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Priester 2013 Text2BHealthy



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  • 1. Implementing aText-Based HealthEducation Program Stephanie Grutzmacher, PhD Department of Family Science University of Maryland, College Park
  • 2. Workshop Topics• Why text messages?• Participants, recruitment• Messages• Evaluation design• Findings• Challenges and tips
  • 3. Benefits of Using Texts• Remote (for us), instant, in context (for them)• Repeated, tailored messages• Real-time, interactive evaluation• Perceived as personal, informal (Gold et al., 2010)• Widely available • Especially to non-whites, low-income, low education (Smith, 2011); parents (Ahlers-Schmidt, 2010)• Low cost
  • 4. How Has Texting Been Used in Health Promotion?• Improve attendance in health care settings (Downer et al., 2006; Geraghty et al., 2008; Koshy et al., 2008; Leong et al., 2008)• Access hard-to-reach populations• Deliver information and reminders• Develop and track goals (Ahlers-Schmidt, 2010)• Measure real-time behavior
  • 5. Text “Priester” to 30644.
  • 6. Text2BHealthy Program and Participants• 2-3 community-specific text messages per week• Pilot: 8 Title I schools, 203 parents in 4 MD counties & Baltimore City; 91% retention• Current: 15 Title I schools, 1126 parents in 6 MD counties & Baltimore City
  • 7. Recruitment• School-based – Posters – Tear-pads – Family events, PTSA, music concerts, etc.• Home-based – Backpack flyer – Postcard mailed to survey completers – Newsletters, robocalls• Incentive items
  • 8. Targeted Messages• Elementary schools can help us to know about…. – Retail – Recreation – Libraries – Weather – School schedules, testing, events – Lunch menus – Local events …..without even knowing your name!
  • 9. Write your own messages!• ≤160 characters• Plain language
  • 10. Evaluation Design and Data Sources Intervention Schools Control Schools (n=691) (n=361) Participants Non-participants Non-participants• Parent pre and post-survey• Texted evaluation questions• Dropout interviews• Focus groups (formative and post)
  • 11. Evaluation ContentPROCESS• Recruitment and retention strategies• Message content, timing, usefulness• Feasibility of texted evaluation questions• Cell/texting behavior – Texting frequency, preferences – Number and type of devices, plansMAIN OUTCOMES– Parent and child FV consumption– Parent and child physical activity
  • 12. Pilot Findings – Barriers to Enrollment• Did not know they could enroll• Concerned about cost of texting• Apprehensive about program content• Had disabled short codes• Did not know how to send a message to someone not in their address book
  • 13. Pilot Findings - Enrollment• Low enrollment (203 parents) during the pilot led to a focus on recruitment• Enrollment increased with: – FSNE staff and principals talking to parents in person – School goals (minimums) for recruitment – Collecting phone numbers
  • 14. Dropouts• Most “accidentally” dropped out – Revised STOP message did not reduce rates• Re-enrolled participants stayed in• A few parents cited limited time to read messages
  • 15. Pilot Findings – Text Questions
  • 16. Pilot Findings – Text Questions • Response Rates: 50 40 30 20 10 0 Message 1 Message 2 Message 3 Message 4 • No increase in opt outs after sending evaluation message.
  • 17. Pilot Findings - Participant Satisfaction• 94% of participants read all texts• 71% said texts were “very helpful”• 84% said they would enroll again next year• Messages perceived as personalized, caring
  • 18. How often did you do something that was suggested in one of the messages?50 Always45 Most of the time40 Sometimes35 Rarely30 Never25 No answer20151050
  • 19. Challenges• Recruitment• Conducting evaluation• Determining message timing• Limited research – Textisms – Broad audience or captive audience?
  • 20. Recommendations for Implementation• Seek substantial buy-in from partners – Can help reach audience – Promote and incentivize enrollment – Connect program to other activities• In-person enrollment promotion• Offer to collect mobile phone numbers and manage enrollment for parents; have alternatives• Focus group test materials, messages
  • 21. Next Steps• Outcome evaluation• Dissemination of pilot process findings – Recruitment – Implementation lessons learned• SMS program development workshops• Evaluate reminder/reinforcement uses of SMS
  • 22. Acknowledgements • Maryland FSNE: Erin Braunscheidel, Laryessa Worthington, Kate Speirs, Sally Ann Kamen, Lisa Lachenmayr • UMD SPH: Ashley Munger, Lauren Messina, Jessica DiBari, Kat Downes, Lindsey Zemeir, FSNE-SPH Undergraduate Research Team • Participating FSNE educators, schools, and families This project was funded by USDAs Supplemental Nutrition AssistanceProgram in cooperation with the Maryland Department of Human Resources and the University of Maryland.
  • 23. Questions?grutz@umd.edu