SAN DIEGO– Dr. Colleen A. Kraft characterizes health care texting as “the right format for today’s families,” because an estimated 91% of young Americans have cell phones and 90% of text messages are read within the first 3 minutes of receiving them.
Text messages “get people’s attention,” she said during a plenary session at the annual meeting of the American Academy of Pediatrics. “They reach a wide audience. Youth text more than their adult counterparts, and low-income Americans text more than higher-income adults.”
Dr. Colleen A. Kraft
One health care–texting program, Text4baby, has become the largest mobile health service in the United States, reaching more than 760,000 moms since it was launched in 2010. Pregnant women and moms with kids under 1 year of age can sign up by texting BABY (or BEBE for the Spanish version) to 511411. Participants receive free health and safety messages three times per week timed to their baby’s due date.
“You also get messages after that until the baby is 1 year old [which] are developmentally appropriate as well,” said Dr. Kraft, who is a member of the content development council for the service. This council creates messages based on the medical literature and comprises representatives from medical organizations including the AAP, the American College of Nurse-Midwives, the American Congress of Obstetricians and Gynecologists, the Centers for Disease Control and Prevention, and the March of Dimes, “a number of people who are very interested in the outcomes of healthy pregnancy,” she said.
Text4baby targets low-income and young women, especially those who identify themselves as Hispanic or African American at higher risk of disproportionately poor birth outcomes. The service addresses critical maternal and child health topics, including safety, development, nutrition, prenatal care, oral health, and preparing for well-baby visits.
“There’s often a very big disconnect with our lower-income families regarding [the notion of] ‘here’s the end of your pregnancy. Now you need to find a pediatrician,’” explained Dr. Kraft, medical director of the Health Network at Cincinnati Children’s Hospital Medical Center. “We find that our upper-income families often will do prenatal visits, but this is not the case with our lower-income families.”
More than half of the messages (58%) contain additional health and resource information and 46% link to mobile Web pages developed in partnership with the AAP and other medical associations. “This is great, because if someone gets a message and they want to find out more about it, they can click a link and be directed to a video or to more information to read,” she said. “There are priority topics, and there’s audience testing so we can see what messages actually resonate with our younger families and with our pregnant moms, because we don’t want to be sending out messages that people aren’t going to read or understand or relate to.”
For example, nine messages prompt mothers to text back LIKE when they find a message helpful, and seven messages encourage mothers to text back MORE to get additional information. Text4baby also features an appointment reminder as a way to improve well-baby and other appointment adherence and immunization rates.
Studies of Text4baby outcomes to date suggest that the service helps participants “become more prepared and more proactive when they go to their obstetric and pediatric appointments, and they’re more likely to keep appointments,” Dr. Kraft said. “It also helps to facilitate interaction with health providers and improves access to health services. We’ve had anecdotal reports of physicians who’ve told us that moms [who use the service] arrive knowing what glucose testing is all about, or what immunizations are all about.”
According to Dr. Kraft, the National Institutes of Health is supporting two research projects related to Text4baby. One involves incorporating the Parents’ Evaluation and Developmental Status (PEDS) as a text message. “If somebody could fill out those questions, would we have access to some developmental information on children prior to when they come in for a physician appointment?” Dr. Kraft asked.
The second research program involves using the service in smoking-cessation efforts, “looking at the feasibility of a text-based interactive tool that counsels pregnant smokers on smoking cessation and ways to develop a sustainability plan.”
Dr. Kraft noted that HIPAA compliance “is one of the big fears about using texting in health care.” HIPAA-compliant texting involves at least four features that are used by current enterprise platforms such as Healthify and Duet Health. First, is there a secure data center at the point of contact of all of these text messages? Is there encryption of the material, so if you lost your cell phone someone could not access the information? Recipient authentication is also important. “You want to make sure that if you’ve sent a text message to somebody, that that particular person is the one who is getting the text message, and that you’re able to verify that the text message is going to the right person,” Dr. Kraft said. The fourth feature of a HIPAA-compliant texting system is having audit controls. In other words, “are you able to monitor what’s happening in terms of the traffic of your text messaging?”