Maternal & Newborn Health: Text4baby San Diego Evaluation Overview: October 2011-October 2012

Transcription

1 Maternal & Newbrn Health: Text4baby San Dieg Evaluatin Overview: Octber 2011-Octber 2012 Anna Hff, Arcela Nunez-Alvarez, PhD, Knane M. Martínez, PhD. Natinal Latin Research Center, CSU San Marcs, D. Yvette Lacursiere MD.Department f Reprductive Medicine, University f Califrnia, San Dieg Executive Summary: The Natinal Latin Research Center at Califrnia State University, San Marcs and the University f Califrnia, San Dieg Department f Reprductive Medicine, with supprt frm the Alliance Healthcare Fundatin, cnducted an evaluatin f the text4baby service in San Dieg Cunty frm Octber 2011 t Octber Evaluatin methds included key infrmant interviews during Phase 1 and a telephne survey administered in three phases, Phase 1 (Octber 2011), Phase 2 (April 2012), and Phase 3 (Octber 2012) t text4baby users in San Dieg t cllect (1) demgraphic infrmatin abut the users, (2) user satisfactin and interactivity with the service, (3) knwledge gained and/r behavir change amng users, and (4) cultural and linguistic apprpriateness f the Spanish messages fr San Dieg users. The telephne survey was administered t 631 unique text4baby users in San Dieg (521 English-speaking users and 110 Spanish speaking users). Text4baby is a free mbile health (mhealth) infrmatin service that prvides pregnant wmen and new mms with infrmatin via text message n their health and their baby s health and cnnects them with health resurces. Wmen enrll by texting Baby (English) r Bebe (Spanish) t Our findings indicate that text4baby is increasing users health knwledge, facilitating interactin with their health prviders, reminding them f their appintments and immunizatins and imprving their access t health services. Belw is a summary f survey findings: Overall: Text4baby is helping users remember appintments and immunizatins: 65% reprted that text4baby helped them remember an appintment r immunizatin that they r their child needed (N=625) Text4baby is increasing access t health and infrmatin resurces: 40% f participants reprted that they called a service r phne number that they received frm a text4baby message (N=625). These messages range frm perinatal and infant care services such as breastfeeding and pst-partum supprt lines, teratgen infrmatin, lw-cst health services t prduct safety, pisn cntrl, and infant immunizatin infrmatin lines. Participants withut health insurance are mre likely t call a number, 50% f participants withut health insurance reprted calling a service number cmpared t 36% thse with insurance (p=.003). Text4baby is infrming wmen f medical issues: 74% f participants reprted that text4baby messages infrmed them f medical warning signs that they did nt knw (N=626) Text4baby is facilitating cmmunicatin with medical prviders: 67% f participants reprted talking t their dctr abut a tpic that they read n a text4baby message (N=626) The average text4baby participant in San Dieg Cunty: is 27.4 years ld has an annual husehld incme between $20,001 and $30,000 has 3-4 persns living in their husehld, including children has 1-2 children (including this pregnancy) is a high schl graduate has health insurance gives the service a satisfactin rating f 8.7 ut f 10 In general, results frm the evaluatin prvide clear evidence f the psitive impact that text4baby is having n users in San Dieg. These findings have significant implicatins fr demnstrating the feasibility and impact f the text4baby prgram and mbile health interventins mre bradly.

