{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T18:38:01Z","timestamp":1793126281099,"version":"4.5.0"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,12,1]],"date-time":"2019-12-01T00:00:00Z","timestamp":1575158400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,12,2]],"date-time":"2019-12-02T00:00:00Z","timestamp":1575244800000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"UNICEF China"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Public Health"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>An exclusive breastfeeding rate in the first 6\u2009months of life of at least 50% is one of the six World Health Organization global nutrition targets for 2025. However, the exclusive breastfeeding rate in China is quite low and decreasing which makes it urgent to explore effective ways to reverse the current downward trend. As mobile technologies have rapidly developed, mobile communication apps such as WeChat (one of the largest social networking platforms in China) are well accepted and have the potential to improve health behaviors in a convenient way. The current paper describes the study protocol of a WeChat intervention that aims to promote breastfeeding in rural areas in China.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The study is designed as a randomized controlled trial in rural Qinghai Province, China. Women who are 14\u201336\u2009weeks pregnant will be randomized to routine antenatal and postnatal care, or routine care plus the WeChat breastfeeding education. pregnant women with a severe disease and complications of pregnancy or HIV-1 will be excluded. Breastfeeding knowledge and promotion information will be delivered to the intervention group through a WeChat official account from 3\u2009months pregnancy to 6\u2009months postpartum. The outcome assessments are conducted at baseline through face-to-face interviews, and at one week, 1\u2009month, 3\u2009months and 6\u2009months postpartum by telephone interviews. The primary outcome is difference in the exclusive breastfeeding rate at 1\u2009month, 3\u2009months, and 6\u2009months postpartum between the intervention group and the control group. Secondary outcomes include the overall duration of any and exclusive breastfeeding across the first 6\u2009months postpartum; mothers\u2019 knowledge of breastfeeding; the proportion of early initiation of breastfeeding; and the timing of the introduction of solid food to infants. Intention-to-treat-analysis will be used. Survival analysis will be used to compare the overall duration of any and exclusive breastfeeding between groups.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Discussion<\/jats:title>\n<jats:p>This study is the first effort to promote exclusive breastfeeding through WeChat in China. Our results will provide scientific evidence for the effect of health education through WeChat on breastfeeding. Thereby this may offer a comprehensive intervention to promote exclusive breastfeeding in China and other settings.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Trial registration<\/jats:title>\n<jats:p>Chinese Clinical Trial Registry \u2013ChiCTR1800017364. Registered 26 July 2018. <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.chictr.org.cn\/showproj.aspx?proj=29325\">http:\/\/www.chictr.org.cn\/showproj.aspx?proj=29325<\/jats:ext-link><\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12889-019-7676-2","type":"journal-article","created":{"date-parts":[[2019,12,2]],"date-time":"2019-12-02T08:05:00Z","timestamp":1575273900000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["The effectiveness of using a WeChat account to improve exclusive breastfeeding in Huzhu County Qinghai Province, China: protocol for a randomized control trial"],"prefix":"10.1186","volume":"19","author":[{"given":"Qiong","family":"Wu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiwen","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle Helena","family":"van Velthoven","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suying","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2147-9594","authenticated-orcid":false,"given":"Yanfeng","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,12,2]]},"reference":[{"key":"7676_CR1","unstructured":"World Health Organization: Global Targets 2025. 2017. https:\/\/www.who.int\/nutrition\/global-target-2025\/en\/"},{"issue":"10017","key":"7676_CR2","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1016\/S0140-6736(15)01024-7","volume":"387","author":"Cesar G Victora","year":"2016","unstructured":"Victora CG, Bahl R, Barros AJ, Franca GV, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016, 387(10017).","journal-title":"The Lancet"},{"key":"7676_CR3","unstructured":"World Health Organization, UNICEF: Global strategy for Infant and Young Child Feeding. WHO, UNICEF. 2003."