Impact of a Text-Messaging Program on Adolescent Reproductive Health: A Cluster-Randomized Trial in Ghana

Abstract

Objectives: To evaluate whether text-messaging programs can improve reproductive health among adolescent girls in low- and middle-income countries.

Methods: We conducted a cluster-randomized controlled trial among 756 female students aged 14 to 24 years in Accra, Ghana, in 2014. We randomized 38 schools to unidirectional intervention (n = 12), interactive intervention (n = 12), and control (n = 14). The unidirectional intervention sent participants text messages with reproductive health information. The interactive intervention engaged adolescents in text-messaging reproductive health quizzes. The primary study outcome was reproductive health knowledge at 3 and 15 months. Additional outcomes included self-reported pregnancy and sexual behavior. Analysis was by intent-to-treat.

Results: From baseline to 3 months, the unidirectional intervention increased knowledge by 11 percentage points (95% confidence interval [CI] = 7, 15) and the interactive intervention by 24 percentage points (95% CI = 19, 28), from a control baseline of 26%. Although we found no changes in reproductive health outcomes overall, both unidirectional (odds ratio [OR] = 0.14; 95% CI = 0.03, 0.71) and interactive interventions (OR = 0.15; 95% CI = 0.03, 0.86) lowered odds of self-reported pregnancy for sexually active participants.

Conclusions: Text-messaging programs can lead to large improvements in reproductive health knowledge and have the potential to lower pregnancy risk for sexually active adolescent girls.

FIGURE 1—

Profile of Cluster–Randomized Controlled Trial of Text-Messaging Programs and Reproductive Health Among Adolescent Girls in Ghana, 2014

FIGURE 2—

Adjusted Mean and 95% Confidence Intervals of Knowledge Score at 0 (Baseline), 3 Months, and 15 Months for Interactive, Unidirectional, and Control Groups in Cluster–Randomized Controlled Trial on the Impact of Text-Messaging Programs on Reproductive Health Among Adolescent Girls in Ghana, 2014 Note. Estimates are predicted scores obtained from a linear regression of knowledge score on intervention group and adjusted for presence of home economics class, school category, age, religion, ethnicity, mother’s education, father’s education, school size, and baseline knowledge.