The CycleBeads Mobile App in Developing Countries: A Review of Research
By: Mara Penne, MD
Director’s Note: This week, we feature a research study  summarized by Mara Penne, MD, a former FACTS elective participant. Prior research has indicated the need for family planning methods in developing nations, which prompts the question of how best to reach women and couples all over the world. The study explores the results of marketing to underserved populations a smartphone application that integrates the Standard Days Method (SDM). In her conclusion, Dr. Penne highlights the need for more research on apps that integrate other FABMs as well. Follow the link to learn about the FACTS research study we published on the use of fertility apps marketed to prevent pregnancy.
There is a large unmet need for family planning in developing countries around the world. This is largely due to poor education about pregnancy risk, low access to contraceptive methods, and concern about side effects of available contraceptives. The study by Haile et al summarized below assesses the potential for a smartphone application (app) to introduce low-cost natural family planning methods (also known as fertility awareness-based methods, or FABMs) to women of reproductive age in developing countries. It provides market testing results of the CycleBeads app, which utilizes the Standard Days Method (SDM), and examines the profiles of the women who used it.
The CycleBeads app was market tested in seven countries: Egypt, Ghana, India, Jordan, Kenya, Nigeria, and Rwanda. Brief social media campaigns were launched to promote the app in these regions and were monitored through Google and Facebook analytics. The application is simple to use: a woman enters her period start dates and is provided with a daily overview of her current fertility status.
Upon download and use of the app, women were asked a series of questions to assess their profile, reasons for using the app, and satisfaction with the product. The study analyzed the efficacy of the social media campaigns as a means of promoting the CycleBeads app, as well as the user profile and satisfaction with its usage.
During the 10-month marketing campaign, there were over 350K app downloads, with a marketing cost per download between $0.17 and $0.69 across different countries. The campaigns were found to be an easy, effective, and low-cost method to reach potential users.
Through the downloads and in-app questionnaires, the researchers were able to gather more information about the app users. While the purpose of use varied among the various countries, they found the largest user segment was women ages 20-34 years old across all countries. In four countries (Ghana, Kenya, Nigeria, Rwanda), the majority were using the CycleBeads app to prevent pregnancy, while in three countries (India, Jordan, Egypt), most women were using it to achieve pregnancy.
The study further focused on women using the app to prevent pregnancy. Some of the top reasons women identified for using the app included, “it’s simple and easy to use,” “it’s natural,” and “I was worried about side effects of other methods.” In some countries, nearly half of these users had never used a hormonal method, and up to a third reported the CycleBeads app was the first family planning method they had used.
“Some of the top reasons women identified for using the app included, ‘it’s simple and easy to use,’ ‘it’s natural,’ and ‘I was worried about side effects of other methods.’”
After tracking cycle three, users were asked about their satisfaction with the CycleBeads app. Across all countries, at least 60% reported they would “definitely recommend” the app, and an additional 20% said they would at least “probably recommend” the app to a friend.
This original research was designed to evaluate the usefulness of the CycleBeads mobile application for women in developing countries using the app for natural family planning. Additionally, it sought to evaluate the cost and effectiveness of social media to recruit users onto the platform. The study found the app was beneficial to a diverse population of women and could be used to address a variety of reproductive goals. It also found that social media was an effective distribution method to expand access to natural family planning.
“The study found the app was beneficial to a diverse population of women and could be used to address a variety of reproductive goals.”
The study participants had diverse backgrounds and family planning goals, with a wide range of ages, relationship status, prior contraceptive use, and intentions. While the majority of users were between 20 and 34 years of age across all countries, other statistics varied greatly by country. It would be interesting to broaden the study to many more developing countries to further evaluate those trends. Doing so would allow for more targeted social media campaigns in the future.
The study reinforced the fact that the unmet need for family planning in developing countries is largely due to cost and distance to healthcare resources. Through modern technology, this free mobile app has the potential to expand access to users. It has been well established in the FACTS about Fertility modules that fertility awareness-based methods for family planning are easy to use and do not require a high level of education or literacy. As measured by user satisfaction, this study reinforced that these methods can be used effectively by women in developing countries, and it is a lack of access that prevents them from achieving their family planning goals.
“This study reinforced that these methods can be used effectively by women in developing countries, and it is a lack of access that prevents them from achieving their family planning goals.”
One area for further research would be to study apps that use methods other than SDM, which is one of the simpler methods and only useful for women with regular cycles lasting 26 to 32 days. By studying other apps, access could be expanded to women with irregular cycles. Of note, effective use of some of these other FABMs will require additional teaching outside of the application. The study was also limited by the fact that all data was self-reported; yet, by doing so, the researchers were able to achieve a very large and valuable sample size.
 Haile LT, Fultz HM, Simmons RG, Shelus V. Market-testing a smartphone application for family planning: assessing potential of the CycleBeads app in seven countries through digital monitoring. MHealth. 2018;4:27-27. doi:10.21037/mhealth.2018.06.07.
ABOUT THE AUTHOR
Mara Penne, MD
Mara Penne, MD completed this review while on the FACTS elective as a fourth-year medical student at Georgetown University School of Medicine in Washington, DC. She is now an ophthalmology resident at Wills Eye Hospital at Thomas Jefferson University. Dr. Penne has a strong interest in women’s health.