Abstract
Objectives
Technology-based outreach offers promise for providing support to a broad population of postpartum mothers while keeping costs low. However, research on the efficacy of this approach is scarce. We conducted a pre-registered randomized pilot trial of the effects of a novel technology-based approach for supporting postpartum mothers – via text-based mentoring – from infant’s birth through 18 months.
Methods
Mothers (n = 201) were recruited at West Penn Hospital in Pittsburgh, PA in the days immediately following delivery. Treatment mothers were matched with volunteer mentors who communicated with them entirely via text messages. Control mothers received monthly one-way texts on basic safety topics. Measures were collected via hospital records and mother surveys. We estimated treatment effects on mothers’ parenting stress, mental health, knowledge of child development, engagement in language and literacy activities, and child milestones at 4- and 18-months postpartum. We used a systematic coding approach and simple descriptive statistics to analyze the treatment mother-mentor texting transcripts.
Results
We found no statistically significant impacts on targeted outcomes. However, impacts for some outcomes were meaningfully large (> 0.2 SDs). Analyses of texting transcripts showed that most mothers stayed engaged for the full 18-month study period and that mother-mentor pairs primarily discussed maternal wellbeing and child-focused topics.
Conclusions for Practice
Postpartum mothers will engage with mentors in a text-based mentoring program around important maternal and child health topics. More research and development on technology-based supports for parents in the early childhood years is needed.
Significance
What is already known on this subject? Technology-based approaches to supporting parents of young children are proliferating, with some showing promise in rigorous trials.
What this study adds? Postpartum mothers will engage with mentors in text-based format and discuss maternal and child health topics. The efficacy of this approach should be tested further in larger trials.
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Data Availability
We do not have consent to provide data in this trial. We can provide copies of measures.
Code Availability
Available upon request from the authors.
Notes
As Martin et al. (2018) detail, mentors attend a three-hour, in-person training which introduces the program and trains mentors on building relationships with mothers. Mentors then work through seven online training videos (each ~ 15–20 min long) that provide an overview of program goals and design, an explanation of the software mentors use, information about recognizing and responding to perinatal mood and anxiety disorders, and information about supporting breastfeeding, safe sleep, and early language and literacy. Each video features a different individual including a lactation consultant, the director of a safe-sleep education nonprofit, a mental health-focused social worker, an Allegheny County Health Department project coordinator, and a Carnegie Library of Pittsburgh representative. Optional ongoing training is provided via regular round table discussions, community presentations, and a mentor-exclusive Facebook group.
See ClinicalTrials.gov Identifier: NCT03497286 for our pre-registration plan.
This research was conducted in accord with prevailing ethical principles and was reviewed and approved by the Institutional Review Board of the Allegheny-Singer Research Institute which oversees research conducted at our recruitment hospital. The University of Pittsburgh Institutional Review Board reviewed and approved all procedures related to transfer, storage and analysis of deidentified data.
Prior to the start of recruitment, the coordinator developed a list of study IDs that were randomly assigned to treatment and control conditions in equal shares. The IDs were then sorted in numeric order. After recruitment of a participant, the coordinator would assign the participant a study ID and link the participant to the treatment condition assigned to that ID.
Approximately 18% of mothers experienced mentor attrition during the study period and were matched with a different mentor.
For example, at eight months post-enrollment, control mothers received the message: “Greetings from NurturePA! At eight months old, your baby may be showing signs of crawling or may even be fully on the move. Be sure to secure cabinets and use safety gates where needed.” Other messages addressed the importance of well-child visits, constant bath-time supervision, and guidelines for rear-facing car seats.
OAB items were created based on Bright Futures Guidelines for Health Supervision and the American Academy of Pediatrics Guidelines for Health Supervision III (Reich, 2005). Sample items we included: “Babies put things in their mouths to learn about them,” and “Having a blanket in the crib, in case the baby gets cold, is a good idea.”
All treatment mothers served by the same mentor are a cluster. We assigned each control mother to a unique mentor id for the purpose of clustering. We calculate cluster-robust standard errors to account for clustering of participants by mentor.
Percentages sum to over 100 as conversations could address multiple topics.
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Acknowledgements
We thank Phil Keys and Kate Brennan of NurturePA for their partnership and support, as well as the mothers and mentors who participated in our study. We are grateful to Mark Steinmeyer at the Smith Richardson Foundation for his flexibility and support. We also thank Catherine Tamis-Lemonda and Shawna Lee for their expert advice and to CHEAR seminar participants at the University of Michigan for their feedback. We are grateful to Jennifer Briggs, Abby Chen, Caitlyn Copp-Millward, Jennifer Dorsey, Caitlin Forbes Spear, Hannah Makarevich, Taylor Wynn, Maya Reyes, Ariella Meltzer, Ava Slune, Danielle Lowry and Jasmine Mumpfield for their contributions to the project.
Funding
We are grateful for funding support from the Smith Richardson Foundation; the University of Michigan Rackham Research Grant Program; and UM’s Center for Human Growth and Development. We are also grateful to the University of Michigan’s School of Education Summer Grants Program and the Office of Planning, Research, and Evaluation at the Administration for Children and Families’ Behavioral Scholars Program for supporting Eleanor Martin’s work on this project. Finally, Tareena Musaddiq’s work on the project was supported by a grant from the Institute for Education Sciences (R305B170015).
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Weiland and Page designed the study, obtained funding, and led writing and analysis. Musaddiq led coding and contributed to the writing. Martin helped design the transcript coding procedures and contributed to the literature review. Homitsky provided expert consultation that shaped the study’s design and contributed to the writing.
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This research was conducted in accord with prevailing ethical principles and was reviewed and approved by the Institutional Review Board of the Allegheny-Singer Research Institute which oversees research conducted at West Penn Hospital. The University of Pittsburgh Institutional Review Board reviewed and approved all procedures related to transfer, storage, and analysis of deidentified data.
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Weiland, C., Page, L., Musaddiq, T. et al. The Efficacy of Text-Based Mentoring for Postpartum Mothers: A Pilot Study. Matern Child Health J 27, 1632–1642 (2023). https://doi.org/10.1007/s10995-023-03704-6
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DOI: https://doi.org/10.1007/s10995-023-03704-6