Mobile Health Evaluation Methods: The Text4baby Case Study

Abstract

Mobile phones have been shown effective in several public health domains. However, there are few evaluations of the effectiveness of mobile health in health promotion. Also, although many studies have referenced behavioral theory, none appears to have explicitly tested theoretical assumptions or demonstrated mechanisms of change. More robust evaluation models that incorporate theory and measurement of behavioral mediators are needed. As in all public health programs, mobile health operates within a social ecological context. For example, organizational- and individual-level programs seek to influence health and health care practices and individual health behaviors. New programs such as Text4baby demonstrate how theory and explicit testing of mediators can be incorporated in evaluations. There are challenges and opportunities facing mHealth evaluations given the nature of the mobile channel. Mobile communication is ubiquitous, available at all times and places, and thus experimental control is often difficult. Natural experiments using variation in dosage of mHealth and place- or location-based designs may increase experimental control. Text4baby is a text messaging program that provides prenatal care messages to pregnant women and new mothers. It uses a partnership model with health care facilities often serving as local implementation partners. The authors review a case example of the evaluation of Text4baby at Madigan Army Medical Center. Participants were randomized to usual prenatal care plus text messaging or usual care alone. The evaluation has a theoretical model of behavior change and measures mediators as well as behavioral outcomes. Results will inform how behavioral theory works within mobile health programs.

Patient Navigator Facilitated Text Messaging Intervention Improves Linkage to care in Viral Hepatitis B: A Pilot Study

“…24 Similarly, the Text4Baby campaign helped expectant mothers to receive prenatal information and other important resources. 25 In addition, text messaging has been successfully implemented in smoking cessation, 26 weight control, 27 and treatment of tuberculosis. 28 In this study, we investigated the use of text messaging in facilitating the connection between subjects and physicians.…”

Tracking development with Baby CROINC: The interplay of parent experience, usage, and technology approach (Preprint)

“…This study examined the use of a digital, early-development screening tool among a middle-to-high economic status sample in a developed country. Most literature [25,28,35,36] in this area focuses on minority samples which are in great need of such support. In low-income communities, limited access and quality of child wellness visits, as well as the increased likelihood of developmental risk has led to child development tracking platforms.…”

“…Over time, evidence attests to the role of ICTs in changing health-related behaviors and beliefs, including those of parents regarding their children (e.g., Text4Me, [28]). Inspired by the research above, we conducted a Baby CROINC deployment study in order to understand users' views and use of the various features.…”

Seniors’ attitude to e-health

“…Furthermore, these mHealth devices are used especially by chronically ill patients for monitoring and control of their disease (cf. Evans, Abroms, Poropatich, Nielsen, & Wallace, 2012).…”