Effectiveness of an mHealth Interactive Education and Social Support Intervention for Improving Postnatal Health

摘要 围产期护理的连续性对优化孕产妇和婴儿健康至关重要;然而， 产后出现明显的差距，不到一半的印度母亲接受产后护理， 严重的后勤和社会文化障碍，特别是对城郊和农村居民而言。克服这些 我们的国际母婴健康临床医生团队， 研究人员开发了一个文化定制的移动的互动教育和支持小组，并进行了试点测试 干预：Maa Shishu Swasthya Sahayak Samooh（妇幼保健支助小组：MeSSSSage）。 MeSSSSage使用提供者主持的小组方法来增加妇女与 提供者，指的是在人的照顾，并将他们与虚拟的社会支持小组。参与者招募 在怀孕后期，通过由护士助产士主持的音频会议， （产前2次，产后6个月每周一次），加上参加一个文字聊天组。试点成果 具有较高的可接受性和可行性，并显示了初步的有效性。 我们建议测试与标准护理相比，MeSSSSage干预对孕产妇的有效性。 和新生儿健康相关行为和健康结果的随机对照试验， 围产期印度妇女。纯母乳喂养的主要结局，产后未满足的需求 避孕药和产后抑郁症将在6个月时进行评估。我们的具体目标是： 移动的互动教育和支持小组干预（MeSSSSage）的有效性， 产后行为优化产妇和新生儿健康在印度（目标1），特点是 MeSSSSage干预措施对印度孕产妇和新生儿健康的影响机制（目标2）， 并确定MeSSSSage干预在改善产后孕产妇 和新生儿健康与护理标准相比。 希望能对妇女产后健康知识和行为产生积极影响，促进健康 产后前六个月妇女及其婴儿的结果。这项研究是一项可扩展的干预措施， 将为孕产妇和围产期健康和群体健康的移动健康证据库做出重要贡献 产后护理护理模式，有助于通过 消除地理和社会障碍。 1

Abstract Perinatal care continuity across the full continuum is essential for optimizing maternal and infant health; however, a stark gap occurs postpartum, with less than one half of Indian mothers receiving postpartum care due to significant logistical and sociocultural barriers, particularly for peri-urban and rural residents. To overcome these barriers and reduce women’s postpartum isolation, our international team of maternal and infant health clinicians and researchers developed and pilot-tested a culturally-tailored mobile interactive education and support group intervention: Maa Shishu Swasthya Sahayak Samooh (maternal and child health support group: MeSSSSage). MeSSSSage uses a provider-moderated group approach to increase women’s communication with providers, refer to in-person care, and connect them with a virtual social support group. Participants are recruited in late pregnancy and have 26 education and support sessions via audioconference facilitated by nurse-midwives (2 prenatal and weekly postpartum sessions through 6 months), plus engage in a text chat group. Pilot results indicated high acceptability and feasibility and suggest preliminary effectiveness. We propose to test the effectiveness of the MeSSSSage intervention compared to standard care on maternal and neonatal health-related behaviors and health outcomes in a randomized controlled trial among 2100 perinatal Indian women. Primary outcomes of exclusive breastfeeding, unmet need for postpartum contraceptives and postpartum depression will be assessed at 6 months. Our specific aims are to: estimate the effectiveness of a mobile interactive education and support group intervention (MeSSSSage) on postpartum behaviors for optimizing maternal and neonatal health in India (Aim 1), characterize the mechanisms of impact of the MeSSSSage intervention on maternal and neonatal health in India (Aim 2), and determine the cost-effectiveness of the MeSSSSage intervention in improving postpartum maternal and neonatal health as compared to the standard of care. We hope to positively impact women’s postnatal health knowledge and behaviors and improve health outcomes for women and their infants in the first six months postpartum. This study of a scaleable intervention will have an important contribution to the evidence base on mHealth for maternal and perinatal health and group care models for postnatal care, contributing to reducing disparities in women’s access to care through the removal of geographic and social barriers. 1