The Text4baby Program: Evaluation of a Mobile Health Initiative
Mobile Health 2011 @ StanfordW. Douglas Evans, [email protected] The George Washington University
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text BABY to 511411
What is text4baby?
…a free mobile information service of Healthy Mothers Healthy Babies Coalition (HMHB)
…in English and Spanish to promote maternal and child health especially among low-income moms
…provides pregnant women and new moms with motivation and information to help them care for their health and their baby’s
…sign up by texting BABY (or BEBE) to 511411 to receive 3 free SMS text messages each week, timed to their due date/date of birth
…messages connect women to prenatal and infant care services and other resources
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Sample Messages
Every state has a program to help you have a healthy baby. Call 1-800-311-BABY to find out about services in your area.
Reply Back
Don’t forget your multivitamin! Baby’s spine and brain are developing now. Getting 400 micrograms of folic acid daily is key to help prevent birth defects.
Reply Back
Consult with your doctor before taking any medication, including over-the-counter items you find at the drug store.
Reply Back
Have you seen your dentist lately? You may notice changes in your gums because of extra blood flow during pregnancy. Floss and brush your teeth to protect your baby’s health!Reply Back
Be a flu-free mom-to-be! Flu shots are safe during every trimester. You’re at high risk for complications from flu, so protect yourself from getting the flu in the first place.
Reply Back
Don’t eat any raw or undercooked meat, poultry, fish or shellfish (sushi or sashimi) while pregnant.
Reply Back
Priority Topics
Pregnancy Infant
Tobacco Tobacco
Alcohol and drugs Infant feeding/oral health
Nutrition Developmental milestones
Safety Safety
Services: referral, encourage use Services
Infection prevention/screening Immunizations
Medications Postpartum depression
Breastfeeding Infection prevention
Support/bonding/”feel good” Support/crying
Influenza
Promotional Materials
Watch the clip here: http://www.mtv.com/videos/misc/496217/text4baby.jhtml#id=1634555
Theory-based Evaluation
Text4baby is a health brand Based on behavior change theory, so is evaluation Health Belief Model: Texts are a cue to action Social influence and diffusion stems from texts Social Cognitive Theory: Self-efficacy, outcome
expectations, social modeling behavior change mHealth is a new level of social ecology, interacts
with existing ecologies like family, community
9Source: Institute of Medicine, 2000
Evaluation conceptual model
Evaluation Questions
Who subscribes and what are they like (demographics, psychographics, health profiles)?
What dose is delivered and what are dose-response effects? Do subscribers also use www.text4baby.org? For what? Are subscribers more likely to use promoted health
information sources (helplines, etc.)? Are subscribers more likely to form positive pre-natal care and
health promoting attitudes/beliefs? Are subscribers more likely to engage in behaviors targeted by
messages?
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Self-efficacy - Individual measures of self-efficacy to engage in each text4baby promoted behavior
Investigator developed
Outcome expectations
- Measures for each promoted behavior
Investigator developed
Social norms - Descriptive and subjective norms for each promoted behavior
Investigator developed
Intentions - Measures for each promoted behavior
Investigator developed
Self-reported recall of text messages
- Measures for each message to be delivered during pregnancy
Investigator developed
Behavioral Mediators (Change Mechanisms)
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Health care utilization - Intention to keep pre-natal appointment- Pre-natal appointments kept
PRAMS phase 6 survey
APNCUImmunization - Most recent seasonal flu shot
- Most recent H1N1 shotPRAMS
Investigator developedPre-natal vitamins - Taking vitamin with folic acid? PRAMSSmoking - Smoking frequency
- Cessation attempts/success- Secondhand smoke exposure
PRAMS
NYTS
Alcohol use - Alcohol consumption past 30 days- Frequency of consumption
PRAMS
Nutrition - Dietary intake- Food preferences
BRFSS
Health information seeking
- Use of health information Websites- Use of FQHC Web resources
Investigator developed
Referral to other health services
- Referral to 311 Babyline- Utilization of referred health services
Investigator developed
Behavioral Outcomes
Strategy is place-based evaluation:2 Current Evaluation Studies
US Army Telemedicine and Advanced Technology Research Center (TATRC) Conducting RCT in Army hospital facility to
compare subscribers/non-subscribers Launches May 2011
HMHB-sponsored study with Inova Health System Pilot in community clinics in Fairfax County,
Virginia to evaluate message receptivity and short-term outcomes
Launched April 2011
Stratum 1: First pregnancy Stratum 2: At least 1 previous live birth
Text4baby + usual care
Usual care Text4baby + usual care
Usual care
Baseline 249 249 249 249
4 week post-baseline follow up
245 245 245 245
28 weeks gestation follow up
235 235 235 235
Post-partum follow up
224 224 224 224
Army RCT Design (sample size)
Powered to detect 12% increase in pre-natal care utilization
Text4baby + usual care Usual care
Baseline 130 130
28 weeks gestation follow up 117 117
Fairfax County RCT Design (sample size)
Powered to detect 15% increase in intentions to utilize pre-natal care
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Fairfax Data – Type of Health Care Provider Visit Since Pregnancy
65%
35%
DoctorCommunity-based clinicOther No
*73% of community-based clinic visitors went in the past month
n = 30
Fairfax Data – Participation in WIC Program
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37%
21%
37%
5%
Yes, currentlyIn the pastNeverDon't Know
Fairfax Data – Search Online for Pre-natal Care Information
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n = 30
Yes, in the past month 1-2 months ago More than 3 months ago Never0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Fairfax Data - Smoking and Alcohol Beliefs
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Smoking will harm health of baby
Second hand smoke will harm my baby
Drinking alcohol will harm my baby
0.00
20.00
40.00
60.00
80.00
100.00
Per
cen
t A
gre
emen
t
n = 30
Fairfax Data – F&V Servings per Day
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1 - 2 3 - 4 5 or more Don't Know0%
10%
20%
30%
40%
50%
60%
70%
80%
n = 30
Conclusions & Next Steps
● Empirically-tested behavioral theory supports mHealth programs like text4baby
● New programs need to be grounded in theory
● Need to develop & validate theory-based metrics Imagine in 10 years someone tried to do a meta-
analysis of mHealth What’s needed now?
● Build evidence base!
Thank you!
Doug Evans: [email protected]
About text4baby: • www.text4baby.org • http://text4baby.ning.com
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