Testing Texts

Can health-related text messages be a boon to expectant mothers and babies?

May 08, 2010

By Danny Freedman

A new initiative aimed at empowering pregnant women and new moms with vital health information sent via text message – the largest-ever program of its kind in the U.S. – got underway recently, with a GW researcher tasked with analyzing its impact.

The program, called text4baby, is a service that delivers free text messages on a variety of health topics to women throughout pregnancy and their baby’s first year.

Launched in February, the public-private partnership is being facilitated by the National Healthy Mothers, Healthy Babies Coalition and includes more than a hundred organizations, from health-centered mobile technology firm Voxiva to the federal government to wireless service providers.

“The question that we’re really trying to answer is: What’s the value added of a mobile health-messaging service on top of usual health care?” says Doug Evans, a professor in GW’s School of Public Health and Health Services, who led the design of protocols for evaluating the project and will be analyzing study data. “Does it get them to follow the guidelines their doctors are recommending in the first place? Is it motivational and informational in that sense?”

One in eight babies in the U.S. is born premature and an estimated 28,000 die in their first year—one of the highest rates in the industrialized world, according to the federal government. Premature babies are further at risk for health and developmental problems, and on average incur medical costs that are 10 times that of full-term babies.

The project largely targets low-income women, says Dr. Evans, among whom issues like premature birth and low birth-weight are especially prevalent. “And it’s strongly believed that a lot of the reason for that is behavioral,” he says.

With 90 percent of Americans carrying a mobile phone, the hope is that by funneling basic information directly into their hands, risky behaviors like smoking or not showing up for doctor visits can be turned around.

“There is an opportunity to engage them with the fact that they’re now pregnant, they have very heightened awareness and concern about their own health and their baby’s health,” says Dr. Evans. “So it’s a moment to motivate change.”

By early April, about 30,000 women had registered. Most have been recruited through hospital visits, though women also can join by texting “BABY” to 511411, or “BEBE” to receive Spanish texts.

Each week participants are sent three messages, timed according to due date or the baby’s age, on topics including prenatal care, the impacts of drugs and alcohol, smoking cessation, mental health, immunizations, breast feeding and safe sleeping habits. “Basically,” says Dr. Evans, “they’ve taken the science and boiled it down to 160 characters.”

In formally announcing the program in February, U.S. Chief Technology Officer Aneesh Chopra said in a statement that “Text4baby is the first free mobile health service to be taken to scale in the United States.” The program, he said, “represents an extraordinary opportunity to expand the way we use our phones, to demonstrate the potential of mobile health technology, and make a real difference for moms and babies across the country.”

In the U.S., research on using mobile technology to deliver health info has tended to be smaller-scale or more limited in scope, like reminding diabetics to monitor their blood glucose, says Dr. Evans. By seeking the broader result of motivating behavioral change, this project is breaking new ground. “That really has not been attempted on any kind of scale,” says Dr. Evans. The attempt to get patients to change their behaviors, not just maintain old ones, is “a big part of what’s innovative here.”

To evaluate the efficacy of project, Dr. Evans and a cluster of GW graduate students have been working for the past year to design studies tailored to the various participating health care sites, like hospitals or an overarching health plan or government agencies. He expects to have some data within the next nine months.

While some sites are only collecting data, others are undertaking more scientifically rigorous studies that could yield illuminating results, says Dr. Evans. Those include a program with the Humana health plan in south Florida, which could enroll a high number of Spanish-speaking women, and a more targeted study with the U.S. Army that will be exploring postpartum depression and issues of family separation.

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