The effectiveness of using a WeChat account to improve exclusive breastfeeding in Huzhu County Qinghai Province, China: protocol for a randomized control trial

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Abstract

Background

An exclusive breastfeeding rate in the first 6 months of life of at least 50% is one of the six World Health Organization global nutrition targets for 2025. However, the exclusive breastfeeding rate in China is quite low and decreasing which makes it urgent to explore effective ways to reverse the current downward trend. As mobile technologies have rapidly developed, mobile communication apps such as WeChat (one of the largest social networking platforms in China) are well accepted and have the potential to improve health behaviors in a convenient way. The current paper describes the study protocol of a WeChat intervention that aims to promote breastfeeding in rural areas in China.

Methods

The study is designed as a randomized controlled trial in rural Qinghai Province, China. Women who are 14–36 weeks pregnant will be randomized to routine antenatal and postnatal care, or routine care plus the WeChat breastfeeding education. pregnant women with a severe disease and complications of pregnancy or HIV-1 will be excluded. Breastfeeding knowledge and promotion information will be delivered to the intervention group through a WeChat official account from 3 months pregnancy to 6 months postpartum. The outcome assessments are conducted at baseline through face-to-face interviews, and at one week, 1 month, 3 months and 6 months postpartum by telephone interviews. The primary outcome is difference in the exclusive breastfeeding rate at 1 month, 3 months, and 6 months postpartum between the intervention group and the control group. Secondary outcomes include the overall duration of any and exclusive breastfeeding across the first 6 months postpartum; mothers’ knowledge of breastfeeding; the proportion of early initiation of breastfeeding; and the timing of the introduction of solid food to infants. Intention-to-treat-analysis will be used. Survival analysis will be used to compare the overall duration of any and exclusive breastfeeding between groups.

Discussion

This study is the first effort to promote exclusive breastfeeding through WeChat in China. Our results will provide scientific evidence for the effect of health education through WeChat on breastfeeding. Thereby this may offer a comprehensive intervention to promote exclusive breastfeeding in China and other settings.

Trial registration

Chinese Clinical Trial Registry –ChiCTR1800017364. Registered 26 July 2018. http://www.chictr.org.cn/showproj.aspx?proj=29325

Related collections

Most cited references 15

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Effect of short message service on infant feeding practice: findings from a community-based study in Shanghai, China.

Hong Jiang, Mu Lan LI, Li Ming Wen … (2014)

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. To assess the effect of an SMS intervention on infant feeding practices. 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. 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. Mothers in the intervention group received weekly SMS messages about infant feeding from the third trimester to 12 months' post partum. 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. 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]). 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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Smartphone Versus Pen-and-Paper Data Collection of Infant Feeding Practices in Rural China

Shuyi Zhang, Qiong Wu, Michelle HMMT van Velthoven … (2012)

Background Maternal, Newborn, and Child Health (MNCH) household survey data are collected mainly with pen-and-paper. Smartphone data collection may have advantages over pen-and-paper, but little evidence exists on how they compare. Objective To compare smartphone data collection versus the use of pen-and-paper for infant feeding practices of the MNCH household survey. We compared the two data collection methods for differences in data quality (data recording, data entry, open-ended answers, and interrater reliability), time consumption, costs, interviewers’ perceptions, and problems encountered. Methods We recruited mothers of infants aged 0 to 23 months in four village clinics in Zhaozhou Township, Zhao County, Hebei Province, China. We randomly assigned mothers to a smartphone or a pen-and-paper questionnaire group. A pair of interviewers simultaneously questioned mothers on infant feeding practices, each using the same method (either smartphone or pen-and-paper). Results We enrolled 120 mothers, and all completed the study. Data recording errors were prevented in the smartphone questionnaire. In the 120 pen-and-paper questionnaires (60 mothers), we found 192 data recording errors in 55 questionnaires. There was no significant difference in recording variation between the groups for the questionnaire pairs (P = .32) or variables (P = .45). The smartphone questionnaires were automatically uploaded and no data entry errors occurred. We found that even after double data entry of the pen-and-paper questionnaires, 65.0% (78/120) of the questionnaires did not match and needed to be checked. The mean duration of an interview was 10.22 (SD 2.17) minutes for the smartphone method and 10.83 (SD 2.94) minutes for the pen-and-paper method, which was not significantly different between the methods (P = .19). The mean costs per questionnaire were higher for the smartphone questionnaire (¥143, equal to US $23 at the exchange rate on April 24, 2012) than for the pen-and-paper questionnaire (¥83, equal to US $13). The smartphone method was acceptable to interviewers, and after a pilot test we encountered only minor problems (eg, the system halted for a few seconds or it shut off), which did not result in data loss. Conclusions This is the first study showing that smartphones can be successfully used for household data collection on infant feeding in rural China. Using smartphones for data collection, compared with pen-and-paper, eliminated data recording and entry errors, had similar interrater reliability, and took an equal amount of time per interview. While the costs for the smartphone method were higher than the pen-and-paper method in our small-scale survey, the costs for both methods would be similar for a large-scale survey. Smartphone data collection should be further evaluated for other surveys and on a larger scale to deliver maximum benefits in China and elsewhere.

