Helping New Parents Feel Good and Function Well After Childbirth: A Study Testing Text Messages to Support Mental Wellbeing

Healthy Beginnings for Hunter New England Kids (HB4HNEKids) is a digital health model of care delivered via mobile health (mHealth) text messages. This trial will specifically evaluate the impact of a new mental wellbeing module embedded within the HB4HNEKids program. The module includes 20 co-designed text messages delivered over five months, starting four weeks after childbirth. Content was developed using behaviour change theory and informed by focus groups and interviews with regional and rural parents and clinicians to ensure relevance, practicality, and theoretical rigour. Messages were pilot tested for acceptability, with feedback used to refine content. The module covers topics such as normalising emotional changes after childbirth, self-care and coping strategies, strengthening parent–infant connection, and how and when to seek additional mental health support. All participants in the trial receive the standard HB4HNEKids program; those in the intervention group also receive the mental wellbeing module, while the control group receives the standard program only. The HB4HNEKids program provides families with evidence-based, age- and stage-appropriate preventive health information from birth to five years. Content includes anticipatory guidance on child health and development, breastfeeding, nutrition, physical activity, movement behaviours, and family/carer wellbeing, as well as reminders for immunisation and health and development checks. Families enrolled in HB4HNEKids receive short text messages (up to 160 characters) with embedded links to credible online resources, such as videos, fact sheets, websites and local support services. Messages are sent approximately once per week from birth to age three, and once per fortnight from ages three to five. Message delivery is monitored via SMS reports, and engagement with content is tracked using a URL analytics platform. Adherence to the intervention is assessed using these engagement metrics, opt-out rates, and follow-up Computer-Assisted Telephone Interviews (CATI) at 6 and 12 months postpartum to ask participants about message use and relevance. Most messages are one-way and alpha-tagged with the program name; however, messages requesting feeding information are two-way to support tailoring. The intervention includes basic personalisation: using the child’s first name in some messages and adapting content to their current mode of milk feeding as well as specific age and stage milestones, to enhance relevance and user engagement. Participants are provided with multiple opportunities to opt out of receiving the program throughout the intervention period (birth to 6 months postpartum). Unsubscribe links are sent via text messages when the child is 1, 3, 10, and 20 weeks old, and remain active for future use. Beyond the trial period, unsubscribe links are sent 2-4 times per year until the child turns five. An opt-out option is also available via the ‘Contact Us’ section of the program website, which includes the project team’s email address and phone number. Additionally, families can request to withdraw from the program during any interaction with the Child and Family Health Service.