Peng James, Wetzler Erica, Wandika Brenda, Kithao Peninah, Moraa June, Udren Jenna I, Schultes Olivia, Akinyi Esther, Osborn Lusi, Hedstrom Anna, Richardson Barbra A, Kumar Manasi, Wamalwa Dalton, Kinuthia John, Ronen Keshet, Unger Jennifer A
Department of Biostatistics, University of Washington, Seattle, Washington, United States of America.
Department of Global Health, University of Washington, Seattle, Washington, United States of America.
PLOS Digit Health. 2025 Aug 7;4(8):e0000968. doi: 10.1371/journal.pdig.0000968. eCollection 2025 Aug.
Despite a global reduction in neonatal deaths in the last few decades, high neonatal mortality rates persist in low- to middle-income countries. Mobile health interventions offer a promising solution to promote early newborn care (ENC) practices and improve neonatal health. The Mobile WACh NEO randomized controlled trial evaluated the effect of a text messaging communication intervention on neonatal health outcomes in Kenya from 2020 to 2023. Perinatal participants received automated messages from enrollment at 28-36 weeks gestation until six weeks postpartum and could message with a study nurse. This secondary analysis aimed to characterize participant text engagement and examine associations between engagement and maternal-neonatal health outcomes. Among 2,470 intervention participants retained through follow-up, median time in the intervention was 14 weeks. Participants received a median of 58 automated messages (average 0.58 per day), sent a median of 24 messages (average 0.25 per day), and received a median of 14 nurse responses (average 0.14 per day). Younger, more educated, unmarried, unemployed, and first-time mothers sent more messages, while those who had a lower social support score at baseline messaged less. Increased participant messaging was associated with greater increase in neonatal danger sign knowledge from baseline to six-week follow-up (Adj Est: 0.39; 95% CI: 0.09-0.68) and lower odds of early initiation of breastfeeding (aOR: 0.62; 95% CI: 0.45-0.86). Our findings contribute to the understanding of who can benefit from mobile health programs and how these interventions might impact behaviors and outcomes.
尽管在过去几十年中全球新生儿死亡人数有所减少，但低收入和中等收入国家的新生儿死亡率仍然居高不下。移动健康干预措施为促进新生儿早期护理（ENC）实践和改善新生儿健康提供了一个有前景的解决方案。“移动WACh NEO”随机对照试验评估了2020年至2023年在肯尼亚进行的短信通信干预对新生儿健康结局的影响。围产期参与者在妊娠28 - 36周登记入组后直至产后六周收到自动发送的信息，并且可以与研究护士进行信息交流。这项二次分析旨在描述参与者对短信的参与情况，并研究参与度与母婴健康结局之间的关联。在通过随访保留的2470名干预参与者中，干预的中位时间为14周。参与者收到的自动信息中位数为58条（平均每天0.58条），发送的信息中位数为24条（平均每天0.25条），收到的护士回复中位数为14条（平均每天0.14条）。更年轻、受教育程度更高、未婚、未就业的初产妇发送的信息更多，而那些在基线时社会支持得分较低的人发送的信息较少。参与者短信发送量的增加与从基线到六周随访时新生儿危险信号知识的更大增加相关（调整估计值：0.39；95%置信区间：0.09 - 0.68），并且早期开始母乳喂养的几率较低（调整后比值比：0.62；95%置信区间：0.45 - 0.86）。我们的研究结果有助于了解谁能从移动健康项目中受益，以及这些干预措施可能如何影响行为和结局。
