Initial Outcomes From a 4-Week Follow-Up Study of the Text4baby Program in the Military Women's Population: Randomized Controlled Trial
Initial Outcomes From a 4-Week Follow-Up Study of the Text4baby Program in the Military Women's Population: Randomized Controlled Trial
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DOI：
10.2196/jmir.3297
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发表时间：
2014-05-01
影响因子：
7.4
通讯作者：
Snider, Jeremy
中科院分区：
文献类型：
--
作者：
Evans, W. Douglas;Bihm, Jasmine Wallace;Snider, Jeremy
背景：近年来，利用移动的电话技术促进健康和预防疾病的工作进展迅速。Text 4 baby是一个基于理论的移动的健康（mHealth）计划，向孕妇和新妈妈发送短信，以改善她们的医疗保健信念和行为，改善健康状况和临床结果。Text 4 baby最近的评估发现，它提高了有针对性的健康态度和信念，但对行为的影响尚未determined.Objective：在这项研究中，调查人员的目的是评估Text 4 baby在军事妇女population.Methods：调查人员进行了随机对照试验，在马迪根陆军医疗中心在塔科马，华盛顿，从2011年12月至2013年9月。所有参与者都是首次在马迪根接受护理的孕妇。研究人员使用24项自我管理的在线调查对Text 4 baby信息内容相关的态度和行为进行了基线评估。参与者被随机分配到Text 4 baby加常规护理（干预）或仅常规护理（对照）。研究者分析了Text 4 baby在入组后4周对短期目标结果的治疗效果。结果：在这项研究中，943名患者被随机分组并完成了基线评估。患者的平均年龄为28岁，近70%的患者自认为是高加索人。48.7%的入组者（459/943）完成了首次随访评估。单身和工作/在校患者退出研究干预组的比例较高，我们在随后的模型中对这一发现进行了调整。然而，虽然研究人员无法重新调查这些参与者，但在研究期间，只有1.9%的Text 4 baby注册者（18/943）放弃了这项服务。调整和未调整的Logistic广义估计方程模型，以评估干预措施对测量结果的影响。在调整年龄，婚姻状况，有过以前的孩子，种族/民族的模型中，Text 4 baby干预暴露对增加与产前服用维生素重要性的信念的一致性有显着影响（OR 1.91，95%CI 1.08-3.34，P=.024）。所有这些态度都有针对性的至少一个短信在4周的评估期间，在这项研究中检查。在未调整的模型中，干预暴露对相信去看医疗保健提供者对成为健康新妈妈的重要性（OR 1.52，95%CI 1.01-2.31，P=.046）和酒精的健康风险有显着影响怀孕期间（OR 2.06，95%CI 1.00-4.31，P=.05）。没有行为影响的干预观察在此analysis.Conclusions：Text 4 baby是一个很有前途的计划，为未来的移动健康活动提供了经验教训。这项大规模研究表明，该方案对妇女在研究期间收到的信息所针对的态度和信念产生了初步影响。结果证实了Text 4 baby研究和其他mHealth研究的先前发现。未来的分析将检查干预对行为和临床结果的剂量效应。
Background: The use of mobile phone technologies for health promotion and disease prevention has advanced rapidly in recent years. Text4baby is a theory-based mobile health (mHealth) program in which text messages are delivered to pregnant women and new mothers to improve their health care beliefs and behaviors and improve health status and clinical outcomes. Recent evaluations of Text4baby have found that it improves targeted health attitudes and beliefs, but effects on behavior have not yet been determined.Objective: In this study, investigators aimed to evaluate Text4baby in the military women's population.Methods: Investigators conducted a randomized controlled trial at Madigan Army Medical Center in Tacoma, Washington, from December 2011 through September 2013. All participants were pregnant women first presenting for care at Madigan. Investigators conducted a baseline assessment using a 24-item, self-administered online survey of attitudes and behaviors related to Text4baby message content. Participants were randomized to Text4baby plus usual care (intervention) or usual care alone (control). Investigators analyzed treatment effects of Text4baby on short- term targeted outcomes 4 weeks post enrollment.Results: For this study, 943 patients were randomized and completed a baseline assessment. The average patient age was 28 years and nearly 70% self-identified as Caucasian. 48.7% of enrollees (459/943) completed the first follow-up assessment. Higher rates of single and working/ in-school patients dropped out of the intervention arm of the study, and we adjusted for this finding in subsequent models. However, while investigators were unable to re-survey these participants, only 1.9% of Text4baby enrollees (18/943) dropped the service during the study period. Adjusted and unadjusted logistic generalized estimating equation models were developed to assess intervention effects on measured outcomes. In the model adjusting for age, marital status, having had a previous baby, and race/ethnicity, there was a significant effect of Text4baby intervention exposure on increased agreement with belief in the importance of taking prenatal vitamins (OR 1.91, 95% CI 1.08-3.34, P=.024). All of these attitudes had been targeted by at least one text message during the 4-week evaluation period examined in this study. In unadjusted models, there was a significant effect of intervention exposure on belief in the importance of visiting a health care provider to be a healthy new mother (OR 1.52, 95% CI 1.01-2.31, P=.046) and in the health risks of alcohol during pregnancy (OR 2.06, 95% CI 1.00-4.31, P=.05). No behavioral effects of the intervention were observed in this analysis.Conclusions: Text4baby is a promising program that offers lessons for future mHealth activities. This large-scale study demonstrated initial effects of the program on attitudes and beliefs targeted by the messages received by women during the study period. Results confirm previous findings from Text4baby studies and other mHealth research. Future analyses will examine dosage effects of the intervention on behaviors and clinical outcomes.