Mobile phone messages to provide support to women during the home phase of medical abortion in South Africa: a randomised controlled trial.
OBJECTIVE
Home use of misoprostol for medical abortion is more convenient for many women than in-clinic use but requires management of abortion symptoms at home without provider backup. This study evaluated whether automated text messages to women undergoing medical abortion can reduce anxiety and emotional discomfort, and whether the messages can better prepare women for symptoms they experience.


METHODS
A multisite randomized controlled trial was conducted in which women undergoing early medical abortion were allocated to receive standard of care (SOC) only (n=235) or SOC+a messaging intervention (n=234). Consenting women were interviewed at the clinic after taking mifepristone and again at their follow-up clinic visit 2-3 weeks later; the intervention group received text messages over the duration of this period. Emotional outcomes were evaluated using the Hospital Anxiety and Depression Scale, Adler's 12-item emotional scale and the Impact of Event Scale-Revised. Preparedness for the abortion symptoms and overall satisfaction with the procedure were assessed using 4-point Likert-type scales.


RESULTS
Between baseline and follow-up, anxiety decreased more (p=0.013), and less emotional stress was experienced (adjusted for baseline anxiety, p=0.015), in the intervention compared to the SOC group. Participants in the intervention group were also more likely to report that they felt very well prepared for the bleeding (p<0.001), pain (p=0.042) and side effects (p=0.027) they experienced. Acceptability and other negative emotions relating to the abortion did not differ between study groups. Ninety-nine percent of the intervention group stated that they would recommend the messages to a friend having the same procedure.


CONCLUSIONS
Text messages to women following mifepristone administration for early medical abortion may assist them in managing symptoms and appear highly acceptable to recipients.


CONCLUSIONS
This randomized controlled trial provides evidence for the effectiveness of text messages following mifepristone administration in strengthening medical abortion care. The messages were associated with significant reductions in women's anxiety and stress during the abortion process; they improved preparedness for the abortion symptoms experienced and appeared highly acceptable.
Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, South Africa; Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, South Africa. Electronic address: deborah.constant@uct.ac.za.
Deborah
D
Constant
Cell-life, Cape Town South Africa.
Katherine
K
de Tolly
Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, South Africa.
Jane
J
Harries
Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, South Africa.
Landon
L
Myer
D000021:Abortifacient Agents, Steroidal / Q000008:administration & dosage; D000028:Abortion, Induced / Q000009:adverse effects* / Q000193:education / Q000523:psychology; D000278:Administration, Buccal; D000286:Administration, Sublingual; D000328:Adult; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057194:Intention to Treat Analysis; D059012:Lost to Follow-Up; D015735:Mifepristone / Q000008:administration & dosage; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011247:Pregnancy; D012646:Self Administration; D012648:Self Care / Q000523:psychology; D012944:Social Support; D013019:South Africa; D013315:Stress, Psychological / Q000209:etiology / Q000517:prevention & control*; D060145:Text Messaging; D014504:Urban Health; D055815:Young Adult
D000021:Abortifacient Agents, Steroidal; D015735:Mifepristone
Acceptability; Medical abortion; Mental health; South Africa; Text messaging