Text4baby: Health Care Providers Are Connecting With Mothers-To-Be Via Cellphones

Text4baby? No, babies in utero are not that tech-savvy, not even in 2011, not yet at least. But a program that sends free health and wellness cellphone text messages to women during pregnancy and the first year of the baby’s life has been getting attention.

The program launched nationally more than a year ago; millions of texts have been sent. We can’t yet be sure the program is having the desired health-improving impact. Common sense may tell us it does, but common sense hasn’t always proved infallible in health innovation. The Department of Health and Human Services is evaluating the program, and will have preliminary data in a few months.

In the meantime there is some encouraging anecdotal evidence, plus results from a small but quite intriguing pilot program at a community clinic in Massachusetts. This isn’t a population of decaf-latte-sipping moms-to-be checking their text messages after their prenatal yoga classes (although they may start getting them soon, too). This is an underserved, higher risk population of young (average age 22) low-income women.

The Lynn Community Health Center, collaborating with Partners Health Care and North Shore Medical Center, enrolled 25 pregnant women in the program, which is similar, though not identical, to the national text4baby campaign.* (It spans two months after birth, while the national plan goes for a full year). It was funded in part by Partners Community Benefits and the Verizon Foundation. The messaging and evaluation was provided by the Center for Connected Health.

Lynn clinic executive director Lori Abrams Berry said they did a bit of homework and learned that not all the women had easy access to computers and the Internet. But the digital divide ended at the cellphone. The women did have cellphones and they were accustomed to getting text messages – although getting texted by their obstetricians was admittedly a new experience.

They got from one to four texts per week from their OB/GYN clinical team – which included the team phone number. Texts were available in either English or Spanish.

The pilot group was small so the results shouldn’t be overinterpreted. But they were encouraging. Women who received the messages got the recommended level of prenatal care 9 percent more than their counterparts who did not get text messages, according to information released by The Center for Connected Health and Partners HealthCare.

“We’ve continued with the program. The patient satisfaction is huge,” said Berry. The frequent messages, worded in an accessible, nonjargony, supportive tone, helped get these young women much more engaged in their prenatal and newborn care. The messages gave them reminders, gave them inspiration, and gave them a sense that someone who cared was watching, she said.

“We sent some messages that said things like your OB team is thinking about you, how you are doing, let us know,” Berry said. Other messages included, “Hi, it’s your OB team reminding you to count your baby’s kicks. Call us if there is a change in frequency,” or “Your OB team is checking in. Have you scheduled your ultrasound? It’s baby picture time! Let us know if we can help.”

That close connection between patient and provider, that sense of personal connection, may be part of the success. Dr. Joseph C. Kvedar, director of the Center for Connected Health, said in a recent telephone interview. “My sense is it has to do with how much the individual receiving the text feels connected” to the person or care team sending the text, which can be customized up to a point in a small program. And that could turn out to be a key difference between the Massachusetts initiative, and the national text4baby campaign.

The Connected Health center, which is also deploying technology for diabetes and medication management, is now working on spreading the prenatal text messages to other sites – and this time they will be trying it on different populations, not just those with high risks or low incomes, but also that decaf-latte crowd.

Nationally, the text4baby program itself had an interesting gestation. It was part of HHSinnovates, part of a larger HHS drive to create a “culture of innovation” allowing good ideas to bubble up within a huge federal bureaucracy. Text4baby sends free short messages, in English or Spanish, to pregnant women or new moms (including teen moms) with cellphones. The messages are tied to their stage of pregnancy, and then after the birth they get another year of well baby, well mom messages for themselves and their baby.

Why is this important? More than 500,000 babies are born prematurely in the U.S. each year and about 28,000 children die before their first birthday. Of course some of those tragic outcomes are due to conditions like congenital heart defects that no text message can avert or ameliorate. But good prenatal health can and does save lives, helps avoid complications, and gets children off to a good start.

The national initiative is run in partnership with tech companies, cellphone carriers, and insurers. It’s free for the women, who can easily subscribe on most cellphones, including prepaid ones.

At a webinar about the program a few months ago, Leslie Conner, of Health Improvement Partnership of Santa Cruz County, Calif. described how her program used text4baby for its young pregnant women. She told the story of Diana, a 17-year-old who became pregnant as a high school senior, and her baby daughter, Lilia.

She wasn’t really engaged in getting the prenatal care that she needed. And, so one of our application assisters met her at the resource center and told her about text4baby. And, Diana was actually reluctant at first. She wasn’t sure it was going to be helpful. She was sort of skeptical. It seemed new. She had never heard of that, but she agreed to go ahead and try it. And, so we signed her right up. We dialed up the text number 511411, and immediately she began getting messages.

And, Diana was actually quite amazed by the speed and the messages have a very user-friendly, sort of friendly feeling, to them. So she really liked the tone. And, she began getting messages on how her baby was developing from week to week. She got information about taking vitamins, getting rest, making sure to see her doctor. She came in one day and talked about the fact that she had gotten information about how important it was to pick a safe crib for her baby when the baby was born.

So about five weeks ago, Diana gave birth to Lilia, a healthy baby girl. And, when she was just a day old, we went into the hospital and our application assister actually enrolled Lilia in Medicaid at the hospital using the very simple form for newborn. And, then we updated Diana’s cellphone so that the text4baby messages would now coincide with Lilia’s birth date. So then her text focused on well-baby care. And, she got simple reminders about not exposing Lilia to cigarette smoke, about the importance of immunizing Lilia. She learned how to take care of the umbilical cord when she got home. She mentioned how giving her baby the sponge bath and how to take care of the umbilical cord was something that struck her. So all in all, text4baby really has helped engage Diana both in her pregnancy and then Lilia’s well care to start off her life.

*Text4baby is an educational program of the National Healthy Mothers, Healthy Babies Coalition. It is made possible through a public-private partnership that includes government agencies, private insurers, Voxiva, CTIA – The Wireless Foundation, and cellphone carriers. Implementation partners include BabyCenter, Danya International, Syniverse Technologies, Keynote Systems, and The George Washington University. MTV Networks is a media sponsor.


Contributing Writer Joanne Kenen writes monthly news features for the Health Policy Forum discussing health policy innovation and “what works” in our health care system, as well as the politics of health policy and reform. As a leading nonprofit health care research and consulting institute dedicated to improving human health, Altarum encourages open discussion and debate about the many challenges in health care today. All postings to the Health Policy Forum (whether from employees or those outside the Institute) represent the views of the individual authors and/or organizations and do not necessarily represent the position, interests, strategy, or opinions of Altarum Institute. Altarum is a nonprofit, nonpartisan organization. No posting should be considered an endorsement by Altarum of individual candidates, political parties, opinions, or policy positions.

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