JMIR Publications

ABSTRACT

Background:

Social messaging strategies such as SMS and radio are promising avenues for health promotion and behaviour change in low-middle income settings. However, evidence for their acceptability, feasibility, and impact in the context of young women’s health and micronutrient deficiencies is lacking.

Objective:

We aimed to evaluate an automated two-way SMS intervention in the context of an ongoing preconception health trial (the Healthy Life Trajectories Initiative, HeLTI Bukhali) in Soweto, a historically disadvantaged township in South Africa. Additionally, we aimed to evaluate acceptability of a health-promotion radio serial, which aired concurrently in the region.

Methods:

In this feasibility study, 120 participants enrolled in HeLTI Bukhali from November 2020-February 2021 received the 6-month two-way SMS. An SMS-control group consisted of the first 120 women recruited from November 2019-February 2020, receiving the Bukhali intervention but not the SMSs. Data on intervention acceptability, usability, interaction, perceived benefit, and fidelity was collected at 5 focus group discussions (FGDs). During these FGDs, data was also collected on the acceptability of the health-promotion radio serial. Following the SMS intervention, capillary haemoglobin levels were assessed and a staff-administered participant questionnaire provided information on self-reported adherence and attitudes towards supplements. Significance testing and a linear mixed model were used to compare outcomes between the SMS-receiving and SMS-control groups.

Results:

The SMS intervention was found to be acceptable and to have perceived benefits, including being reminded to take supplements, gaining knowledge, and feeling supported by the study team. Use of the two-way SMS reply function was limited, with only 11% of participants responding by week 24. Barriers to replying included a lack of interest, a lack of available airtime (phone credit), and technical issues. Compared to the SMS-control group, participants receiving the SMS had higher self-reported adherence at follow-up (66.7% vs. 38.8% reported taking supplements every time, P=0.015), and altitude-adjusted Hb increased more between baseline and follow-up in the SMS-receiving group than in the SMS-control group (1.03, 95%CI 0.49- 1.57, P<0.001). The content of the radio serial was found to be acceptable, but few participants reported exposure to the radio serial prior to the focus group discussion.

Conclusions:

Women reported that the SMS-intervention was useful and described benefits of receiving the messages. Examination of haemoglobin status indicated a promising beneficial effect of SMS support on preconception adherence to micronutrient supplementation. Health promotion through radio and SMS were both found to be acceptable, but more research is needed to establish reach of the radio serial amongst young women. Directed messaging (such as SMS) and mass messaging strategies (such as radio) could be used to complement each other to promote health in the preconception period. Clinical Trial: HeLTI Bukhali: Pan African Clinical Trials Registry, PACTR201903750173871, 27 March 2019