The document summarizes the formative research conducted for CycleTel, a mobile health service in India that uses text messages to facilitate use of the Standard Days Method for family planning. The research included focus groups, cognitive interviews, and manual testing with 88 women in India. Results showed high satisfaction, ease of use, and correct use of the method. The research helped design an improved service and identified attributes and a pricing model for users. Partnerships were important across the different stages of the project from formative research to piloting to public launch.

1. 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

2. 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?

3. A:
Our research in India on CycleTel
suggests “yes.” Let me tell you more.

4. The Standard Days Method® (SDM):
A Direct-to-Consumer Approach to Family
Planning
SDM 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

5. CycleTel™
Family Planning on the Mobile Phone
 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

6. Model: Formative Research to Scale
Product
Launch
Partnership & Scale
Development up
Business
Planning Planned 2012
Planned
2012
Automated Jan-Feb „12
Testing
Proof-of-
Jul „11-Jan „12
Concept
Sep ‟09 – Jul „11

7. Structure of CycleTel Proof-of-Concept
3 Phases Objectives
Focus Group  Understand phone use patterns
 Determine potential interest among target
Discussions audience
54 participants  Explore appropriate messaging and preferences
for the service
Cognitive Interviews  Verify comprehension of messages
18 participants  Adapt and finalize messages (in English &
Hinglish)
Manual Testing  Enroll women for 2 cycles to assess feasibility,
26 women in Lucknow satisfaction and correct method use
21-28 years old, housewives  Initially used a low-cost open source software to
manually send/receive messages (FrontlineSMS)
88 women in New Delhi  Troubleshoot problems and determine how to
24-33 years, working women improve service
 Determine target audience

8. 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

9. Completion Rates
90
80 88 82 84 80
70
# of Participants
60
50
40
30
20
10 10
0
Enrolled 1st Follow-up 2nd Follow-up Female Exit Male Exit

10. Results: Satisfaction, Ease of Use, Correct Use
100% of users would
Satisfaction & 92% were very satisfied
recommend the service to
Ease of Use with CycleTel to prevent friends
pregnancy Features users liked the
most: ease of
98% said it was easy to
use, convenience, lack of
send/receive SMS
side effects
95% participants reported that they received SMS at an
appropriate time and that the # of messages sent were the
“right amount”
37% of participants 22% reporting having
Correct Use
called the helpline unprotected sex during an
during the 1st cycle of unsafe day during the 1st cycle
use, 15% called during of use; this decreased to 13%
during the 2nd cycle of use
the 2nd cycle of use

11. Results: Male Involvement & Willingness to
Pay
23% expressed interested in
Male 76% said it was easy to
having their husband
Involvement tell their husband that it
receive unsafe day alerts
was an unsafe day.
too
About 70% of women reported showing their husbands
messages from CycleTel
83% of users said that they would be willing to
Willingness
to Pay pay on average Rs. 33 per month for the
CycleTel service, ranging from Rs. 15-400 (US
$1 = Rs. 45)

14. 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

15. 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.

16. A Note on Partnerships
FORMATIVE RESEARCH
 Lead org. – IRH
 Research Agency
 FrontlineSMS PILOT TESTING
 Donor - USAID  Lead organization – IRH
 Technology partner –
ThoughtWorks
 SMS Gateway Provider – Unicel
 Hosting Provider PUBLIC LAUNCH & SUSTAINABILITY
 Call Center – ISHP
 Research Agency  Lead organization – IRH?
 Donor - USAID  Technology partner
 Aggregators/Mobile operators
 SMS Gateway Provider
 Hosting Provider
 Call Center
 Data Management Organization
 Marketing Agency
 Regulatory Authorities
 Donor(s)

17. CycleTel ™
Family planning via
SMS
For more information, contact Meredith Puleio at mp447@georgetown.edu or visit
www.irh.org