2 Overview f Text4baby The text4baby prgram was launched natinally n February 4, Text4baby is a FREE bilingual (English/Spanish) mbile health (mhealth) infrmatin service that prvides pregnant wmen and new mms with babies under age ne with health tips and resurces via text message. Individuals can enrll in the free service by simply texting Baby (English) r Bebe (Spanish) t r via nline using enrllment buttns available n text4baby and partner websites. In an effrt t help address pr maternal and child health in the United States the Natinal Healthy Mthers, Healthy Babies Calitin (HMHB), a nnprfit rganizatin with a 30-year histry f supprting health educatin fr mthers and babies, and Vxiva, Inc., an internatinal mbile health leader, and came tgether t design text4baby. With supprt frm funding partners including, CTIA - the Wireless Fundatin, the Grey Healthcare Grup, and the funding spnsr, Jhnsn & Jhnsn, the service was made available t users natinally. In additin t funding partners, text4baby is dependent n a vast and grwing netwrk f individuals and rganizatins, including the White Huse Office f Science & Technlgy and the Department f Health & Human Services, that are helping t deliver critical health and safety infrmatin t pregnant wmen and mthers with infants arund the cuntry. Individuals and rganizatins can partner with HMHB t jin this netwrk that is wrking tgether t create healthier cmmunities. The service seeks t imprve the health f babies and mthers by prviding users f all races, ethnicities, educatin, and incme levels with better health infrmatin and faster access t care. The text4baby service is ne tl in addressing pr birth utcmes. The prgram has fur main gals: Gal 1 Gal 2 Gal 3 Gal 4 Table 1: Gals f Text4baby Prgram Demnstrate the ptential f mbile health technlgy t address a critical natinal health pririty: maternal and child health. Demnstrate the ptential f mbile health technlgy t reach underserved ppulatins with critical health infrmatin. Develp a base f evidence n the efficacy f mbile health interventins. Catalyze new mdels fr public-private partnerships in the area f mbile health. Messages Health tips are delivered via text message t enrlled users. HMHB develped the (160 character) text-length messages and crdinates cntent review in cllabratin with leading federal agencies, health care prviders, majr medical assciatins, and natinal nnprfit rganizatins, including the Centers fr Disease Cntrl and Preventin (CDC), American Cngress f Obstetricians and Gyneclgists (ACOG), American Academy f Pediatrics (AAP), and Assciatin f Wmen s Health, Obstetric, and Nenatal Nurses (AWHONN). Enrlled can users receive ver 250 messages with the mst critical infrmatin that experts want pregnant wmen and mms with infants under ne t knw. Messages cver a range f tpics critical t maternal and child health, including: Labr and delivery Nutritin Breastfeeding Safe sleep Prenatal care Infant care Oral health Immunizatin Mental health Smking cessatin Develpmental milestnes Exercise Family nnvilence Safety Physical Activity Injury Preventin Substance Abuse Car Seat Safe San Dieg Text4baby Evaluatin Summary Reprt (2012) Page 2

3 Custmizatin f Text4baby San Dieg Text4baby ffers a custmizable versin f the service fr state and lcal health departments and health plans. In an effrt t make the service mre effective fr users in San Dieg Cunty, the San Dieg text4baby calitin partnered with HMHB t mdify a subset f the messages t direct users t lcal services and resurces and send ad hc bradcast messages t its users. Custmizatin was rchestrated by calitin members and funded by the Alliance Healthcare Fundatin. Study Methdlgy The Natinal Latin Research Center at Califrnia State University, San Marcs and the University f Califrnia, San Dieg Department f Reprductive Medicine, with supprt frm the Alliance Healthcare Fundatin, cnducted an evaluatin f the text4baby service in San Dieg Cunty frm Octber 2011 t Octber During the first phase, Octber 2011, key infrmant interviews were cnducted t prvide the guiding framewrk fr the brad telephne survey. The telephne survey was administered during Phase 1 (Octber 2011), Phase 2 (April 2012), and Phase 3 (Octber 2012) t text4baby users in San Dieg t cllect (1) demgraphic infrmatin abut the users, (2) user satisfactin and interactivity with the service, (3) knwledge gained and/r behavir change amng users, and (4) cultural and linguistic apprpriateness f the Spanish messages fr San Dieg users. All currently active San Dieg text4baby users received a text message asking them t cmplete a telephne survey fr evaluatin purpses. Participants wh vlunteered t participate in the survey did s by calling a specified number and cmpleting the survey using their cell phnes Participants were directed t a phne survey, which was administered in the riginal language in which the text4baby messages were received by the user. Data were cllected in English and Spanish. The telephne survey was administered t 631 unique text4baby users in San Dieg (521 English-speaking users and 110 Spanish speaking users) and captured sciecnmic and demgraphic measures fr the participants, their experience with the service and the knwledge and behavir changes that users attribute t the service. Participants cmpleted the survey in English r Spanish, accrding t their wn preference. 83% f participants cmpleted the survey in English and 17% f participants cmpleted it in Spanish. These figures rughly match the percentages f users wh sign up fr English messages (87%) vs. Spanish messages (13%) in the ttal active text4baby userbase in San Dieg Cunty. Natinal Text4baby Database Evaluatin f the custmized text4baby service in San Dieg Cunty utilizes the natinal text4baby enrllment database created and managed by Vxiva, Inc. This database tracks and mnitrs data n enrllment, cmpletin and cancellatin, user-reprted reasn fr cancellatin (as f February 2012), referral surce (as f February 2012), and descriptive data frm varius questins asked thrugh the mbile platfrm. The database prvides access t real-time enrllment data t utreach and custmized partners. San Dieg evaluatrs wrked clsely with the natinal partners - Healthy Mthers, Healthy Babies Calitin and Vxiva, Inc. - t access enrllment data fr the San Dieg text4baby prgram and crdinated directly with the database management team t prepare and send text messages t participants related t evaluatin activities. Analysis Descriptive statistics, including frequencies, percentages and means, were prepared and chi-square tests were used t examine data fr assciatins. Ninety five percent cnfidence intervals with crrectin fr cntinuity are reprted fr single prprtins/percentages. San Dieg Text4baby Survey Findings: Overall (cumulative analysis frm Phase 1, 2, and 3) evaluatin findings indicate that text4baby is increasing users health knwledge, facilitating interactin with their health prviders, reminding them f appintments and immunizatins and imprving their access t health services. Prgram participants reprt significant benefits frm the free text messaging prgram, text4baby:

