K4Health Is Using Interactive Voice Response Technology to Train Kenya’s Health Workforce on Family Planning
These days, many of us are glued to our mobile phones. We use them for texting, looking up directions, playing word games, or listening to music. Using them to talk seems secondary. Mobile phones have become the one thing we can’t seem to live without.
We are not alone. According to GSMA, there are more than 7.7 billion mobile phone subscriptions worldwide—a number that is growing rapidly. In Kenya, for example, the mobile market has grown significantly over the last few years with coverage increasing to 96% of the population. The increase in mobile operators over the last two years has contributed to a decrease in mobile phone prices.
Capitalizing on the spread of mobile phones and the growing capability of mobile technology, K4Health is implementing a program in Kitui, Kenya, to support refresher family planning training for students and health workers. We are excited to see this program implemented to experience firsthand how adapting content for mobile learning in Kenya can hit those triggers— reaching health workers with critical family planning information they need to improve reproductive health services.
K4Health has a large repository of global family planning and reproductive health technical content, including eLearning courses, toolkits, journal articles, and more. For the past year and a half we’ve been looking into ways to adapt our global content to platforms that can reach health program managers and health providers that have limited access to our online content. One popular solution we found is Interactive Voice Response (IVR), which allows content to be sent as an audio recording via a phone call to a user’s mobile phone.
The training we designed is based on the Spaced Education learning methodology, which requires participants to answer 20 questions on family planning methods and counseling correctly twice in a row. The questions were selected from the final exams of two Global Health eLearning (GHeL) Center courses—Family Planning 101 and Family Planning Counseling. IntraHealth’s Kenya Office staff created the audio recordings to ensure the training was delivered in a Kenyan English dialect and accent. As for the technology platform, we adapted InSTEDD’s Verboice platform with custom code to fit our activity design and paired it with Callcentric, an affordable internet phone service.
A number of factors went into selecting health providers and students from Kitui, Kenya, as the implementation site. According to Kenya’s Demographic Health Survey 2014, unmet need for family planning is at 18% of currently married women and 31% of family planning users discontinue use after 12 months of starting its use. The third highest number of GHeL learners are from Kenya, and the country’s medical education system has been very supportive of distance learning approaches. Also, the Kenya Medical Training College (KMTC) in Kitui is known as the Center for Family Planning Excellence. Many students, after matriculation, go on to work at the District Hospital of Kitui, located adjacent to the college, and many of the lecturers at KMTC also practice at the hospital.
Phones for Learning
During a recent evaluation of the IVR Training activity, we were able to visit Kitui, Kenya, and hear firsthand how participants in the training felt about using their mobile phones for the course.
From the 76 participants who completed the usability survey, 42 said they were motivated to participate in the training because they were interested in learning more about family planning. When it came to using their phone to receive the training, 29 participants found it easy, while 35 found it very easy.
Janet Muli, a Diploma in Nursing student in her second year, told us, “I liked the mobile learning because, one thing, it is not expensive. You only send a request that you are ready to answer. They call you, they give you an explanation of a certain question. They are using simple language to explain to you. Even you can call at anytime when you’re free. You’re not limited in time. That’s the good thing about the Family Planning Counseling [training].”
Justina Muthoni Kamau, also a second year Diploma in nursing student, talked to us about why she was first interested in participating in the IVR training: “I come from a home background where people just give birth. I wanted to explore more on how I will help them, reach out to them and maybe advise them on spacing. And I wanted to learn more about the [contraceptive] methods.”
After completing the training, she “feels more confident because I know the content. I feel like I’m a step ahead of others.”
Perhaps one of the most interesting findings was that mobile phones are the most popular way of accessing information online. Both students and staff at the nearby hospital talked about using their phones to search the Internet, which they found preferable to using a computer. Phones are cheaper and easier to carry and charge than a laptop.
One key finding was that participants wanted to learn how to better search for information online. “I want to know where to go to find accurate, up-to-date information on family planning,” said one participant. “Such as what is supported by the WHO or not. I just Google and don’t know if what turns up is correct.”
Youth and Family Planning
Many of the enthusiastic participants in the IVR Training are students—youth who are training to be nurses, midwives, and health officers. Family planning knowledge is important for them, not just so they can counsel and provide services to clients, but also so they are better prepared to make their own informed family planning choices.
When we talked with students during focus group discussions about why they were taking the course, several said it was for their own knowledge.
“I want to know my own options for family planning. I want to be able to talk to my friends about family planning,” said one participant. He was quite serious about how to support his own community to make decisions about family size. “Many people are having 5 and 6 children. This is too many,” he said.