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Where can a pregnant woman find low-cost prenatal care in her area? How should she position a car seatbelt to best protect herself and her baby? Should she get a flu shot? During pregnancy, expectant mothers can have lots of questions; Text4Baby seeks to keep pregnant women informed about pregnancy issues through regular SMS updates sent to their mobile phones.

Developed by the national Healthy Mothers, Healthy Babies Coalition and mobile health service provider Voxiva, Text4Baby uses SMS to send free health news and information to US subscribers. Started in February 2010, the program now has (as of November 28, 2011) about 258,000 people enrolled.

About 24 million messages have been sent on a variety of subjects like labor and delivery, nutrition, immunizations, mental health, developmental milestones, family violence, physical activity, and breastfeeding. Messages are timed based on delivery dates, and are available in both English and Spanish by texting either "baby" (for English) or "bebe" (for Spanish) to the US shortcode 511411.

SMS, Accessibility, and Interactivity

The organizations chose to use SMS as the main channel of communication because it is available on the widest variety of mobile devices and allows for quick scaling of the project. Lauren Sogor, Campaign Manager of text4baby, said in a recent webinar that although text4baby is exploring other content delivery methods like smartphone apps and mobile web information, SMS was a natural place to start. She explained, "We understand the value of having it in a text format because it's so simple."

Mobile phones were chosen for their ubiquity among a wide array of backgrounds and income levels. Explains Paul Meyer, Chairman and President of Voxiva, "If you think about things like educating people, reminding them, encouraging them, there's a big role for digital tools to fill that gap in a far more cost effective way than having a doctor do it or a nurse in a call center do it. I think there's an enormous role for digital services and digital tools to become a core part of our health delivery system, and mobile happens to be great delivery mechanism." He later added, "When you think about how to deliver critical information to pregnant women who really need it, cell phones are what they have, and texting is what they do."

In the fall of 2011, Text4Baby launched its first interactive text campaign. Focused on the theme "flu shots for pregnant women", the campaign asked 103,007 subscribed women if they planned to get flu shots; if they responded yes, they could sign up for a free flu shot reminder, if they responded no, they were given a multiple choice answer to tell why they weren't getting one, or they could respond that they had already received a flu shot. Roughly 31% of recipients (32,084 subscribers) responded; based on the results text4baby plans to incorporate more interactive features into the program next year.

Text4Baby is currently being evaluated by six independent studies; the results of the first study were released on November 1st 2011 by researchers at the National Latino Research Center (NLRC) at Cal State San Marcos and the Department of Reproductive Medicine at UCSD. The researchers studied satisfaction among 2,200 subscribers in the San Diego area. Sogor said that the study revealed unsurprisingly that Text4Baby was well regarded by under-served women, who may not easily have had access to free pregnancy and child care information otherwise. The study on San Diego Text4Baby users found that 75.4% said they learned about new medical warning signs through the program, 71.3% said they spoke to their doctor about a topic they learned about through Text4Baby, and 38.5% said they called a service they learned about from the SMS. 

Scaling

Text4Baby aims to reach one million subscribers by the end of 2012. The project has previously been criticised for the low enrollment numbers given the project's budget. For instance, Joel Selanikio who runs Datadyne, another mobile health services provider, pointed out the low number of enrolled pregnant women compared to all pregnant women in the US last year on his blog. (Since that post, enrollment numbers have increased.)

Meyer said that an important component of building the Text4Baby platform was developing partner relationships, and there are now more than 650 partner organizations working to promote Text4Baby in their communities. Funding for the project came from Johnson & Johnson, a partnership with CITA The Wireless Association, and partnerships with US telecommunications carriers – the service is available for free on all major networks in the US (covering 96% of mobile users) and the partner telecoms have committed to Text4Baby through at least the end of 2013. 

Meyer says that the partnerships and local grassroots promotion are what has helped text4baby reach the quarter million subscriber mark. He said,

"For mobile health, there's lots of neat stuff out there, lots of neat pilots and demonstrations; the challenge now is to see what things can actually be taken to scale. And that's where it's a much greater challenge. As I think about Text4Baby, I think for me the real lesson is that it's much more about how to spread the word and create a movement around these programs; it's not about building or operating a service, it's about building the movement and campaign around them."

Text4Baby is now starting a program in Russia. As Brian Dolan of Mobile Health News writes:

"Text4Baby, the high profile free SMS-based service for new and expectant mothers, is heading to Russia this fall. Voxiva and Johnson & Johnson have teamed up to support the service in Russia, where the content of the text messages will be shaped by the Kulakov Center for Obstetrics, Gynecology and Perinatology of the Russian Ministry of Health and Social Development, or MOHSD. While a press release announcing Text4Baby Russia hit the wires today, the service was announced last month during US Vice President Joe Biden’s wife’s visit to Moscow’s Kulakov Center. Dr. Jill Biden even blogged about it in the White House blog."

For pregnant women and new parents, getting free, direct information via their phones could influence how they approach prenatal and early childhood care. As the project scales up, it may be an example for how mobile health projects in the US can reach larger numbers with timely, interactive information - especially in a country where many are currently not receiving adequate healthcare.

Image courtesy Text4Baby