Measuring the Effect of Different Modes of Mobile Phone-Based Antenatal Family Planning Counseling on the Intention for Early Postpartum Family Planning Uptake in Western Kenya: A Pragmatic Factorial Randomized Control Trial

Abstract

INTRODUCTION: The Maternal and Child Health care continuum offers a key opportunity to integrate postpartum family planning (PPFP) interventions, particularly through antenatal counseling. This study assessed the impact of mobile phone-based antenatal family planning counseling on the intention for early PPFP among postpartum mothers in Western Kenya. METHODOLOGY: This pragmatic factorial randomized controlled trial assessed the effectiveness of family planning counseling delivered by nurses and community health workers using a mobile phone-based tool, compared to routine counseling, on the intention for early postpartum family planning among postpartum mothers in Kisumu County, Western Kenya. Ordinal regression identified predictors of intention, while ANOVA evaluated the effectiveness of counseling modalities, with significance set at P < 0.05. Tukey’s post hoc test and partial eta² were used to determine differences between study arms and effect size, respectively. RESULTS: The mean intention for early PPFP on a 7-point Likert scale was 6.59±0.87 for the nurses’ arm, 6.05±0.86 for the community arm, and 6.03±0.69 for the control arm. ANOVA revealed a significant difference in mean intention scores between the arms (F(2,243)=12.43, P<0.0001). Tukey’s post hoc test showed significantly higher mean intention in the nurses’ arm compared to both the community (P<0.0001) and control arms (P<0.0001) with a medium effect size (partial eta² = 0.06 to <0.14). The combined mean intention for the two intervention arms (6.22±0.85) was significantly higher than the control arm (P=0.012) with a small effect size (partial eta² = 0.026). There was no significant difference between the community and control arms (P=0.986).CONCLUSION: Mobile phone-based antenatal family planning counseling by nurses was more effective in increasing intention for early postpartum family planning for participants in Kisumu County compared to community-based and routine delivery of counseling. Therefore, more efforts should be directed toward empowering nurses with mobile phone-based antenatal family planning counseling tools to enhance intention for early postpartum family planning.