The Text4baby Program Harnessing the Power of Mobile for Maternal & Child Health

1. The Text4baby Program Harnessing the Power of Mobile for Maternal & Child Health

2. Program Summary • Text4baby is a free program of the non-profit National Healthy Mothers, Healthy Babies Coalition (HMHB). The founding sponsor is Johnson & Johnson.The White House Office of Science & Technology and the Department of Health & Human Services are among the over 900 partners who are actively promoting the service. • Text4baby is the largest national mobile health initiative reaching over 505,000moms since launch two and a half years ago. • Text4baby is available in both English and Spanish. • Through free text messages, pregnant women and moms with babies under age one receive customized health and safety information and public health alerts to support them in achieving key developmental milestones, giving their babies the best possible start in life. • We reach low-income and young women, particularly those who identify as Hispanic or African-American. Research shows that these women are at a higher risk of having disproportionately poor birth outcomes.

3. Text4baby Founding Partners National Partnership Non-profit maternal and child health expert Nation’s public health agency Leader in mobile health technology & strategy Federal leader in innovation Founding Sponsor & world’s 6th largest consumer health company Healthcare sector communications & marketing expert Association representing U.S. mobile phone companies

4. Mobile Provider Partners Participating mobile providers have agreed to deliver text4baby to their subscribers at no charge.

5. Mom gets free tips 3x/week throughout pregnancy & until baby’s 1st bday Mom can also learn more about key topics; get support for enrolling in Medicaid/CHIP; take quizzes; get urgent health alerts; sign up for appointments, WIC meetings and vaccination reminders; provide feedback on specific messages; and get connected to support hotlines. Momtexts BABY (or BEBE for Spanish ) to 511411 Mom gives due date/DOB & zip code How Text4baby Works How Text4baby Works

6. Content Development & Review Process • Message feedback from organizations, including (but not limited to)*: • Arizona Dept of Health Services • Association of Poison Control Centers • Berkeley University • California Dept of Social Services • Carolina Breastfeeding Institute • Cincinnati Children's Hospital • Fairview Hospital (Cleveland) • First Candle • Florida Dept of Health • Georgia Dept of Community Health • Healthy Fathering Collaborative • Institute for Health and Recovery • Just in Time Parenting • Kansas Dept of Health & Environment • Lamaze International • Massachusetts Breastfeeding Coalition • National Center for Hearing Assessment and Management • National WIC Association • Nevada Dept of Health • New York State Dept of Health • Ohio Dept of Health • Oral Health Kansas • Oregon Dept of Human Services • Organization of Teratology Information Specialists • Prevent Child Abuse Arizona • Safe Kids USA • The AOA Foundation • The National Campaign to Prevent Teen & Unwanted Pregnancy • Utah County WIC • Virginia Dept of Health • Washington State Dept of Health • DC Breastfeeding Coalition • West Virginia Hospital Association • Wisconsin Childhood Lead Poisoning Prevention Program • Expert input from: • Alliance for Hispanic Health • American Academy of Pediatrics • American Academy of Pediatric Dentistry • American College of Nurse-Midwives • American College of Obstetricians and Gynecologists • National Domestic Violence Hotline • Postpartum Support International • Text4baby Breastfeeding Council Literature Review Priority Topics Content Development Expert Review Audience Testing Ongoing Revision • Federal Government • U.S. Department of Health and Human Services: • Centers for Medicare and Medicaid Services • Centers for Disease Control and Prevention • Health Resources and Services Administration, Maternal and Child Health Bureau • HHS Office on Women’s Health • National Institutes of Health • U.S. Consumer Product Safety CommissionU.S. Department of Agriculture, Food and Nutrition ServiceU.S. Department of Defense Military Health SystemU.S. Department of Transportation Audience Testing • Emory University Rollins School of Public Health • HablamosJuntos

7. Messages on Critical Issues • Smoking Cessation • Breastfeeding • 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

8. Critical Alerts • 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 • Pertussis – 44 states (CDC), June 2012 • Food Safety Hurricane Sandy, October 2012

9. Program Impact 96% Would refer a friend 46% Register in 1st trimester UC San Diego & National Latino Research Center (N=625) N 65% Reported that text4baby helped them remember an appointment or immunization that they or their child needed 74% Reported that text4baby messages informed them of medical warning signs that they did not know 67% Reported talking to their doctor about a topic that they read on a text4baby message 40% Reported that they called a service or phone number that they received from a text4baby message 50% …of participants without health insurance reported calling a service number Alliance of Chicago Community Health Services CareFirst Blue Cross Blue Shield- George Washington University There was a lower percentage of missed appointments among t4b users (n=917) vs. non-users (n =1647) * 11% vs 17% • Text4baby mothers were nearly 3X times more likely to believe that they were prepared to be new mothers compared to those in control group 3 x * Note: not the result of rigorous research methods

