A Pilot mHealth Text Messaging Program Targeting Parents During the First 2000 Days: Nonrandomized Repeat Cross-Sectional Analysis to Evaluate Feasibility, Engagement, Acceptability, and Potential Effectiveness.

Background: The first 2000 days can profoundly influence long-term health. Healthy Beginnings for Hunter New England Kids (HB4HNEKids) is an SMS text messaging program delivered alongside routine Child and Family Health Nursing (CFHN) care, which provides families with evidence-based, age- and stage-related preventive health information across the first 2000 days. Objective: This pilot study aimed to explore the feasibility, engagement, and acceptability of the HB4HNEKids program. It also aimed to explore the potential effectiveness of the program at 6 and/or 12 months post partum on outcomes including breastfeeding, child diet, child movement, and parental mental well-being. Methods: During the pilot phase (October 2021 to July 2024), project records were used to assess the number of families enrolled, number of SMS text messages sent (feasibility), and the number of opt outs (engagement). Repeat cross-sectional surveys were conducted at 5-7 months post partum and again at 12-14 months post partum using validated survey instruments. Using convenience sampling methods, survey participants consisted of birthing parents who had received HB4HNEKids and a concurrent nonrandomized comparison group that did not receive the program. Surveys assessed parental self-reported engagement with the messages, program acceptability, breastfeeding status, child diet, child movement, and parental mental well-being. Mixed linear regression analyses were conducted to calculate mean differences and odds ratios. Results: During the pilot phase, HB4HNEKids was delivered to 6243 families (73.4% of families contacted by CFHN). A total of 383 birthing parents completed the survey at 6 months (99/383, 26% receiving HB4HNEKids), and 283 completed the survey at 12 months (104/283, 37% receiving HB4HNEKids). Of the survey participants who received HB4HNEKids (n=200), between 76% and 83% reported that they always or very often read the SMS text messages, spending on average 5-7 minutes engaged with the content. At both survey time points, more than 90% of participants receiving HB4HNEKids agreed that the program was acceptable. Child daily intake of vegetables was significantly higher in the HB4HNEKids group (adjusted mean difference 0.23, 95% CI 0.07-0.40; P=.006) than in the comparison group at 12 months. Parents receiving HB4HNEKids also reported significantly better mental well-being scores (P=.005). While HB4HNEKids participants reported breastfeeding rates 5 percentage points greater than comparison participants at 6 and 12 months, this result was not statistically significant. There were no statistically significant differences between HB4HNEKids, and comparison participant responses related to child movement behaviors. Conclusions: The HB4HNEKids SMS text messaging program is feasible to deliver at scale alongside routine CFHN care and is highly acceptable and engaging to parents. This pragmatic evaluation of the pilot, embedded into usual care, indicates potential effectiveness of the program for improving child vegetable intakes and parental mental well-being. Further evaluation of this program using robust methodology is needed to determine the effectiveness of this innovative mHealth program across the first 2000 days.