title: Assessment of completion of early medical abortion using a text questionnaire on mobile phones compared to a self-administered paper questionnaire among women attending four clinics, Cape Town, South Africa.
abstract: In-clinic follow-up to assess completion of medical abortion is no longer a requirement according to World Health Organization guidance, provided adequate counselling is given. However, timely recognition of ongoing pregnancy, complications or incomplete abortion, which require treatment, is important. As part of a larger trial, this study aimed to establish whether women having a medical abortion could self-assess whether their abortion was complete using an automated, interactive questionnaire on their mobile phones. All 469 participants received standard abortion care and all returnees filled in a self-assessment on paper at clinic follow-up 2-3 weeks later. The 234 women allocated to receive the phone messages were also asked to do a mobile phone assessment at home ten days post-misoprostol. Completion of the mobile assessment was tracked by computer and all completed assessments, paper and mobile, were compared to providers' assessments at clinic follow-up. Of the 226 women able to access the mobile phone assessment, 176 (78%) completed it; 161 of them (93%) reported it was easy to do so. Neither mobile nor paper self-assessments predicted all cases needing additional treatment at follow-up. Prediction of complete procedures was good; 71% of mobile assessments and 91% of paper assessments were accurate. We conclude that an interactive questionnaire assessing completion of medical abortion on mobile phones is feasible in the South African setting; however, it should be done later than day 10 and combined with an appropriate pregnancy test to accurately detect incomplete procedures.
authors.affiliation: Researcher and Principal Investigator, Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town (UCT), South Africa. Electronic address: deborah.constant@uct.ac.za.
authors.forename: Deborah
authors.initials: D
authors.lastname: Constant
authors.affiliation: mHealth Project Manager and Senior Researcher, Cell-life, Cape Town South Africa (at the time of this study).
authors.forename: Katherine
authors.initials: K
authors.lastname: de Tolly
authors.affiliation: Director, Women's Health Research Unit, School of Public Health and Family Medicine, UCT, South Africa.
authors.forename: Jane
authors.initials: J
authors.lastname: Harries
authors.affiliation: Head, Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, UCT, South Africa.
authors.forename: Landon
authors.initials: L
authors.lastname: Myer
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage; D000028:Abortion, Induced / Q000379:methods / Q000523:psychology*; D000328:Adult; D000554:Ambulatory Care Facilities; D040421:Cell Phone; D005260:Female; D006801:Humans; D016595:Misoprostol / Q000008:administration & dosage; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011247:Pregnancy; D057566:Self Report; D013019:South Africa; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol
keywords: South Africa; follow-up; medical abortion; mobile phones; self-assessment of complete abortion; text messaging