text4baby Evalulation Info!

I'm excited to share some new information about evaluation of text4baby. A small (n=160) survey-based study was done in San Diego with some pretty neat results. There's a great pdf showing it all but it was emailed to me in the text4baby newsletter, instead of posted online, so I can't link to it, boo.

I think my favorite stat is that "63.1% reported that text4baby helped them remember an appointment of immunization that they or their child needed." Missed appointments are a big deal, and this is a pretty direct text->action connection.

I also liked "38.5% ... of participants reported that they called a service or phone number that they received from a  text4baby message. These messages range from perinatal and infant care services such as breastfeeding and post-partum support lines, teratogen information, low-cost health services to product safety, poison control, and infant immunization information lines." This kind of integration is a strength of mHealth. You're looking at a phone number on your phone so you just go ahead and dial. Also neat is that this percentage jumped to 58.3% for those participants without health insurance.

The study also looked at cultural and linguistic appropriateness for the Spanish version of text4baby. Oddly, a third of recipients reported incorrect Spanish in the messages. Were they not checked by native speakers? Fortunately, a large majority said that the messages were understandable anyway.

More general information in a whitehouse.gov post here, and if you're interested in reading details about other upcoming larger scale evaluations, let me know and I can forward the email! (Some of it is available at the links here.)

Recent text4baby thoughts

I subscribe to the weekly text4baby Tuesday newsletter - sign up at the link here if you're interested - and have long been vaguely annoyed at the paucity of data they publish. For a while, (I've been receiving the newsletter over a year, since about 2 months after the text4baby launch) they showed only number of subscribers per state in a bar chart (not weighted by population). It didn't used to have a scale, either, so it was like, hm, about 5 mm of people in Vermont and wow! about a decimeter of people in California. (Woops, I just checked and they also gave % English/% Spanish, and % pregnant/% first year (there are texts through the baby's first birthday) and % would recommend to a friend (consistently 93-97%).

Anyway, today's issue included a better graph, labeled, weighted and all, so I thought I'd share. Sorry for the craptastic graphic quality:

from text4baby Tuesday newsletter May 10, 2011

I am really eager to see some evaluation from text4baby (spoken like a true public health nerd). I know Professor Doug Evans at George Washington University is working on something formal. Information is hard to find.

Regarding the extremely ambitious text4baby goal of one million subscribers by the end of 2012. Here is my homegrown crappy data (from the same newsletters since March 2010) about their growth rate:

text4baby subscribers. the cute little february 2011 bump is this

At this rate, by my rather haphazard calculations (approx 369 new subscribers a day, beautifully linear, and taking nothing extra into account), at the end of 2012*, they'll be about 608,145 people short.

But then, I feel like a million subscribers is a dubious goal in the first place without any (any!) evaluation data.

Someone else has similar things to say.

I would be critical for some of the same and some new reasons now, a year after I wrote this paper and having taken many more public health courses.


*601 days from today!

text4baby paper!

Just a quick post to link to my text4baby paper, which is now up on the class blog. I finished my first public health class successfully!

Today is the first session of my second class - Introduction to Environmental Health. So far I'm finding the textbook very interesting and highly readable. I was anxious about keeping up with the work of a class during an intensive summer term, especially since things at work have been quite busy recently too. However, the syllabus looks totally doable and I'm already ahead on reading. And, I have now dreamed about wastewater management two nights in a row.

Readin', Writin', and Procrastinatin'

Updates on Class

You know, if I didn't have class and classwork, I'd have a lot more time to blog about class. The semester is drawing to a close - I'm done with all the reading and am concentrating on my second paper.

My first paper was about cognitive dissonance and handwashing among health care workers, inspired in part by my first post in which I thought about behaviors that should not be affected by issues of access. At that point, inequity and inequality of access were a more major part of my understanding of poor health outcomes and unhealthy behaviors. During this semester, I've developed a more sophisticated and I think more accurate understanding of these issues.

What I ended up discussing in my paper, in part, was the idea that it is often difficult or impossible to know why it is that people fail to do healthly behaviors or participate in unhealthy behaviors. I proposed an intervention that attempts to circumvent this problem by making the health behavior a desirable activity for reasons unrelated to its health value, and instead tying it to a person's self-concept.*

Writing the paper was hard - it's been a few years since my last academic paper, and I really want to make a good impression in this class. I think I made a strong case within the confines of my chosen subject, but in truth the intervention I suggested probably isn't a very good idea. Oh well.

Now I'm very excited about the next paper, which is much longer. The assignment is to critique a public health intervention on the basis of the social/behavioral theories covered in class and propose changes to the intervention that would make it more effective. I've chosen to write about text4baby. Text4baby is a mobile-phone based intervention that aims to reduce the rates of premature birth and infant mortality by providing information to pregant women and new mothers via text message.  What's novel about this intervention is (pretty much only) the delivery method.  The aforementioned problems are worse among lower-income and minority women, and mobile phone use among those groups is higher than internet use. So the idea is to meet these women in a medium they use and are comfortable with, and provide them with helpful information that way. There are things I like about this intervention, but I also didn't find it too hard to come up with the required three criticisms. Well, I usually don't have a hard time being critical, so there's that, too.

*I'm using this term in the way it was used in the cognitive dissonance literature, which I don't think is very widely accepted. It's something like: a person's belief that s/he is moral, competent, and able to predict his/her own behavior.