# Preliminary Effectiveness of a Postnatal mHealth and Virtual Social Support Intervention on Newborn and Infant Health and Feeding Practices in Punjab, India: Quasi-Experimental Pre-Post Pilot Study

## TL;DR

A mobile health program in India aimed to improve maternal and infant health through group sessions and virtual support, showing some promising but modest results.

## Contribution

This study presents a novel group-based mHealth intervention combining in-person and virtual support for postnatal maternal and infant health.

## Key findings

- Participants in the synchronous group had a statistically significant increase in knowledge of infant danger signs.
- Synchronous arm participants were nearly three times more likely to seek infant health checkups compared to the asynchronous group.
- Early breastfeeding initiation remained low across all groups, with no significant differences in vaccination coverage.

## Abstract

We evaluated a pilot mobile health (mHealth) intervention aimed at improving postnatal maternal and infant health. The intervention featured provider-led group sessions for education, health care communication, in-person care referrals, and virtual mHealth support for postpartum mothers through weekly calls, texts, interactive voice response (IVR), and a phone app.

We aimed to assess the preliminary effectiveness of the pilot mHealth intervention, MeSSSSage (Maa Shishu Swasthya Sahayak Samooh, which means maternal and child health support group), on infant health knowledge, behaviors, and outcomes at 6 months post partum. We focus on maternal knowledge of infant danger signs and optimal young child feeding practices at 6 months post partum and also evaluate maternal care-seeking behaviors for infants, adherence to age-appropriate immunization, and infant and young child feeding practices such as early initiation of breastfeeding and complementary feeding.

We evaluated the preliminary effectiveness of an intervention on maternal health knowledge among 135 participants in Punjab, India, who completed pre- and postintervention surveys. The intervention, led by research personnel with backgrounds similar to community health officers, aimed to empower society and support universal health coverage if successful. We assessed changes in knowledge of maternal danger signs and the appropriate age for introducing different food groups over 6 months post partum. Additionally, we examined postintervention differences in health-seeking behavior for infants, adherence to age-appropriate immunizations, and adoption of breastfeeding and complementary feeding practices among women in the synchronous (group call), asynchronous (IVR and app), and control arms.

Of 12 infant risk factors, maternal knowledge of infant danger signs remained low (mean range: 1.85-2.31 preintervention and 1.81-2.22 postintervention). Participants in the synchronous arm had a statistically significant higher mean increase (mean difference: 0.87, 95% CI 0.06‐1.69) compared to the control arm. Participants in synchronous arms had nearly 3-fold increased odds of infant health checkup by a clinical provider than asynchronous arm participants (odds ratio [OR] 2.72, 95% CI 1.02-7.23). No significant differences were noted in age-appropriate vaccine coverage among infants between arms, though vaccination coverage was more than 80% across all arms. Early initiation of breastfeeding remained low across all arms (~47%).

Our pilot study on group-based mHealth education and virtual social support during the postnatal phase showed modest yet promising results. Rigorous testing is crucial to strengthening the limited evidence base for group-oriented mHealth approaches.