Influence of mHealth Short Message Service Utilization on Risky Sexual Behaviour among Adolescents in Homa-Bay County, Kenya.
Muhonja, Faith Hope
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Adolescents’ Risky Sexual Behaviours (ARSB) is a global public health concern as it is second among the top ten risk factors in the global burden of all diseases. It is estimated that 60% of adolescents in Homa-Bay County begin early sexual debut with 62% multiple sexual partners and low condom use. Consequently, Homa-Bay County has poor indicators of Adolescent Sexual and Reproductive Health (ASRH). Adolescent pregnancy rate is 38% and contributes 11.5% of adolescents 10-19 years living with HIV in Kenya. mHealth technology has exhibited positive Risky Sexual Behaviours (RSB) change however, it has not been optimized in the present Homa-Bay County. This study sought to assess the influence of mHealth SMS intervention on risky sexual behaviours among adolescents 15-19 years in Homa-Bay County, Kenya. Study design was experimental, Randomized Control Trial (RCT). A computer-based randomization of 28 villages/clusters was conducted and assigned to either control or treatment group at a ratio of 1:1 for a period of 6 months. A sampling frame of 1480 was generated and a sample size of 612 computed. Participants were randomly assigned to either the treatment group or control group at a ratio of 1:1. mHealth intervention was a 3 weekly interactive alert quiz text messages on ASRH. Ethical and logistical clearance was sought from relevant institutions. Data collection tools were questionnaire and key informant interview guide. Data analysis tools were Ms-Excel and Stata V 14 and thematic content analysis. Descriptive statistics was used to determine the prevalence of RSB, attitude and knowledge level. Logistic regression was used for inferential statistics (Pearson’s’ Chi-square, Fisher’s exact, Odds Ratio (OR), at a 95% Confidence Interval, C.I.) were used to determine association. The study recorded an overall RSB of 242(67.9%) at pre-test and 194(64.8%) at post-test. There was a significant association between mHealth SMS intervention and RSB (O.R.=1.728; C.I.=0.57-3.81; P=0.027; χ2=66.72). mHealth SMS showed an association with sexual activity (O.R.=1.031; C.I.=0.38-1.45; P=0.045; χ2=7.45) and condom use (O.R.=1.260; C.I.=0.93-1.19; P=0.037; χ2=23.18) but not on sexual partners and sex under drug/alcohol influence (P>0.05). Apart from sex (O.R.=2.016; C.I.=0.23-1.16; P=0.008) age (O.R.=1.033; C.I.=0.61-3.32; P=0.043) other factors showed no significant association (P>0.05) with RSB. Overall level of positive attitude towards RSB at pre-test was 79(22.1%) and 73(24.1%) at post-test. There was an association between mHealth SMS and adolescents’ attitude towards RSB (O.R.=1.916; C.I.=0.78-3.82; P=0.003; χ2=27.92). mHealth SMS had a positive influence on sexual activity P=0.075, safe sex P=0.033 and sexual partners P=0.009 but not on alcohol/drugs P=0.214. Overall score of ASRH knowledge was 131(36.7%) at pre-test and 124(40.9%) and post-test. There was an association between mHealth SMS and ASRH knowledge (O.R.=1.357; C.I.=0.16-2.79; P=0.004; χ2=34.26). mHealth SMS had a positive influence on conception & pregnancy P=0.034, condom use P=0.048 and HIV/AIDS/STI’S P=0.042 but not on contraceptives P=0.977. The study recommends public health policy makers to develop guidelines on mHealth SMS on ASRH education.