1. Text2BHealthy Colorado’s Formative Evaluation and Pilot Study
ASNNA Conference
February 8, 2018

2. Acknowledgements Thanks to Rocky Mountain Prevention Research Center in the University of Colorado’s School of Public Health
Presenting on behalf of the Rocky Mountain Prevention Research Center, Colorado School of Public Health.
Two implementing agencies conducted this formative evaluation: The Culture of Wellness in Preschools and the Integrated Nutrition Education Program.

3. Background Innovative education strategies utilizing technology
Text2BHealthy identified through the SNAP-Ed Toolkit
Partnership with University of Maryland SNAP-Ed
In Colorado, SNAP-Ed is looking for innovative strategies for reaching our SNAP eligible or participating families.
Through the SNAP-Ed toolkit, Text2BHealthy, was identified as a proven evidence-based intervention that utilizes both social marketing and direct education strategies.
T2BH engages families by sending text messages which connect parents with nutrition education opportunities, grocery store specials and tips such physical activity ideas and recipes.
In FFY18, Colorado received approval to use this intervention strategy.
We partnered with Laryessa Worthington with the University of Maryland Extension to collect example message library's and to understand how content was designed for their community.

4. Purpose Formative Evaluation and Pilot Study
Ensure the Text2BHealthy content resonates with our Colorado community
Determine the level of engagement parents wish to have with the text messaging initiative
Target Audience: Parents of children who participate in SNAP- Ed with a focus on female, Hispanic mothers from both urban and rural settings
As an initial step in the program design we conducted a formative evaluation and pilot study to test the materials.
The purpose of this study was to:
Ensure the texting content resonated with our target audience
And to determine the level of engagements our parents wished to have with the text messaging initiative.
For our target audience we narrowed the scope to parents of children who participate in SNAP-Ed program. Focusing primarily on female, Hispanic mothers in both urban and rural communities.

5. Study Structure Interview (Pre-Post) Pilot Text Message
Recruitment: SNAP-Ed educators/coordinators identified parents and protocols were followed for recruitment.
Parents enrolled in the pilot text message program and participated in a pre- post phone interview.
Interview (Pre-Post)
Here are the methods we utilized:
Parents were into the pilot through the relationships that our SNAP-Ed educators built with the community. We identified parents who may be interested in participating in the project.
We developed protocols with scripts for the recruiters to use.
The study had three parts. A pre and post interview lasting between minutes each and wedged between was a pilot text message campaign that last five weeks.
The pre and post interview were conducted on a phone.
The pre interview focused on parents perceptions, attitudes, and preferences regarding text messages
The post interview focused on interaction preference, experience, and pros/cons of the campaign.
The pilot campaign lasted 5 weeks with an avg. of 3 texts per week
Parents were enrolled into English or Spanish based on preference.
All of the texts were sent at 5:00 pm, and consisted of various messages such as: Community Events, Interactive Text which asked for feedback, Physical Activity Tips, Goal Setting, Recipes and Sugary Beverages.
Additionally, all texts started with the acronym T2BH, as having a identifier at the beginning of each text is a best practice in mobile messaging.
15-20 minute phone interview
Conducted by staff member unfamiliar to the parent
Protocol containing questions
T2BH: Be brave and try something new! Try this recipe using Jicama, a root veggie native to Mexico. Watch the video to learn how to make it.
Pilot Text Message
5 weeks with an avg. 3 texts per week
Enrolled in either English or Spanish

6. Description of Parents
62%
38%
Reach
Total
Pre-Interview
n=26
Texting Campaign
n=24
Post-Interview
n=21
A total of 21 adults completed the entire pilot and pre/post interview
26 parents complete the pre interview, and 24 participated in the texting campaign.
The majority of the participants were Spanish speaks with 62% speaking Spanish.
While 65% were from urban settings, there was rural representation from several parents.

7. Results: General Cell Phone Behavior
Majority send & receive 1-10 texts per day, which is the preferred amount
Phone numbers remained consistent over the year
Most had unlimited data plans and are not charged to send/receive texts
Smart phones were common and most reported using cell phones multiple times a day to access the internet
Nearly all parents reported that they have not participated in any text messaging campaign before
The time or day to receive texts did not matter to families
Most felt comfortable with an average of 3 texts per week
Lets start looking at the results by seeing the general cell phone behaviors of our families.
Majority of parents reported sending and receiving 1 to 10 texts per day and most preferred this amount as well.
Our parents reported having the same phone number over the past year, so numbers did not regularly change.
Most had unlimited data plans and were not charged extra to send/receive texts
Smart phones were very common and almost all parents reported using cell phones multiple times a day to access the internet.
Nearly all parents reported that have not participated in any type text messaging campaign before.
Most parents did not have a preferred time or day to receive texts and all felt comfortable with the 5:00 pm time chosen
Through the campaign we sent an average of three texts per week for the five weeks and the majority thought this was the right amount to send.

