{"doi":"10.1371/journal.pdig.0000968","title":"Associations between text communication engagement and maternal-neonatal outcomes in the Mobile WACh NEO Trial","abstract":"Despite a global reduction in neonatal deaths in the last few decades, high neonatal mortality rates persist in low- to middle-income countries. Mobile health interventions offer a promising solution to promote early newborn care (ENC) practices and improve neonatal health. The Mobile WACh NEO randomized controlled trial evaluated the effect of a text messaging communication intervention on neonatal health outcomes in Kenya from 2020 to 2023. Perinatal participants received automated messages from enrollment at 28-36 weeks gestation until six weeks postpartum and could message with a study nurse. This secondary analysis aimed to characterize participant text engagement and examine associations between engagement and maternal-neonatal health outcomes. Among 2,470 intervention participants retained through follow-up, median time in the intervention was 14 weeks. Participants received a median of 58 automated messages (average 0.58 per day), sent a median of 24 messages (average 0.25 per day), and received a median of 14 nurse responses (average 0.14 per day). Younger, more educated, unmarried, unemployed, and first-time mothers sent more messages, while those who had a lower social support score at baseline messaged less. Increased participant messaging was associated with greater increase in neonatal danger sign knowledge from baseline to six-week follow-up (Adj Est: 0.39; 95% CI: 0.09-0.68) and lower odds of early initiation of breastfeeding (aOR: 0.62; 95% CI: 0.45-0.86). Our findings contribute to the understanding of who can benefit from mobile health programs and how these interventions might impact behaviors and outcomes.","journal":"PLOS Digital Health","year":2025,"id":571970,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9551,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1078787,"name":"Erica Wetzler","orcid":"0000-0002-3076-5034","position":1,"is_corresponding":false},{"id":820301,"name":"Brenda Wandika","orcid":null,"position":2,"is_corresponding":false},{"id":551021,"name":"Peninah Kithao","orcid":null,"position":3,"is_corresponding":false},{"id":1460121,"name":"June Moraa","orcid":null,"position":4,"is_corresponding":false},{"id":611917,"name":"Jenna Udren","orcid":"0000-0002-9523-1041","position":5,"is_corresponding":false},{"id":369083,"name":"Olívia Lang Schultes","orcid":"0000-0002-9838-7631","position":6,"is_corresponding":false},{"id":1478260,"name":"Esther Akinyi","orcid":null,"position":7,"is_corresponding":false},{"id":541204,"name":"Lusi Osborn","orcid":"0000-0002-7100-2666","position":8,"is_corresponding":false},{"id":542459,"name":"Anna B. Hedstrom","orcid":"0000-0002-3269-1892","position":9,"is_corresponding":false},{"id":407491,"name":"Barbra A. Richardson","orcid":"0000-0001-9564-1828","position":10,"is_corresponding":false},{"id":61221,"name":"Manasi Kumar","orcid":"0000-0002-9773-8014","position":11,"is_corresponding":false},{"id":376369,"name":"Dalton Wamalwa","orcid":"0000-0002-5510-462X","position":12,"is_corresponding":false},{"id":299054,"name":"John Kinuthia","orcid":"0000-0001-6571-8927","position":13,"is_corresponding":false},{"id":344985,"name":"Keshet Ronen","orcid":"0000-0001-5625-4884","position":14,"is_corresponding":false},{"id":323805,"name":"Jennifer A. Unger","orcid":"0000-0002-6317-226X","position":15,"is_corresponding":false},{"id":255281,"name":"James Peng","orcid":"0000-0002-8245-8319","position":0,"is_corresponding":true}],"reference_count":34,"raw_metadata":null,"created_at":"2026-07-19T02:57:19.669553Z","pmid":"40773418","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}