10. George Washington University Randomized Evaluation Results About the Service • Text4baby mothers were nearly 3Xtimes more likely to believe that they were prepared to be new mothers compared to those in control group*. • Suggests health literacy may be a mediator of the relationship between t4b and attitude/behavior/outcome change • Approaching significant (p<.10) improvement in the following attitudes among t4 mothers with a HS education or >: • Fruit/vegetable consumption • Taking prenatal vitamins • Understanding effects of smoking • Importance of visiting health care provider • Suggests health literacy may be a mediator of the relationship between t4b and attitude/behavior/outcome change • * n=123 • “This pilot experimental study found that text4baby participation improved a central belief targeted by the campaign - that the pregnant woman receiving text messages was prepared for motherhood.”

11. Interactive Modules

12. Medicaid Module • Goals: • Encourage uninsured moms to apply for coverage by providing a brief description of benefits and eligibility. • Remind current Medicaid/CHIP recipients and those interested in Medicaid/CHIP to reapply for coverage. • Identify the number of uninsured users who reported they applied for Medicaid/CHIP. • Summary: • Collaboration with Center for Medicare and Medicaid Services to increase health insurance access for Medicaid/CHIP eligible T4B mothers and families. • The module is timed to send reminders regarding Medicaid/CHIP. • 10 days after a mom indicates she has no health insurance, she will receive a follow-up message asking if she applied for Medicaid/CHIP. • 2 weeks before a child’s 1st birthday, for all users that indicate they are Medicaid/CHIP enrollees or have no health insurance a follow-up message will be sent reminding them to re enroll. • The module reinforces text4baby moms to: • Call Medicaid/CHIP at 877-543-7669 or visit www.insurekidsnow.gov/state • Launched on the text4baby platform on December 2012.

13. WIC Reminder Service • Goals: • Provide text4baby users receiving WIC the opportunity to set up reminders for their WIC appointments. • Provide general text4baby users the opportunity to set up reminders for their appointments as well. • Identify the number of text4baby users who receive WIC and how they interact with the service. • Summary: • A standard WIC message is sent to all users in pregnancy weeks 11,19, 31 and infant weeks 4, 14, and 35. • Those who have enrolled using a WIC participant code or texted in WIC, will received a second message inviting them to set up a reminder for their WIC appointment.  • Generic users will NOT receive this second message. • Both WIC and Generic users also receive other messages throughout both protocols inviting them to text “Remind” to set up a doctor’s appointment. • We know from Barbara Longo research that appointment scheduling apps are highly used by WIC Moms

14. Interactive Flu Module Interactive Flu Module Flu message to 96,070 users in Oct. 2011 Text4baby: Flu season is here. Are you planning to get a flu shot? Reply 1 for Yes, Reply 2 for No, or Reply 3 if you already got it. Follow-Up Survey 14% of a subset of respondents not planning to get flu shot subsequently reported getting it. (N=2504)

15. Immunization Module- CA CDPH • Goals: • Encourage well baby visit attendance (at 2,4,6 and 12 months) and recipient of timely vaccination among infants 0 – 12 months • Determine the usefulness of the text messaging vaccination reminder service based on user feedback • Gain insights around self-reported well baby visit attendance and vaccination coverage (for infants aged 2, 4, 6 and 12 months) among text4baby users. • Gain insights around differences in self-reported well baby visit attendance and vaccination coverage among text4baby users who did and did not request (and likely receive) specific appointment reminders via text. • Summary: • In Partnership with California Department of Health, will be available 2/2013 • Messages sent at 2 weeks before baby’s 2nd, 4th, 6th and 12 month birthday • Ask users if they have scheduled the Dr’s visit and encourage them to do so if they have not. Provide users with the option of setting up a text reminder for their appointment. • Follow up with users to ask if they have been to the Dr’s visit and if so, if their child receive vaccinations. • Evaluation questions ask if reminder text messages were helpful in getting baby vaccinated.

16. Press Event: April 29th • Announce the California Department of Health’s Immunization-Text4baby module in California • Focus: Address infant immunization rates in California • San Diego Health Leaders: Supervisor Greg Cox, HHSA Director Nick Macchione& Nancy Sasaki (Alliance Healthcare Foundation) • San Diego County commitments (First 5 San Diego, HHSA San Diego & Council of Community Clinics)

17. Partner Outreach • Provider video: • https://www.text4baby.org/index.php/news/343-provider-video/ • Web Enrollment Button: • https://www.text4baby.org/index.php/text4baby-enrollment-button-info • Become a text4baby Partner: • http://my.text4baby.org/page/s/formal-partner-sign-up

18. Thank you! Questions? Contact ahoff@hmhb.org or visit www.text4baby.org for more information