Maternal and Child Health Journal

, Volume 18, Issue 1, pp 223–232 | Cite as

Text4baby Program: An Opportunity to Reach Underserved Pregnant and Postpartum Women?

  • Julie A. GazmararianEmail author
  • Lisa Elon
  • Baiyu Yang
  • Megan Graham
  • Ruth Parker


Text4baby was launched in 2010 to promote healthy pregnancies and babies by the use of text messaging. The primary objective of this study was to assess factors related to the enrollment process and reception of text4baby. A prospective cohort study was conducted in two Women, Infant and Children clinics in Atlanta (April 2010–July 2011). Randomly selected pregnant and postpartum women (n = 468) were queried on cell phone use and instructed on text4baby enrollment. Self-enrollment issues were assessed at one-week follow-up (n = 351, 75.0 %), and message reception and reading patterns at two-month follow-up (n = 209, 44.7 %). Forty-two percent of the women had some college education and 82 % had household income <=$20,000. About half attempted text4baby self-enrollment (162/351), with enrollment success more likely among women with more education (80 % with some college vs. 62 % with less education), with household income above $10,000 (61 % < $10,000 vs. 83 % $10,001-$20,000 and 76 % > $20,000), and among women living in smaller households (77 % 1–3 members vs. 58 % > 3 members) (all p < 0.001). Among the 209 participants in the final follow-up contact, >90 % reported uninterrupted reception and regular reading of messages, and 88 % planned to continue using text4baby. Results also suggested that respondents who were younger (<26 year), less educated and had lower health literacy skills were more likely to have interrupted messages. Despite substantial interest in the text4baby program in an underserved population, innovative ways to help women with significant disadvantages enroll and receive uninterrupted messages are needed.


Maternal and child health education Health education Text messaging Underserved populations 



Grant funding support was provided by the de Beaumont Foundation. The authors would like to thank the ongoing support by Judy Meehan and E. Lauren Sogor with the National Healthy Mothers, Healthy Babies Coalition; project support by William Oswald and Lydia Odenat; and the staff and participants at the Adamsville and College Park WIC clinics.


