Plain English summary
Background
Methods
1. MOTIF mobile phone-based service
|
You recently used the new Marie Stopes mobile phone post-abortion service. Could you please tell me about your experience of the service? |
a. Voice Messages (outgoing)
|
I would like to hear your experience regarding the voice messages. |
• Tell me what it was like when you received the VMs? • What did you think about the VMs? / How did it make you feel? • Can you remember what were you told about the VMs when you signed up? |
POSSIBLE PROMPTS |
i. How many voice messages did you listen to? ii. Do you recall what the voice messages said? iii. What was your understanding of the VMs? iv. What were you doing at the time you received the VMs? v. Any comments about the sound quality / voice of the message? vi. What did you expect to happen if you pressed ‘1’, ‘2’ or ‘3’? vii. Did you respond to the VM? |
1. If so, what number did you press, and why? |
viii. Did anyone else listen to the VM instead of you? |
1. Any consequences of this? |
b. Pill/injection reminders (if relevant)
|
i. Did you receive any pill or injection reminder VMs? |
1. If so, what was your experience of this? |
c. IVR system and leaving messages (incoming)
|
i. Did you ever call into the service? |
1. If so, what was your experience of this? |
d. Counselling
|
• Did you receive any direct phone calls from the counsellor? |
If yes, |
• What was it was like when you spoke to the counsellor? • What did you think about speaking to the counsellor? / How did it make you feel? |
POSSIBLE PROMPTS |
i. What kind of information were you given from the counsellor? ii. What support do you receive about post-abortion care? (E.g. medical, emotional) iii. What information were you given about contraception? iv. What did you think about any advice you were offered about contraception? Any conflict with clinic service provider advice? v. Any counsellor contact with husband/partner, any links with model clients vi. Where do you think the counsellor is based? Do you think she is old or young? Would like to see her picture before participating in the service? |
2. Support/change in behaviour/unintended consequences from intervention
|
• In general, (thinking about VMs and counselling), did anything happen to you as a consequence of receiving the service (positive of negative)? OR did you do anything different? • How would this compare to if you hadn’t received the service? |
POSSIBLE PROMPTS |
i. Any support with SE’s/ to continue using method? ii. Any support starting or switching to a new method iii. Clinic attendances for check up’s/post-abortion follow up appointment avoided? Any time/money saved? iv. Use other services in addition to MSI? Why? v. Any suggestions for the service? |
Would anything else have worked better for you? Would you recommend it to a friend seeking abortion services? |
POSSIBLE PROMPTS |
• Length of service, voice messages versus direct calls etc. • How could we make it more likely for you to listen and respond to VM? • Would you be prepared to pay an additional fee for the service? If so, how much? |
3. Views on trial
|
• What was your experience of participating in the trial? |
POSSIBLE PROMPTS: |
a. Any comments on the recruitment process (information for participants, consent)? b. Any comments on phone follow up? c. Any comments on reimbursement to cover time/costs for interviews? d. Any suggestions for improvement? |
Can I finally ask you for any final comments that have not been covered in this interview? |
Results
No. | Age | Occupation | Marital status | Residence | Post-abortion contraception use |
---|---|---|---|---|---|
1 | 22 | Housewife | Married or living together | Urban | Used oral contraceptive post-abortion |
2 | 31 | Employed | Married or living together | Urban | Didn’t use PAFP then had IUD inserted after repeat abortion |
3 | 30 | Self-employed | Married or living together | Urban | Returned to clinic for IUD insertion |
4 | 24 | Housewife | Married or living together | Rural | Used oral contraceptive post-abortion but discontinued as husband working away. Sent oral contraceptive reminder message |
5 | 33 | Housewife | Married or living together | Urban | Used IUD post-abortion |
6 | 34 | Self-employed | Married or living together | Rural | Returned to clinic for implant insertion |
7 | 34 | Self-employed | Married or living together | Urban | Returned to clinic for IUD insertion |
8 | 34 | Factory worker | Married or living together | Rural | Used oral contraceptive post-abortion but discontinued as husband living away |
9 | 25 | Student | Married or living together | Rural | Advised to have abortion for medical reasons and avoid pregnancy for a year; using oral contraceptive. Sent oral contraceptive reminder message |
10 | 25 | Factory worker | Married or living together | Rural | Returned to clinic for IUD insertion |
11 | 22 | Student | Married or living together | Urban | Using oral contraceptive. Sent oral contraceptive reminder message |
12 | 20 | Student | Never married or living together | Urban | Using oral contraceptive |
13 | 38 | Self-employed | Married or living together | Urban | Used oral contraceptive post-abortion then had IUD inserted |
14 | 41 | Farmer | Married or living together | Rural | Used implant post-abortion |
15 | 25 | Entertainment worker | Never married or living together | Rural | Not using contraception as not in relationship |
Communication by mobile phone
“Sending voice message wasn’t the disturbance because if we wanted to talk to her, we just talked and if we didn’t want to talk, we just pressed number 2 or 3 if we didn’t want her to call us, she would stop calling us” (interview 11)
“I think that pressing number 1 or number 2 is better because when I face problem, I just press number 1 or number 2… That’s why it is quite important for me” (interview 9)
