Pilot evaluation of the text4baby mobile health program

BACKGROUND: Mobile phone technologies for health promotion and disease prevention have evolved rapidly- but few studies have tested the efficacy of mobile health in full-fledged programs. Text4baby is an example of mobile health based on behavioral theory- and it delivers text messages to traditionally underserved pregnant women and new mothers to change their health- health care beliefs- practices- and behaviors in order to improve clinical outcomes. The purpose of this pilot evaluation study is to assess the efficacy of this text messaging campaign. METHODS: We conducted a randomized pilot evaluation study. All participants were pregnant women first presenting for care at the Fairfax County- Virginia Health Department. We randomized participants to enroll in text4baby and receive usual health care (intervention)- or continue simply to receive usual care (control). We then conducted a 24-item survey by telephone of attitudes and behaviors related to text4baby. We surveyed participants at baseline- before text4baby was delivered to the intervention group- and at follow-up at approximately 28 weeks of baby’s gestational age.

RESULTS:

We completed 123 baseline interviews in English and in Spanish. Overall, the sample was predominantly of Hispanic origin (79.7%) with an average age of 27.6 years. We completed 90 follow-up interviews, and achieved a 73% retention rate. We used a logistic generalized estimating equation model to evaluate intervention effects on measured outcomes. We found a significant effect of text4baby intervention exposure on increased agreement with the attitude statement “I am prepared to be a new mother” (OR = 2.73, CI = 1.04, 7.18, p = 0.042) between baseline and follow-up. For those who had attained a high school education or greater, we observed a significantly higher overall agreement to attitudes against alcohol consumption during pregnancy (OR = 2.80, CI = 1.13, 6.90, p = 0.026). We also observed a significant improvement of attitudes toward alcohol consumption from baseline to follow-up (OR = 3.57, CI = 1.13 – 11.24, p = 0.029).

CONCLUSIONS:

This pilot study is the first randomized evaluation of text4baby. It is a promising program in that exposure to the text messages was associated with changes in specific beliefs targeted by the messages.