Child Fatality Task Force 2016 Issue Application Text4baby

Transcription

1 Child Fatality Task Force 2016 Issue Application Text4baby Name: Janice Freedman, MPH, Executive Director Organization: North Carolina Healthy Start Foundation (NCHSF) Web address: and 1. Briefly state the issue and/or proposal you are requesting the CFTF to consider. The North Carolina Healthy Start Foundation requests that the Child Fatality Task Force consider a new proposal that ensures that pregnant women and new parents in North Carolina have access to free information and resources through promotion of a free national texting service (Text4baby.) This service provides tailored information, resources and appointment reminders to those who enroll - based on a woman s due date or the birth date of her baby. Service is available in English and Spanish. The North Carolina Healthy Start Foundation has six years of experience successfully promoting Text4baby in NC but limited, and sporadic, funding has not allowed for sustained, statewide activities that would yield a greater impact on NC families. 2. Briefly describe the direct relationship between this issue/proposal and the goal of the Child Fatality Prevention System to prevent future child deaths, abuse, and neglect, and to promote the safe and healthy development of children. What is the evidence that this issue/proposal would positively impact the safety and well-being of children? (For example, point to a study that supports the effectiveness.) This proposal directly supports the goals of the Child Fatality Prevention System to prevent child deaths, abuse and neglect and promote the safe and healthy development of children by supporting and educating pregnant women and new parents. Research done on Text4baby shows that pregnant women using the service are more likely to practice evidence-based, health-promoting behaviors before, during and after pregnancy. New moms using Text4baby are three times more likely to report feeling better prepared to be moms and were better able to access health services and resources (including health insurance) for their children. Started in 2010 by the National Healthy Mothers, Healthy Babies Coalition, Text4baby is now coordinated by Zero to Three, a national organization dedicated to ensuring that babies and toddlers benefit from the early connections that are critical to their well-being and development. Text4baby is a data-driven initiative with a strong research and evaluation component. More than 1 million women have registered for services to-date. Fifty-two percent (52%) have household incomes of <$16,000. Text4baby provides 3 outgoing text messages a week with information and resources relevant to a woman s due date or her baby s age during his first year. Topics include: prenatal care, safe sleep, immunization, breastfeeding, nutrition, oral health, family violence, physical activity, safety, injury prevention, mental health, substance abuse, developmental milestones, labor and delivery, car seat safety, and exercise. 96% of all cell phone carriers provide the messages free of charge (and do not count messages for text messaging plans.) Messages are free of advertising and do not contain product promotions. Subscribers can opt out at any time. A free Text4baby mobile app provides an additional way for participants to access key information beyond the character limit of text messages. As a complementary tool to the SMS (texting) service, the free app offers additional content and interactive features that enhance the overall Text4baby experience.

2 Key findings: 90% of Text4baby subscribers read the incoming messages and found them easy to understand, 95% felt messages informed them of health information they did not know, 65% talked to a doctor about a topic in Text4baby, 75% said they were reminded to get an immunization. There was a 200% increase in flu vaccination among moms, planning to get vaccinated, who received a reminder message. The attached fact sheet Understanding the Impact of Text4baby summarizes key findings about the participants; changes in their knowledge, beliefs and behavior; interactions with health providers, etc. Academic research, federally funded evaluations and peer-reviewed publications are also available. 3. Explain why this issue/proposal requires state-level attention, and identify which of the following types of state-level action your issue/proposal would involve: new or revised legislation; funding; agency collaboration; agency policy change; other (if so, what?). Infant mortality is a statewide problem requiring on-going state-level attention. In 2014 more than 120,000 babies were born in NC. Unfortunately, 11.4% of these births were preterm, 9% were low birthweight and 7.1 babies per 1,000 live births died before their first birthday. Furthermore, data indicates shockingly disproportionate rates of infant mortality for African American babies (12.8/1,000 vs. 5.1/1,000 for white babies.) NC s infant mortality rate remains above the national average (6.0/1,000.) Many of the causes of infant mortality in the U.S. can be positively impacted with increased education and access to care. Text4baby is one piece of the solution to addressing this complicated problem. By providing women particularly those facing disproportionately high risks of poor birth outcomes and infant mortality with free, accurate and easy-to-understand health information via text message, more moms are connected to resources, care and knowledge they need to make the best possible choices for themselves and their babies. The Text4baby appointment reminder feature lets women know about their upcoming prenatal and postpartum visits (and encourages scheduling of post-partum visits), well-baby visits and immunizations, as well as flu shots during flu season. This has increased enrollees show rate for appointments and immunizations. This proposal requires funding to promote this existing, invaluable, free service to pregnant women and new moms in NC. Strategic partnerships with state agencies and local nonprofits will enable state-level and local agencies to develop procedures that enable more NC women to enroll. 4. Explain the specifics of the type of action(s) you identified above including cost, if any, and agency involvement. This proposal requests $150,000 for state-wide project coordination, and project activities and materials. According to Text4baby s research, states that have initiated state-level and statewide activities have been the most successful in enrolling participants. This proposal benefits from lessons learned in other states and from national Text4baby case studies about successful enrollment initiatives. Through the existing Text4baby data portal, detailed information about NC enrollees will be used to assess the impact of this program in NC. Activities include, but are not limited to: 1. Statewide generalized promotion (to raise awareness) Display Text4baby promotional materials where pregnant women or new moms are (i.e., using flyers, posters, point-of-purchase stands with cards, etc.) Promote texting service through articles written for parenting magazines, blogs and listservs. Present at regional and statewide conferences to professionals serving pregnant women and new mothers (i.e., hospital staff, home visiting programs, federally funded Healthy Start projects, etc.) Work with local media; identify opportunities to feature the texting service s benefits and enrollees. Regularly use social media (Facebook, Twitter and Instagram); make information easy to be shared.

