The impact of dose in an mHealth intervention to support parents and carers across the first 2000 days of life, Healthy Beginnings for HNEKids; a quantitative study (Preprint)

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BACKGROUND The dose of mobile health (mHealth) interventions can significantly influence participant engagement, acceptability, and the overall effectiveness. However, few mHealth interventions have explored the dose-response relationship. OBJECTIVE Given the limited evidence, this study aims to explore how dose influences the acceptability, engagement, effectiveness, and cost effectiveness of a parent targeted mHealth text messaging program which aims to enhance child health and wellbeing. METHODS The Healthy Beginnings for Hunter New England Kids (HB4HNEKids) program provides age and stage appropriate text messages aimed to support participants (parent/carers) and their children by providing evidence-based health and wellbeing care across the first 2000 days. Participants were enrolled in HB4HNEKids from five Child and Family Health Service (CFHS) pilot sites in the Hunter New England region of New South Wales, and then randomised into either a low dose or high dose message group for the first 2 years of the program. Engagement with the messages was determined using click rates and program opt out rates. Participant acceptability was assessed via a brief online survey. Participants were asked to update their feeding status (as an indicator of effectiveness) at several time points across the program. The average cost of sending the text messages for the 2-year period was calculated, per participant. RESULTS There were no statistically or clinically significant differences in click rates between high or low dose or via feeding status. Overall, 6.7% of participants opted out of HB4HNEKids. There were no statistically significant differences in feeding status between high and low dose. In the first 6 months significantly more participants opted out of the high dose arm (6.8%) compared to the low dose (3.9%, p<0.001). In terms of program acceptability, 70% of high dose participants and 88% of low dose participants were satisfied with the frequency of text messages. Additionally, 86% of high dose and 85% of low dose participants indicated they would recommend the program to other caregivers. The average cost of sending messages was lower in the low dose group ($9.32/participant) compared to the high dose group ($12.96/participant). CONCLUSIONS The HB4HNEKids program demonstrated positive process outcomes and high acceptability across both groups, irrespective of dose. Given the higher opt-out rates and message costs in the high dose group, a lower dose is likely more scalable for future use.

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