Text4baby Program

Harnessing the Power of Mobile for Maternal & Child Health in the U.S.

text4baby

Program Summary • Text4baby is a free service mobile health information service addressing the

critical health needs of pregnant women and new parents. • Women sign up for Text4baby by texting BABY to 511411 (BEBE for Spanish)

to receive 3 personalized text messages per week timed to their due date or baby’s birthday.

• Text4baby’s personalized messages and interactive features cover prenatal visits, infant visits, nutrition, smoking cessation, labor signs, breastfeeding, safety, immunizations, oral health, and health insurance coverage, 39+ weeks, and more.

• Text4baby is the largest mobile health initiative in the nation reaching over 691,300 nationally (over 258,00 in Michigan) moms since launch in 2010.

• Text4baby is provided for free thanks to a public-private partnership: • The National Healthy Mothers Healthy Babies Coalition • Voxiva • Founding Sponsor Johnson & Johnson • The Wireless Foundation and leading mobile operators • The Department of Health and Human Services • Over 1,100 outreach partners

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Why Go Mobile?

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• 89% of young women have cell

phones

• 99% of text messages are read. 90% are read within 3 minutes

• People of color are more likely to text than their White counterparts

• Low-income Americans text more than higher-income adults

The Need

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WIC Moms & Technology USDA Western Region WIC Electronic Technologies Project Advisory Group* • 8144 WIC Moms participated on on-line survey

• Text messaging is among top 3 technologies used by WIC moms of

all races ( text messaging, e-mail, internet)

• 92.5 % own cell phones

• 93.6 % are texting (79 % unlimited texting)

• 67.4 % download apps

• 54.6 % unlimited data plans (18 % limited data plans ~ estimate) *source:http://www.cdph.ca.gov/programs/wicworks/Documents/Millennial%20Generation/Project%20Information/WR%20WIC%20Electronic%20Technology%20Project%20Abstract--%20NWA%20May%2022%202012.pdf

The Need

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How Text4baby Works

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Mom texts BABY/BEBE to 511411

Mom gives due date/DOB & zip code

Mom gets free tips 3x/week throughout pregnancy & until baby’s 1st birthday

Through Text4baby, moms can also learn more about certain 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.

The Service

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Literature Review

Priority Topics

Audience Testing

Content Development

Expert Review

Audience Testing

Ongoing Revision

Content Development & Review

Content Development Council: • American Academy of Pediatrics • American College of Nurse-Midwives • The American College of Obstetricians and

Gynecologists • Association of Women’s Health, Obstetric and

Neonatal Nurses • Centers for Disease Control and Prevention • Health Resources & Services Administration • March of Dimes • National Association of Pediatric Nurse

Practitioners • Society for Maternal-Fetal Medicine

Text4baby’s Content Manager -- who developed the American Academy of Pediatrics Bright Futures guidelines — ensures accuracy, currency, and consistency with medical research and science.

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The Service

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We Deliver Messages on Critical Issues

• Smoking Cessation • Breast Feeding • 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

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The Service

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We Alert Moms of Urgent Health News • 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 • Hurricane Sandy Refrigerated Food –

12 states, November 2012 • Health Exchange Marketplace Launch,

August & October 2013

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The Service

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Interactivity

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267 Messages Total

58% contain additional health and resource info

46% or 123 links to Text4baby mobile web pages developed in partnership with major medical associations

25% or 68 messages provide a resource phone number

45 links to videos

15 visit & appointment reminders

6% of messages link to external websites

9 messages prompt mothers to text back LIKE when they find a message helpful

7 messages encourage mothers to text back MORE to get additional information

2 Quizzes (Food safety in pregnancy and car seat safety in infancy)

The Service

(1/2) text4baby: Every week of pregnancy is important for your baby’s development. So if you have a healthy pregnancy, wait for labor to begin on its own. (1/2) Go to text4b.org/088 to watch a fun video about waiting for at least 39 weeks.

Message Layers of Additional Resources

Mobile Web Pages Provide More Information

Videos and more information

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Current Text4baby Nutritional Message

• Connect moms to Health & Nutrition resources: WIC resources, Women and Infant Health Resources, National Hunger Helpline, Breastfeeding Support, etc.

• Provide moms with Critical Health and Nutritional Information & Reinforce WIC/SNAP nutrition messages:

• You need calcium to build your baby's teeth & bones. Good sources of calcium are low-fat or fat-free milk, yogurt & hard cheeses (like cheddar).

• Healthy eating is important for you & your baby! If you need help buying food, connect to WIC. Call 800-311-2229 & ask for your local WIC office.

• If you need help getting food, call the National Hunger Hotline at 866-348-6479.

The Service

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More Than 1,000 National Partners

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The Service

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Improve WIC Appointment Attendance • Your WIC clients can set up a reminder for their next WIC appointment for free

using these simple steps: 1. If the participant is already a text4baby participant, have them text the word “WIC” (or “miWIC” for Spanish) to 511411. 2. To set up the appointment reminder have them text REMIND (or “CITA” for Spanish) to 511411. 3.When prompted, enter the appointment date (e.g. 10/12/13) and a short description for their appointment (e.g., “with WIC at Front St. office/bring proof of address/ get lab results for Jose”). 4. The participant will receive the following automated text message: “Your reminder is set for your appointment on 10/12/13. We will send you a reminder three days before.” • Participant will receive reminder three days before and morning of appointment.

