Effect of a smartphone intervention on self-managed medication abortion experiences among safe-abortion hotline clients in Indonesia: A randomized controlled trial

Objective To investigate the impact of a smartphone application (app) providing information and support for medication abortion (MA) on the primary outcomes of 'feelings of support' and 'preparedness' among clients of Samsara, a safe-abortion hotline in Indonesia. Methods In a parallel-arm, non-clinical, randomized controlled trial, women (ages >= 15) who contacted Samsara between February 2017- July 2018 seeking information on MA for pregnancies <= 13 weeks gestation were randomized to receive either an app with abortion information, or standard of care (high-quality comprehensive and empathic counseling on pregnancy options). Participants completed a questionnaire 24 days after enrollment; Fisher exact tests and risk differences were used to assess differences in self-reported feelings of preparedness and support throughout the process of self-managed MA. Results No differences in feelings of support or preparedness were detected between participants in the app arm versus the standard of care arm. Conclusion This study represents the first-ever randomized control trial (and prospective study) among those who contacted a safe-abortion hotline for information about and support for self-managed abortion. Levels of preparedness, confidence, and feelings of support were all extremely high among both control and intervention arms-indicative of the high-quality, evidence-based information, comprehensive, and supportive abortion counseling that safe-abortion hotline clients receive.