The Text4baby Program Harnessing the Power of Mobile for

Maternal & Child Health

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Text4baby is a free program of the non-profit National Healthy Mothers, Healthy Babies Coalition (HMHB). The founding sponsor is Johnson & Johnson. The White House Office of Science & Technology and the Department of Health & Human Services are among the over 900 partners who are actively promoting the service.

Text4baby is the largest national mobile health initiative reaching over 505,000 moms since launch two and a half years ago.

Text4baby is available in both English and Spanish.

Through free text messages, pregnant women and moms with babies under age one receive customized health and safety information and public health alerts to support them in achieving key developmental milestones, giving their babies the best possible start in life.

We reach low-income and young women, particularly those who identify as Hispanic or African-American. Research shows that these women are at a higher risk of having disproportionately poor birth outcomes.

Program Summary

National PartnershipText4baby Founding Partners

Non-profit maternal and child health expert

Leader in mobile health technology & strategy

Nation’s public health agency

Federal leader in innovation

Association representing U.S. mobile phone companies

Healthcare sector communications & marketing expert

Founding Sponsor & world’s 6th largest consumer health company

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Participating mobile providers have agreed to deliver text4baby to their subscribers at no charge.

Mobile Provider Partners

Mom gives due date/DOB & zip code

Mom texts BABY (or BEBE for Spanish ) to

511411

How Text4baby Works

Mom gets free tips 3x/week throughout

pregnancy & until baby’s 1st bday

How Text4baby Works

Mom can also learn more about key topics; get

support for enrolling in Medicaid/CHIP; take

quizzes; get urgent health alerts; sign up for

appointments, WIC meetings and vaccination

reminders; provide feedback on specific messages; and get

connected to support hotlines.

Literature Review

Audience Testing

Priority Topics

Content Development

Federal Government U.S. Department of Health and Human Services: • Centers for Medicare and Medicaid Services• Centers for Disease Control and Prevention• Health Resources and Services Administration, Maternal and Child Health

Bureau• HHS Office on Women’s Health • National Institutes of HealthU.S. Consumer Product Safety CommissionU.S. Department of Agriculture, Food and Nutrition ServiceU.S. Department of Defense Military Health SystemU.S. Department of Transportation

Expert Review

Audience Testing

Ongoing Revision

Expert input from:•Alliance for Hispanic Health•American Academy of Pediatrics•American Academy of Pediatric Dentistry•American College of Nurse-Midwives•American College of Obstetricians and Gynecologists

•National Domestic Violence Hotline•Postpartum Support International•Text4baby Breastfeeding Council

Message feedback from organizations, including (but not limited to)*:• Arizona Dept of Health Services• Association of Poison Control

Centers• Berkeley University• California Dept of Social Services• Carolina Breastfeeding Institute• Cincinnati Children's Hospital • Fairview Hospital (Cleveland)• First Candle• Florida Dept of Health• Georgia Dept of Community

Health• Healthy Fathering Collaborative

• Institute for Health and Recovery• Just in Time Parenting• Kansas Dept of Health &

Environment• Lamaze International• Massachusetts Breastfeeding

Coalition• National Center for Hearing

Assessment and Management• National WIC Association • Nevada Dept of Health• New York State Dept of Health• Ohio Dept of Health• Oral Health Kansas• Oregon Dept of Human Services

• Organization of Teratology Information Specialists

• Prevent Child Abuse Arizona• Safe Kids USA • The AOA Foundation• The National Campaign to Prevent

Teen & Unwanted Pregnancy• Utah County WIC• Virginia Dept of Health• Washington State Dept of Health• DC Breastfeeding Coalition• West Virginia Hospital Association• Wisconsin Childhood Lead

Poisoning Prevention Program

Content Development & Review Process

• Emory University Rollins School of Public Health

• Hablamos Juntos

Smoking Cessation Breastfeeding Health Care Access Diabetes Nutrition Oral Health Immunization Prenatal Care Disabilities Family Planning HIV/AIDS Prevention Violence Prevention Physical Activity Safety & Injury Prevention Mental Health Substance Abuse Prevention Developmental Milestones Labor & Delivery Car Seat Safety Safe Sleep Exercise

Messages on Critical Issues

Critical Alerts

Tylenol recall, May 2010 Pertussis outbreak CA (CDC), July 2010 Similac formula recall, September 2010 Sleep positioners warning (FDA), October 2010 New car safety seat guidelines (AAP), March 2011 Deadly hot cars (Safe Kids), July 2011 Benzocaine warning (FDA), August 2011 Window falls prevention (AAP & CDC), September 2011 Warning about crib bumpers (AAP & CDC), October 2011 Carbon monoxide poisoning (CT & MA) in response to power

outages, November 2011 Warning about button batteries (Safe Kids), December 2011 CMS enrollment (CMS), February 2012 Medicine safety (CDC), March 2012 Pertussis - 7 states (CDC), April 2012 Pertussis – 44 states (CDC), June 2012 Food Safety Hurricane Sandy, October 2012

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Reported that text4baby helped them remember an appointment or immunization that they or their child needed

Reported that text4baby messages informed them of medical warning signs that they did not know

Reported talking to their doctor about a topic that they read on a text4baby message

65%74%67%

Reported that they called a service or phone number that they received from a text4baby message

…of participants without health insurance reported calling a service number

40%50%

UC San Diego & National Latino Research Center (N=625)

Register in 1st trimester46% Would refer a friend96%

Alliance of Chicago Community Health Services

There was a lower percentage of missed appointments among t4b users (n=917) vs. non-users (n =1647) *

11% vs 17% * Note: not the result of rigorous research methods

Program Impact

3 xText4baby mothers were nearly 3X times more likely to believe that they were prepared to be new mothers compared to those in control group

CareFirst Blue Cross Blue Shield- George Washington University

About the ServiceGeorge Washington University Randomized Evaluation Results

• Text4baby mothers were nearly 3X times more likely to believe that they were prepared to be new mothers compared to those in control group*.

