Objective  To evaluate the application of maternal and child health (MCH) handbook in Guangdong province for providing evidence to local promotion of MCH handbook utilization.

  Methods  Using convenient sampling and a question-naire self-designed on the basis of reach, efficacy, adoption, implementation, and maintenance (RE-AIM) framework, we conducted an on-site on-line anonymous survey among 2 548 would-be mothers/pregnant women/puerpera visiting MCH institutions at 15 prefectures across Guangdong province and in-depth interviews among professionals responsible for issues about MCH handbook application in 6 MCH institutions at prefecture level during March – April 2021.

  Results  Of the 2 384 valid participants completing the questionnaire survey, 82.16%, 67.72%, and 64.48% reported the awareness, registration, and utilization of MCH handbook. Not knowing details of the MCH handbook was reported by 25.58% of the participants being aware of the handbook but not having the registration for the handbook's utilization; not being aware of and not knowing application approach of the handbook were reported by 36.36% and 23.38% of the participants being registered holder of the handbook but not yet using the handbook. There were 92.50% of the participants being registered holder of the handbook completed their registration during pregnancy. Among the participants having used the handbook, 33.27% and 43.68% reported high and moderate satisfaction to the role of the handbook; 92.84% considered that the application of the handbook resulted in a desired effect; while, 33.46% expressed the worry for potential leakage of personal information. Among the participants having used the handbook and with maternal school involvement, 84.01% reported recognizing the significance of the MCH handbook by taking part in programs of maternal school. Impaired and delayed information sharing associated with the handbook utilization among the MCH institutions were reported by professionals undertaking in-depth interviews. In all the MCH handbook registrants, 58.65% were registered for the application of the handbook of both paper and electronic versions. Regional disparity was revealed in responsibilities assigned to the MCH institutions registering the handbook holders. Not knowing application approach of the handbook were reported by 10.09% of the participants having used the handbook. In terms of maintenance in application of the handbook, reading through the handbook, completing all self-documenting content in the handbook, and applying the handbook two times or more in a week were reported by 24.54%, 18.82%, and 36.33% of the participants having used handbook. Impaired interconnection in the information system for MCH handbook application was indicated by the professionals interviewed.

  Conclusion  The efficacy of MCH handbook application is good in Guangdong province, but publicity of the handbook, unification of MCH institutions′ responsibilities and optimization of information system for MCH handbook utilization still need to be improved. Meanwhile, it is necessary to explore the integration mechanism with maternal systematic management and children systematic management in basic public health service projects.