},{"key":"7676_CR4","unstructured":"Gove S. Integrated management of childhood illness by outpatient health workers: technical basis and overview. The WHO Working Group on Guidelines for Integrated Management of the Sick Child. Bull World Health Organization. 1997, 75, Suppl 1:7\u201324."},{"key":"7676_CR5","unstructured":"World Health Organization: Infant and young child feeding counseling: an integrated course. In. WHO. 2005."},{"key":"7676_CR6","unstructured":"World Health Organization. Infant and young child feeding: Model Chapter for textbooks for medical students and allied health professionals. 2009."},{"key":"7676_CR7","unstructured":"Ministry of Health Implementation guidelines on national basic public health service program (2009). Ministry of Health; 2009. http:\/\/www.moh.gov.cn\/jws\/s3581r\/200910\/fe1cdd87dcfa4622abca696c712d77e8.shtml"},{"issue":"2","key":"7676_CR8","doi-asserted-by":"publisher","first-page":"249","DOI":"10.3390\/nu10020249","volume":"10","author":"Yifan Duan","year":"2018","unstructured":"Duan Y, Yang Z, Lai J, Yu D, Chang S, Pang X, Jiang S, Zhang H, Bi Y, Wang J, et al. Exclusive Breastfeeding Rate and Complementary Feeding Indicators in China: A National Representative Survey in 2013. Nutrients. 2018;10(2):1\u20139.","journal-title":"Nutrients"},{"key":"7676_CR9","unstructured":"Center for Health Statistics Information Ministry of Health, China. An Analysis Report of National Health Services Survey in China. Beijing: Peking Union Medical College Press; 2009."},{"issue":"5","key":"7676_CR10","doi-asserted-by":"publisher","first-page":"322","DOI":"10.2471\/BLT.12.111310","volume":"91","author":"S Guo","year":"2013","unstructured":"Guo S, Fu X, Scherpbier RW, Wang Y, Zhou H, Wang X, Hipgrave DB. Breastfeeding rates in central and western China in 2010: implications for child and population health. Bull World Health Organ. 2013;91(5):322\u201331.","journal-title":"Bull World Health Organ"},{"issue":"7","key":"7676_CR11","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-005108","volume":"4","author":"Q Wu","year":"2014","unstructured":"Wu Q, Scherpbier RW, van Velthoven MH, Chen L, Wang W, Li Y, Zhang Y, Car J. Poor infant and young child feeding practices and sources of caregivers' feeding knowledge in rural Hebei Province, China: findings from a cross-sectional survey. BMJ Open. 2014;4(7):e005108.","journal-title":"BMJ Open"},{"key":"7676_CR12","unstructured":"UNICEF global databases. Percent of infants 0\u20135 months of age exclusively breastfed, by country and region, 2018. https:\/\/data.unicef.org\/topic\/nutrition\/infant-and-young-child-feeding\/"},{"issue":"38","key":"7676_CR13","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000007619","volume":"96","author":"P Huang","year":"2017","unstructured":"Huang P, Ren J, Liu Y, Luo B, Zhao X. Factors affecting breastfeeding adherence among Chinese mothers: a multicenter study. Medicine (Baltimore). 2017;96(38):e7619.","journal-title":"Medicine (Baltimore)"},{"issue":"2","key":"7676_CR14","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1177\/0890334413477240","volume":"29","author":"P Liu","year":"2013","unstructured":"Liu P, Qiao L, Xu F, Zhang M, Wang Y, Binns CW. Factors associated with breastfeeding duration: a 30-month cohort study in Northwest China. J Hum Lact. 2013;29(2):253\u20139.","journal-title":"J Hum Lact"},{"issue":"3","key":"7676_CR15","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1177\/1367493517719160","volume":"21","author":"K Sun","year":"2017","unstructured":"Sun K, Chen M, Yin Y, Wu L, Gao L. Why Chinese mothers stop breastfeeding: Mothers' self-reported reasons for stopping during the first six months. J Child Health Care. 2017;21(3):353\u201363.","journal-title":"J Child Health Care"},{"issue":"5","key":"7676_CR16","doi-asserted-by":"publisher","first-page":"4520","DOI":"10.3390\/ijerph120504520","volume":"12","author":"K Zhang","year":"2015","unstructured":"Zhang K, Tang L, Wang H, Qiu LQ, Binns C, Lee A. Why do mothers of young infants choose to formula feed in China? Perceptions of mothers and hospital staff. Int J Environ Res Public Health. 2015 May;12(5):4520\u201332.","journal-title":"Int J Environ Res Public Health"},{"issue":"10","key":"7676_CR17","doi-asserted-by":"publisher","first-page":"604","DOI":"10.1089\/bfm.2017.0065","volume":"12","author":"H Skouteris","year":"2017","unstructured":"Skouteris H, Bailey C, Nagle C, Hauck Y, Bruce L, Morris H. Interventions designed to promote exclusive breastfeeding in high-income countries: a systematic review update. Breastfeed Med. 2017;12(10):604\u201314.","journal-title":"Breastfeed Med"},{"key":"7676_CR18","volume-title":"110 amazing WeCaht statistics and facts (December 2018)","author":"C Smith","year":"2018","unstructured":"Smith C. 110 amazing WeCaht statistics and facts (December 2018). 2018. https:\/\/expandedramblings.com\/index.php\/wechat-statistics\/"},{"key":"7676_CR19","unstructured":"Graziani Thomas. WeChat impact report 2018 shows impressive social impact. WALKTHECHAT. 