The Impact of Prenatal Short Messages (SMS) on Maternal and Newborn Health

Study Overview
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Brief Summary
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It is hypothesized that delivering short messages (SMS) to pregnant women can improve maternal and newborn health outcomes. This pilot offers mothers-to-be in rural China free daily short messages (SMS) via cell phone. The aim is to advise them on (a) good household prenatal practices (GHPP) and (b) care seeking (CS) in order to improve the quality of life for mothers and newborns.

Detailed Description
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Factorial quasi-randomization is utilized to compare two groups of interventions (i.e., GHPP and CS) as well as to compare these individual interventions with a combination of the interventions. It is also possible that distinct treatments have interaction effects, and we plan to test for this. Policymakers are interested in using different strategies to enhance neonatal health. For example, the bank of SMS developed by our team is a combination of several components: reminders for regular checkups, information on GHPP, and information on CS. From a policy perspective, the evaluation of the full bank of SMS may be sufficient for the government to decide whether or not to scale up the full bank of SMS. However, to understand maternal behavior and, for policy purposes, to understand which components in the bank of SMS should be scaled up, it is important to disentangle which component contributes most to final neonatal health. Taken together, are all the components of the bank of SMS effective in changing maternal behavior and enhancing neonatal health? Which mechanisms are at play, good household prenatal care, care seeking in pregnancy, or both?

Official Title
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The Impact of Prenatal Short Messages on Maternal and Newborn Health

Conditions
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Short Message Service, Text Messaging

Intervention / Treatment
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* Behavioral: Good household prenatal practice
* Behavioral: Care seeking
* Behavioral: Full bank of SMS


Participation Criteria
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Eligibility Criteria
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There were two inclusion criteria: Local pregnant women must 1) own a cell phone in the household, and 2) visit a MCHC for antenatal care during pregnancy.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Good household prenatal practice (GHPP)<br>The GHPP arm receives SMS messages regarding knowledge on nutrition, labor, non-medical pain management, breastfeeding, and depression. This arm also receives messages delivered to the control group. | Behavioral: Good household prenatal practice<br>* Knowledge on nutrition, labor, non-medical pain management, breastfeeding and depression<br>|
| Experimental: Care seeking (CS)<br>The CS arm receives SMS messages which include danger-sign recognition and reminders for government-subsidized projects. This arm also receives messages delivered to the control group. | Behavioral: Care seeking<br>* Danger-sign recognition Reminders for government projects<br>|
| Experimental: Full bank of SMS<br>This arm receives the SMS messages delivered to the GHPP, CS and control group. | Behavioral: Full bank of SMS<br>* Danger-sign recognition Reminders for government projects Knowledge on nutrition, labor, non-medical pain management, breastfeeding and depression<br>|
| No Intervention: Control<br>Control group receives SMS messages regarding: Reminders of prenatal visits and certified skilled attendance of labor (status quo); Fetal development in different gestational stages. The three experimental groups receive the control messages as well. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Newborn health | Newborn health is measured by appropriateness of weight for gestational age. | the first month after birth | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Neonatal Adverse Outcome Indicator (NAOI) | The NAOI focuses on measuring severe neonatal morbidity. | the first month after birth | 
| Actual number of prenatal visits over expected visits |  | In the duration of pregnancy, an expected average of 9 months | 
| Uptake of government-subsidized programs | This outcome is measured by the following metrics: Duration of folic acid Uptake of infant vaccinations | In the duration of pregnancy, an expected average of 9 months, and 1 month after birth | 
| C-section rate |  | child birth | 
| Maternal health | Maternal health is measured by change of perception in general health and postpartum depression. | Child birth and 1 year after birth | 
| Near-miss | The near-miss focuses on measuring severe maternal morbidity. | In the duration of pregnancy, an expected average of 9 months, and childbirth | 
| Psychological outcomes | Attitudes, personal norms, self-efficacy, social desirability, intentions, plans, susceptibility, expectations, and severity | In the duration of pregnancy, an expected average of 9 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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good household pregnancy practice, care seeking, Short Message Service, newborn health, maternal behavior