A randomized controlled trial of a health literacy–based digital intervention to promote postpartum recovery and self-care

To evaluate a six-week Postpartum Comprehensive Health Intervention Program (PCHIP), a health literacy-based digital intervention designed to promote early postpartum self-care and selected recovery outcomes. This pre-registered, two-arm, single-blind randomized controlled trial was conducted at Changzhou Second People's Hospital, Changzhou, China. Participants were primiparous women (mean age 29.75 years) recruited from January 25 to February 15, 2025 and enrolled within the first three days postpartum. Eighty-eight participants were randomized 1:1 using a computer-generated sequence, with allocation concealed in sealed opaque envelopes, to PCHIP plus standard education or standard education alone. PCHIP began on postpartum day 3 and lasted six weeks. Primary outcomes were eating behaviors, physical activity, and breastfeeding practices; health literacy and recovery indicators were secondary outcomes. Complete-case analyses included 82 women. ANCOVA was used for continuous outcomes with baseline values, weight-related outcomes were adjusted for baseline postpartum weight, and Fisher's exact test was used for exclusive or predominant breastfeeding. Eighty-two participants completed follow-up (PCHIP: 40/44; control: 42/44). Baseline-adjusted analyses showed lower pain (AMD = -0.698, 95% CI: -1.339 to -0.057), depression (AMD = -1.313, 95% CI: -2.398 to -0.229), anxiety (AMD = -1.357, 95% CI: -2.543 to -0.170), emotional eating (AMD = -4.421, 95% CI: -8.177 to -0.666), and external eating (AMD = -4.043, 95% CI: -7.957 to -0.129), and higher health literacy (AMD = 2.714, 95% CI: 0.032 to 5.397) and physical activity (AMD = 0.969, 95% CI: 0.227 to 1.711) in the PCHIP group. Restrained eating showed a favorable but non-significant trend. Weight-related analyses adjusted for baseline postpartum weight showed greater weight reduction in the PCHIP group (AMD = 2.527 kg, 95% CI: 0.835 to 4.218). Outcomes measured only at 6 weeks suggested shorter red lochia duration (MD = -1.224 weeks, 95% CI: -1.811 to -0.638), better selected pelvic floor muscle indicators, and more frequent exclusive or predominant breastfeeding (risk difference = 22.6%, 95% CI: 2.4% to 42.8%) in the PCHIP group. No adverse events were reported. PCHIP may support early postpartum self-care and selected recovery outcomes, but findings should be interpreted cautiously because of the single-center design, small sample, complete-case analysis, short follow-up, and multiple outcomes. Larger multicenter trials with longer follow-up are needed. The trial was prospectively registered with the Chinese Clinical Trial Registry (ChiCTR2500096473) on January 24, 2025.