  1. 1.
    Jordan, E. T., Ray, E. M., Johnson, P., & Evans, W. D. (2011). Text4Baby: Using text messaging to improve maternal and newborn health. Nursing for Women’s Health, 15(3), 206–212.CrossRefGoogle Scholar
  2. 2.
    MacDorman, M. F., & Mathews, T. J. (2011). Understanding racial and ethnic disparities in U.S. infant mortality rates. NCHS data brief, no 74. Hyattsville, MD: National Center for Health Statistic.Google Scholar
  3. 3.
    Mathews, T. J., MacDorman, M. F. (2011). Infant mortality statistics from the 2007 period linked birth/infant death data set. National vital statistics reports; vol 59 no 6. Hyattsville, MD: National Center for Health Statistics.Google Scholar
  4. 4.
    International Telecommunication Union. Key 2000–2011 country data: Mobile-cellular subscriptions 2012; Accessed August 14, 2012.
  5. 5.
    Pew Internet & American Life Project. The best (and worst) of mobile connectivity. Pew Research Center. November 30, 2012. Available at: Accessed February 6, 2013.
  6. 6.
    CTIA-The Wireless Association. (2011). CTIA Semi-Annual Wireless Industry Survey. Accessed July 24, 2012.
  7. 7.
    Chander, G., Stanton, C., Hutton, H., et al. (2012). Are Smokers with HIV using information and communication technology? Implications for behavioral interventions. AIDS and Behavior, 16(2), 383–388.CrossRefGoogle Scholar
  8. 8.
    Cornelius, J. B., & St Lawrence, J. S. (2009). Receptivity of African American adolescents to an HIV-prevention curriculum enhanced by text messaging. Journal of the Society of Pediatric Nurses, 14(2), 123–131.CrossRefGoogle Scholar
  9. 9.
    Kharbanda, E. O., Vargas, C. Y., Castaño, P. M., Lara, M., Andres, R., & Stockwell, M. S. (2011). Exploring pregnant women’s views on influenza vaccination and educational text messages. Preventive Medicine, 52(1), 75–77.CrossRefGoogle Scholar
  10. 10.
    Battistotti, A., Quaglini, S., & Cuoco, E. (2006). Reducing dropouts in outpatient care through an SMS-based system. Studies in Health Technology and Informatics, 124, 935–940.PubMedGoogle Scholar
  11. 11.
    Nelson, T. M., Berg, J. H., Bell, J. F., Leggott, P. J., & Seminario, A. L. (2011). Assessing the effectiveness of text messages as appointment reminders in a pediatric dental setting. Journal of the American Dental Association, 142(4), 397–405.CrossRefGoogle Scholar
  12. 12.
    Coker, T. R., Sareen, H. G., Chung, P. J., Kennedy, D. P., Weidmer, B. A., & Schuster, M. A. (2010). Improving access to and utilization of adolescent preventive health care: The perspectives of adolescents and parents. Journal of Adolescent Health, 47(2), 133–142.CrossRefGoogle Scholar
  13. 13.
    Kharbanda, E. O., Stockwell, M. S., Fox, H. W., Andres, R., Lara, M., & Rickert, V. I. (2011). Text message reminders to promote human papillomavirus vaccination. Vaccine, 29(14), 2537–2541.CrossRefGoogle Scholar
  14. 14.
    Kharbanda, E. O., Stockwell, M. S., Fox, H. W., & Rickert, V. I. (2009). Text4Health: A qualitative evaluation of parental readiness for text message immunization reminders. American Journal of Public Health, 99(12), 2176–2178.CrossRefGoogle Scholar
  15. 15.
    Hou, M. Y., Hurwitz, S., Kavanagh, E., Fortin, J., & Goldberg, A. B. (2010). Using daily text-message reminders to improve adherence with oral contraceptives: A randomized controlled trial. Obstetrics and Gynecology, 116(3), 633–640.CrossRefGoogle Scholar
  16. 16.
    Castano, P. M., & Martinez, R. A. (2007) Harnessing technology for adolescent health promotion. Adolescent Medicine: State of the Art Reviews 18(2):400–406, xiii.Google Scholar
  17. 17.
    Castaño, P. M., Westhoff, C., Martínez, R. A., & Lara, M. (2009). The effect of daily text message reminders on adolescent oral contraceptive pill continuation. Journal of Adolescent Health, 44(2), S23.CrossRefGoogle Scholar
  18. 18.
    Shapiro, J. R., Bauer, S., Hamer, R. M., Kordy, H., Ward, D., & Bulik, C. M. (2008). Use of text messaging for monitoring sugar-sweetened beverages, physical activity, and screen time in children: A pilot study. Journal of Nutrition Education and Behavior, 40(6), 385–391.CrossRefGoogle Scholar
  19. 19.
