Text4Baby: An Initiative to Reduce Infant Mortality Rates Among Poor Women via Mobile

According to the National Healthy Babies, Healthy Mothers Coalition, "more than 500,000 babies in the U.S. are born prematurely and nearly 28,000 children die before" they reach their first birthday. A number of these premature births and early deaths occur among women who are poor and have little access to adequate pre/post-natal services and education.

While more affluent women benefit from access to regular pre-natal screenings and educational materials provided by managed care organizations and other groups, underserved women often do not benefit from these services. In addition, although the Web has become a major health resource for many women, poor and minority populations are less likely to have access to high-speed and readily accessible Internet connections -- i.e., at home or work rather than public libraries. This online participation gap leaves underserved women with fewer opportunities to access health information online. In addition, even if they go online it is not certain that they will have adequate health literacy and research skills. (For more information about the growing participation gap, please see this Living the Path article.)

However, research indicates that poor and less affluent women are more likely to have access to mobile technologies, including SMS (or text messaging) than the Internet This data, and the need to reduce infant mortality and premature birth in the United States, led the Healthy Babies, Healthy Mothers Coalition to embark on a large scale public-private partnership designed to educate underserved women about infant and maternal health via mobile technology. This initiative is called Text4Baby.

Key Activities:

Text4Baby is a free one-way mobile information service that is designed to "promote healthy birth outcomes among underserved populations." In addition, Text4Baby's other objectives are to:

"Demonstrate the potential of mobile health technology to address a critical national health priority: maternal and child health
Demonstrate the potential of mobile health technology to reach underserved populations with critical health information
Develop a base of evidence on the efficacy of mobile health
interventions
Catalyze new models for public-private partnerships in the area of mobile health."

For more information about how the Tex4Baby initiative operates, please see the slide below (click to enlarge).

Text4Baby Coalition Employs a Range of Outreach Strategies

Because it can be challenging to reach underserved women, the Text4Baby Coalition (which includes Johnson & Johnson, the White House, the Centers for Disease Control and Prevention (CDC) and others) is employing a range of outreach strategies such as:

Point-of-Care Communication: State, local and federal health agencies (including the Centers for Medicaid and Medicare Services) and managed care organizations serving the underserved will use e-mail, constituent letters, flyers and other content delivered to new and expecting mothers to promote the initiative
Media Promotion: A range of media partners, including MTV, and BET have agreed to promote Text4Baby
Public Relations: Grey Healthcare Group will provide a range of communications services for the initiative

Please see the slide below for information on some of the tools developed for Text4Baby's outreach partners (click to enlarge).

Content Developed and Vetted by Health Experts

With any health promotion initiative, it is critical that messages encouraging behavior change be carefully developed and tested with the target population. The Text4Baby Coalition worked with a range of health communications and public health experts, including the CDC, to develop content for this initiative. Program messages were tested and refined during a series of focus groups held with women in Washington DC, New York, Georgia and other states. For more information about how content was developed, please see the slide below (click to enlarge).

For additional information on how the Text4Baby initiative is designed, please see this slide presentation.

Results:

The Text4Baby Coalition is carefully evaluating the initiative to determine if it had a positive impact on the health behaviors of new and expectant mothers. Most importantly, the Coalition plans to conduct a randomized study comparing Text4Baby with usual pre-natal care (e.g., physician outreach, flyers, etc.). Key evaluation questions will include:

How well are mothers recalling and responding to Text4Baby's messages?
Are mothers improving their pre-natal behaviors?
Are Text4Baby mothers more likely to have babies with a healthy birth weight?

In addition, the Text4Baby Coalition's managed care partners (including Wellpoint) will examine claims data to determine whether mothers and children are receiving the appropriate vaccinations and other pre- and post-natal behaviors.

For more information on how Text4Baby will be evaluated, please see the slides below (click to enlarge).

New Data on Text4Baby Adoption Released in 2011; Some Suggest text4baby is Ineffective

In an article published in April 2011, MobiHealthNews published data on how text4baby has been adopted since launch. According to the publication: "In the year since it launched in the US Text4Baby has enrolled some . . . 157,000 people. The service’s most impressive feat . . . was its ability to gather together the more than 500 outreach partners that included national, state, business, academic, nonprofit and other groups to promote the service."

While the raw adoption numbers for the service are significant, some have criticized text4baby for expending large financial resources for little gain. According Joel Selanikio of DataDyne "despite glowing reports from the New York Times and Time, T4B had only reached about 3% of its target population."

In 2010, Health and Human Services' Chief Technology Officer Todd Park announced that the Health Resources and Services Administration will evaluate the program sometime in 2011.

Industry:

Healthcare

Primary Communications Discipline:

Mobile Marketing

Organizations Involved:

Healthy Mothers, Healthy Babies, Johnson and Johnson, White House Office of Science and Technology Policy, Others

Campaign Dates:

Spring 2009 - Present

For More Information:

Compare this Initiative to Text4Baby: MoTeCH: A Mobile Approach to Maternal Health Care (in Ghana), MobileActive.org Case Study, February 10, 2010, http://mobileactive.org/motech-new-approach-health-care
University of Maryland Dietetic Internship Program, Text4Baby Program Description, December 2009, http://pathoftheblueeye.com/multimedia/community_resources/text4baby_Rem...
U.S. Chief Technology Officer Announces Launch of First Free Mobile
Health Service for Pregnant Women, New Mothers, National Healthy Babies, Healthy Mothers Coalition, Press Release, February 4, 2010, http://www.hmhb.org/text4babypr.html
Oklahoma Healthy Mothers, Healthy Babies, Text4Baby Executive Summary, http://pathoftheblueeye.com/multimedia/community_resources/Text_4_Baby_e...
Association of Maternal and Child Health Programs, Text4Baby Webinar, 2009, http://amchp.na4.acrobat.com/p28997621/
White House Launches text4baby, JNJBTW, February 4, 2010, http://jnjbtw.com/2010/02/white-house-launches-text4baby/
New Mothers Get Digital Helper Right on Their Phones, White House Blog, February 4, 2010, http://www.whitehouse.gov/blog/2010/02/04/new-mothers-get-digital-helper...
Mobile Health Text Messaging Service Begins, Information Week, February 5, 2010, http://www.informationweek.com/news/healthcare/mobile-wireless/showArtic...
Text4Baby to expand. But does it work?, MobiHealthNews, April 7, 2011, http://mobihealthnews.com/10669/text4baby-to-expand-but-does-it-work/
Text4Baby: 30% worse than I thought, DataDyne Blog, March 14, 2011, http://www.datadyne.org/blog/fail4baby
Text4Baby successfully jumpstarts mother-doctor conversations, Fierce Mobile Healthcare, November 17, 2011, http://www.fiercemobilehealthcare.com/story/text4baby-successfully-jumps...

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