2018. https:\/\/walkthechat.com\/wechat-impact-report-2018-shows-impressive-social-impact\/"},{"key":"7676_CR20","doi-asserted-by":"publisher","first-page":"1524","DOI":"10.12659\/MSM.907284","volume":"24","author":"Y Cao","year":"2018","unstructured":"Cao Y, Lin SH, Zhu D, Xu F, Chen ZH, Shen HH, Li W. WeChat public account use improves clinical control of cough-variant asthma: a randomized controlled trial. Med Sci Monit. 2018;24:1524\u201332.","journal-title":"Med Sci Monit"},{"issue":"1","key":"7676_CR21","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1186\/s12936-016-1621-y","volume":"15","author":"W Li","year":"2016","unstructured":"Li W, Han LQ, Guo YJ, Sun J. Using WeChat official accounts to improve malaria health literacy among Chinese expatriates in Niger: an intervention study. Malar J. 2016;15(1):567.","journal-title":"Malar J"},{"issue":"10","key":"7676_CR22","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.7861","volume":"19","author":"C He","year":"2017","unstructured":"He C, Wu S, Zhao Y, Li Z, Zhang Y, Le J, Wang L, Wan S, Li C, Li Y, et al. Social media-promoted weight loss among an occupational population: cohort study using a WeChat Mobile phone app-based campaign. J Med Internet Res. 2017;19(10):e357.","journal-title":"J Med Internet Res"},{"key":"7676_CR23","volume-title":"2017 government report of Huzhu County","author":"Huzhu County People\u2019s Government","year":"2018","unstructured":"Huzhu County People\u2019s Government. 2017 government report of Huzhu County. 2018, http:\/\/www.huzhu.gov.cn\/contents\/211\/10406.html (In Chinese)."},{"issue":"5","key":"7676_CR24","doi-asserted-by":"publisher","first-page":"961","DOI":"10.1097\/AOG.0000000000000481","volume":"124","author":"KL Wong","year":"2014","unstructured":"Wong KL, Fong DY, Lee IL, Chu S, Tarrant M. Antenatal education to increase exclusive breastfeeding: a randomized controlled trial. Obstet Gynecol. 2014;124(5):961\u20138.","journal-title":"Obstet Gynecol"},{"issue":"5","key":"7676_CR25","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1001\/jamapediatrics.2014.58","volume":"168","author":"H Jiang","year":"2014","unstructured":"Jiang H, Li M, Wen LM, Hu Q, Yang D, He G, Baur LA, Dibley MJ, Qian X. Effect of short message service on infant feeding practice: findings from a community-based study in Shanghai. China JAMA Pediatr. 2014;168(5):471\u20138.","journal-title":"China JAMA Pediatr"},{"key":"7676_CR26","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/j.midw.2016.09.010","volume":"42","author":"Y Gu","year":"2016","unstructured":"Gu Y, Zhu Y, Zhang Z, Wan H. Effectiveness of a theory-based breastfeeding promotion intervention on exclusive breastfeeding in China: a randomised controlled trial. Midwifery. 2016;42:93\u20139.","journal-title":"Midwifery"},{"key":"7676_CR27","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/j.midw.2016.03.003","volume":"36","author":"MY Chan","year":"2016","unstructured":"Chan MY, Ip WY, Choi KC. The effect of a self-efficacy-based educational programme on maternal breast feeding self-efficacy, breast feeding duration and exclusive breast feeding rates: a longitudinal study. Midwifery. 2016;36:92\u20138.","journal-title":"Midwifery"},{"key":"7676_CR28","unstructured":"WHO, UNICEF, USAID, AED, UCDAVIS, IFPRI. Indicators for assessing infant and young child feeding practices-part 1 introduction. WHO; 2010."},{"issue":"5","key":"7676_CR29","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.2183","volume":"14","author":"S Zhang","year":"2012","unstructured":"Zhang S, Wu Q, van Velthoven MH, Chen L, Car J, Rudan I, Zhang Y, Li Y, Scherpbier RW. Smartphone versus pen-and-paper data collection of infant feeding practices in rural China. J Med Internet Res. 2012;14(5):e119.","journal-title":"J Med Internet Res"}],"container-title":["BMC Public Health"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-019-7676-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12889-019-7676-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-019-7676-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,30]],"date-time":"2020-11-30T19:28:19Z","timestamp":1606764499000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpublichealth.biomedcentral.com\/articles\/10.1186\/s12889-019-7676-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12]]},"references-count":29,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["7676"],"URL":"https:\/\/doi.org\/10.1186\/s12889-019-7676-2","relation":{},"ISSN":["1471-2458"],"issn-type":[{"value":"1471-2458","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,12]]},"assertion":[{"value":"15 March 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 September 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 December 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Not applicable.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1603"}}