Effect of a Multi-Site Trial using Short Message Service (SMS) on Infant Feeding Practices and Weight Gain in Low-Income Minorities

ABSTRACT

Objective: To test the effects of weekly SMS for improving infant feeding practices and infant weight.

Methods: This was a multi-site randomized clinical trial in a convenience sample of 202 caregivers of healthy term infants 0–2 months participating in the WIC program in Puerto Rico and Hawaii. Participants were randomized to receive SMS about infant's general health issues (control) or SMS for improving feeding practices (intervention) for four months. Weight, length and infant feeding practices were assessed at baseline and four months later.

Results: A total of 170 participants completed the study (n = 86 control and n = 84 intervention). Baseline characteristics were similar between groups. At the end, exclusive breastfeeding rates were similar between groups (67.4% control and 59.1% intervention). Introduction of other foods and beverages, addition of foods to the bottle, placing infants to sleep with milk bottles, caregiver's method and response to feeding infants and distractions while feeding infants were similar between groups. Also, weight status or rate of weight gain was similar between groups.

Conclusion: There were no significant improvements in feeding practices or in weight with the intervention. The timeline of the messages in relation to the targeted behavior may have affected the effectiveness of the intervention. Earlier dissemination of messages, higher level of intensity, longer intervention, additional contacts and inclusion of other caregivers may be needed to achieve the desired effects.

KEYWORDS:

• Infant
• mobile messages
• feeding practices
• weight, intervention

Conflict of interest

There are no conflicts of interests to disclose.

The authors' responsibilities were as follows—CP, JB and MC: designed research; CP, JB, CG, and MC: conducted research; JEL: analyzed data; CP, JEL, JB: wrote the paper. CP: had primary responsibility for final content. All authors read and approved the final version of the paper.

Disclaimers

There are no conflicts of interest to disclose.

Acknowledgments

The authors acknowledge Linda Chock (Branch Chief), Iris Takahashi (Clinic Operations Section Chief), Laura Morihara (Wahiawa WIC Coordinator), Wendy Baker (Wahiawa WIC Office Assistant), Jean Kanda (Leeward WIC Coordinator), Dawn Fujimoto-Redoble (Leeward WIC Nutritionist), and Christina Mariano (Pearl City WIC Coordinator) from the Hawai'i Department of Health WIC Services Branch. They also acknowledge the Puerto Rico WIC Program, including Dana Miró (Executive Director), Blanca Sastre (Interim supervisor of Nutrition and Lactation Division), Alexandra Reyes (Nutrition Education Coordinator), Iris Roldan (Breastfeeding Coordinator), Ivelisse Bruno (Breastfeeding Peer Support Coordinator), Sherley M. Panell (Nutrition Supervisor in Plaza Las Americas WIC Clinic) and her team, and Marta Meaux (Nutrition Supervisor in Trujillo Alto WIC Clinic) and her team. They also thank the WIC participants and undergraduate and graduate research assistants.

Sources of support

This study was supported by the National Institute of Minority Health and Health Disparities (NIMHD), of the National Institutes of Health under award number U54MD008149. Infrastructure support was also provided in part by the National Institute on Minority Health and Health Disparities RCMI Grant: 8G12MD007600. This research was also supported in part by grant U54MD007584 (RMATRIX) from the National Institute on Minority Health and Health Disparities (NIMHD) of the National Institutes of Health (NIH).