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  • 1. Harnessing the Power ofMobile for Maternal &Child Health: TheText4baby Program
  • 2. The Need
  • 3. Maternal & Child Health in the U.S. The United States has one of the highest infant mortality rates in the industrialized world. Each year in the United States:  500,000 (1 in 8) babies are born prematurely.  28,000 die before their first birthday. Many factors contribute to these negative outcomes including:  Lack of access to healthcare  Negative health behaviors  Poverty Research supports that increasing knowledge around health can help people stay healthier.3
  • 4. Maternal & Child Health in the U.S. Distribution of prenatal care adequacy categories: US, 2002 In the United States, 11.3% of live births were to women receiving inadequate care.4
  • 5. Maternal & Child Health in the U.S. Percentage of women aged 18--49 years pregnant during October 2010--January 2011 (N = 1,457) who received influenza vaccination before, during, or after pregnancy, by month of delivery or expected month of delivery --- United States, Internet panel survey, April 2011 In 2010-2011, only 49% of pregnant women had received influenza vaccination: 32% during pregnancy and 17% before pregnancy or after delivery.5
  • 6. Maternal & Child Health in the U.S. Each year in the United States, more than 4,500 infants die suddenly of no immediately, obvious cause. Half of these deaths are due to Sudden Infant Death Syndrome (SIDS), the leading of all deaths among infants aged 1–12 months. 6
  • 7. Why go mobile?  82% of adults age 18 and older in the U.S. have cell phones.  81% of adult women in the U.S. have cell phones.  72% of adults with cell phones send and receive text messages.  Adults who text typically send and receive a median of 10 texts a day. Source: Amanda Lenhart. Cell Phones and American Adults. Washington, DC: Pew Research Center; 20107
  • 8. Texting by Insurance Type Texting by Insurance Type Source: PricewaterhouseCoopers HRI Consumer Survey, 20108
  • 9. Innovation in MCH
  • 10. What is Text4baby? An educational program of the National Healthy Mothers, Healthy Babies Coalition (HMHB). A free texting service that provides pregnant women and moms with babies under age one with timed health and safety information to help them care for their health and give their babies the best possible start in life. The largest national mobile health initiative to date with over 400,000 enrollees since launch.
  • 11. National PartnershipNational Partnership
  • 12. Mobile Provider Partners Participating mobile providers have agreed to deliver text4baby to their subscribers at no charge.12
  • 13. How Text4babyHow Text4baby Works Works User registration via text or website: Text BABY/BEBE to 511411 User gives zip and due date/DOB If pregnant, user gets a starter-pack of 6 key messages (over 2wks) User gets free tips 3x/week Ends if user texts STOP or on the baby’s 1st b-day
  • 14. Text4baby Content
  • 15. Content Development & Review ProcessMessage feedback from •Institute for Health and Recovery •Organization of Teratologyorganizations, including (but not •Just in Time Parenting Information Specialistslimited to)*: •Kansas Dept of Health & Environment •Prevent Child Abuse Arizona Expert input from:•Arizona Dept of Health Services •Lamaze International •Safe Kids USA •Alliance for Hispanic Health•Association of Poison Control Centers •Massachusetts Breastfeeding •The AOA Foundation •American Academy of Pediatrics•Berkeley University Coalition •The National Campaign to Prevent •American Academy of Pediatric•California Dept of Social Services •National Center for Hearing Teen & Unwanted Pregnancy Dentistry•Carolina Breastfeeding Institute Assessment and Management •Utah County WIC •American College of Nurse-Midwives•Cincinnati Childrens Hospital •National WIC Association •Virginia Dept of Health •American College of Obstetricians and•Fairview Hospital (Cleveland) •Nevada Dept of Health •Washington State Dept of Health Gynecologists•First Candle •New York State Dept of Health •DC Breastfeeding Coalition •National Domestic Violence Hotline•Florida Dept of Health •Ohio Dept of Health •West Virginia Hospital Association •Postpartum Support International•Georgia Dept of Community Health •Oral Health Kansas •Wisconsin Childhood Lead Poisoning •Text4baby Breastfeeding Council•Healthy Fathering Collaborative •Oregon Dept of Human Services Prevention Program Literature Review Priority Content Expert Audience Ongoing Topics Development Review Testing Revision Federal Government U.S. Department of Health and Human Services: Audience Testing • Centers for Medicare and Medicaid Services • Centers for Disease Control and Prevention • Health Resources and Services Administration, Maternal and Child Health Bureau• Emory University Rollins School of • HHS Office on Women’s Health Public Health •National Institutes of Health• Hablamos Juntos 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
  • 16. 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
