Effect of a short message service intervention on infant feeding practices in Shanghai, China: a prospective, community-based, controlled study

Abstract

BackgroundInfant feeding practices can have long-term health effects for children. Short message service (SMS) through mobile telephones has been increasingly used for health promotion and health services. We assessed the effectiveness of an SMS intervention for improvement of infant feeding practices. MethodsWe recruited participants from four community health centres (CHCs) in Shanghai, China. Two CHCs were designated the intervention group and two other CHCs were designated the control group. We recruited participants at the beginning of the third trimester. Mothers were eligible to participate if they: owned a mobile phone, were first-time mothers, were aged older than 20 years, were at less than 13 weeks gestation, had completed at least compulsory junior high school education (up to age 15 years), were carrying a singleton fetus, and had no illness that restricted breastfeeding after childbirth. All participants received routine maternal and child health care. Mothers in the intervention group also received weekly SMS messages for infant feeding from the third trimester to 12 months post-partum. Participants were followed up at 4, 6, and 12 months post-partum. The primary outcome was duration of exclusive breastfeeding (EBF). We compared the duration of EBF between groups by survival analysis. FindingsWe enrolled 582 participants (281 in the intervention group and 301 in the control group). At 6 months after birth, 265 mothers in the intervention and 284 in the control groups were followed up. Participants in the intervention group had a significantly longer median duration of EBF at 6 months compared with those in the control group (11·4 weeks, 95% CI 10·3–12·6 vs 8·9 weeks, 95% CI 7·8–9·9; p<0·0002). InterpretationAn SMS intervention might help to promote EBF for new mothers. Large randomised controlled trials are needed to further explore this approach. FundingNestlé Foundation, Shanghai Municipal Health Bureau.