Co-production of Health in Communities, Exclusive Breastfeeding
Conditions
Keywords
breastfeeding, rural, m-health, mHealth, Patojitos, Guatemala, exclusive breastfeeding, mobile, eHealth, e-health
Brief summary
The purpose of this study was to determine whether exposure to m-health platforms promoting recommended breastfeeding practices was effective in transmitting the exclusive breastfeeding message to participant mothers, and in improving weight evolution of infants.
Interventions
OTHERUni-directional SMS
Exposure to breastfeeding promoting SMSs
DEVICEFeature phone
Participants were given a feature phone.
OTHERVirtual communities
Exposure to virtual community communication via SMS
OTHERHybrid setup
Exposure to virtual community and access to communications with health professional via SMS
Sponsors
Ecole Polytechnique, France
The SHM Foundation, UK
Universidad Francisco Marroquín
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
FEMALE
Healthy volunteers
Yes
Inclusion criteria
* Can read * Has a baby of less than 4 months of age OR is in her 8th month of pregnancy
Exclusion criteria
* Cannot read * Does not have a newborn
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Changes in Knowledge | December 2013 - May 2014, 23 weeks | Specifically, we were interested in: the number of participants who switched from an incorrect to a correct knowledge regarding exclusive breastfeeding during the experiment (learned the message); the number of participants who had a correct knowledge but switched to an incorrect one during the experiment (forgot the message); the number of participants who had an incorrect knowledge and kept it until the end of the experiment (continued to be unaware); the number of participants who had a correct knowledge and kept it until the end of the experiment (remembered the message). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Text-messages Exchanged in Virtual Communities | December 2013 - May 2014, 23 weeks | We were interested in the activity of virtual communities in terms of sent text-messages. |
| Qualitative Nature of Health-related Text-messages | December 2013 - May 2014, 23 weeks | Specifically, we were interested in classifying individual text-messages as social support or health related. |
| Mean Change in Weight-for-Age Z-score | Baseline at December 2013 and 23 weeks later in May 2014 | We used the World Health Organization Anthro software (http://www.who.int/childgrowth/software/en/) to calculate z-scores for the weight-for-age anthropometric indicator of participants' infants at the beginning and at the end of the project. The software is based on the WHO Child Growth Standards and allowed to compare measurements of infants to the normal growth standards. The Z-score indicates the number of standard deviations away from the mean. The indicator is particularly useful to detect abnormal growth patterns in infants' development. For instance, an infant whose weight falls in the -2 z-score for the weight-for-age anthropometric indicator is underweight. Below -3, the child is severely underweight. Similarly, a child whose weight-for-age is above a +1 z-score may have a growth problem. We report the mean change of the z-scores for the weight-for-age anthropomorphic indicator of participants' babies. |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Uni-directional SMS Participants in this group received breastfeeding promoting messages based on the MAMA (http://www.mobilemamaalliance.org/) breastfeeding database. Individuals could only receive text messages.
Uni-directional SMS: Exposure to breastfeeding promoting SMSs
Feature phone: Participants were given a feature phone. | 20 |
| Virtual Communities Participants were made part of virtual communities in which could exchange about infant's health as groups, via SMS, following the SHM Foundation's (http://www.shmfoundation.org/) m-health methodology.
Uni-directional SMS: Exposure to breastfeeding promoting SMSs
Feature phone: Participants were given a feature phone.
Virtual communities: Exposure to virtual community communication via SMS | 24 |
| Hybrid Setup Participants were made part of virtual communities in which they could exchange about infant's health as groups, via SMS. Additionally, a health professional was included in the virtual community.
Uni-directional SMS: Exposure to breastfeeding promoting SMSs
Feature phone: Participants were given a feature phone.
Virtual communities: Exposure to virtual community communication via SMS
Hybrid setup: Exposure to virtual community and access to communications with health professional via SMS | 22 |
| Control Group Individuals were given a feature phone (simple mobile phone)
Feature phone: Participants were given a feature phone. | 12 |
| Total | 78 |
Baseline characteristics
| Characteristic | Uni-directional SMS | Virtual Communities | Hybrid Setup | Control Group | Total |
|---|---|---|---|---|---|
| Age, Customized 16-22 years | 9 participants | 11 participants | 10 participants | 2 participants | 32 participants |
| Age, Customized 23-30 years | 9 participants | 10 participants | 9 participants | 7 participants | 35 participants |
| Age, Customized >30 years | 2 participants | 3 participants | 3 participants | 3 participants | 11 participants |
| Aware of exclusive breastfeeding message Aware | 8 participants | 18 participants | 10 participants | 9 participants | 45 participants |
| Aware of exclusive breastfeeding message Not Aware | 12 participants | 6 participants | 12 participants | 3 participants | 33 participants |
| Education > High school | 0 participants | 0 participants | 0 participants | 1 participants | 1 participants |
| Education None | 2 participants | 3 participants | 1 participants | 1 participants | 7 participants |
| Education Some high school education | 2 participants | 3 participants | 3 participants | 3 participants | 11 participants |
| Education Some primary school education | 16 participants | 18 participants | 18 participants | 7 participants | 59 participants |
| Maternal experience No | 9 participants | 12 participants | 9 participants | 4 participants | 34 participants |
| Maternal experience Yes | 11 participants | 12 participants | 13 participants | 8 participants | 44 participants |
| Sex: Female, Male Female | 12 Participants | 14 Participants | 5 Participants | 6 Participants | 37 Participants |
| Sex: Female, Male Male | 8 Participants | 10 Participants | 17 Participants | 6 Participants | 41 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 0 / 20 | 0 / 24 | 0 / 22 | 0 / 12 |
| serious Total, serious adverse events | 0 / 20 | 0 / 24 | 0 / 22 | 0 / 12 |
Outcome results
Primary
Number of Participants With Changes in Knowledge
Specifically, we were interested in: the number of participants who switched from an incorrect to a correct knowledge regarding exclusive breastfeeding during the experiment (learned the message); the number of participants who had a correct knowledge but switched to an incorrect one during the experiment (forgot the message); the number of participants who had an incorrect knowledge and kept it until the end of the experiment (continued to be unaware); the number of participants who had a correct knowledge and kept it until the end of the experiment (remembered the message).
