Evaluating gain and loss-framed mobile messaging to improve maternal health service uptake: A cluster randomized controlled trial in Jimma, Ethiopia.
Gebeyehu Bulcha Duguma, Hordofa Gutema, Mulusew Gerbaba et al.
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In 30 seconds
This three-arm cluster-randomized controlled trial assessed whether gain- or loss-framed SMS messaging improved maternal health service use among 588 pregnant women in Jimma Zone, Ethiopia. Participants received 39 messages over 6–8 months or usual care. Compared with control, both messaging approaches increased attendance for antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC). The largest reported odds ratio was for ANC attendance with loss-framed messages (OR 7.14, 97.5% CI 2.40-21.26). Knowledge improved in both intervention groups, while self-efficacy did not change significantly.
Key findings
- Gain-framed messaging increased 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) versus control.
- Loss-framed messaging increased ANC attendance (OR 7.14, 97.5% CI 2.40-21.26), SBA (OR 7.31, 97.5% CI 2.13-25.09), and PNC (OR 4.07, 97.5% CI 1.46-11.39) versus control.
- Knowledge improved in both messaging groups; attitudes improved only with gain-framed messages, and self-efficacy showed no significant change.
- Self-reported maternal morbidity decreased in both intervention groups.
Why it matters
The trial suggests that mobile messaging can support uptake across several stages of maternal care in a rural, low-resource setting. Both message frames were associated with improved service use, while their reported effects differed across outcomes. These findings make message framing a potentially relevant consideration when designing maternal health communication, although the study does not establish which approach is preferable overall.
What to keep in mind
The trial was conducted in one zone of Ethiopia, and the abstract reports self-reported maternal morbidity. It does not provide enough information to assess the durability of effects beyond the study follow-up.