Impact of Text Message Reminders on Caregivers' Adherence to a Home Fortification Program Against Child Anemia in Rural Western China: A Cluster-Randomized Controlled Trial


Objectives. To test whether text message reminders sent to caregivers improve the of micronutrient supplementation, however, effectiveness of a home micronutrient fortification program in western China. Methods. We carried out a cluster-randomized controlled trial in 351 villages (clusters) in Shaanxi Province in 2013 and 2014, enrolling children aged 6 to 12 months. We randomly assigned each village to 1 of 3 groups: free delivery group, text messaging group, or control group. We collected information on compliance with treatments and hemoglobin concentrations from all children at baseline and 6-month follow-up. We estimated the intent-to-treat effects on compliance and child anemia using a logistic regression model. Results. There were 1393 eligible children. We found that assignment to the text is mostly limited to studies based on small, nonrandomized samples.13– 18 Although supplementation has potential if caregivers systematically comply with supplement programs, there are indications that, internationally, lack of compliance has been a barrier to its success.19– 21 Unfortunately, almost no research has been conducted on how supplementation can best be delivered or how caregivers can be messaging group led to an increase in full compliance (marginal effect = 0.10; 95% persuaded to regularly give their children confidence interval [CI] = 0.03, 0.16) compared with the free delivery group and decrease micronutrient supplements. One study in the rate of anemia at end line relative to the control group (marginal effect = – 0.07; evaluated household compliance to a 95% CI = – 0.12, – 0.01), but not relative to the free delivery group (marginal effect = – 0.03; 95% CI = – 0.09, 0.03). Conclusions. Text messages improved compliance of caregivers to a home fortification program and children’s nutrition. (Am J Public Health. 2016;106:1256– 1262. doi:10.2105/ AJPH.2016.303140)

American Journal of Public Health