# Estimating the impact of Viamo call-in information services on sexual and reproductive health knowledge, behavior, and outcomes among women of reproductive age: A 2-arm open label randomized controlled trial in Uganda

## TL;DR

This study tested a call-in service in Uganda to improve reproductive health knowledge and behaviors among women, finding small but positive effects on knowledge and iron supplementation.

## Contribution

The study provides empirical evidence on the effectiveness of call-in services for improving sexual and reproductive health knowledge in low-resource settings.

## Key findings

- The call-in service increased sexual and reproductive health knowledge by 0.07 standard deviations.
- The treatment increased iron supplementation among recently pregnant women by 4 percentage points.
- The program had mixed effects on secondary outcomes like diet and family planning but no impact on hemoglobin or BMI.

## Abstract

Despite substantial increases in access to schooling and to the internet, health information and knowledge remains limited among women of reproductive health in many low- and middle-income countries. Given the near universal cell-phone coverage in low- and middle-income countries, call-in services offer an interesting new platform to provide high quality information to targeted populations. In this paper, we assessed the impact of the Viamo 3-2-1 call-in platform on health knowledge and behavior among women of reproductive age in Uganda.

We conducted a 2-arm open label randomized controlled trial targeting 6000 women, ages 18–49 years, with access to a simple feature Airtel cell phone in Uganda. Fifty enumeration areas were randomly selected in Kampala, Madi-Okollo, Rwampara and Katakwi districts for a total of 200 enumeration areas. Consenting women were asked to complete a baseline and endline survey implemented by trained interviewers using tablets through home visits. After completion of baseline, women were randomized with equal probability to treatment and control using a tablet-generated random number draw. Study staff introduced treated women to the call-in service and encouraged its use through various incentives and promotional messages. Primary outcomes were sexual and reproductive health knowledge scores as well as iron supplementation in pregnancy. Secondary outcomes included self-reported use of contraception, healthy diets, birth spacing and birth outcomes as well as hemoglobin levels and BMI. Linear regression models were used to estimate mean differences in outcomes between treatment and control. Standard errors were corrected for the cluster-based sampling of women.

A total of 6,011 women were enrolled into the study between December 6, 2022 and February 11, 2023; 3,052 were assigned to treatment, 2,959 used as controls. Endline data was collected between May 8, 2024 and August 4, 2024. Overall follow-up rates were 92% in both the treatment and the control group. Treatment increased average sexual and reproductive health knowledge by 0.07 standard deviations (95% CI [0.01, 0.11], p-value = 0.02) and increased the likelihood of taking iron supplements by 4% pts among recently pregnant women ([0.003, 0.08], p-value 0.04). Results for secondary outcomes were mixed, with positive changes for nutritional intake and family planning behaviors and intentions and no impact on hemoglobin levels and BMI. No adverse events or outcomes were reported.

The results of this trial suggest that access to call-in services can increase health knowledge and to some extent also health behaviors. Longer and more intensive program exposure may be needed to yield measurable changes in reproductive outcomes and nutritional status.