JMIR Publications

ABSTRACT

Background:

The promotion of physical activity (PA) and healthy feeding (HF) habits is important to stop the unprecedented global rise in obesity.

Objective:

This study aims to assess the effectiveness and feasibility of implementing an mHealth intervention that promotes PA and HF practices among principal caregivers (PC) of Mexican children under age five.

Methods:

Effectiveness-implementation hybrid trial of an mHealth intervention (named NUTRES). For 36 weeks, intervention group (IG) participants (n=230) received approximately 108 text messages (or short message service, SMS) according to their children’s age. SMS messages were related to PA, HF, and the importance of child feeding in the context of COVID-19. NUTRES participants came from urban and rural health units in two states of Mexico and a mixed methods approach was used in this trial. Due to the context of COVID-19, both baseline and follow-up surveys were conducted by mobile/fixed telephone. A qualitative component explored PC experience with NUTRES and some implementation indicators, such as: acceptance, pertinency, and coverage. Coding and analysis were carried out using grounded theory. Difference-in-differences regression models were performed to identify differences between groups in terms of knowledge and practices related to infant PA and HF.

Results:

A total of 494 PCs were enrolled in NUTRES, but only 334 continued to the end of the study, which represents 67.7% for both groups. Most PCs (30.5% always and 68.8% sometimes) used the SMS information. Satisfaction/acceptability towards NUTRES reached 98% and informants agreed that NUTRES is 'good', 'useful,' and 'helpful' for improving child nutrition. There was, a significant increase of 0.03 between the study groups in terms of knowledge about the benefits of PA (p <0.05). PCs felt accompanied and counseled, especially during the disruption of routine healthcare services during COVID-19.

Conclusions:

NUTRES had a limited impact on target knowledge/behaviors, but the SMS served as a reminder or source of new knowledge among PCs of Mexican children under age five. Lessons learned are: mHealth intervention strategies can be used to keep in touch with people in emergency contexts, as was COVID-19 pandemic; methodological and implementation barriers limit the impact of mHealth interventions; and mixed methods approaches ensure complementarity of results. Findings contribute to evidence on the opportunities and limitations related to using mobile phones to improve knowledge and practices related to PA and HF among PCs of infants and children. Clinical Trial: ClinicalTrials.gov database [Registration ID: NCT04250896].