Maternal Parenting Electronic Diary in the Context of a Home Visit Intervention for Adolescent Mothers in an Urban Deprived Area of São Paulo, Brazil: Randomized Controlled Trial

Daniel Fatori, Adriana Argeu, Helena Brentani, Anna Chiesa, Lislaine Fracolli, Alicia Matijasevich, Euripedes C Miguel, Guilherme Polanczyk, Daniel Fatori, Adriana Argeu, Helena Brentani, Anna Chiesa, Lislaine Fracolli, Alicia Matijasevich, Euripedes C Miguel, Guilherme Polanczyk

Abstract

Background: Pregnancy during adolescence is prevalent in low- and middle-income countries (LMICs), which is associated with various adverse outcomes that can be prevented with home visiting programs. However, testing these interventions in LMICs can be challenging due to limited resources. The use of electronic data collection via smartphones can be an alternative and ideal low-cost method to measure outcomes in an environment with adverse conditions.

Objective: Our study had two objectives: to test the efficacy of a nurse home visiting intervention on maternal parenting and well-being measured by an electronic daily diary (eDiary), and to investigate the compliance rate of the eDiary measurement method.

Methods: We conducted a randomized controlled trial to test the efficacy of Primeiros Laços, a nurse home visiting program, for adolescent mothers living in an urban deprived area of São Paulo, Brazil. A total of 169 pregnant adolescents were assessed for eligibility criteria, 80 of whom were included and randomized to the intervention (n=40) and control group (care as usual, n=40). Primeiros Laços is a home visiting intervention delivered by trained nurses tailored to first-time pregnant adolescents and their children, starting during the first 16 weeks of pregnancy until the child reaches 24 months of age. Participants were assessed by blind interviewers at 8-16 weeks of pregnancy (baseline), 30 weeks of pregnancy, and when the child was 3, 6, and 12 months of age. At 18 months, participants were assessed regarding maternal parenting and parental well-being using a 7-consecutive-day eDiary. The smartphone app was programmed to notify participants every day at 9:00 PM over a period of seven days.

Results: We were able to contact 57/80 (71%) participants (29 from the intervention group and 28 from the control group) when the child was 18 months of age. Forty-eight of the 57 participants (84%) completed at least one day of the eDiary protocol. The daily compliance rate ranged from 49% to 70%. Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, 95% CI [0.06, 0.58], P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, 95% CI [1.20, 4.50], P=.01).Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, P=.01).

Conclusions: The Primeiros Laços intervention improved maternal parenting and parental well-being, demonstrating its promise for low-income adolescent mothers. The compliance rate of the eDiary assessment showed that it was generally accepted by adolescent mothers with limited resources. Future studies can implement ambulatory assessment in LMICs via smartphones to measure mother and child behaviors.

Trial registration: ClinicalTrials.gov NCT02807818; https://ichgcp.net/clinical-trials-registry/NCT02807818.

Keywords: ambulatory assessment; daily diary; early childhood development; mHealth; maternal care; randomized clinical trial.

Conflict of interest statement

Conflicts of Interest: GP has served as a consultant to Shire and Johnson & Johnson. He has served on the speakers’ bureau of Shire. He has received royalties from Editora Manole. The remaining authors have no conflicts of interest to declare.

©Daniel Fatori, Adriana Argeu, Helena Brentani, Anna Chiesa, Lislaine Fracolli, Alicia Matijasevich, Euripedes C Miguel, Guilherme Polanczyk. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 28.07.2020.

Figures

Figure 1
Figure 1
Consolidated Standards of Reporting Trials (CONSORT) diagram.
Figure 2
Figure 2
eDiary compliance rate per day (n=57).
Figure 3
Figure 3
Effect of intervention on continuous outcomes: mother well-being (B=0.18, 95% CI [-0.15, 0.51],P=.286), parental well-being (B=0.32, 95% CI [0.06, 0.58], P=.015), total time spent with the child (B=0.05, 95% CI [-0.43, 0.52], P=.845).
Figure 4
Figure 4
Effect of intervention on categorical outcomes: mother taking care of the child (OR=0.71, 95% CI [0.19, 2.60], P=.61), mother reading or showing a book to the child (OR=2.35, 95% CI [0.90, 6.11], P=.08), mother telling stories or singing to the child (OR=2.33, 95% CI [1.20, 4.50]. P=.01), mother going out or for a stroll with the child (OR=0.76, 95% CI [0.33, 1.72], P=.51), mother playing with the child (OR=1.17, 95% CI [0.44, 3.17], P=.75), mother talking to the child (OR=1.82, 95% CI [0.69. 4.77], P=.22), mother eating/having meals with the child (OR=0.65, 95% CI [0.22, 1.90], P=.43).

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