8. Results: Experience in the Campaign Pilot
Nearly all stated a positive experience
Parents reported the campaign was helpful for:
Engagement, accountability and motivation
Goal setting and behavior change
Helping to generate new ideas
When we delved into the experience the parents had in the campaign pilot nearly all stated a positive experience and excitement for the campgain
Parents said the campaign was helpful for
Engagement, Accountability and Motivation
Goal Setting and Behavior Change
And helping to generate new ideas such as recipes and physical activity ideas
When we asked more specially about behavior change the majority said that while the pilot was too short the constant reminder to continue their healthy habits did make a difference
For instance parents reported doing something physically active after dinner once they got the text reminder or planning a new recipe when they got the idea.
We asked what health topics interested them and here is the order of expressed interest.
Recipes, Cooking tips, and healthy eating tips
Activities to do as a family
Physical Activity ideas
Sugary Beverage and water tips
Lastly, Trauma, Emotional Support, and Stress Management.
During the Post interview we asked how could we improve the messages, families explained they wanted the texts:
Make specific – don’t just say increase eat healthy, give us strategies to do so
Send more texts that are interactive
Send texts that help you find strategies to increase your self-esteem
Families spoke about receiving more texts on sugary beverages particularly for kids
They wanted more texts that target motivation to perform healthy behaviors
And lastly parents wanted more texts that are specific to their community.
Improvements to Messages (Post Interview)
Make tips specific
Include more interactive texts
Focus on strategies for increasing self-esteem
More texts on sugary beverages
Focus on increasing motivation around healthy behaviors
Texts that are specific to their community
Health Topics of Interest (in order of expressed interest)
1. Recipes, Cooking Tips, Healthy Eating Tips
2. Family Activities
3. Physical Activity
4. Sugary Beverage/Water Tips
5. Trauma, Emotional Support, & Stress Management

9. Results: Experience in the Campaign Pilot, cont’d
Did texts feel personal?
52% said yes:
“Yes, it felt like it was a message from a friend who cared about me.”
Others thought the texts were generic
“They could be more personal. I live in Alamosa and the one about the farmers market where I live is personal. If you could write my name when you send me a message that would make it more personal and less like a machine talking to me.”
T2BH Brand Name
T2BH helped to identify who the text was coming from
No one could remember what T2BH meant
Overall fine with name
When asked if the texts sent during the campaign seemed personal, like they were designed for them, a little over half (52%) responded yes
“Yes, it felt like it was a message from a friend who cared about me.”
Others thought the texts were generic
“They could be more personal. I live in Alamosa and the one about the farmers market where I live is personal. If you could write my name when you send me a message that would make it more personal and less like a machine talking to me.”
We also wanted to explore the Text2Bhealthy Brand name with our families.
During the post-interview, we asked if the T2BH at the front of each text helped participants identify who the text was coming from and the majority said that it did help. Though a few reported they were confused or didn’t even pay attention to the acronym.
When asked if they could remember what T2BH stood for no one could remember, though it was shared with them during recruitment and in the welcome text.
Then we asked about their thoughts of the name Text2BHealthy (T2BH for short), overall they were fine with the name.
We did find that some of our Spanish speaking parents felt the name was a little hard to pronounce because there is no good way to translate the name.
T2BH: Welcome to Text2BHealthy (T2BH)! We will send you 2-4 mgs/week with fun tips to keep your family healthy! To opt out at any time reply STOP

10. Recommendations Program Planning Lessons Learned
T2BH, as it was designed in the toolkit, resonated well with our families.
We kept the name Text2BHealthy, even though it was hard to pronounce for some Spanish speaking families
Messaging Library Changes:
Include more interactive texts with responses
Make texts more personal by localizing texts with events and sale messaging, and using participant’s first name
Include specific health recommendations
Find a way to make our obesity prevention texts have a social and emotional lens: E.g.: Are you and your family active? Being active has mental and emotional benefits some include sharper memory and thinking, better sleep, more energy and stronger resilience.
Use the SNAP-Ed Toolkit to identify interventions and then conduct formative evaluation to make sure the program resonates with your target audience.
Overall T2BH as it was designed in the toolkit resonated well with our families and there was enthusiasm for this campaign from our parents
We kept the name Text2Bhealthy, even though it was hard to pronounce for some Spanish speaking families.
From our families we specifically heard to include:
More interactive texts both in questions asked to them but then in responses back to their answers.
Since our parents want interaction this is a great way to collect both impact and process evaluation data.
Make texts more personal by localizing texts with events and sale messaging, and using participants first name
Making sure our texts are specific in their health recommendations and not just using core messaging
Find ways to make our obesity prevention texts have a social and emotional lens
Are you and your family active? Being active has mental and emotional benefits some include sharper memory and thinking, better sleep, more energy and stronger resilience.
Ultimately what we learned was that the while the toolkit offers evidence-based interventions, it is our responsibility to ensure that the intervention resonate with the target audience in our community. This includes doing formative evaluation work to explore that potential.

11. Max.Young@state.co.us • (303) 501-7058
Thank You!
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