Breaking New Ground: The Text4baby Program

On February 4, 2010, White House Chief Technology Officer Aneesh Chopra announced the launch of text4baby, the nation’s first free mobile health service, developed in partnership by the National Healthy Mothers, Healthy Babies Coalition (HMHB), Voxiva, CTIA—The Wireless Foundation, the U.S. Department of Health and Human Services (HHS), and Johnson & Johnson, the founding sponsor. Text4baby, which has been implemented through an unprecedented public-private partnership, has reached more than 400,000 people with critical health and safety information about pregnancy and a baby’s first year of life. Text4baby aims to reduce barriers to accessing information and resources, increase knowledge around key health topics, improve positive health behaviors, and build a mother’s selfefficacy to engage in healthy behaviors that will benefit herself and her baby. Individuals enroll in text4baby by texting ‘‘BABY’’ for the English service or ‘‘BEBE’’ for the Spanish service to 511411; they can also enroll on the http://www.text4baby.org Web site. A user is asked to register her due date or her baby’s birth date and provide her zip code. The user receives a message on her cell phone on Monday, Wednesday, and Friday every week timed to her due date or baby’s birthday. A user can sign up at any time during pregnancy or the baby’s first year of life and can cancel at any time. The primary target audience for text4baby is women who may be at higher risk for poor health outcomes and may have problems accessing health information: young women (younger than age 25 years), low-income women, and women of color, such as women who identify as AfricanAmerican or Hispanic/Latina. To ensure that text4baby is accessible to mothers of all income levels, CTIA—The Wireless Foundation worked with the U.S. wireless phone companies to waive all text messaging fees associated with the program. Text4baby Content In the first phase of the program, an interdisciplinary team of clinicians, medical epidemiologists, public health practitioners, and communications experts identified potential topics for inclusion. Key sources included federal government materials (e.g., http://www.cdc.gov, http:// www.womenshealth.gov) and national medical association guidelines (e.g., American College of Obstetricians and Gynecologists [http://www.acog.org]), American Academy of Pediatrics (AAP; Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd ed.). The topics were prioritized based on public health importance (e.g., the number of mothers and babies affected), health disparities, and the strength of the supporting evidence. Text4baby messages are 160 characters in length, and each message includes ‘‘Free msg’’ at the beginning of each text, as required by the Mobile Marketing Association. Messages are available in English and Spanish and are written at a sixth grade reading level. Text4baby messages have actionoriented educational content, and many include phone numbers connecting users to resources for more information or for help. There are 114 messages included in the pregnancy protocol and 159 messages in the infant protocol. As of January 2012, 28 million text messages had been sent to users. The text messages provide information on a variety of topics critical to maternal and child health, such as prenatal care, influenza, immunization, developmental milestones, breastfeeding, safe infant sleep, injury prevention, mental health, and tobacco use. Visit http://www. text4baby.org for a comprehensive list of topic areas. Sample prenatal messages include the following.