• Suggests health literacy may be a mediator of the relationship between t4b and attitude/behavior/outcome change

• Approaching significant (p<.10) improvement in the following attitudes among t4 mothers with a HS education or >:

Fruit/vegetable consumption Taking prenatal vitamins Understanding effects of smoking Importance of visiting health care provider

Suggests health literacy may be a mediator of the relationship between t4b and attitude/behavior/outcome change

* n=123“This pilot experimental study found that text4baby participation improved a central belief targeted by the campaign - that the pregnant woman receiving text messages was prepared for motherhood.”

Interactive Modules

Goals: Encourage uninsured moms to apply for coverage by providing a brief

description of benefits and eligibility. Remind current Medicaid/CHIP recipients and those interested in Medicaid/CHIP

to reapply for coverage. Identify the number of uninsured users who reported they applied for

Medicaid/CHIP.

Summary: Collaboration with Center for Medicare and Medicaid Services to increase health

insurance access for Medicaid/CHIP eligible T4B mothers and families. The module is timed to send reminders regarding Medicaid/CHIP.

10 days after a mom indicates she has no health insurance, she will receive a follow-up message asking if she applied for Medicaid/CHIP.

2 weeks before a child’s 1st birthday, for all users that indicate they are Medicaid/CHIP enrollees or have no health insurance a follow-up message will be sent reminding them to re enroll.

The module reinforces text4baby moms to: Call Medicaid/CHIP at 877-543-7669 or visit www.insurekidsnow.gov/state

Launched on the text4baby platform on December 2012.

Medicaid Module

Goals: Provide text4baby users receiving WIC the opportunity to set up reminders for

their WIC appointments. Provide general text4baby users the opportunity to set up reminders for their

appointments as well. Identify the number of text4baby users who receive WIC and how they interact

with the service.

Summary: A standard WIC message is sent to all users in pregnancy weeks 11,19, 31 and

infant weeks 4, 14, and 35. Those who have enrolled using a WIC participant code or texted in WIC, will

received a second message inviting them to set up a reminder for their WIC appointment. 

Generic users will NOT receive this second message. Both WIC and Generic users also receive other messages throughout both

protocols inviting them to text “Remind” to set up a doctor’s appointment. We know from Barbara Longo research that appointment scheduling apps are

highly used by WIC Moms

WIC Reminder Service

14%

Follow-Up Survey

of a subset of respondents not planning to get flu shot subsequently reported getting it.

(N=2504)

Flu message to 96,070 users in Oct. 2011

Text4baby: Flu season is here. Are you planning to get a flu shot? Reply 1 for Yes, Reply 2 for No, or Reply 3 if you already got it.

Interactive Flu Module Interactive Flu Module

Goals: Encourage well baby visit attendance (at 2,4,6 and 12 months) and recipient of

timely vaccination among infants 0 – 12 months Determine the usefulness of the text messaging vaccination reminder service

based on user feedback Gain insights around self-reported well baby visit attendance and vaccination

coverage (for infants aged 2, 4, 6 and 12 months) among text4baby users. Gain insights around differences in self-reported well baby visit attendance and

vaccination coverage among text4baby users who did and did not request (and likely receive) specific appointment reminders via text.

Summary: In Partnership with California Department of Health, will be available 2/2013 Messages sent at 2 weeks before baby’s 2nd, 4th, 6th and 12 month birthday Ask users if they have scheduled the Dr’s visit and encourage them to do so if they

have not. Provide users with the option of setting up a text reminder for their appointment.

Follow up with users to ask if they have been to the Dr’s visit and if so, if their child receive vaccinations.

Evaluation questions ask if reminder text messages were helpful in getting baby vaccinated.

Immunization Module- CA CDPH

Press Event: April 29th• Announce the California Department of Health’s

Immunization-Text4baby module in California

• Focus: Address infant immunization rates in California

• San Diego Health Leaders: Supervisor Greg Cox, HHSA Director Nick Macchione & Nancy Sasaki (Alliance Healthcare Foundation)

• San Diego County commitments (First 5 San Diego, HHSA San Diego & Council of Community Clinics)

Partner Outreach

• Provider video:

https://www.text4baby.org/index.php/news/343-provider-video/

• Web Enrollment Button:

https://www.text4baby.org/index.php/text4baby-enrollment-button-info

• Become a text4baby Partner: http://my.text4baby.org/page/s/formal-partner-sign-up

Thank you!

Questions? Contact ahoff@hmhb.org or visit

www.text4baby.org for more information