3 2. Statewide personalized promotion (one-on-one conversations) Train staff on benefits of Text4baby, how to promote it and how to help pregnant women/new mothers enroll (in settings such as prenatal providers offices, pediatric practices, WIC clinics, at home visits, with Breastfeeding Peer Counselors, Teen Parenting programs, etc.) 3. State-level partnership (to facilitate and institutionalize enrollment) Partner with at least one state-level program; assess the feasibility of creating a process to enroll women in Text4baby concurrent with program enrollment. 4. Strategic use of traditional and electronic media Use television and/or mobile ads to reach targeted geographic areas and populations. NC has demonstrated positive results doing this ( ) and its success has been featured in a Text4baby case study and as a Time Warner Cable Media success story. This proposal would support 1.0 FTE and cover program and promotional activities (e.g. materials not provided by national Text4baby, media costs, training expenses, travel, etc.) and related operational expenses. 5. If your proposal involves seeking funding, explain why state funding (as opposed to other funding sources) is being sought. State funding for this proposal is necessary to support this program in NC because improving the health of NC s women and babies is a state imperative. This resource helps fill the void created by the loss of a number of free state-funded, statewide resources for pregnant women and new parents. The NCHSF plans to seek funds from the private sector (large corporations and social/broadcast media) to supplement this proposal. 6. Is the existing infrastructure of agencies/organizations sufficient to support your proposal? If not, what would be needed? North Carolina has a strong public health system and many other statewide and local partners working with young families and families of young children that is more than sufficient to support this proposal. Text4baby is an easy sell since the impact on enrollees has already been demonstrated nationally and text messages support what providers already advise, increase show rates in clinics and offer additional credible resources. 7. Who else actively supports your issue/proposal? Please indicate which groups would be willing to help advance this issue if it were to become an action agenda item of the CFTF. Who would be the lead agency/organization advancing this solution? (Do not include contact information here; see #9.) This proposal requests the CFTF s support (highest level) to help secure the funding. The NCHSF will actively partner with the CFTF to actively pursue state funding and educate others about the program s services, benefits and impact. While stakeholders listed below are committed, further discussion is needed (with them and others) to assess their level of involvement. 8. Please identify the key stakeholders interested in this issue/proposal, including people or organizations likely to raise concerns about it. (Do not include contact information here; see #9 below.) Key stakeholders that support this proposal (and have already given approval to be listed) include the: North Carolina Association of Local Health Directors Community Care of North Carolina s Pregnancy Medical Home program Additional stakeholders will be added later. Concerns are not anticipated about this proposal to promote a successful national resource with demonstrated impact.

