1. The Text4baby Program Harnessing the Power of Mobile for
Maternal & Child Health 1

2. Program Summary
Text4baby is a free program of the non-profit National Healthy Mothers, Healthy Babies Coalition (HMHB). The founding sponsor is Johnson & Johnson. The White House Office of Science & Technology and the Department of Health & Human Services are among the over 900 partners who are actively promoting the service.
Text4baby is the largest national mobile health initiative reaching over 505,000 moms since launch two and a half years ago.
Text4baby is available in both English and Spanish.
Through free text messages, pregnant women and moms with babies under age one receive customized health and safety information and public health alerts to support them in achieving key developmental milestones, giving their babies the best possible start in life.
We reach low-income and young women, particularly those who identify as Hispanic or African-American. Research shows that these women are at a higher risk of having disproportionately poor birth outcomes.
- From CDC: “Very preterm infants accounted for only 2% of births, but over one-half of all infant deaths in both 2000 and Because the majority of infant deaths occur to very preterm infants, changes in either the percentage of these infants or in their infant mortality rate can have a large impact on the overall infant mortality rate.”

3. Text4baby Founding Partners
National Partnership
Non-profit maternal and child health expert
Nation’s public health agency
Leader in mobile health technology & strategy
Federal leader in innovation
Founding Sponsor & world’s 6th largest consumer health company
Healthcare sector communications & marketing expert
Association representing U.S. mobile phone companies

4. Mobile Provider Partners
Participating mobile providers have agreed to deliver text4baby to their subscribers at no charge.

5. How Text4baby Works How Text4baby Works
Mom texts BABY (or BEBE for Spanish ) to
Mom gives due date/DOB & zip code
Mom gets free tips 3x/week throughout pregnancy & until baby’s 1st bday
Mom can also learn more about key 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.
User can update due date at any time by texting in UPDATE.
User can always stop at any time by texting in STOP and is sent weekly reminders on how to quit.
The enrollment process now also captures who the user is (options include pregnant/new mom, dad/parent, relative/friend, and healthcare provider/other observer) so that we have more information about who is using the service.
Users are automatically transitioned from Pregnancy messaging to New Baby messaging when they reach the due date they provided, if they haven’t proactively updated with baby’s actual birth date to ensure continuous service.

6. Content Development & Review Process
Message feedback from organizations, including (but not limited to)*:
Institute for Health and Recovery
Organization of Teratology Information Specialists
Just in Time Parenting
Kansas Dept of Health & Environment
Prevent Child Abuse Arizona
Arizona Dept of Health Services
Lamaze International
Safe Kids USA
Association of Poison Control Centers
Massachusetts Breastfeeding Coalition
The AOA Foundation
Berkeley University
The National Campaign to Prevent Teen & Unwanted Pregnancy
California Dept of Social Services
National Center for Hearing Assessment and Management
Carolina Breastfeeding Institute
Utah County WIC
Cincinnati Children's Hospital
National WIC Association
Virginia Dept of Health
Fairview Hospital (Cleveland)
Nevada Dept of Health
Washington State Dept of Health
First Candle
New York State Dept of Health
DC Breastfeeding Coalition
Florida Dept of Health
Ohio Dept of Health
West Virginia Hospital Association
Georgia Dept of Community Health
Oral Health Kansas
Wisconsin Childhood Lead Poisoning Prevention Program
Healthy Fathering Collaborative
Oregon Dept of Human Services
Expert input from:
Alliance for Hispanic Health
American Academy of Pediatrics
American Academy of Pediatric Dentistry
American College of Nurse-Midwives
American College of Obstetricians and Gynecologists
National Domestic Violence Hotline
Postpartum Support International
Text4baby Breastfeeding Council
Literature Review
Priority Topics
Content Development
Expert
Review
Audience Testing
Ongoing
Revision
Goal to provide text messages that are relevant, clear, actionable, and scientifically accurate.
Discussion groups with target audience determined topics of importance and relevance of messages.
Focus group tested by the Grady Health Literacy Team at Emory University in Atlanta, GA.
No product promotions.
Federal Government
U.S. Department of Health and Human Services:
Centers for Medicare and Medicaid Services
Centers for Disease Control and Prevention
Health Resources and Services Administration, Maternal and Child Health Bureau
HHS Office on Women’s Health
National Institutes of Health
U.S. Consumer Product Safety Commission U.S. Department of Agriculture, Food and Nutrition Service U.S. Department of Defense Military Health System U.S. Department of Transportation
Audience Testing
Emory University Rollins School of Public Health
Hablamos Juntos

7. Messages on Critical Issues
Smoking Cessation
Breastfeeding
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

8. Critical Alerts 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
Food Safety Hurricane Sandy, October 2012

9. Alliance of Chicago Community Health Services
Program Impact
46%
Register in 1st trimester
96%
Would refer a friend
UC San Diego & National Latino Research Center (N=625) N
65%
Reported that text4baby helped them remember an appointment or immunization that they or their child needed
74%
Reported that text4baby messages informed them of medical warning signs that they did not know
67%
Reported talking to their doctor about a topic that they read on a text4baby message
40%
Reported that they called a service or phone number that they received from a text4baby message
50%
…of participants without health insurance reported calling a service number
Alliance of Chicago Community Health Services
CareFirst Blue Cross Blue Shield- George Washington University
11% vs 17%
There was a lower percentage of missed appointments among t4b users (n=917) vs. non-users (n =1647) *
Text4baby mothers were nearly 3X times more likely to believe that they were prepared to be new mothers compared to those in control group
3 x
* Note: not the result of rigorous research methods

