中国农村地区通过短信开展的孕产妇教育项目的影响：整群随机对照试验
The Impact of a Maternal Education Program Through Text Messaging in Rural China: Cluster Randomized Controlled Trial.
作者信息
Xie Ri-Hua, Tan Hongzhuan, Taljaard Monica, Liao Yan, Krewski Daniel, Du Qingfeng, Wen Shi Wu
机构信息
Department of Nursing, Nanhai Hospital, Southern Medical University, Foshan, China.
General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, China.
出版信息
JMIR Mhealth Uhealth. 2018 Dec 19;6(12):e11213. doi: 10.2196/11213.
BACKGROUND
In recent years, attempts have been made to use mobile phone text messaging (short message service, SMS) to achieve positive results for a range of health issues. Reports on the impact of maternal education programs based on this widely available, inexpensive, and instant communication tool are sparse.
OBJECTIVE
This study aimed to explore the impact of a maternal education program through text messaging.
METHODS
We conducted a cluster randomized trial in a remote region in the Chinese province of Hunan between October 1, 2011, and December 31, 2012. We used county as the unit of randomization (a total of 10 counties), with half of the counties randomly allocated to the intervention arm (with maternal education material adapted from the World Health Organization being delivered by text messaging to village health workers and pregnant women alike) and the other half to the control arm (normal care without text messaging). Data on maternal and infant health outcomes and health behaviors were collected and compared between the 2 arms, with maternal and perinatal mortality as the primary outcomes.
RESULTS
A total of 13,937 pregnant women completed the follow-up and were included in the final analysis. Among them, 6771 were allocated to the intervention arm and 6966 were allocated to the control arm. At the county level, the mean (SD) of maternal mortality and perinatal mortality rate were 0.0% (0.1) and 1.3% (0.6), respectively, in the intervention arm and 0.1% (0.2) and 1.5% (0.4), respectively, in the control arm. However, these differences were not statistically significant. At the individual level, there were 3 maternal deaths (0.04%) and 84 perinatal deaths (1.24%) in the intervention arm and 6 maternal deaths (0.09%) and 101 perinatal deaths (1.45%) in the control arm. However, the differences were again not statistically significant.
CONCLUSIONS
Adequate resources should be secured to launch large-scale cluster randomized trials with smaller cluster units and more intensive implementation to confirm the benefits of the text messaging-based maternal education program suggested by this trial.
TRIAL REGISTRATION
ClinicalTrials.gov NCT01775150; https://clinicaltrials.gov/ct2/show/NCT01775150 (Archived by WebCite at http://www.webcitation.org/74cHmUexo).
背景
近年来，人们尝试利用手机短信（短消息服务，SMS）来在一系列健康问题上取得积极成果。基于这种广泛可用、价格低廉且即时的通讯工具开展的孕产妇教育项目的影响报告较少。
目的
本研究旨在探讨通过短信开展的孕产妇教育项目的影响。
方法
2011年10月1日至2012年12月31日期间，我们在中国湖南省的一个偏远地区进行了一项整群随机试验。我们以县作为随机分组单位（共10个县），其中一半的县被随机分配到干预组（将根据世界卫生组织改编的孕产妇教育材料通过短信发送给乡村卫生工作者和孕妇），另一半被分配到对照组（常规护理，不发送短信）。收集并比较两组的孕产妇和婴儿健康结局及健康行为数据，以孕产妇和围产期死亡率作为主要结局。
结果
共有13937名孕妇完成随访并纳入最终分析。其中，6771名被分配到干预组，6966名被分配到对照组。在县级层面，干预组孕产妇死亡率和围产期死亡率的均值（标准差）分别为0.0%（0.1）和1.3%（0.6），对照组分别为0.1%（0.2）和1.5%（0.4）。然而，这些差异无统计学意义。在个体层面，干预组有3例孕产妇死亡（0.04%）和84例围产期死亡（1.24%），对照组有6例孕产妇死亡（0.09%）和101例围产期死亡（1.45%）。但差异同样无统计学意义。
结论
应确保有足够资源开展以更小的整群单位和更密集实施方式的大规模整群随机试验，以证实本试验所提示的基于短信的孕产妇教育项目的益处。
试验注册
ClinicalTrials.gov NCT01775150；https://clinicaltrials.gov/ct2/show/NCT01775150（由WebCite存档于http://www.webcitation.org/74cHmUexo）
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