4 Understanding the Impact of Text4baby Text4baby is a data-driven initiative. Staff routinely monitor and analyze a wide array of data collected by the program, including data on enrollment, completion and cancellation, participant-reported reason for cancellation, referral source, and descriptive data from various surveys sent through the mobile platform. Data are reviewed to inform and improve program promotional, outreach, and product strategies. Additionally, Text4baby provides partners with access to real-time enrollment data to support them in understanding the impact of outreach initiatives on enrollment. Below are some key findings from Text4baby s ongoing research and evaluation efforts. Text4baby is Reaching its Target Population enroll early in their pregnancy: Over 38% of participants who signed up to receive pregnancy messages enrolled during the first trimester. live in high-poverty areas: A higher percentage of Text4baby participants live in zip codes with the highest levels of poverty compared to the overall U.S. distribution. are from low-income households: Over half (52%) of respondents to a national survey of Text4baby participants implemented by the California State University San Marcos National Latino Research Center (CSUSM) reported their household income was $16,000 or less.1 Text4baby is Well Received by 99% of Text4baby participants in a Health Services and Resource Administration (HRSA) funded evaluation said they would recommend the service to a friend or family member, 90% read the messages and found them easy to understand, and 64% thought the messages were useful.2 99% of WIC participants in an Emory University study had no concerns about enrolling in Text4baby; 95% reported the enrollment process was easy; 92% regularly read Text4baby messages; and 88% planned to continue to use Text4baby.3 92% of Text4baby participants who responded to a text-based survey since launch said they would refer Text4baby to a friend and rated the helpfulness of the service as a 7.7 out of 10. Evidence of Knowledge and Behavior Change Health Knowledge and Preparedness: On four critical topics safe sleep, infant feeding, best time to deliver in a healthy pregnancy, and the meaning of fullterm Text4baby participants in the HRSA evaluation demonstrated a significantly higher level of health knowledge than the comparison groups (81% of Text4baby participants responded correctly vs % of other prenatal participants). are knowledgeable are prepared have improved beliefs A George Washington (GW) University-led randomized study found Text4baby mothers were nearly 3X more likely to believe that they were prepared to be new mothers compared to those in the control group.4 Findings from an RCT funded by the DOD Telemedicine and Advanced Technology Research Center and lead by GW and the Madigan Army Medical Center found improvements in beliefs targeted by Text4baby, including (1) the importance of prenatal care, (2) the risk of alcohol use, and (3) the importance of prenatal vitamins, among participants with short term (4 week) exposure to Text4baby compared to the control group.5 Facilitating Interaction with Health Providers and Improving Access to Health Services: talk with their providers 65% of CSUSM participants reported they talked to their doctor about a topic they read on a Text4baby message. access health services 47% of CSUSM participants reported Text4baby helped connect them to health services for them and/or their baby, with a higher percentage of uninsured participants (60%) reporting that Text4baby helped them access health services. utilize hotlines and websites 77% of CSUSM participants reported they opened a Text4baby link, and 46% reported they called a referral number they received from Text4baby. More than half (53%) of Text4baby participants in the HRSA-funded evaluation reported they saved referral numbers for future use. Appointment Attendance and Behavior Change: remember appointments have improved glycemic control report lower postpartum alcohol consumption 63% of CSUSM participants reported Text4baby helped them remember an appointment. Preliminary results from a study conducted by St. Louis University researchers show a significant difference in average glucose values within goal between the Text4baby control group and the no-text control group (73% vs 20%, N=30). Recruitment for the study is ongoing.6 60% of Text4baby participants in the DOD-funded RCT reported no alcohol consumption at follow-up versus 40% of control participants. Additionally, high-dose Text4baby participants in the DOD-funded RCT were more than 2X as likely to report they abstained from drinking at postpartum follow-up compared to low-dose participants.7

