PloS one
Evaluating gain and loss-framed mobile messaging to improve maternal health service uptake: A cluster randomized controlled trial in Jimma, Ethiopia
By Duguma GB, Gutema H, Gerbaba M and 2 others.
Abstract
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.