“These messages help a lot-especially for those who live far away from here like me. Because of busy, I might forget to use contraception methods, but when I listen to voice messages, I can remember. If do not want to have pregnant, I just listen to it. Voice messages always remind me…Whenever I listen to voice messages, I feel like someone stays next to me and supports me about using contraceptive methods” (interview 9)
“Counseling via phone call gives advantage…because we don’t have to come to PET [health worker], spend money to clinic directly, and we discuss with her and if we don’t discuss with her and we have to come to PET, we spend money first for travel fee and second for PET fee” (interview 6)
“The message just tell me to click one or two for answer… at that time I still work but if I’m busy, it’s ok but sometimes when I’m very busy and like stress and sometimes it’s annoying” (interview 2)
Supporting contraception use
“She explained even about drug, IUD/implant, injection, oral pill, and IUD, and condom. She explained all. She told me a lot” (interview 5)
“The message ended and a short while, she would call me back… I asked her that, for example, we forgot to take the pill… What should I do if [I] forgot taking till 3 days?” (interview 11)
“After I got information from counsellors I then went to clinic to insert IUD…I learnt how to insert IUD and taking pills. Inserting of IUD is much more easier. Talking pill has to be on time and take it daily but for IUD we do not have to do like this. We can have sex whenever! Counselling service made me feel confident because I thought that medical science is better than our thought. Some people said that IUD can move around, but when I came to ask counsellor, she said that IUD did not have legs to move around…. I also told people I know to insert IUD as well” (interview 10)
“She explained me to have contraception here, use implant at this clinic, there was discount” (interview 6)
“She said that the side effects of IUD lasted 3 months, I remember that. And after these 3 months, our body can tolerate with it, it will be alright…and now I am alright” (interview 3)
“I was confident because she said that when we took the pill, we had to take regularly. If we didn’t take the pill regularly, it was possible to be pregnant… so I changed my habit according to her” (interview 1)
Broader post-abortion care
“For that voice message that I received, I think that it’s good. It’s good and like makes me feel warm like there’s someone take care about us” (interview 8)
“When I received that voice message, I felt that… she encouraged me and she loved our health so that she wanted to know about our health if we were healthy” (interview 12)
“Struggle in my life, because sometimes I want to commit suicide, but counsellor not allow me to do this, they encourage me to be strong” (interview 15)
“After I used medicine I asked her my problem “why around my abdominal still painful? Why I cannot do something? Even just walking, I cannot walk”. Counselor said that bleeding it just side effect of medicine, but if you has much bleeding you need to go back to clinic. I followed up myself and I found that there was just small bleeding, so I decided not coming to clinic” (interview 9)
“If I make comparison, I see a lot of changing. Before I seldom to hear information, by the time I have started to use services here, I can consult at anytime and I know more about illness problem that often happen to women and its prevention” (interview 9)
Interaction with family and friends
“The reason why I believe her because she encouraged me that she wouldn’t tell other about my secret and what she talked with me she kept in secret…I believe that they can help a lot of other women, sister, because woman is shy, and sometimes she can’t talk to other… it just sometimes we felt embarrassed. There’re some matters that we don’t want other to know” (interview 12)
“Sometimes there was my mother; I didn’t want to talk because I was shy and I didn’t want her to know. But if I stayed with my family, my couple, there was no problem. But sometimes…he didn’t stay with me every time, but we didn’t want like questioning words like I was sick like this or like that I didn’t want to talk in front of my mother, and my younger siblings. But she called me when I was alone or with my family, I would talk and there was no problem” (interview 8)
“No one listens to my voice messages because my phone stays with me all the time. Even my husband, he also does not hack and listen alone. When new message coming, my husband told me… Moreover my husband always asks me questions when I finished listen to messages because he concerns much about my health condition” (interview 9)
“I never let anyone listen to it but I brought my younger sister who wanted to use IUD like me. I always told her that I felt well” (interview 3)
Suggestions for improvement
“I do not have any request because it is good enough already. I rarely to see services like this in others organization” (interview 9)
“I want direct phone call… I am not interested in voice message at all because it takes long time, but if you call me, I once pick up the phone call” (interview 1)
“Text message. Sometimes when I go bathroom when comeback, I can see message rather than missed call.” (interview 15)
“There was a message said that this message was the last message. To me, when the message said that it was the last message, I felt regret and I didn’t want” (interview 3)
“Sometimes I don’t know in the future I will meet what problem, sister, so I am difficult to call her. When she sends voice message to me, she has my number and that number is easy for me to call to ask her too” (interview 12)
“We go to small pharmacies, we have to spend the money too; therefore, I don’t mind about paying this amount. This is for our health too” (interview 3)
“I am interested in general health short voice messages if we send you weekly? For example, messages tell you how to prevent from diseases, how prevent from pregnancy, STI and so on…I want these services still providing for long period” (interview 14)