5 Ongoing Text4baby Research and Evaluation Text4baby regularly collaborates with experts on research and evaluation efforts. Recent activities include: Well-baby Visit and Childhood Vaccination Pilot Project: Text4baby worked with the California Department of Health and Immunize Nevada to implement a well-baby visit and childhood vaccination module in March The goal of the project was to gain insight on selfreported well-baby visit attendance and childhood vaccination status among participants. Preliminary results show higher self-reported appointment attendance among participants who received education and appointment reminders compared to those who did not receive them, and high rates of self-reported hepatitis B vaccination. 8 Encouraging Medicaid and CHIP Enrollment: In partnership with the Centers for Medicare and Medicaid Services, Text4baby implemented an interactive module of messages to identify the health insurance status of Text4baby participants and provide information on Medicaid/ CHIP eligibility/enrollment to uninsured participants. Preliminary results suggest messaging sent to uninsured women may encourage Medicaid/CHIP application among pregnant and new mother Text4baby participants. 9 Additionally, the Kaiser Family Foundation (KFF) conducted interviews with Text4baby participants to better understand the impact of the Medicaid Module. Findings are highlighted in their February 2014 Issue Brief. 10 Encouraging Influenza Vaccination: In October 2012, Text4baby implemented an interactive module of messages encouraging influenza vaccination to gain insight around whether appointment reminders and tailored education improve self-reported vaccination coverage among participants. Preliminary results were presented at the 2013 mhealth Summit. 11 Text4baby also collaborated with the Centers for Disease Control and Prevention to incorporate Text4baby questions into an existing surveillance effort to compare influenza vaccination coverage for pregnant Text4baby participants to non-participants (in progress). Encouraging Smoking Cessation for Pregnant Women: Text4baby is collaborating with GW to assess the feasibility and efficacy of a smoking cessation text messaging program (Quit4baby) for pregnant smokers. Results from the feasibility study found participants reported that the program was helpful in quitting, that the program gave good ideas on quitting, and that they would recommend the program to a friend. 13 The next phase of the project will test the efficacy of Quit4baby in a population of 500 Text4baby pregnant smokers (in progress). Feasibility of Text-Based Developmental Screening: Text4baby collaborated with GW, the State of Maryland, and Prince George s County Infant and Toddlers and WIC programs to assess the feasibility of text-based developmental screening and inform a scalable model. Results will be shared soon. Text4baby Receptivity and Theory Evaluation: Text4baby is collaborating with the University of Maryland School of Public Health, Herschel S. Horowitz Center for Health Literacy on two separate evaluation efforts, including (1) a small pilot to assess receptivity to Text4baby messages and knowledge, awareness, and behavioral outcomes among Text4baby participants and non-participants; and (2) an analysis of Text4baby messages based on health communication and health behavior theory in an effort to identify how Text4baby messages align with theories (in progress). Informing Future Physical Activity Messaging: Text4baby is collaborating with Arizona State University on a study to inform the development of effective physical activity messaging during pregnancy. The study tracked physical activity (using a Fitbit) among pregnant women randomized to four text interventions, including standard Text4baby messages. Results will be shared soon M Martinez, K. and Uekusa, S National Survey of Text4baby. California State University San Marcos (CSUSM). Available: N=1,171; n for income level= U.S. Department of Health and Human Services. Health Resources and Services Administration Promoting Maternal and Child Health Through Health Text Messaging: An Evaluation of the Text4baby Program Final Report. Rockville, Maryland: U.S. Department of Health and Human Services, Available: N=707 3 Gazmararian, J., Elon, L., Yang, B., Graham, M., Parker, R. Text4baby Program: An Opportunity to Reach Underserved Pregnant and Postpartum Women? Maternal Child Health Journal. 2014; 18(1): Abstract available: Baseline N=468 4 Evans, W., Wallace, J., and Snider, J. Pilot Evaluation of the Text4baby Mobile Health Program, BMC Public Health. 2012; 12:1031. Available: Baseline N=123 5 Evans, W., Wallace, J., Szekely, D., et al. Initial Outcomes From a 4-Week Follow-Up Study of the Text4baby Program in the Military Women s Population: Randomized Controlled Trial. Journal of Medical Internet Research (15). Available: Baseline N=943; 4 week follow-up n=459 6 Grabosch, S., Gavard, J., and Mostello, D. Text4baby improves glycemic control in pregnant women with diabetes. St. Louis University, Obstectrics, Gynecology, & Women s Health. American Journal of Obstetrics & Gynecology. January 2014 Supplement; 151. Available: N=30 for pilot results 7 Evans, W., Nielsen, P., Szekely, D., et al. Dose-Response Effects of the Text4baby Mobile Health Program: Randomized Controlled Trial. Journal of Medical Internet Research. 2015; 3(1). Available: org/2015/1/e12/. Baseline N=943; postpartum n= Text4baby Childhood Immunization Pilot Module: Preliminary Findings. Available: 9 Connecting to Health Care and Coverage: Preliminary Results from Text4baby Medicaid/CHIP Module. Available: 4%208%2014.pdf 10 Gates, A, Stephens, J., Artiga, S. Kaiser Family Foundation. Profiles of Medicaid Outreach and Enrollment Strategies: Using Text Messaging to Reach and Enroll Uninsured Individuals into Medicaid and CHIP. March 2014 Issue Brief. Available: 11 Research Symposium: Findings from an Interactive Module Encouraging Influenza Vaccination among Text4baby. Dec 2013 mhealth Summit. Available: findings-interactive-module 12 Text4baby is collaborating with Dr. Jennifer Huberty at Arizona State University. ASU bio available: 13 Abroms, L., Johnson, P., Heminger, C., et.al. Quit4baby Results From a Test of a Mobile Smoking Cessation Program for Pregnant Women. Journal of Medical Internet Research. 2015; 3(1). Abstract available: