Trial reportBMC pregnancy and childbirth2026
Effect of gain- versus loss-framed messages on improving newborn care practices among mothers: a three-arm cluster randomized controlled trial.
Trial report in BMC pregnancy and childbirth, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
backgroundEthiopia’s neonatal mortality rates stand at 25 per 1,000 live births, signifying a high rate. Effective newborn care practices are vital to reducing neonatal mortality and morbidity. While message framing and mHealth interventions have demonstrated promise in enhancing health outcomes, there is a lack of adequate evidence on the effectiveness of mobile phone text message-based framing for improving newborn care practices.
objectiveThe study was conducted to evaluate which type of message framing approach (gain- framed vs. loss-framed) delivered through a mobile phone is more effective in promoting newborn care practices.
methodsA three-arm cluster randomized controlled trial was conducted in three districts of Jimma Zone in the Oromia region. Twenty-one villages (health posts) were randomly assigned to one of the three arms: the gain-framed group (n = 196), the loss-framed group (n = 196), and the control group (n = 196). The intervention groups received a series of text messages structured in the form of either gain framing or loss framing from the date of enrolment until 6–8 months, while the control group received existing care without text messages. The primary outcome was newborn care practices (early initiation of breastfeeding, exclusive breastfeeding, safe cord care, and thermal care). Secondary outcomes included knowledge, attitude, self-efficacy, and newborn illness. The intervention effect was analyzed using generalized linear mixed model for categorical outcomes and linear mixed models for continuous outcomes.
resultsGain- and loss-framed groups had significantly improved composite newborn care practices, with adjusted odds ratio (AOR) of 3.58 (95% CI: 2.08–6.12) and 3.44 (95% CI: 1.98–5.64) compared to the control group respectively. Both intervention groups significantly improved knowledge about newborn care practices, with Adjusted mean difference (AMD) of 4.56 (95% CI: 4.09–5.02) in the gain-framed group and 4.2 (95% CI: 3.78–4.7) in the loss-framed group compared to the control group. Similarly, both gain- and loss-framed groups had a significant effect on attitude toward newborn care practices, (gain-framed AMD = 6.84, 95% CI: 5.2–8.48; loss-framed AMD = 7.67, 95% CI: 6.03–9.32). Participants in the gain-framed group had higher self-efficacy score toward newborn care practices (AMD = 4, 95% CI: 3.36–4.64), compared with control group. Similarly, those in loss-framed group had higher self-efficacy score toward newborn care practices (AMD = 3.37, 95% CI: 2.73–4.01) compared with those in control group. Newborns in the gain-framed group had 88% lower odds of illness than those in the loss-framed group (AOR = 0.12, 95% CI: 0.06–0.25) and 84% lower odds of illness than those in control group (AOR = 0.16, 95% CI: 0.08–0.33).
conclusionUsing gain-framed and loss-framed messages significantly improved overall newborn care practices, knowledge, attitudes and self-efficacy toward newborn care practices. While gain-framed messages showed better results in promoting early initiation of breastfeeding and exclusive breastfeeding practice. These findings suggests that mobile phone text communication strategies containing gain- and loss-framed messages can enhance the effectiveness of promoting newborn care practices. But, only gain-framed message better improve self-efficacy.
trial registrationClinical trials PACTR202201753436676, 4th January 2022.
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