Feasibility and acceptability of a telephone support intervention during early postnatal period among teenage mothers in Western Kenya: A pilot randomised controlled trial

Abstract

Background: Teenage pregnancy, birth and the transition to motherhood present potentially stressful life events that may significantly affect maternal physical, social and mental wellbeing. For many young/teenage mothers, this transition may be a daunting task both in caring for themselves and their babies. Consequently, these mothers, and their babies, may experience considerable health risks, if unsupported. Innovative interventions such as telephone support have been considered promising in improving maternal and newborn care. The aim of this study was to pilot a postnatal telephone support intervention (TSI), informed through identification and prioritisation of the health needs and/or concerns of young/teenage mothers. Methods: In this mixed-methods pilot trial, young/teenage mothers, in Kenya, were randomly assigned 1:1 to TSI or usual care/control groups and followed up for 10 weeks postpartum. Feasibility outcomes included recruitment, and attrition and retention rates. Outcome measures on maternal self-esteem (Rosenberg Self-esteem scale), postnatal depression (Edinburgh Postnatal Depression Scale), maternity social support (Maternity Social Support scale), postpartum bonding (Postpartum Bonding Instrument), and general maternal-infant health outcomes were assessed at 10 weeks postpartum. Interviews were used to assess feasibility and acceptability of TSI. Results: Over three months, 91 young/teenage mothers were assessed for eligibility (recruitment rate=30/month), and 52 (57.1%) were randomised: 26 to TSI and 26 to usual care/control. Nine were lost to follow-up, with 43 (82.7%) retained for analysis. The overall attrition rate was high (17.3%) with differential attrition between groups (15.4% vs 19.2% for intervention and control groups respectively). Lack of personal mobile phones, network connectivity and insufficient electricity power were notable feasibility challenges. The impact of the TSI on maternal self-esteem and infant-focussed anxiety was promising, but a further adequately powered trial would be necessary to confirm this. The teenage mothers in the intervention group, however, valued the TSI. Conclusions: The findings suggest that it is feasible to recruit young mothers for a similar definitive trial in the future. The study highlighted the potential areas in which TSI could provide meaningful, supportive in maternal and infant care. Overall, the findings are informative for a future definitive trial in low-and- middle-income settings.