  • 17. Sample Messages Sample Messages Premature babies need extra Diabetes can happen for the A seat belt protects you & help with breastfeeding. Even 1st time in pregnancy. You your baby. Shoulder belt goes if your baby can’t breastfeed may be tested at 24-28 between your breasts & lap at first, she can still be fed weeks. If you have it, you & strap goes under your belly your pumped milk. your Dr. will make a plan to (not on or above). Wear it Back control it. every time. Back Back Keep your baby away from Keeping your baby’s mouth tobacco smoke. It can Time for baby’s 2-month checkup! Time for him to get clean is important even before damage baby’s heart, lungs she has teeth! Wipe her gums & brain and increase baby’s vaccines to protect him from serious diseases. And time each day with a wet washcloth chances of getting colds or use a soft baby toothbrush. and ear infections. for you to share how your Back Back baby’s doing! Back
  • 18. Delivery of Time-Sensitive Messages  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
  • 19. The Public-Private Partnership
  • 20. More than 800 Promotional Partners Federal Agencies State & Local Health & 97 Health Plans Medicaid Agencies representing all 50 states, DC, & US territories64 National Health Orgs 125 Hospital Networks Media
  • 21. SpreadingAbout the Service the WordPromotional activities have included: Mass emails to colleagues & consumers Printed promotional materials in health clinics/exam & waiting rooms & hospital discharge packets Medicaid/health plan member enrollment letters/mailings E-newsletter or print newsletter blurbs Word-of-mouth at conferences & community events (“baby showers”) Promotion through home visiting programs Earned and paid public service advertising on TV, radio, buses, billboards, etc. Text4baby info recorded on phone “hold” messages Media events Outreach to elected officials
  • 22. American College of Obstetricians and Gynecologists Co-branded fact sheet for OB/GYNs. Information on patient (at right) and members-only web pages Congressional Leadership Conference session (Feb 2012). Media release (at right; Feb 2012). ACOG News article (Spring 2012). National Women’s Health Week blast email to 37,500 members (May 2012). Co-sponsorship of Congressional Briefing (May 2012). Materials included in flu season mailing to 35,000 members (Fall 2012)
  • 23. AAP Promotion Academy of Pediatrics Promotion American Blurbs in SmartBrief, AAP News, & Healthy Child Care America newsletters President’s letter to 40,000 pediatricians citing evaluation results & encouraging promotion (Jan 2012) Co-branded Bright Futures/AAP tear-pads mailed to members & in t4b store Dedicated page on AAP site for pediatricians to view messages (
  • 24. Association of Women’s Health, Obstetricand Neonatal Nurses  Cover article in Journal of Nursing for Women’s Health spring 2011 (at left)  Promotion through Healthy Mom&Baby consumer magazine  Text4baby info on website
  • 25. Congressional Support Congressional SupportCongresswoman Lois Capps (D-CA): Held a Congressional Briefing in 2010 Distributed a press release expressing her support Sent a letter to members of the House of Representatives encouraging her colleagues to host text4baby events in their local districts. Attended events in California to launch the text4baby campaignCongressman Trey Gowdy (R-SC): Strong advocate of program Working with the South Carolina Department of Health and the Environment to spread word about text4baby to constituentsSenator Tom Carper (D-DE): Hosted a Congressional Briefing in May 2012 Encourages organizations in Delaware to promote text4baby “Text4baby works by providing patients with the information they need to have a safe, healthy pregnancy in an inexpensive, easy to use format that is delivered regularly to their cell phone. This simple tool can help ensure healthier pregnancies and reduce health care costs that stem from a lack of access to important information about prenatal health.”
  • 26. Text4baby in the News
  • 27. Earned Media CoverageText4baby in the Media
  • 28. Text4babyText4baby in the Media: NYT in the New York Times February 7, 2011, 9:15 pm Mothers-to-Be Are Getting the Message By DAVID BORNSTEIN We’re used to hearing about public initiatives that get mired in politics or entangled in bureaucracy, but we rarely hear about programs that exceed expectations. So here’s one: last week marked the one-year anniversary of a program called text4baby, a service that sends free text messages to women who are pregnant or whose babies are less than a year old, providing them with information, and reminders, to improve their health and the health of their babies. The service, made available through a broad partnership of community health organizations, wireless carriers, businesses, health care providers and government health agencies, is catching on like wildfire: to date, about 135,000 women have signed up – and organizers have set a new goal of reaching one million users by the end of 2012 (there are four million births each year in the U.S.) What are they doing right?
