Multi‐site trial using short mobile messages (SMS) to improve infant feeding practices among participants in the WIC program
Authors: Palacios Cristina , Campos Maribel , Gibby Cheryl , Banna Jinan 
Published: November 2023

BackgroundInfant obesity is higher among Hispanics (14.8%) and Native Hawaiians (11.4%) compared to other groups (Blacks 8.7%; White 8.4%). The first 1,000 days of life are crucial in the development of obesity; therefore, interventions geared toward this period have the potential to prevent obesity. Interventions using short mobile messages (SMS) have demonstrated success in promoting health behavior change. Therefore, the objective of this study was to pilot test weekly SMS to improve infant dietary patterns and obesity.MethodsThis was a multi‐site clinical trial among a convenience sample of 200 mothers of infants 0–2 months participating in the WIC program in Puerto Rico and Hawaii (100 participants in each site). Participants were randomized to receive SMS about general infant's health issues (control) or SMS for improving feeding practices (intervention) for 4 months. Infant feeding practices were assessed at baseline and after 4 months with a questionnaire, which asked about type of milk consumed (human milk or formula), duration of breastfeeding, age of introduction of juices and solid foods, use of the bottle to sleep baby, addition of foods to the bottle, etc.ResultsA total of 92 participants completed the study in PR (4 were excluded because did not receive most of the SMS) and 78 in HI. At the end of the study, the breastfeeding rate among participants who reported breastfeeding at baseline was 48% in the intervention group and 52% in the control group (p>0.05). Breastfeeding duration was similar (1.8 months in the intervention and 2.3 months in controls). A greater proportion of infants in the intervention group used the spoon to feed baby (35%) compared to the control group (20%; p<0.05). Also, a greater proportion of infants in the intervention group were being fed without distractions (66%) compared to the control group (55%), although this was not significant (p>0.05). A greater proportion of infants in the intervention were placed to sleep with the bottle (33%) compared to the control group (20%), although this was also not significant (p>0.05). Juice was consumed by 10% of infants in the intervention and 15% in the control group (p>0.05). Cereal and baby food or poi were added to the bottle by 14% and 8% in the intervention and by 9% and 6% in the control group, respectively (p>0.05).ConclusionThe intervention group reported small improvement in some but not all of the targeted feeding practices, although most were not significant. The timeline of the messages in relation to the targeted behavior may have affected the effectiveness of the intervention. In the future, we plan to improve the outcomes through earlier dissemination of messages and assessing if a higher level of intensity (increased frequency) is needed to achieve the desired effects.Support or Funding InformationThis study was supported by the National Institute of Minority Health and Health Disparities (NIMHD), of the National Institutes of Health under award number U54MD008149. Infrastructure support was also provided in part by the National Institute on Minority Health and Health Disparities RCMI Grant: 8G12MD007600. This research was supported in part by grant U54MD007584 (RMATRIX) from the National Institute on Minority Health and Health Disparities (NIMHD) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessary represent the official view of NIMHD or NIH. We thank the WIC program in PR and HI for their support.