A pilot mHealth text-messaging program targeting parents during the first 2000 days: a non-randomized, repeat cross-sectional analysis to pragmatically evaluate feasibility, engagement, acceptability and potential effectiveness within the Hunter New England region of New South Wales, Australia. (Preprint)

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BACKGROUND The first 2000 days of a child’s life represents a critical window for growth and development, profoundly influencing long-term physical health, cognitive outcomes, and the risk of future chronic disease. Healthy Beginnings for Hunter New England Kids (HB4HNEKids) is a text-messaging program delivered alongside routine Child and Family Health Nursing (CFHN) care which provides families with easy to access, evidence-based, age and stage related preventive health information across the first 2000 days. OBJECTIVE This pilot study explores the feasibility, engagement and acceptability of the HB4HNEKids program when embedded into routine CFHN service delivery. It also explores the potential effectiveness of the program at 6- and/or 12-months post-partum on outcomes including: breastfeeding, child diet, child movement, and parental mental well-being. METHODS During the pilot phase (October 2021-July 2024), project record data was used to assess the number of families enrolled and number of text-messages sent (feasibility), and the number of families that opt-out (engagement). Repeat cross-sectional online or telephone surveys were conducted at 5-7 months post-partum (T1, May-December 2022) and again at 12-14 months post-partum (T2, August 2023-July 2024), with birthing parents who had received HB4HNEKids, and a concurrent non-randomized comparison group located within the Hunter New England region of New South Wales, Australia that did not receive the program. Surveys assessed parental self-reported engagement with the messages, and program acceptability, as well as health behaviors including breastfeeding status, child diet, child movement and parental mental wellbeing. Unadjusted and adjusted mixed linear regression analyses were conducted to calculate mean differences (MD) and odds ratios (OR). RESULTS During the pilot phase, HB4HNEKids was delivered to 6243 families (73.4% of families contacted by CFHN). A total of 383 birthing parents completed the survey at 6 months (26% receiving HB4HNEKids), and 283 completed the survey at 12 months (37% receiving HB4HNEKids). Of the survey participants who received HB4HNEKids (n=200), between 76-83% reported that they always or very often read the text-messages, spending on average 5-7 minutes engaged with the content. At both survey timepoints, over 90% of participants receiving HB4HNEKids agreed the program was acceptable. Child daily intake of vegetables was significantly higher in the HB4HNEKids group (adjusted MD: 0.23 (95% CI: 0.07 to 0.40), P=.006) compared with the comparison group at 12 months. Parents receiving HB4HNEKids also reported significantly better mental wellbeing scores than those in the comparison group (P=.005). While HB4HNEkids participants reported breastfeeding rates 5 percentage points greater than comparison participants at 6 and 12-months, this result was not statistically significant. There were no statistically significant differences between HB4HNEKids, and comparison participant responses related to child movement behaviors. CONCLUSIONS The HB4HNEKids text-messaging program is feasible to deliver at scale alongside routine CFHN care and is highly acceptable and engaging to parents. This pragmatic evaluation of the pilot, embedding into usual care, indicates potential effectiveness of the program for improving child vegetable intakes and parental mental wellbeing. Further evaluation of this program within larger samples using robust methodology is needed to determine the effectiveness of this innovative mHealth program across the first 2000 days.

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