Related Experiment Video
Updated: Oct 28, 2026
A Point-of-Care Method with Integrated Decision Support Tool to Estimate Anemia at Population Level
Published on: January 19, 2024
Evaluating gain and loss-framed mobile messaging to improve maternal health service uptake: A cluster randomized
Gebeyehu Bulcha Duguma1,2, Hordofa Gutema1, Mulusew Gerbaba3
1Department of Health, Behaviour, and Society, Faculty of Public Health, Institutes of Health, Jimma University, Jimma, Ethiopia.
Background:
Maternal mortality has declined in Ethiopia, yet rural areas still struggle with access to care. Mobile phone-based gain or loss-framed messaging-hold promise for improving maternal health outcomes. Evidence on the comparative impact of these framing strategies in low-resource rural settings remains limited. This study evaluated the effectiveness of gain- versus loss-framed SMS messages in improving maternal health service utilization in Jimma Zone, Ethiopia.
Methods:
A three-arm cluster-randomized controlled trial was conducted across 21 clusters, with clusters allocated to gain-framed messaging, loss-framed messaging, or control (usual care). A total of 588 pregnant women (16-20 GA) were recruited in March 2023 and followed from May to December 2023, with endline assessment in February 2024. Participants received 39 messages over a 6-8 month period, aligned with gestational age and postnatal timeline. Primary outcomes were at least one ANC, SBA, and PNC within 7 days. Secondary outcomes included knowledge, attitudes, self-efficacy, and self-reported morbidity. Analyses used generalized and linear mixed models with cluster-level adjustments.
Result:
Both framing strategies improved service utilization compared to control. Gain-framed messages increased odds of ANC attendance (OR 5.40, 97.5% CI 1.95-14.94), SBA (OR 7.53, 97.5% CI 2.20-25.79), and PNC (OR 4.83, 97.5% CI 1.71-13.67). Loss-framed messages also improved ANC attendance (OR 7.14, 97.5% CI 2.40-21.26), Skilled Birth Attendance (SBA) (OR 7.31, 97.5% CI 2.13-25.09), and PNC (OR 4.07, 97.5% CI 1.46-11.39). Knowledge improved in both arms, attitudes improved only in the gain-framed arm, and self-efficacy showed no significant change. Self-reported maternal morbidity decreased in both intervention arms.
Conclusion:
Both gain- and loss-framed mobile messages led to increased maternal health service utilization. Loss-framed messages were more effective for ANC attendance, knowledge, and morbidity reduction, while gain-framed messages showed greater impact on SBA, PNC, and attitudes.
Trial Registration:
Pan African Clinical Trials Registry (PACTR), PACTR202201753436676, registered on January 4, 2022; https://tinyurl.com/ykhnpc49.
Related Concept Videos
01:26Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast, controlled...
01:25Role of Communication in the Nursing Process II: Planning and Implementation