Implementing aText-Based HealthEducation Program Stephanie Grutzmacher, PhD Department of Family Science University of Maryland, College Park
Workshop Topics• Why text messages?• Participants, recruitment• Messages• Evaluation design• Findings• Challenges and tips
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
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
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
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
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!
Write your own messages!• ≤160 characters• Plain language
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)
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
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
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
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
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.
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
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
Challenges• Recruitment• Conducting evaluation• Determining message timing• Limited research – Textisms – Broad audience or captive audience?
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
Next Steps• Outcome evaluation• Dissemination of pilot process findings – Recruitment – Implementation lessons learned• SMS program development workshops• Evaluate reminder/reinforcement uses of SMS
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.