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Original Investigation |

Effect of Short Message Service on Infant Feeding Practice:  Findings From a Community-Based Study in Shanghai, China

Hong Jiang, PhD1,2; Mu Li, PhD3; Li Ming Wen, PhD3,4; Qiaozhen Hu, MS1,2,5; Dongling Yang, MS1,2,6; Gengsheng He, PhD1,2,7; Louise A. Baur, PhD3,8; Michael J. Dibley, MPH3; Xu Qian, PhD1,2,7
[+] Author Affiliations
1School of Public Health, Fudan University, Shanghai, China
2Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
3Sydney School of Public Health, The University of Sydney, Sydney, Australia
4Health Promotion Service, Sydney South West Area, Health Service, New South Wales, Sydney, Australia
5Center for Disease Control and Prevention, Hongkou District, Shanghai, China
6Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
7Global Health Institute, Fudan University, Shanghai, China
8The Children’s Hospital at Westmead Clinical School, The University of Sydney, Sydney, Australia
JAMA Pediatr. 2014;168(5):471-478. doi:10.1001/jamapediatrics.2014.58.
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Importance  Appropriate infant feeding practices have the potential for long-term health effects. However, research findings on improving early infant feeding practices are limited. The wide use of mobile phone short message service (SMS) provides new opportunities for health promotion and services.

Objective  To assess the effect of an SMS intervention on infant feeding practices.

Design and Setting  Quasiexperimental design with follow-up measures scheduled at 4, 6, and 12 months at 4 community health centers in Shanghai, China. Two community health centers represented the intervention group, and 2 other community health centers represented the control group.

Participants  In total, 582 expectant mothers were recruited during the first trimester. Expectant mothers were eligible to participate if they owned a mobile phone, were first-time mothers, conceived a singleton fetus, were older than 20 years and less than 13 weeks’ gestation, had completed at least a compulsory junior high school education, and had no illness that limited breastfeeding after childbirth.

Intervention  Mothers in the intervention group received weekly SMS messages about infant feeding from the third trimester to 12 months’ post partum.

Main Outcomes and Measures  The primary outcome was the duration of exclusive breastfeeding (EBF). Survival analysis was used to compare the duration of EBF between the intervention group and the control group.

Results  Compared with the control group, the intervention group had a significantly longer median duration of EBF at 6 months (11.41 [95% CI, 10.25-12.57] vs 8.87 [95% CI, 7.84-9.89] weeks). The hazard ratio for stopping EBF in the intervention group was 0.80 (95% CI, 0.66-0.97). The intervention resulted in a significantly higher rate of EBF at 6 months (adjusted odds ratio, 2.67 [95% CI, 1.45-4.91]) and a significantly lower rate of the introduction of solid foods before 4 months (adjusted odds ratio, 0.27 [95% CI, 0.08-0.94]).

Conclusions and Relevance  An SMS intervention may be effective in promoting EBF, delaying the introduction of solid foods, increasing awareness of the World Health Organization breastfeeding guidelines, and improving knowledge of appropriate infant feeding practices for new mothers.

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Figure 1.
Participant Recruitment and Retention

In total, 582 women participated in the study, 281 in the intervention group and 301 in the control group.

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Figure 2.
Rates of Exclusive Breastfeeding by Group Allocation

The median duration of exclusive breastfeeding at 6 months differed significantly between the intervention group and the control group (P < .001, log-rank test).

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