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Social Media–Promoted Weight Loss Among an Occupational Population: Cohort Study Using a WeChat Mobile Phone App-Based Campaign

Chao He, Shiyan Wu, Yingying Zhao … (2017)

Background Being overweight and obese are major risk factors for noncommunicable diseases such as cardiovascular diseases. The prevalence of overweight and obesity is high throughout the world and these issues are very serious in the Shunyi District in China. As mobile technologies have rapidly developed, mobile apps such as WeChat are well accepted and have the potential to improve health behaviors. Objective This study aims to evaluate the effectiveness of a mobile app (WeChat) as an intervention on weight loss behavior. Methods This study was conducted among an occupational population from August 2015 to February 2016 in the Shunyi District of Beijing. Before the intervention, the Shunyi District Government released an official document for weight loss to all 134 government agencies and enterprises in Shunyi District. Participants willing to use our official WeChat account were enrolled in a WeChat group and received 6 months of interventions for weight loss; those who were not willing to use the account were in a control group given routine publicity on weight loss. Results In total, 15,310 occupational participants including 3467 participants (22.65%) in the control group and 11,843 participants (77.35%) in the WeChat group were enrolled. Participants in the WeChat group lost more weight (mean 2.09, SD 3.43 kg) than people in the control group (mean 1.78, SD 2.96 kg), and the difference in mean weight loss between the two groups for males was significant based on the stratification of age and educational level. To control for confounding factors and to explore the effects of WeChat on weight loss, the propensity score method with a multinominal logistic regression was utilized. For males, this showed that the WeChat group (with both active and inactive subgroups) had a higher probability of maintaining weight, weight loss from 1 to 2 kg, or weight loss more than 2 kg than the control group. However, the control group had higher probability of weight loss from 0 to 1 kg. Being active in WeChat was likely to be associated with weight loss. The more active participants were in the weight loss program via WeChat, the more weight they lost. Conclusions The weight loss intervention campaign based on an official WeChat account focused on an occupation-based population in Shunyi District was effective for males. The more active male participants were in using WeChat, the more weight they lost. There might be no effect or there may even be a negative effect on weight loss for females. Future research should focus on how to improve adherence to the WeChat weight loss interventions, to improve and refine the WeChat content such as developing a variety of materials to attract interest, and to protect personal privacy, especially for females.

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Author and article information

Contributors

Suying Chang: schang@unicef.org

Yanfeng Zhang:

ORCID: http://orcid.org/0000-0003-2147-9594

summyzh@126.com

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 2 December 2019

Publication date PMC-release: 2 December 2019

Publication date Collection: 2019

Volume: 19

Electronic Location Identifier: 1603

Affiliations

[1 ]ISNI 0000 0004 1771 7032, GRID grid.418633.b, Department of Integrated Early Childhood Development, , Capital Institute of Pediatrics, ; No. 2 Yabao Road, Chaoyang District, Beijing, 100020 People’s Republic of China

[2 ]ISNI 0000 0004 1936 8948, GRID grid.4991.5, Department of Paediatrics, Level 2, Children’s Hospital, John Radcliffe, , University of Oxford, ; Headington, Oxford, OX3 9DU UK

[3 ]Health and Nutrition, Water, Environment and Sanitation Section, UNICEF China, 12, Sanlitun Lu, Beijing, 100600 People’s Republic of China

Author information

Yanfeng Zhang http://orcid.org/0000-0003-2147-9594

Article

Publisher ID: 7676

DOI: 10.1186/s12889-019-7676-2

PMC ID: 6889429

PubMed ID: 31791295

SO-VID: f5091f3a-9db3-420e-a79f-004c2293551e

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 15 March 2019

Date accepted : 23 September 2019

Funding

Funded by: UNICEF China

Custom metadata

ScienceOpen disciplines: Public health

Keywords: breastfeeding,exclusive breastfeeding,mhealth,wechat,randomized controlled trial

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ScienceOpen disciplines: Public health

Keywords: breastfeeding, exclusive breastfeeding, mhealth, wechat, randomized controlled trial

The effectiveness of using a WeChat account to improve exclusive breastfeeding in Huzhu County Qinghai Province, China: protocol for a randomized control trial

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Trial registration

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Point-of-Care Testing for Infectious Diseases Super Collection

Most cited references 15

Effect of short message service on infant feeding practice: findings from a community-based study in Shanghai, China.

Smartphone Versus Pen-and-Paper Data Collection of Infant Feeding Practices in Rural China

Social Media–Promoted Weight Loss Among an Occupational Population: Cohort Study Using a WeChat Mobile Phone App-Based Campaign

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