  • 29. Text4baby in the Media: TimeText4babyMagazine Magazine in Time “With cell-phone companies comping the text charges, text4baby is the first free, large-scale foray into mobile health education in the U.S. States are creating text4baby coalitions and encouraging nurses to talk up the program. Word is also going out through local health departments and TV channels like Telemundo and MTV.” - May 2010
  • 30. Text4babyText4baby on MTV on MTV I didn’t know I was supposed to be cleaning out her mouth already…And they sent me messages about trying to find daycare. They also reminded me about her two-month doctor appointment. I had completely forgotten about it. For me, since I’m new at this and really don’t know, it’s helpful.”
  • 31. HHS Innovates AwardText4baby Wins Prestigious Award
  • 32. Making a Difference
  • 33. Using DataTracking Enrollment to Drive Enrollment text4baby Enrollment by Zip Code Virginia Feb-Aug 2010Six text4baby billboardswent up in Martinsville
  • 34. Tracking Enrollment North Carolina PSAs launch 7/26/11 Number of Radio New PSAs Unique Users Date (January 1, 2011 through August 11, 2011)Text4baby data allows for a real-time understanding ofeffective promotional strategies. In 2011, partners in NorthCarolina ran TV PSAs that increased state enrollment by400% over one week.
  • 35. Program Impact 95% of text4baby survey respondents say they would refer it to a friend (n=24,093) Text4baby is improving adherence to appointments and immunizations: 67.0% reported that 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). Although these findings are not statistically significant, and were not the result of rigorous research methods, the trend is in a very positive direction and will continue to be monitored. Users are increasing health knowledge: 73.4% reported that a text4baby message informed them of medical warning signs they did not know.* The Service is facilitating interaction with health providers: 63.5% reported talking to their doctor about a topic that they read on a text4baby message.* Improving access to health services: 39.2% reported they called a service or phone number they received from a text4baby message.* Underinsured participants are improving their access to health services and health information services as a result of text4baby messages :46.5% reported that they called a service or phone number they received from a text4baby message.* *Study by National Latino Research Center at California State University, San Marcos and the University of California, San Diego Department of Obstetrics and Gynecology of 342 text4baby users in San Diego
  • 36. External Evaluations Alliance Healthcare Foundation – National Latino Research Center: Phone survey with t4b users in San Diego, CA – Phase 1 & Phase 2 completed CareFirst BlueCross BlueShield – George Washington University: Pre/post survey exploring behavior and knowledge change for women in Fairfax County, Virginia - completed, awaiting dissemination Beaumont Foundation – Emory University: Pre/post survey exploring behavior and knowledge change for WIC recipients in Atlanta, GA- completed, awaiting dissemination DOD TATRC - Madigan Army Medical Center/George Washington University: Randomized control trial exploring behavior and knowledge change with pregnant women seeking care in Takoma, WA – recruitment ongoing HHS – Mathematica Policy Research: Behavior and knowledge change in users in 4 communities
  • 37. Join the Movement
  • 38. Action StepsBecome a Friend or Outreach Partner of Text4baby: 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:
  • 39. Action StepsTell all pregnant women and moms with infants < 1about text4baby. Make sure to say:  This service is free to you – your wireless company is waiving the fees. Even if you don’t have a texting plan, you can get these messages.  I feel good about this content. It comes from a trustworthy source.  Sign up by texting the word BABY to the number 511411.  You will get messages until baby’s 1st birthday but you can stop any time; just reply with STOP.
  • 40. Action Steps Tear-off pads (4 designs)Spread the word: Send a mass email with information about text4baby (standard language at Include text4baby info in your organization’s print or electronic newsletter. Order free printed materials to hand out to consumers – place a stash next to your check-in/out counters, waiting rooms, exam rooms, and the like. Visit  Flyers (4 designs) to order.
  • 41. Action StepsGo digital:  Post on Facebook and Twitter about the program. Sample post: Free #text4baby service sends helpful pregnancy & baby tips to your cell phone. Text BABY to 511411.  Add our traceable web button to your webpage. Download it at resources/2-uncategorised/186
  • 42. Action StepsStop the presses: Host a media event in your community and invite broadcast, print, and digital outlets to attend. Call local media you already partner with and tell them about text4baby. Use health observances like Infant Mortality Awareness Month (September) when you pitch. Share the TV and radio PSAs with local stations in your area. Preview and share them at:  TV PSAs:  Radio PSAs: hp
  • 43. Action StepsConnect with others in your area:  Over 800 organizations are already partnering with text4baby. Learn who’s involved in your area so you can team up at ers
  • 44. Thank you!Questions? Contact or for more information