Mobile Technology for Improved Family (MOTIF)

Date: February 2013 — Present
Location: Cambodia
Technology: Verboice

(Article from Marie Stopes International Cambodia)

The MOTIF project comprised the development, implementation and the evaluation of a mobile phone-based intervention using voice messages to support post-abortion family planning.

MOTIF is being evaluated with a randomised controlled trial of 500 participants. Clients aged 18 or over, attending for abortion at four Marie Stopes International clinics in Cambodia, owning a mobile phone and not wishing to have a child at the current time are randomised to the mobile phone-based intervention or control.

The intervention was developed following a review of the literature, formative research with abortion clients, and with input from clinicians and technology partners in Cambodia.

The intervention has a similar basis to the approach used by Lester (2010) in Kenya who hypothesised that a structured mobile phone protocol to keep in touch with patient could improve HIV medication adherence.

MOTIF conducted formative research comprising a review of MSIC post-abortion client case notes to estimate baseline PAFP rates, semi-structured interviews with clients, observation of current practice and focus group discussions to develop an appropriate intervention to support PAFP in Cambodia.

Despite high mobile phone uptake and usage in Cambodia, previous attempts at using SMS-based mHealth interventions have anecdotally had limited success due to the lack of techno-literacy, general illiteracy and phones not supporting Khmer script.

iLab Southeast Asia developer, Mann Lim, works with MOTIF Project Manager, Vannak, to test the Verboice system.

Client interviews indicated a clear preference for phone calls rather than SMS. MOTIF was therefore developed as a voice-based

mHealth service.  Voice messages were developed with clients and technology partners at the InSTEDD iLab South East Asia in Phnom Penh (to design call flows, message content and audio quality), BBC Media Action (to share experience of using voice messages), a local women’s radio station (to record message content) and extensively tested and refined with clients during the formative research process.


The MOTIF intervention comprises a series of automated voice messages to participants’ mobile phones over the three-month period following their abortion, at times of their preference. Clients receive the first message within a week of receiving abortion services and then every two weeks, with a total of six messages. The messages are designed to remind clients about FP methods available to them and also support clients’ experiencing side-effects from contraception. A typical message, recorded in the Khmer language, is as follows:

“Hello, this is a voice message from a Marie Stopes counsellor. I hope you are doing fine. Contraceptive methods are an effective and safe way to prevent unplanned pregnancy. I am waiting for provide free and confidential support for you with contraception. Press 1 if you would like me to call you back to discuss contraception. Press 2 if you are comfortable with using contraception and you do not need me to call you back this time. Press 3 if you would prefer not to receive any messages again”

Clients who indicate they would like to talk to a counselor, or who do not respond to the message prompts receive a call from an MSIC counselor. The counselors provide individualised information on contraceptive methods and advice if the client is experiencing side-effects from contraception. Follow up calls to clients are made during preferred times indicated by the client on her registration form. Clients in the intervention arm are also able to call the MOTIF service at any time to request to speak with a counselor. Clients who opt to receive the OC or injectable can opt-in to receive additional reminder messages appropriate to their method i.e. to start a new packet of pills or when to receive a new injection.

The MOTIF intervention is delivered by trained counsellors at the country head office in Phnom Penh. Voice messages are scheduled and sent using the open-source software programme ‘Verboice’, developed by InSTEDD iLab Southeast Asia. Verboice has functionality with all the mobile phone network operators. MSIC incurs the cost of outgoing communication from the provider to client, and clients incur any costs calling into the service (the cost of a local call). The counsellor records information on the voice messages sent, responses to messages, and outcomes of follow-up phone calls.

MOTIF hypothesise that the intervention will remind clients about contraceptive methods available, identify problems with side-effects early and providing support, and therefore increase use of post-abortion family planning, whilst reducing discontinuation and unsafe method switching.

Participants will be assessed at baseline and at four months. The primary outcome measure is use of a reliable modern contraceptive method at four months post-abortion. Secondary outcome measures include contraception use over the four-month post-abortion period, pregnancy, and repeat abortion.

MOTIF have not yet commenced follow up, but early indications are that clients appreciate the service and find the support received helpful.