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 will improve the effectiveness of a home micronutrient fortification program in western China.

Methods: A cluster-randomized controlled trial was carried out in 351 villages in Shaanxi province in 2013-14. We enrolled children aged 6-12 months in target villages. Each village/cluster was randomly assigned into one of three groups: Free Delivery Group (FDG; caregivers received free micronutrient packets); Text Messaging Group (TMG; FDG treatment plus daily text message); and 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 (ITT) effects on compliance and child anemia using a logistic regression model, controlling for infant, caregiver and household characteristics.

Results: There were 1393 eligible children. We found that assignment to TMG led to an increase full compliance (marginal effect = 0.10, 95% CI = 0.03, 0.16) and decrease in the rate of anemia at endline (marginal effect=-0.07, 95% CI= -0.12, -0.01).

Conclusions: Text messages improved compliance of caregivers to a home fortification program and children’s nutrition.