit provides an info graphic outlining user numbers from Kenya and Tanzania, demographic information on the users, as well information on the content most requested by users. 

The section on results outlines the monitoring and evaluation methods used by m4RH, as well as some of the evaluation results. In brief, the monitoring and evaluation though sms-based methods and telephonic interviews, showed that “m4RH reaches a diverse group of users, including key target groups for FP [family planning] programs such as men and young people. These users find m4RH to be an acceptable format for receiving FP information, and appreciate the convenience and privacy of this channel. Some m4RH users report use of the service increasing their knowledge about FP, improving communication with a partner, and leading them to take up a method. In addition, a randomized controlled trial conducted by Abt Associates in Kenya in 2013 demonstrated a 13% improvement in family planning knowledge after 3-months among m4RH users compared to a control group.”

This section also includes the results of a text message-based survey conducted in Kenya in 2015 to look at users’ reasons for accessing m4RH. The toolkit offers examples of responses which fall within the following categories: to learn about specific family planning methods, general curiosity, desire to space births, desire to delay pregnancy and protect the future, to improve general contraceptive knowledge, to correct myths and misconceptions, concern for partner, to learn about side effects, to support contraceptive choice, and to share information with others. 

A chapter on messages briefly outlines examples of family planning messages, which include implants, condoms, and personal stories; and youth messages, which include puberty, pregnancy, the definition of HIV, and stories by young people. 

In order to ensure financial sustainability, the toolkit outlines several possible approaches to managing implementation costs. These are offered as a series of financial exercises that are meant to be useful to those seeking to implement similar mHealth interventions at scale. The exercises show that, while programme costs can be high, particularly the cost of SMS fees if the service reaches scale and remains free to users, there are different options that donors, governments, and implementers of m4RH and similar SMS-based health information services have for reducing their implementation costs — either by asking users to pay or by negotiating lower SMS fees.

To guide the process for adapting m4RH for new populations, settings, and content areas, the final section of the toolkit outlines FHI 360’s 10-step content adaptation and implementation framework. The framework is based on best practices for health communication theory, design, and implementation, and globally recognised adaptation and scale-up models. It incorporates iterative communication and testing with the target audience to identify their specific information needs and ensure content is tailored to meet their needs and effectively encourage healthy behaviour. The steps are as follows and are described in more detail in the toolkit:

1. Establish mobile messaging technical working group
2. Identify priority health issues and appropriate delivery format
3. Adapt or develop content for local context
4. Review content with stakeholders
5. Test content with target audience
6. Programme technology platform in appropriate delivery format
7. Test user interface and near-final content with target audience
8. Finalise content and platform
9. Launch and promote
10. Monitoring and evaluation