4 Demgraphics The survey cllected demgraphic variables t gain a better understanding f wh enrlls in the prgram. Table 2: Abut the Average San Dieg Text4baby User Age is 27.4 years ld (SD=6.84) Incme has an annual husehld incme between $20,001 and $30,000 Husehld Size has 3-4 persns living in their husehld, including children Parity has 1-2 children (including this pregnancy) (SD=1.5) Educatin is a high schl graduate Satisfactin gives the service a rating f 8.7 ut f 10 Ethnicity Survey respndents were asked: Which f the fllwing ethnicities best describes yu? Over half (54%) f survey participants reprt being Latin/Hispanic and 28% reprt being White. Figure 1 displays the self-reprted race/ethnicity f all telephne survey participants, which is cmparable t the distributin f ethnicities in the Cunty, with a greater prprtin f Hispanic/Latins (54%) than Whites (28%). Figure 1: Ethnicity f Survey Participants (N=626) Excluding individuals in the Spanish speaking prtcl, the ethnicities f English-speaking survey respndents were as fllws: 45% Hispanic/Latin, 34% White, 9% Asian, Pacific Islander r Hawaiian, 8% African American, 3% Other, and nearly 1% as Native American (N=516). Incme Survey participants were asked: What is yur annual husehld incme? The Annual Husehld Incme chart (Figure 2) displays the percent breakdwn f participants wh prvided their incme level (N=480). The mean annual husehld incme reprted by participants was $20,001-30,000, with nearly half (45%) reprting an annual husehld incme belw $20,000. Furthermre, f thse wh prvided their incme level (N=480), 80% reprted an annual husehld incme belw 40, % 40% 30% 20% 10% 0% 45% 24% 12% 20% Less than 20,000 20,001-30,000 30,001-40,000 Mre than 40,001 Figure 2: Annual Husehld Incme f Survey Participants (N=480) Parity& Family Size Survey participants were asked: Including this pregnancy, hw many children have yu given birth t? Respndents reprted an average f 1-2 children (Mean=1.5 SD=1) including their current pregnancy (N=630). Survey participants were asked: Including children, hw many peple live in yur husehld? The majrity f survey respndents reprted having 3-4 persns (Mean=3.66 SD=1.84) living at hme (N=625). San Dieg Text4baby Evaluatin Summary Reprt (2012) Page 4

