Preliminary efficacy of a postnatal mHealth and virtual social support intervention on newborn and infant health and feeding practices in Punjab, India: a quasi-experimental pre-post pilot study (Preprint)

Abstract

Background: We evaluated a pilot mHealth intervention aimed at improving postnatal maternal and infant health. The intervention featured provider-led group sessions for education, healthcare communication, in-person care referrals, and virtual support for postpartum mothers through weekly calls, texts, interactive voice response, and an application.

In this study, we aimed to assess the preliminary effectiveness of the pilot mHealth intervention, MeSSSSage, which delivered educational content and social support through various mHealth modalities, on maternal knowledge of infant danger signs and knowledge of infant and young child feeding at six months postpartum. The other outcomes of interest included changes in maternal care-seeking behaviors for infants, adherence to age-appropriate immunization, and infant and young child feeding practices such as early initiation of breastfeeding and complementary feeding.

Methods: We evaluated the preliminary effectiveness of an intervention on maternal health knowledge among 135 participants in Punjab, India, who completed pre- and post-intervention surveys. The intervention, led by research personnel with backgrounds similar to CHOs, aimed to empower society and support universal health coverage if successful. We assessed changes in knowledge of maternal danger signs and the appropriate age for introducing different food groups over six months postpartum. Additionally, we examined post-intervention differences in health-seeking behavior for infants, adherence to age-appropriate immunizations, and adoption of breastfeeding and complementary feeding practices among women in the synchronous (group call), asynchronous (IVR and app), and control arms.

Results: Of 12 infant risk factors, maternal knowledge of infant danger signs remained low (mean range: 1.85 to 2.31 pre-intervention and 1.81 to 2.22 post-intervention). Participants in the synchronous arm had a statistically significant higher mean increase (mean difference: 0.87; 95%CI: 0.06-1.69) compared to the control arm. Participants in synchronous arm had nearly three-fold increased odds of infant health check-up by a clinical provider than asynchronous arm participants (OR 2.72; 95%CI: 1.02, 7.23). No significant differences noted in age-appropriate vaccine coverage among infants between arms, though vaccination coverage was more than 80% across all arms. Early initiation of breastfeeding remained low across all arms (~47%).

Conclusion: Our pilot study on group-based mHealth education and virtual social support during the postnatal phase showed modest yet promising results. Rigorous testing is crucial to strengthen the limited evidence base for group-oriented mHealth approaches

Clinical trials registration: NCT04693585.