    Patrick, K., Raab, F., Adams, M., et al. (2009). A text message-based intervention for weight loss: Randomized controlled trial. Journal of Medical Internet Research, 11, e1.CrossRefGoogle Scholar
  20. 20.
    Obermayer, J. L., Riley, W. T., Asif, O., & Jean-Mary, J. (2004). College smoking-cessation using cell phone text messaging. Journal of American College Health, 53(2), 71–78.CrossRefGoogle Scholar
  21. 21.
    Riley, W., Obermayer, J., & Jean-Mary, J. (2008). Internet and mobile phone text messaging intervention for college smokers. Journal of American College Health, 57(2), 245–248.CrossRefGoogle Scholar
  22. 22.
    Cole-Lewis, H., & Kershaw, T. (2010). Text messaging as a tool for behavior change in disease prevention and management. Epidemiologic Reviews, 32(1), 56–69.CrossRefGoogle Scholar
  23. 23.
    Gerber, B. S., Stolley, M. R., Thompson, A. L., Sharp, L. K., & Fitzgibbon, M. L. (2009). Mobile phone text messaging to promote healthy behaviors and weight loss maintenance: A feasibility study. Health Informatics Journal, 15(1), 17–25.CrossRefGoogle Scholar
  24. 24.
    Wright, E., Fortune, T., Juzang, I., & Bull, S. (2011). Text messaging for HIV prevention with young Black men: Formative research and campaign development. AIDS Care, 23(5), 534–541.CrossRefGoogle Scholar
  25. 25.
    Person, A. K., Blain, M. L., Jiang, H., Rasmussen, P. W., & Stout, J. E. (2011). Text messaging for enhancement of testing and treatment for tuberculosis, human immunodeficiency virus, and syphilis: A survey of attitudes toward cellular phones and healthcare. Telemedicine and E-Health, 17(3), 189–195.CrossRefGoogle Scholar
  26. 26.
    Baptist, A. P., Thompson, M., Grossman, K. S., Mohammed, L., Sy, A., & Sanders, G. M. (2011). Social media, text messaging, and email-preferences of asthma patients between 12 and 40 years old. Journal of Asthma, 48, 824–830.CrossRefGoogle Scholar
  27. 27.
    Cocosila, M., Archer, N., & Yuan, Y. (2008). Would people pay for text messaging health reminders? Telemedicine and E-Health, 14(10), 1091–1095.CrossRefGoogle Scholar
  28. 28.
    Ahlers-Schmidt, C. R., Chesser, A., Hart, T., Paschal, A., Nguyen, T., & Wittler, R. R. (2010). Text messaging immunization reminders: Feasibility of implementation with low-income parents. Preventive Medicine, 50(5–6), 306–307.CrossRefGoogle Scholar
  29. 29.
    Ahlers-Schmidt, C. R., Hart, T., Chesser, A., Paschal, A., Nguyen, T., & Wittler, R. R. (2011). Content of text messaging immunization reminders: What low-income parents want to know. Patient Education and Counseling, 85(1), 119–121.CrossRefGoogle Scholar
  30. 30.
    Jareethum, R., Titapant, V., Chantra, T., Sommai, V., Chuenwattana, P., & Jirawan, C. (2008). Satisfaction of healthy pregnant women receiving short message service via mobile phone for prenatal support: A randomized controlled trial. Journal of the Medical Association of Thailand, 91(4), 458–463.PubMedGoogle Scholar
  31. 31.
    Fjeldsoe, B., Miller, Y., & Marshall, A. (2010). MobileMums: A randomized controlled trial of an SMS-based physical activity intervention. Annals of Behavioral Medicine, 39, 101–111.CrossRefGoogle Scholar
  32. 32.
    Evans, W. D., Wallace, J. L., & Snider, J. (2012). Pilot evaluation of the text4baby mobile health program. BMC Public Health, 12, 1031.CrossRefGoogle Scholar
  33. 33.
    Weiss, B. D., Mays, M. Z., Martz, W., et al. (2005). Quick assessment of literacy in primary care: The newest vital sign. The Annals of Family Medicine, 3(6), 514–522.CrossRefGoogle Scholar
  34. 34.
    SAS Institute Inc. The SURVEYFREQ Procedure Accessed July 23, 2012.
  35. 35.
    California State University San Marcos Office of Communications. San Diego Researchers First to Report Positive Impact of Text4Baby Program. 2011; Accessed August 14, 2012.

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Julie A. Gazmararian
    • 1
    Email author
  • Lisa Elon
    • 2
  • Baiyu Yang
    • 1
  • Megan Graham
    • 1
  • Ruth Parker
    • 3
  1. 1.Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaUSA
  2. 2.Department of Biostatistics, Rollins School of Public HealthEmory UniversityAtlantaUSA
  3. 3.School of MedicineEmory UniversityAtlantaUSA

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