Improve Appointment Attendance: Text4baby Appointment Reminder Service

Goals: • Provide Text4baby participants with the opportunity to set up

reminders for their well baby appointments. • Mom’s and parents enrolled in Text4baby with and without

smartphones can receive free text appointment reminders • The reminders improve appointment adherence • Moms receive a reminder three days before and morning of

appointment.

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Mom texts REMIND or

CITA (Spanish)

Prompts mom to text appointment

date (e.g., 10/02/12)

Prompts mom to text description (Vista DR office, bring lab results. 760-000-0000 )

The Service

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Case Study: Neighborhood WIC of Public Health Solutions, NYC & Text4baby

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In June 2013, implemented in-depth training for ALL client-interacting staff, particularly focusing on the Breastfeeding Peer Counselors. • Strong emphasis on on-site enrollment and WIC-

specific appointment reminders with goal of Text4baby enrollment leading to retention and increased WIC appointment adherence.

• Use of promotional materials: • Flyers in waiting rooms, nutritionist’s office, and

displayed on digital screens in centers. • Staff wear “Ask me about Text4baby!” pins. • Digital promotion (website, social media). • Media outreach to press and local

congressional leaders. • So far, 1200 women have enrolled using WIC

participant code in Neighborhood WIC counties.

Text4baby Impact Research from the University of California/Cal State University has demonstrated that Text4baby is increasing mother’s health knowledge, appointment attendance, immunization adherence, interaction with providers, and access to health resources. A George Washington University randomized evaluation demonstrated that Text4baby mothers were nearly 3X times more likely to believe that they were prepared to be new mothers compared to those in control group.

Text4baby

Text4baby | Medicaid / CHIP module

Text4baby wants you to know about free/low-cost health insurance. What type of health insurance do you have? Reply 1-No health insurance, 2-Employer/ Union; 3-Medicaid/CHIP; 4-Veterans/Military; 5-Other

54% Medicaid/ CHIP

20% Employer

13% Military /Other

13% None

N=51,925 47% Response Rate for Pregnant Women/New Moms

Insurance Type? If none, apply!

Medicaid/CHIP pays for pregnancy check-ups & delivery. For kids, it covers check-ups, sick visits, medicine, dentist visits & more. You may qualify if your family (of 4) income is below $46,100 (maybe more). Call 877-543-7669 or go to insurekidsnow.gov/ state

Source: Text4baby database 8/31/2013

52% Yes

N= 2,691 42% Response Rate for Pregnant Women/New Moms

Did you apply?

48% No

Text4baby check in! Were you able to apply for free/low-cost health insurance called Medicaid/CHIP? Reply 1 for Yes or 2 for No.

+ 1 week

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Text4baby is Reaching its Target Audience • Text4baby is reaching

individuals early in their pregnancy: Of the users who signed up to receive pregnancy messages, over 47% enrolled during the first trimester.

• Text4baby is reaching women

in high-poverty areas: A higher percentage of text4baby users live (or lived upon enrollment) in zip codes with the highest levels of poverty compared to the overall U.S. distribution.

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Making a Difference

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Users Like the Service

• 93% of users who responded to a survey (n=33,627) said they would refer Text4baby to a friend and rated the helpfulness of the service as a 7.8 out of 10.

• A short survey conducted with patients at Carilion Clinic in Roanoke, VA who enrolled in text4baby for 6 months or more found that 92% of women who continued to use the service (49 of 53) were satisfied with the program.

• The average satisfaction rating for users who participated in the first California State University San Marcos National Latino Research Center and University of California San Diego (CSUSM/UCSD) evaluation was 8.5 out of 10, with Spanish-speaking users reporting a higher level of satisfaction compared to English-speaking users.

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Making a Difference

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Text4baby as an Interactive Tool

Nearly three quarters (73%) of respondents not planning to get the shot (n=8,841) were willing to provide a reason when asked, “why not?” via text.

Making a Difference

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In October, 2011, 31% (29,316 of 96,070) of users responded to a text asking about their intention to get a flu shot, indicating that the user base in engaged and willing to respond to question of this nature.

Respondents planning to get the vaccine expressed interest in receiving a text reminding them to get the shot; 55.7% of those who responded to a text asking if they wanted to receive a reminder (n=4,578) replied “yes”.

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Evidence of Knowledge & Behavior Change • Increasing Health Knowledge and Preparedness: 74% of participants in the

CSUSM/UCSD evaluation reported text4baby messages informed them of medical warning signs they did not know.

• A George Washington University-led randomized evaluation found that Text4baby mothers were nearly three times more likely to believe that they were prepared to be new mothers compared to those in the no exposure control group.

• Appointment Attendance: 65% of participants in the CSUSM/UCSD evaluation reported Text4baby helped them remember an appointment or immunization that they or their child needed.

