The Value of Formative Research & Partnerships in mHealth: The Experience of CycleTel™ in India CORE Group May 1, 2012 Susana Mendoza Birdsong Institute for Reproductive Health, Georgetown University
Nov 29, 2014
The Value of Formative Research & Partnerships in mHealth:
The Experience of CycleTel™ in India
CORE GroupMay 1, 2012
Susana Mendoza BirdsongInstitute for Reproductive Health, Georgetown University
Q: Can we leverage the growing telecom industry and ubiquity of mobile phones to expand access to and address unmet need for family planning in India?
A: Our research in India on CycleTel suggests “yes.” Let me tell you more.
The Standard Days Method® (SDM): A Direct-to-Consumer Approach to Family
PlanningSDM IS WELL-POSITIONED FOR DIRECT-TO-CONSUMER APPROACHES Knowledge based Does not require a visit to a provider
(for initiation or re-supply) Easy to teach & learn
VALUE PROPOSITION As a new FP method, SDM is not yet
widely available Direct-to-consumer approaches
expand access to SDM thru avenues outside of health services
What? A mobile health service that
uses text messaging to facilitate use of SDM
Unique: Goes beyond unidirectional provision of health information
How? Alerts woman of her fertile
days via SMS during each menstrual cycle
Requires a woman to send in the start date of her period each cycle
Where? Tested and built in India
CycleTel™Family Planning on the Mobile
Phone
Proof-of- Concept
Automated Testing
Business Planning
Partnership Development
Product Launch & Scale up
Model: Formative Research to Scale
TECHNOLOGY DEVELO
PMENT & ITERATION
PARTNERSHIPS
Sep ’09 – Jul ‘11
Jul ‘11-Jan ‘12
Jan-Feb ‘12
Planned 2012
Planned 2012
Structure of CycleTel Proof-of-Concept
3 Phases Objectives
Focus Group Discussions54 participants
Understand phone use patterns Determine potential interest among target
audience Explore appropriate messaging and
preferences for the service
Cognitive Interviews18 participants
Verify comprehension of messages Adapt and finalize messages (in English &
Hinglish)
Manual Testing 26 women in Lucknow 21-28 years old, housewives
88 women in New Delhi 24-33 years, working women
Enroll women for 2 cycles to assess feasibility, satisfaction and correct method use
Initially used a low-cost open source software to manually send/receive messages (FrontlineSMS)
Troubleshoot problems and determine how to improve service
Determine target audience
Profile of Delhi Phase Participants
Age: 24-33 years; mean age 28.4 yrs
Education: Bachelors degree and above
Employment: 97% employed (either full time or part time)
Children: 97% had children, 52% had 1 child, 48% had 2 children
Current use of FP: 77% were using condoms inconsistently; others were either not using any method or using traditional methods
Mobile phone use: All participants owned a personal mobile phone;15% reported sharing their cell phone with someone regularly
0
10
20
30
40
50
60
70
80
90
Enrolled 1st Follow-up 2nd Follow-up Female Exit Male Exit
88 82 84 80
10
# o
f Par
tici
pan
tsCompletion Rates
Results: Satisfaction, Ease of Use, Correct Use
100% of users would recommend the service to
friends
Satisfaction & Ease of
UseFeatures users liked the
most: ease of use, convenience, lack of side
effects
98% said it was easy to send/receive SMS95% participants reported that they received SMS at an appropriate time and that the # of messages sent
were the “right amount”
92% were very satisfied with CycleTel to prevent pregnancy
22% reporting having unprotected sex during an unsafe day during the 1st
cycle of use; this decreased to 13% during the 2nd cycle
of use
Correct Use37% of participants called the helpline
during the 1st cycle of use, 15% called
during the 2nd cycle of use
Results: Male Involvement & Willingness to Pay
Willingness to Pay
83% of users said that they would be willing to pay on average Rs. 33 per
month for the CycleTel service, ranging from Rs. 15-400 (US $1 = Rs. 45)
23% expressed interested in having
their husband receive unsafe day alerts too
76% said it was easy to tell their husband that it was an unsafe
day.
Male Involvement
About 70% of women reported showing their husbands messages from CycleTel
“My husband is very
shy, every time we
go to the doctor, he
sits outside and I
talk. CycleTel has
provided us an easy
solution at home.”
-Female
“I received all messages on time. I
appreciate the reminder messages
because I may get
busy and forget, but CycleTel never
forgets.” - Female
“I would recommend
CycleTel to my friends
because it’s a completely
easy method. Anyone can
benefit from it. One can get
all the important
information sitting at
home.”
- Female
Using Research Results to Design the Innovation
Confirmed timing and frequency of messages Identified messages that could be improved
based on user-feedback Confirmed need for a call center Identified issues with the service’s functionality
(e.g., some women had issues with the screening questions and we are exploring other options to improve the experience)
Determined that men do not necessarily want to receive the messages, but some would like to have the option
Determined attributes of the service (e.g., ease of use, no side effects, confidential) that could be used in marketing campaigns
Key Takeaways: Value of Formative Research
Proof-of-concept results and user-feedback were critical to design and develop a service that met the needs of the target population.
There are low-cost open source platforms available (e.g., FrontlineSMS) that can help an organization test a concept.
Only with proof-of-concept results did IRH move forward with investing in technology development.
A Note on PartnershipsFORMATIVE RESEARCH Lead org. – IRH Research Agency FrontlineSMS Donor - USAID
PILOT TESTING Lead organization – IRH Technology partner –
ThoughtWorks SMS Gateway Provider – Unicel Hosting Provider Call Center – ISHP Research Agency Donor - USAID
PUBLIC LAUNCH & SUSTAINABILITY Lead organization – IRH? Technology partner Aggregators/Mobile operators SMS Gateway Provider Hosting Provider Call Center Data Management
Organization Marketing Agency Regulatory Authorities Donor(s)
Family planning via SMS
CycleTel™
For more information, contact Meredith Puleio at [email protected] or visit www.irh.org