5 Health Insurance Survey participants were asked: D yu have health insurance? 74% CI (70.04, 77.05%) f respndents reprted having health insurance (N=631). Survey participants were asked: D yu have Medi-Cal? 46% CI (41.71, 49.62%) f respndents reprt having Medi-Cal/Medicaid (N=631). Educatin Educatin was asked in tw parts, survey participants were asked: Are yu a high schl graduate? (N=630), if they answered yes they were asked: Are yu a cllege graduate? (N=516). 18% f respndents reprt having less than a High Schl diplma; 82% reprt being high schl graduates; and 37% are cllege graduates. Table 2: Overall Significant Survey Findings Text4baby are getting imprtant health reminders: Text4baby is increasing access t health and infrmatin resurces: 65% CI (61.38, 68.99%) reprted that text4baby helped them remember an appintment r immunizatin that they r their child needed (N=625). 40% CI (36, 43.81%) f participants reprted that they called a service r phne number that they received frm a text4baby message (N=625). Health Insurance: 50% f participants withut health insurance reprted calling a service number cmpared t 36% thse with insurance (p=.003). Medi-Cal/Medicaid: 47% f participants wh reprted being Medi-Cal (Medicaid) recipients reprted calling a service number cmpared t 33% f thse nt receiving Medi-Cal (p <0.001)) These messages range frm perinatal and infant care services such as breastfeeding and pst-partum supprt lines, teratgen infrmatin, lw-cst health insurance and health services t pisn cntrl and infant immunizatin infrmatin lines. This suggests that individuals wh have health insurance may already have mre access t infrmatin frm their insurance prviders, while, fr individuals wh are nt insured, text4baby is prviding direct access t significant health and supprt resurces fr themselves and their children. Text4baby is infrming wmen f medical issues: Text4baby is facilitating cmmunicatin with medical prviders: Text4baby regularly instructs users in recgnizing/identifying medical warning signs, relevant t their stage f pregnancy. 74% CI (70.47, 77.47%) f participants reprted that they acquired new knwledge abut ne r mre pertinent medical warning signs frm text4baby (N=626). 67% CI (63.51, 71%) f participants reprted talking t their dctr abut a tpic that they read n a text4baby message (N=626). Learning abut medical warning signs via text4baby messages was assciated with a tendency t talk t ne's dctr abut a tpic n a text4baby message, p < % f participants wh learned abut medical warning signs talked with their dctrs, while nly 56% did amng f participants wh did nt learn abut medical warning signs. These data suggest that the infrmatin prvided by text4baby messages strengthens relatins with ne's healthcare prvider, by prmting cmmunicatin with ne's medical prvider. Page 5

6 Cultural and Linguistic Apprpriateness: In rder t assess the cultural and linguistic apprpriateness f the Spanish messages, Spanish-speaking users were asked varius questins regarding the cntent, clarity, and use f language emplyed in the messages (N=110). 87.3% CI (79.24, 92.61%) f participants enrlled in the Spanish text4baby service reprted that the wrds and phrases used in the service were familiar t them; 94.5% CI (88.3, 97.77%) reprted that the Spanish used in the messages was crrect. Further, 94.5% CI (85.74, 96.58%) reprted that the cntent included in the messages was clear and understandable. These data suggest that the text4baby service is culturally and/r linguistically apprpriate fr Spanish-speaking users in San Dieg. Satisfactin The telephne survey asked participants t rate their satisfactin with the text4baby service n a scale frm 1 10 (1=Bad, 10=Great). The average rating prvided by respndents (N=618) was 8.7 ut f 10 (Median= 10). Cnclusin: In general, results frm the evaluatin prvide clear evidence f the psitive impact that text4baby is having n users in San Dieg. These findings have significant implicatins fr demnstrating the feasibility and impact f the text4baby prgram and mbile health interventins mre bradly. The demgraphic data captured frm the survey infrms us that text4baby is reaching its target audience, which includes underrepresented cmmunity residents frm minrity grups and lwer sciecnmic statuses. While lw-incme wmen have the least access t prenatal and maternal services, the brad majrity have access t cell phnes. By prviding wmen with tailred health infrmatin, text4baby is increasing their access t health infrmatin and knwledge, infrming interactin with their health prviders, reminding participants abut appintments and immunizatins, and imprving their access t health services. As a result f the text4baby service, users in San Dieg reprt that they are mre infrmed abut their pregnancies, mre likely t attend appintments and get immunizatins, better prepared t interact with their health prviders, and they and their babies have mre access t the health services they need. Evaluatin findings affirm that the text4baby service is psitively reaching pregnant wmen, new mms, and thers wh are getting infrmatin abut caring fr their health and giving their babies the best pssible start in life, thereby achieving the gal f the Natinal Healthy Mthers, Healthy Babies Calitin and text4baby partners. The Natinal Latin Research Center at Califrnia State University, San Marcs is a dynamic university-based research center bridging the university cmmunity t lcal, state, and natinal rganizatins. Specializing in research n Latin ppulatins, the Center designs tailred research studies and innvative prjects t fit a brad range f critical tpics and needs. Principal Investigatrs: Arcelan Nunez-Alvarez, Ph.D. and Knane Martinez, Ph.D. University f Califrnia, San Dieg (UCSD) Department f Reprductive Medicine delivers cmprehensive, quality care that is respnsive t the needs f the San Dieg regin as a whle and f the lcal cmmunity. The UCSD Department f Reprductive Medicine trains medical students, residents, and fellws; and expands medical knwledge thrugh clinical and basic research. Principal Investigatr: Yvette LaCursiere, M.D., M.P.H. Page 6