10. George Washington University Randomized Evaluation Results
About the Service
Text4baby mothers were nearly 3X times more likely to believe that they were prepared to be new mothers compared to those in control group*.
Suggests health literacy may be a mediator of the relationship between t4b and attitude/behavior/outcome change
Approaching significant (p<.10) improvement in the following attitudes among t4 mothers with a HS education or >:
Fruit/vegetable consumption
Taking prenatal vitamins
Understanding effects of smoking
Importance of visiting health care provider
* n=123
“This pilot experimental study found that text4baby participation improved a central belief targeted by the campaign - that the pregnant woman receiving text messages was prepared for motherhood.”

11. Interactive Modules

12. Medicaid Module Goals:
Encourage uninsured moms to apply for coverage by providing a brief description of benefits and eligibility.
Remind current Medicaid/CHIP recipients and those interested in Medicaid/CHIP to reapply for coverage.
Identify the number of uninsured users who reported they applied for Medicaid/CHIP.
Summary:
Collaboration with Center for Medicare and Medicaid Services to increase health insurance access for Medicaid/CHIP eligible T4B mothers and families.
The module is timed to send reminders regarding Medicaid/CHIP.
10 days after a mom indicates she has no health insurance, she will receive a follow-up message asking if she applied for Medicaid/CHIP.
2 weeks before a child’s 1st birthday, for all users that indicate they are Medicaid/CHIP enrollees or have no health insurance a follow-up message will be sent reminding them to re enroll.
The module reinforces text4baby moms to:
Call Medicaid/CHIP at or visit
Launched on the text4baby platform on December 2012.
Identifies mother’s current health insurance coverage status.
For those that are not currently insured:
Provides brief description of benefits and information regarding Medicaid/CHIP eligibility status.
Encourages Mom to apply for coverage via or go to .

13. WIC Reminder Service Goals:
Provide text4baby users receiving WIC the opportunity to set up reminders for their WIC appointments.
Provide general text4baby users the opportunity to set up reminders for their appointments as well.
Identify the number of text4baby users who receive WIC and how they interact with the service.
Summary:
A standard WIC message is sent to all users in pregnancy weeks 11,19, 31 and infant weeks 4, 14, and 35.
Those who have enrolled using a WIC participant code or texted in WIC, will received a second message inviting them to set up a reminder for their WIC appointment. 
Generic users will NOT receive this second message.
Both WIC and Generic users also receive other messages throughout both protocols inviting them to text “Remind” to set up a doctor’s appointment.
We know from Barbara Longo research that appointment scheduling apps are highly used by WIC Moms
WIC clients can set up a reminder for their next WIC appointment for free using these simple steps:
If the participant is already a text4baby participant, have them text the word “WIC” to
To set up the appointment reminder have them text the word “REMIND” (or “CITA” for Spanish) to
When prompted, enter the appointment date (e.g., 10/02/12) and a short description for their appointment (e.g., “with WIC at Front St. office/bring proof of address/get lab results for Jose”)
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.

14. Interactive Flu Module
Flu message to 96,070 users in Oct. 2011
Text4baby: Flu season is here. Are you planning to get a flu shot? Reply 1 for Yes, Reply 2 for No, or Reply 3 if you already got it.
Follow-Up Survey
14%
of a subset of respondents not planning to get flu shot subsequently reported getting it.
(N=2504)

15. Immunization Module- CA CDPH
Goals:
Encourage well baby visit attendance (at 2,4,6 and 12 months) and recipient of timely vaccination among infants 0 – 12 months
Determine the usefulness of the text messaging vaccination reminder service based on user feedback
Gain insights around self-reported well baby visit attendance and vaccination coverage (for infants aged 2, 4, 6 and 12 months) among text4baby users.
Gain insights around differences in self-reported well baby visit attendance and vaccination coverage among text4baby users who did and did not request (and likely receive) specific appointment reminders via text.
Summary:
In Partnership with California Department of Health, will be available 2/2013
Messages sent at 2 weeks before baby’s 2nd, 4th, 6th and 12 month birthday
Ask users if they have scheduled the Dr’s visit and encourage them to do so if they have not. Provide users with the option of setting up a text reminder for their appointment.
Follow up with users to ask if they have been to the Dr’s visit and if so, if their child receive vaccinations.
Evaluation questions ask if reminder text messages were helpful in getting baby vaccinated.

16. Press Event: April 29th
Announce the California Department of Health’s Immunization-Text4baby module in California
Focus: Address infant immunization rates in California
San Diego Health Leaders: Supervisor Greg Cox, HHSA Director Nick Macchione & Nancy Sasaki (Alliance Healthcare Foundation)
San Diego County commitments (First 5 San Diego, HHSA San Diego & Council of Community Clinics)

17. Partner Outreach Provider video:
/news/343-provider-video/
Web Enrollment Button:
/text4baby-enrollment-button-info
Become a text4baby Partner:

18. Thank you! Questions? Contact ahoff@hmhb.org or visit
for more information