• Alliance of Chicago Community Health Services (network of FQHCs) found the percentage of missed appointments was lower among text4baby enrollees (N=917) compared to non-enrollees (N=1,647) when comparing the two patient populations at one point in time (11% vs. 17% missed appointments, respectively).1

• Facilitating Interaction with Health Providers and Improving Access to Health Services: 67% of participants in the CSUSM/UCSD evaluation reported they talked to their doctor about a topic they read on a text4baby message and 40% reported they called a number for a service they received from text4baby, with a higher percentage of uninsured respondents reporting they called a service number.

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1 Although the Alliance findings are not the result of rigorous research (and thus not statistically significant), the trend is positive and will continue to be monitored.

74% Increase Health Knowledge 65% Increase Appointment Attendance 67% Reported they talked to their doctor about a topic they read on a text4baby message

Making a Difference

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Text4baby appointment reminders impact well-baby visit attendance

• Self-reported well-baby visit attendance was 6 percentage points higher across all visits among respondents who received education and appointment reminder messages compared to those who received neither (n=2,884). – This relationship was stronger among

respondents receiving messages in Spanish (9 percentage points higher, n=477).

– California & Nevada data presented

Appointment-Making and Attendance

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Reach WIC Clients with Text4baby • Talk to every client about Text4baby and show them how easy it is

to sign up! – Tell clients to use text4baby’s “REMIND” function to provide free

appointment reminders.

• Train patient-facing staff (breastfeeding coordinators, application assistants, nurses, etc.) to inform patients about Text4baby and encourage enrollment through text or the web enrollment button on the organization’s website.

• Order free promotional materials for your clients at http://www.tinyurl.com/t4bstore.

• Show the text4baby provider video (t4b.org/video) at your next staff meeting to share testimonials from other providers on how they have successfully enrolled moms in Text4baby.

• Sign up for the Text4baby Tuesday e-newsletter to get weekly updates at http://eepurl.com/h9h3.

Get Involved

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Become an Outreach Partner

Get Involved

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• No cost to your organization. • Access to text4baby logo and Adobe InDesign art files for customization. • Access to zip code-level data to track enrollment. • Promotion in Text4baby Tuesday, a weekly e-mail alert providing program

updates. • Technical assistance through HMHB. • Recognition on the text4baby website & in select communications. • Opportunity to be connected with your peers. • Sign up here: http://my.text4baby.org/page/s/partner

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Thank you!

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For more information contact Lindsay Handelsman at lhandelsman@hmhb.org

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Text4baby in Michigan

Get Involved

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• MI Healthy Baby

• Maternal and Infant Health Program, Perinatal Health Unit, Women, Infant

and Family Section, Division of Family and Community Health

• Maternal, Infant, and Early Childhood Home Visiting, Children’s Health Unit, Child and Adolescent Health Section, Division of Family and Community Health

• WIC

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MI Healthy Baby

Get Involved

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• Website of resources for before pregnancy, during pregnancy, and after baby

is born (www.mihealthybaby.mobi/) developed by MDCH through a grant from First Time Motherhood/New Parent Initiative grant through HRSA/MCHB from fiscal year 2011-2012.

• Links parents to a number of state and national resources with a particular emphasis on United Way 2-1-1 which offers a live operator for referrals to services in a particular community 24 hours a day/365 days a year

• Text4baby is a featured resource on the website which includes links to its site under particular topic areas as well as three Text4baby PSAs

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Maternal and Infant Health Program, Perinatal Health Unit

Get Involved

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• Pregnant or new mom given MIHP booklet and/or signed up for Text4baby

• Check off box on the reprogrammed discharge summary that indicates whether or not an MIHP beneficiary was signed up for Text4baby (% enrolled; % enrolled entire time)---new discharge summary in process at this time

• Semi-annual Coordinator Meeting in September---training on appointment function will be provided using a handout, a new brochure developed by Text4baby, and possibly a web training which will be posted on the MIHP website

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Maternal, Infant, and Early Childhood Home Visiting, Children’s Health Unit

Get Involved

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State Custom Support Text4baby Package Set-up Which Includes:

• 2-year contract

• customization of messages to include state-specific information and resources

• 12 statewide broadcast messages

• tools and support to integrate Text4baby enrollment into state systems and processes

• enhanced data access, reporting, and support

• customized and broadcast messages are translated into Spanish

• promotion of Text4baby planning underway

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WIC

Get Involved

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• WIC Coordinator Meeting October 23-24, 2013

– 120 people attended representing 48 agencies

– Text4baby display included banner, tear off sheets in English and Spanish, lapel pins, flyers (Text4baby in English and Spanish, Text4baby and WIC: Building on a Shared Mission, Understanding the Impact of Text4baby, Text4baby: An Innovative Free Health Text Messaging Service), Text4baby Fact Sheet placed in the WIC Coordinator Meeting participant binder

• Nutrition Education Update Webcast: Oral Health, Text4baby, Eat Safe Fish March 20, 2014

• WIC Annual Conference April 29-30, 2014

– Will staff a Text4baby display

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For More Information, Please Contact:

Get Involved

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Sally Meyer, MPH Infant Health Consultant Division of Family and Community Health 517/335-9017 MeyerS9@michigan.gov