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CRAMER et al .
Due to time constraints of the study, patients recruited early in the study were enrolled in the intervention group, and those re‐ cruited later were enrolled in the control group. Despite nonrandom assignment, both the intervention and control groups were virtually equivalent on all demographic variables. Attrition Of N = 98 enrolled in our study, there were n = 77 who had com‐ plete birth data with which to measure birth outcomes. Those who had birth outcome data did not differ in attrition from those with‐ out complete data (control M = 21.3%; intervention M = 23.1%) ( p = 0.83). The two groups were similar on most demographic vari‐ ables except that those without complete data were significantly more likely to be uninsured or on government insurance ( p = 0.009); smoke ( p = 0.013); and be Hispanic/Latino ( p = 0.006). The loss of five loaned smartphones was also associated with attrition. 3.2.2 | Acceptability Fifty‐one participants completed the CSQ‐8 ( N = 16 control and N = 35 intervention). Intervention participants were satisfied and scored higher on the CSQ‐8 ( M = 3.59, SD = 0.3) than the control ( M = 3.22, SD = 0.7). Intervention participants also rated themselves higher on every CSQ‐8 item. The largest improvements were on Item 3: “ To what extent has our program met your needs ?” (intervention M = 3.46 vs. control M = 2.88) and Item 5: “ How satisfied are you with the amount of help you received ?” (intervention M = 3.63 vs. control M = 3.13). Thirty‐two respondents from the intervention group of‐ fered comments about the PTP and all were deemed positive by the
research team. Participants stated that they valued the information provided through the PTP (e.g., “ the personalized text messages were very helpful, and I learned different info that I had no clue about”, “the advice and text messages were a good reminder on topics that you may not think of”, and “learned about nutrition and resources that I was able to share with other moms ”). Participants liked the personalized as‐ pects of the program and individualized contacts with the CHW via technology (e.g., “ Knowing that I could call/text her,” “[I liked] personal contact with the representative ”). Several commented on the ease of the PTP (e.g., “ very easy to follow,” “I liked getting texts every week,” “it was convenient to get the reminders”) . Finally, some suggested having more text messages and contacts with the CHW (e.g., “ more access to the nurse [sic], “would like more text messages and more meetings”) .
3.2.3 | Fidelity Patient delivery and receipt
We measured the number of PTP (1) chats, (2) hyperlink hits, and (3) participant phone calls with the CHW. Overall, participants were highly engaged and receptive to the PTP. There were 241 chats among 41 participants. Most were initiated by participants (i.e., in‐ coming) during the first few months following enrollment. English‐ speaking participants were more engaged than Spanish‐speaking only participants; however, anecdotally, the CHW believed the lower participation rate was because most Spanish‐only speaking participants worked at the local meat packing plant where phone use was discouraged. There were many outgoing chats (initiated by the CHW) and most were focused on technology‐related is‐ sues or medical appointment reminders. Further evidence of
TABLE 1 Outcomes comparison between control and intervention groups
Group
Mean (SD)
Range
N
Weeks gestation Control
39.13 (1.6)
37 40 77 37 40 77
33.5–41.9
Intervention 39.43 (1.1)
36–41
Total
39.29 (1.4) 7.46 (1.1)
33.5–41.9
Birth weight
Control
4–9.3
Intervention 7.34 (0.9)
4.8–9.9
Total
7.4 (1)
4–9.9
N (%) Control
N (%) Intervention Total
Preterm or full term
Preterm Full term
2 (5.4%)
1 (2.5%)
3
35 (94.6%)
39 (97.5%)
74 77
Total Low
37
40
Low birth weight
1 (2.7%)
1 (2.5%)
2
Normal
36 (97.3%)
39 (97.5%)
75 77
Total
37
40 21 35 56 35 37 72
PAM increase
Control
0.15 (0.3) 0.19 (0.2) 0.18 (0.2) 95.06 (6.8)
−0.2 to 0.8 −0.2 to 0.9 −0.2 to 0.9 78.6–100 73.3–100 73.3–100
Intervention
Total
Percent adher‐ ence to medical visits
Control
Intervention 93.85 (8.3)
Total
94.44 (7.5)
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