# Evaluation of a Short Message Service (SMS)-Based Health Education Program (“Active Moms”) on Antenatal Knowledge and Health Attitudes Among Primigravida Women in South Gujarat: A One-Group Pretest-Posttest Study

## TL;DR

An SMS-based health education program improved antenatal knowledge and attitudes among first-time pregnant women in South Gujarat.

## Contribution

This study demonstrates the effectiveness of SMS-based education in improving maternal health knowledge and attitudes in low-resource settings.

## Key findings

- Mean knowledge scores increased significantly from 12.0 to 16.8 after the SMS intervention.
- A strong positive correlation was found between improved knowledge and improved health attitudes.
- The intervention accounted for 42% of the variance in outcomes.

## Abstract

Introduction

Maternal health education during antenatal care remains suboptimal among primigravida women, particularly in semi-urban and rural settings, leading to gaps in knowledge and health-related attitudes. Short message service (SMS)-based interventions offer a low-cost and accessible strategy to address these gaps by reinforcing essential antenatal information.

Methods

A quantitative one-group pretest-posttest design was implemented among 60 primigravida women in South Gujarat. Participants received standardized SMS messages on antenatal topics, nutrition, hygiene, rest, supplementation, danger-sign recognition, and delivery preparedness, adapted from WHO guidelines and localized in Gujarati. Data were collected using validated instruments assessing knowledge (20 items) and attitudes (22-item Likert scale). Paired-samples t-tests were used to analyze changes in knowledge and attitude scores, while chi-square tests and Pearson’s correlation assessed demographic associations and relationships between outcomes. Paired t-tests, chi-square tests, and correlation analyses were conducted using SPSS v25 (IBM Corp., Armonk, NY, USA), with significance set at p < 0.05.

Results

Mean knowledge scores increased significantly from 12.0 ± 2.4 to 16.8 ± 1.9 (p < 0.001, Cohen’s d = 1.30), while mean attitude scores rose from 16.0 ± 1.17 to 18.6 ± 1.0 (p < 0.001, d = 1.10). A strong positive correlation was observed between knowledge and attitudes (r = 0.62, p < 0.001). Education level, nuclear family type, and higher income were significantly associated with greater knowledge gain. The intervention accounted for 42% of the variance in outcomes (η² = 0.42).

Significance

The Active Moms SMS-based intervention was associated with improvements in antenatal knowledge and health attitudes among primigravida women. Given the exploratory nature of this one-group pretest-posttest study and the absence of a control group, these findings should be interpreted cautiously. Nonetheless, the results suggest that SMS-based education may represent a promising, scalable, culturally adaptable, and cost-effective approach to supporting maternal health education in low-resource settings. Further controlled studies are needed to confirm effectiveness before large-scale integration into national antenatal care frameworks.