Text messaging to help women with overweight or obesity lose weight after childbirth: the intervention adaptation and SMS feasibility RCT

Abstract

Background There is a need to develop weight management interventions that fit seamlessly into the busy lives of women during the postpartum period. Objective The objective was to develop and pilot-test an evidence- and theory-based intervention, delivered by short message service, which supported weight loss and weight loss maintenance in the postpartum period. Design Stage 1 involved the development of a library of short message service messages to support weight loss and weight loss maintenance, with personal and public involvement, focusing on diet and physical activity with embedded behaviour change techniques, and the programming of a short message service platform to allow fully automated intervention delivery. Stage 2 comprised a 12-month, single-centre, two-arm, pilot, randomised controlled trial with an active control. Setting This study was set in Northern Ireland; women were recruited via community-based approaches. Participants A total of 100 women with overweight or obesity who had given birth in the previous 24 months were recruited. Interventions The intervention group received an automated short message service intervention about weight loss and weight loss maintenance for 12 months. The active control group received automated short message service messages about child health and development for 12 months. Main outcome measures The main outcomes measured were the feasibility of recruitment and retention, acceptability of the intervention and trial procedures, and evidence of positive indicative effects on weight. Weight, waist circumference and blood pressure were measured by the researchers; participants completed a questionnaire booklet and wore a sealed pedometer for 7 days at baseline, 3, 6, 9 and 12 months. Outcome assessments were collected during home visits and women received a voucher on completion of each of the assessments. Qualitative interviews were conducted with women at 3 and 12 months, to gather feedback on the intervention and active control and the study procedures. Quantitative and qualitative data were used to inform the process evaluation and to assess fidelity, acceptability, dose, reach, recruitment, retention, contamination and context. Results The recruitment target of 100 participants was achieved (intervention, n = 51; control, n = 49); the mean age was 32.5 years (standard deviation 4.3 years); 28 (28%) participants had a household income of < £29,999 per annum. Fifteen women became pregnant during the follow-up (intervention, n = 9; control, n = 6) and withdrew from the study for this reason. At the end of the 12-month study, the majority of women remained in the study [85.7% (36/42) in the intervention group and 90.7% (39/43) in the active control group]. The research procedures were well accepted by women. Both groups indicated a high level of satisfaction with the short message service intervention that they were receiving. There was evidence to suggest that the intervention may have a positive effect on weight loss and prevention of weight gain during the postpartum period. Limitations The interviews at 3 and 12 months were conducted by the same researchers who collected other outcome data. Conclusions An evidence- and theory-based intervention delivered by short message service was successfully developed in conjunction with postpartum women with overweight and obesity. The intervention was acceptable to women and was feasible to implement in the 12-month pilot randomised controlled trial. The progression criteria for a full randomised controlled trial to examine effectiveness and cost-effectiveness were met. Future work Some minor refinements need to be made to the intervention and trial procedures based on the findings of the pilot trial in preparation for conducting a full randomised controlled trial. Trial registration Current Controlled Trial ISRCTN90393571. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 4. See the NIHR Journals Library website for further project information. The intervention costs were provided by the Public Health Agency, Northern Ireland.

Evaluation of a Text Messaging Intervention to Promote Preconception Micronutrient Supplement Use: Feasibility Study Nested in the Healthy Life Trajectories Initiative Study in South Africa

“…Indicative effect results suggest a promising potential effect of the SMS text messaging intervention on self-reported supplement adherence and changes in hemoglobin from baseline to follow-up, although these are not based on a randomized comparison. These findings are in line with evidence from high-income countries on the acceptability and potential of SMS text messaging interventions to support behavior change in various life stages and contribute to the existing evidence, although less conclusive, for SMS text messaging interventions from low-and middle-income countries [20,21,27,28]. Finally, the health-promoting radio serial was found to be acceptable for young women.…”

“…The HAPA is a sociocognitive model encompassing 2 phases: the motivation phase, including outcome and risk perception and self-efficacy, and the volitional phase, including action-oriented processes such as action planning and maintenance of self-efficacy. HAPA has previously been shown to successfully inform medication adherence and UK-based SMS text messaging interventions [28,34,35]. The message bank was developed with input from young women in Soweto, including lessons from formative work for HeLTI Bukhali around barriers to supplement use [31], and was tested for any content or technical issues before this feasibility study.…”

“…In our study, the 2-way reply function of the SMS text messaging intervention was underused, with only 10.8% (13/120) of participants using the reply function in the final week of the intervention. A study evaluating a 2-way SMS text messaging intervention for weight loss in postpartum women in a high-income setting found good engagement with a comparable yes or no SMS text message reply option, with most participants replying to over half of the messages and high engagement contributing to the outcome of interest [28]. In a low-to middle-income setting, some evidence suggests that a 2-way SMS text messaging intervention could be effective if engagement is high enough [49]; however, a study of a 2-way SMS text messaging intervention for improved HIV care in pregnant and postpartum women in Kenya found a similarly low response frequency [50].…”

“…In South Africa, SMS text messaging interventions have shown highly promising results for HIV care adherence, support, and education [23][24][25], as well as for pregnant and postpartum women, through the National MomConnect SMS text message health messaging program [26,27]. Data from high-income settings suggest that a 2-way SMS text messaging intervention can support nutritional behavior change, resulting in weight loss and maintenance in the postpartum period [28], and that a mobile app can effectively improve preconception nutrition [29]. However, to the best of our knowledge, the use of SMS text messaging to improve nutritional status during the preconception period has not been previously explored.…”

An mHealth Intervention to Reduce Gestational Obesity (mami-educ): Protocol for a Randomized Controlled Trial

“…Interventions based on behavioral theories provide a greater understanding of the underlying mechanisms that determine health-related behavior change and have the potential to be more effective in promoting adherence to weight gain control [ 28 ]. The social cognitive theory [ 29 , 30 ] considers the social dimension of the individual since each individual has a belief system and the capacity for self-motivation and positive behavioral changes [ 29 , 31 , 32 ]. Therefore, technologies such as mobile phones can be useful to effectively address this problem.…”