Impact of an SMS advice programme on maternal and newborn health in rural China: study protocol for a quasi-randomised controlled trial

Abstract

IntroductionExpectant mothers in low-income and middle-income countries often lack access to vital information about pregnancy, preparation for birth and best practices when caring for their newborn. Innovative solutions are needed to bridge this knowledge gap and dramatically improve maternal and neonatal health in these settings. This study aims to evaluate the impact of an innovative text messaging intervention on maternal and neonatal health outcomes.Methods and analysisThis study offers expectant mothers in rural China a package of free short messages via cell phone regarding pregnancy and childbirth. These messages are tailored to each mother's gestational week. It is hypothesised that delivering these short advice messages to pregnant women can improve maternal and newborn health. The study uses factorial quasi-randomisation to compare psychological, behavioural and health outcomes between 4 groups: 2 groups receiving different sets of short message interventions (ie, good household prenatal practices and healthcare seeking), a group receiving both interventions and a control group. Treatment assignment occurs at the individual level. The primary outcome is newborn health, measured by appropriateness of weight for gestational age. Secondary outcomes include severe neonatal and maternal morbidity as well as psychological and behavioural measures. This study has enrolled pregnant women who attend county maternal and child health centres for their prenatal visits.DiscussionThis pilot is the first large-scale effort to build a comprehensive evidence base on the impact of prenatal text messages via cell phone on maternal and newborn health outcomes in China. The study has broad implications for public health policy in China and the implementation of mobile health interventions in low-resource settings around the world.EthicsThis study was approved by the Ethics Committee of the School of Medicine at Xi'an Jiaotong University on 18 January 2013.Trial registration numberNCT02037087; Pre-results.

The Effects on Inappropriate Weight for Gestational Age of an SMS Based Educational Intervention for Pregnant Women in Xi’an China: A Quasi-Randomized Controlled Trial

“…To address this issue, we designed and implemented a quasi-randomized controlled trial, the Newborn Health Project in rural China, to determine if and how an innovative SMS intervention providing educational information via texts to pregnant women in China might lead to maternal and child health outcomes. A more in-depth discussion of the literature and the study protocol has been reported previously [18]. Our study will add to the literature that maternal health education via cell phone text messages could greatly prevent the occurrence of inappropriate weight for gestational age, particularly on the macrosomic end of the spectrum.…”

“…This study was approved by the Ethics Committee of the School of Medicine at Xi'an Jiaotong University on 18 January 2013 and an updated version was approved on May 2016 (Approval number: 2016-392). In addition, this study was registered at clinicaltrials.gov (NCT02037087), and the protocol has been published previously [18]. Power calculation to determine sample size was presented in the published protocol [18].…”

“…In addition, this study was registered at clinicaltrials.gov (NCT02037087), and the protocol has been published previously [18]. Power calculation to determine sample size was presented in the published protocol [18].…”

“…Therefore, two-by-two intervention assignments was conducted to comparatively evaluate three groups of SMS messages, i.e., GHPP messages, CS messages, and the combination of both types of messaging. A summary of the intervention texts by group is presented in Table 1 and the detailed information can be found in the study protocol published previously [18]. Table 1.…”

Does Message-Based Communication Through Mobile Phones for Medication and Treatment Adherence Improve Health Outcomes? A Systematic Review

“…The study involved various message categories emphasizing adherence to positive behaviours including reminders for prenatal visits, facility delivery and healthy lifestyles (nutrition and physical activity). Study findings imply that a mHealth intervention using messages can be more effective if participants have a chance to interact with a medical practitioner to discuss the messages for reinforcement and confirmation [34].…”