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

摘要 围产期护理在整个连续过程中的连续性对于优化孕产妇和婴儿健康至关重要；然而， 产后出现了明显的差距，只有不到一半的印度母亲由于 重大的后勤和社会文化障碍，特别是对城乡居民而言。要克服这些障碍 障碍和减少妇女产后隔离，我们的国际母婴保健临床医生团队 研究人员开发并试点测试了一个根据文化定制的移动互动教育和支持小组 干预：MaA Shishu Swparya Sahayak Samooh(妇幼健康支持小组：MeSSage)。 MeSSage使用提供商主持的小组方法来增加女性与 提供者，指的是面对面护理，并将他们与虚拟社会支持小组联系起来。参与者被招募 在怀孕后期，在助产士的帮助下，通过音频会议进行26次教育和支持会议 (两次产前和每周一次的产后会议，持续6个月)，外加一个短信聊天群。试点结果 表明具有较高的可接受性和可行性，并表明初步效果。 我们建议测试MeSSAGE干预与标准护理对孕产妇的有效性 在2100人中进行的一项随机对照试验中的新生儿健康相关行为和健康结局 围产期的印度妇女。纯母乳喂养的主要结果，产后需求未得到满足 避孕药和产后抑郁症将在6个月后进行评估。我们的具体目标是：估计 流动互动教育和支持团体干预(MeSSage)的有效性 印度优化产妇和新生儿健康的产后行为(目标1) MeSSage干预对印度孕产妇和新生儿健康的影响机制(目标2)， 并确定MeSSage干预在改善产后孕产妇方面的成本-效果 和新生儿健康相比较的照护标准。 我们希望积极影响妇女产后健康知识和行为，促进健康 妇女及其婴儿在产后前六个月的结局。这项可扩展干预措施的研究 将对孕产妇和围产期健康和群体的mHealth证据基础做出重要贡献 产后护理的护理模式，有助于减少妇女通过 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