Development of an intervention to support reproductive health of women after seeking medical abortion in Cambodia

The aims of this partnership are to: (1). Develop a long-term research collaboration between the London School of Hygiene and Tropical Medicine (LSHTM) and the School of Oriental and African Studies (SOAS) in field of mobile/digital health (delivering health care via mobile phones) in low and middle-income countries (LMICs), particularly in South-East Asia. (2). Conduct a joint research project between LSHTM and SOAS to study reproductive health after seeking induced abortion for unintended pregnancy and mobile phone use among factory workers in Cambodia from holistic medical, cultural, and information-sharing practices perspectives; (3). Integrate project-based qualitative methods (such as interviews and focus groups) used in the medical field with the long-term orientated ethnographic (observational) methods and language approaches from the humanities, to better understand the socio-cultural implications of digital technologies in healthcare in LMICs.

Understanding Cambodian female factory workers reproductive health needs after medical abortion (MA), together with understanding how people seek information, share information and use mobile phones could help inform the development of a relevant and highly used intervention to support comprehensive post-abortion care (such as support for side-effects or health issues and contraception use). In order to do so, however, it is necessary to understand (1). Women's current behaviours in information seeking and sharing; (2). The way in which people currently use mobile phones, and how they fit within off-line practices of information sharing; (3). Cultural challenges around reproductive health, both also mobile phones; (4). Linguistic challenges around mobile phone use, e.g. language input, or oral versus written practices. A partnership between LSHTM, with medical expertise, SOAS, whose specialisation is on socio-cultural and language aspects of mobile phone communication in Asia, and Marie Stopes International, a Non-Governmental Organisation long involved in the field and active in Cambodia, would allow understanding of the situation, challenges, and potential solutions from a truly holistic perspective.

The partnership will involve activities in the UK and Cambodia with the following goals:
(1): In London, develop research collaboration between LSHTM, SOAS, and Marie Stopes in the field of Digital Health and in the context of South-East Asia through (a) inter-disciplinary Digital Health research seminars, to be held monthly at LSHTM and SOAS, about themes arising from the research project and open to staff, students and NGOs (specifically this will involve the expansion of the LSHTM eHealth group (http://ehealth.lshtm.ac.uk/) to SOAS with a new name and website e.g. a "Bloomsbury Digital Health group"); (b) collaboration between PhD and MSc/MA students at the respective organisations by involving them on the research project and seminars; (c) monthly meetings between the four named UK-based project staff to review progress and plan next steps of the project and potential future projects.
(2): In Cambodia, develop a common field work approach based on research methods from both disciplines, in order to:
- understand current behaviours around post-MA information sharing and seeking (both with and without mobile phones)
- design a pilot intervention delivered by mobile phone to support reproductive health of women who work in factories around Phnom Penh.

In London and in the academic community, the partnership will benefit both the wider Digital Health and reproductive health research and practitioner groups through research seminars, peer-reviewed publications and conference presentations, and student training. In Cambodia, Marie Stopes staff and research assistants will be trained in qualitative research methods skills that are transferable across disciplines, and that can create more culturally sensitive interventions.

Potential beneficiaries of this project outside academia include NGOs active in the field of healthcare, as well as, ideally, the targeted population of Cambodian women seeking for reproductive health information, in particular post medical abortion follow-up care.

NGOs
The main beneficiary among NGOs will be the project partner, Marie Stopes, as the fieldwork will be conducted with their assistance and by involving their local personnel. Findings from both research and the pilot project could influence directly how the organisation provides post-abortion care and communicates with its clients. The findings will also be presented to other NGOs active in the sector in Cambodia, and potentially to local healthcare institutions, through HACC, the Health Action Coordinating Committee (http://hacccambodia.org/)

The interdisciplinary digital health research seminars in London that are planned as part of the project will actively try to involve staff from NGOs. This will involve the expansion of the LSHTM eHealth group (http://ehealth.lshtm.ac.uk/) to SOAS with a new name and website e.g. a "Bloomsbury Digital Health group". Research will also be disseminated through MSI Global Research knowledge networks such as MSI 'Webinars' with a global audience to present research findings

Targeted Population
If field research shows that peer-to-peer communication is an effective way to engage women in post-abortion care, we will organise a training workshop for women in the targeted population who are interested in becoming peer-to-peer counsellors and for health-care. This could become an example of best practice in the field of peer-to-peer health information dissemination.