Improving Parental Health Literacy in Primary Caregivers of0-to 3-Year-Old Children Through a WeChat Official Account:Cluster Randomized Controlled Trial

Background: Parental health literacy is important to children's health and development, especially in the first 3 years.However, few studies have explored effective intervention strategies to improve parental literacy. Objective: This study aimed to determine the effects of a WeChat official account (WOA)-based intervention on parentalhealth literacy of primary caregivers of children aged 0-3 years. Methods: This cluster randomized controlled trial enrolled 1332 caregiver-child dyads from all 13 community health centers(CHCs) in Minhang District, Shanghai, China, between April 2020 and April 2021. Participants in intervention CHCsreceived purposefully designed videos via a WOA, which automatically recorded the times of watching for each participant,supplemented with reading materials from other trusted web-based sources. The contents of the videos were constructedin accordance with the comprehensive parental health literacy model of WHO (World Health Organization)/Europe (WHO/Europe). Participants in control CHCs received printed materials similar to the intervention group. All the participants werefollowed up for 9 months. Both groups could access routine child health services as usual during follow-up. The primaryoutcome was parental health literacy measured by a validated instrument, the Chinese Parental Health Literacy Questionnaire(CPHLQ) of children aged 0-3 years. Secondary outcomes included parenting behaviors and children's health outcomes.We used the generalized linear mixed model (GLMM) for data analyses and performed different subgroup analyses. The beta coefficient, risk ratio (RR), and their 95% CI were used to assess the intervention's effect. Results: After the 9-month intervention, 69.4% (518/746) of caregivers had watched at least 1 video. Participants in theintervention group had higher CPHLQ total scores (beta=2.51, 95% CI 0.12-4.91) and higher psychological scores (beta=1.63, 95%CI 0.16-3.10) than those in the control group. The intervention group also reported a higher rate of exclusive breastfeeding(EBF) at 6 months (38.9% vs 23.44%; RR 1.90, 95% CI 1.07-3.38) and a higher awareness rate of vitamin D supplementationfor infants younger than 6 months (76.7% vs 70.5%; RR 1.39, 95% CI 1.06-1.82). No significant effects were detected for thephysical score on the CPHLQ, breastfeeding rate, routine checkup rate, and children's health outcomes. Furthermore, despiteslight subgroup differences in the intervention's effects on the total CPHLQ score and EBF rate, no interaction effect wasobserved between these subgroup factors and intervention factors. Conclusions: Using a WHO literacy model-based health intervention through a WOA has the potential of improving parentalhealth literacy and EBF rates at 6 months. However, innovative strategies and evidence-based content are required to engagemore participants and achieve better intervention outcomes. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000031711; https://www.chictr.org.cn/showproj.aspx?proj=51740