Time frame: December 2013 - May 2014, 23 weeks
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Uni-directional SMS | Number of Participants With Changes in Knowledge | Remembered it | 8 participants |
| Uni-directional SMS | Number of Participants With Changes in Knowledge | Forgot it | 0 participants |
| Uni-directional SMS | Number of Participants With Changes in Knowledge | Continued to be unaware at the end of experiment | 0 participants |
| Uni-directional SMS | Number of Participants With Changes in Knowledge | Learned it | 12 participants |
| Virtual Communities | Number of Participants With Changes in Knowledge | Forgot it | 8 participants |
| Virtual Communities | Number of Participants With Changes in Knowledge | Remembered it | 10 participants |
| Virtual Communities | Number of Participants With Changes in Knowledge | Learned it | 2 participants |
| Virtual Communities | Number of Participants With Changes in Knowledge | Continued to be unaware at the end of experiment | 4 participants |
| Hybrid Setup | Number of Participants With Changes in Knowledge | Forgot it | 0 participants |
| Hybrid Setup | Number of Participants With Changes in Knowledge | Continued to be unaware at the end of experiment | 1 participants |
| Hybrid Setup | Number of Participants With Changes in Knowledge | Learned it | 11 participants |
| Hybrid Setup | Number of Participants With Changes in Knowledge | Remembered it | 10 participants |
| Control Group | Number of Participants With Changes in Knowledge | Remembered it | 5 participants |
| Control Group | Number of Participants With Changes in Knowledge | Learned it | 3 participants |
| Control Group | Number of Participants With Changes in Knowledge | Forgot it | 4 participants |
| Control Group | Number of Participants With Changes in Knowledge | Continued to be unaware at the end of experiment | 0 participants |
Secondary
Mean Change in Weight-for-Age Z-score
We used the World Health Organization Anthro software (http://www.who.int/childgrowth/software/en/) to calculate z-scores for the weight-for-age anthropometric indicator of participants' infants at the beginning and at the end of the project. The software is based on the WHO Child Growth Standards and allowed to compare measurements of infants to the normal growth standards. The Z-score indicates the number of standard deviations away from the mean. The indicator is particularly useful to detect abnormal growth patterns in infants' development. For instance, an infant whose weight falls in the -2 z-score for the weight-for-age anthropometric indicator is underweight. Below -3, the child is severely underweight. Similarly, a child whose weight-for-age is above a +1 z-score may have a growth problem. We report the mean change of the z-scores for the weight-for-age anthropomorphic indicator of participants' babies.
Time frame: Baseline at December 2013 and 23 weeks later in May 2014
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Uni-directional SMS | Mean Change in Weight-for-Age Z-score | -0.064 z-score |
| Virtual Communities | Mean Change in Weight-for-Age Z-score | 0.030 z-score |
| Hybrid Setup | Mean Change in Weight-for-Age Z-score | 0.199 z-score |
| Control Group | Mean Change in Weight-for-Age Z-score | -0.197 z-score |
Secondary
Number of Text-messages Exchanged in Virtual Communities
We were interested in the activity of virtual communities in terms of sent text-messages.
Time frame: December 2013 - May 2014, 23 weeks
Population: In virtual communities, participants were added to 1 of 3 peer-to-peer groups. They could communicate by sending SMSs to a short-code number. In the hybrid setup, participants were added to 1 of 3 peer-to-peer groups, but in addition received information regarding breastfeeding practices and could communicate with a health professional.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Virtual Communities | Number of Text-messages Exchanged in Virtual Communities | 2793 Number of text messages |
| Hybrid Setup | Number of Text-messages Exchanged in Virtual Communities | 909 Number of text messages |
Secondary
Qualitative Nature of Health-related Text-messages
Specifically, we were interested in classifying individual text-messages as social support or health related.
Time frame: December 2013 - May 2014, 23 weeks
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Virtual Communities | Qualitative Nature of Health-related Text-messages | Health related messages | 761 Number of text messages |
| Virtual Communities | Qualitative Nature of Health-related Text-messages | Other messages | 71 Number of text messages |
| Virtual Communities | Qualitative Nature of Health-related Text-messages | Social support related messages | 1961 Number of text messages |
| Hybrid Setup | Qualitative Nature of Health-related Text-messages | Health related messages | 501 Number of text messages |
| Hybrid Setup | Qualitative Nature of Health-related Text-messages | Social support related messages | 356 Number of text messages |
| Hybrid Setup | Qualitative Nature of Health-related Text-messages | Other messages | 52 Number of text messages |