How the largest mobile health initiative in the United States is learning from its participants: Text4baby content and interactivity enhancements

Background: Text4baby is a free mobile text messaging service that provides timely health information in English and Spanish via cell phone to women during pregnancy and through their babies' first year. Since launch in February 2010, more than 500,000 individuals have enrolled, over 60 million health tips have been sent, and 900 outreach partners are promoting the service nationwide. The dynamic nature of the program and its data feedback loop have resulted in continuous quality improvements that reflect how the target population is using technology, and lessons learned in implementing the program. Methods: Text4baby has implemented several new interactive enhancements and data collection efforts to personalize, enrich, and inform the content development and promotion activities. Data analysis results related to reach and user interaction on various topics and modules will be presented. Results: The majority of text4baby users are pregnant women (53%) and new mothers (42%); the remaining 5% are other interested observers. New Medicaid analysis of text4baby users suggests at least 69% represent the text4baby target audience. Furthermore, results from a poverty level zip code analysis of all users suggest participation is higher in low-income areas, where adverse infant outcomes tend to be more common. Data on user-reported referral source— including coded free text responses—will also be presented. Finally, we will discuss response rates and descriptive data from various questions. Conclusion: Public health outreach can learn from text4baby's success in how traditionally underserved populations interact with technology and how this interaction can improve engagement with these populations.