DESCRIPTION (provided by applicant): There are over 4 million births annually in the U.S.; most are healthy full-term newborns. However, mothers with full-term infants experience early postpartum hospital discharge (within 24-48 hours) and little to no routine additional support following hospital discharge. This is especially problematic if mothers are poor, minority, first time mothers, and have problems with access to postbirth health care. Low-income, first-time mothers represent one of the largest groups living below the poverty level, having no health insurance; low social support; increased stress; unmet learning needs; and difficulty accessing the healthcare system. And problems will only increase for this group. Proposed federal and state healthcare budget cuts include: a House $155 billion federal payment reduction forcing hospitals to eliminate many maternal child- community health care services; proposed House cuts to Medicaid affecting nearly 30 million low-income children who depend on Medicaid for health care; cuts for the State Children's Health Insurance Program (SCHIP); cuts to state public health services for low-income families; and the federal Medicaid law allowing states to impose cost sharing on families with children on Medicaid. These legislative acts, making access to health care more difficult for children, are creating major delays for both routine and acute newborn healthcare resulting in increased infant hospitalizations and mortality rates. Interventions to improve maternal and newborn outcomes in low-income postpartum mothers have included nurse home visits, hospital or community follow-up programs, follow-up telephone calls or a combination of these. They have been costly and difficult to sustain. Studies using promising mobile technology have reported improved communication and increased treatment adherence in those with chronic health problems. Studies with low-income new mothers using mobile technology are almost nonexistent. Thus, the purpose of this randomized clinical trial is to test the effects of a mobile technology intervention on maternal and infant health outcomes and healthcare charges between 2 groups of low-income, first-time mothers and their full-term newborns. All mothers (N=126) will receive routine post-hospital discharge care. Intervention group mothers will receive a minimum of 10 two-way advanced practice nurse (APN) cell phone calls plus text messaging on post hospital discharge days 3, 7, 14, 21, months 1-6; be able to contact the APNs by cell phone or texting Monday through Saturday from 9 a.m. to 5 p.m. Outcomes include: maternal outcomes of stress, social support; infant outcomes of immunizations, weight gain, morbidity; and healthcare charges for urgent care , emergency care, rehospitalizations. Data will be analyzed using two-sample t-tests and Chi- square test for equality of proportions to determine a difference in the means between control intervention groups. Wilcoxon Signed Rank test, will be used if the assumption of normal distribution is not met. Significant differences in means will support the hypotheses.

Low-income, first-time mothers are one of the largest groups living in poverty, having no health insurance, low social support, increased stress and difficulty accessing health care. Current and proposed budget cuts to health care are making the problem worse. This study will test a low- cost mobile technology intervention using cell phone and text messaging by advanced practice nurses to improve infants' and mothers' health outcomes and potentially reduce healthcare charges.