Developing Creative Content Enhancements for Text4baby

Background:  Text4baby is a free mobile text messaging service, launched in 2010, that provides timely health information in English and Spanish via cell phone to women during pregnancy and through their baby’s first year. Text messaging provides an opportunity to address health inequalities for populations at the highest risk for poor health outcomes - low-income and young women, particularly those who identify as Hispanic or African American. Compared to their older and white counterparts, young adults, Hispanics, and African-Americans are more likely to own a cell phone, text more frequently, and are more likely to do most of their online browsing on their mobile device. Among U.S. 18-29 year old cell phone owners, 95% send or receive text messages; 79% of African Americans and 83% of English-speaking Hispanics text.

Program background:  Text4baby is a public-private partnership with over 900 national, state, and local organizations including the American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and Centers for Disease Control and Prevention. External evaluations show text4baby is facilitating interaction with health providers, improving adherence to appointments, strengthening access to health services, and participants are significantly more likely to report they are better prepared for motherhood compared to non-participants.

Evaluation Methods and Results:  The messages are based on evidence-informed guidance from top maternal and child health experts. Message content is reviewed by a Content Development Council made up of leading national medical organizations and federal partners who review messages to keep the content current and accurate. The messages fall into three main categories: recommended behaviors (e.g. immunizations); behaviors to avoid (e.g. tobacco use); and important knowledge (e.g. how to access free or low-cost care). The message content has recently been enhanced to reflect evolving health priorities and the latest feedback from text4baby participants.   Between 3/1/2012 – 3/1/2013, 49 % of new enrollees (n = 206,084) were pregnant women, 47 % were new mothers, and 2% were fathers. In response to participant feedback and Content Development Council recommendations, the 267 total messages have been enhanced with more interactivity. Specifically: 58% of all messages contain additional health and resource information, 46% link to text4baby mobile web pages developed with major medical associations, 6% include well-baby visit and appointment reminders, and there are more quizzes and response-prompted messages in the new message set (17% compared with 1%). The new mobile website has had 24,901 visitors and 62,748 page views in the first month of launch. The most popular mobile pages were baby development (3,315 total page views) and baby care (1,918 total page views).

Conclusions:  Text4baby is directed towards those most vulnerable to poor birth outcomes. There is a rigorous content development process to ensure messages are clinically accurate and address important public health issues. Based on the large number of page views, the mobile enhancements to the text4baby messages appear to be popular with participants. 

Implications for research and/or practice: As a next step, the text4baby team is exploring methods to reach fathers in order to further engage them during pregnancy and infancy.