Stephanie Grutzmacher, PhD

Department of Family Science University of Maryland, College Park

Implementing a Text-Based Health Education Program

Workshop Topics

• Why text messages?

• Participants, recruitment

• Messages

• Evaluation design

• Findings

• Challenges and tips

Benefits of Using Texts

• Remote (for us), instant, in context (for them)

• Repeated, tailored messages

• Real-time, interactive evaluation

• Perceived as personal, informal (Gold et al., 2010)

• Widely available

• Especially to non-whites, low-income, low education (Smith, 2011); parents (Ahlers-Schmidt, 2010)

• Low cost

How Has Texting Been Used in Health Promotion?

• Improve attendance in health care settings (Downer et al., 2006; Geraghty et al., 2008; Koshy et al., 2008; Leong et al., 2008)

• Access hard-to-reach populations

• Deliver information and reminders

• Develop and track goals (Ahlers-Schmidt, 2010)

• Measure real-time behavior

Text “Priester” to 30644.

Text2BHealthy Program and Participants

• 2-3 community-specific text messages per week

• Pilot: 8 Title I schools, 203 parents in 4 MD counties & Baltimore City; 91% retention

• Current: 15 Title I schools, 1126 parents in 6 MD counties & Baltimore City

Recruitment

• School-based

– Posters

– Tear-pads

– Family events, PTSA, music concerts, etc.

• Home-based

– Backpack flyer

– Postcard mailed to survey completers

– Newsletters, robocalls

• Incentive items

Targeted Messages • Elementary schools can help us to know about….

– Retail

– Recreation

– Libraries

– Weather

– School schedules, testing, events

– Lunch menus

– Local events

…..without even knowing your name!

Write your own messages!

• ≤160 characters

• Plain language

Evaluation Design and Data Sources

• Parent pre and post-survey

• Texted evaluation questions

• Dropout interviews

• Focus groups (formative and post)

Intervention Schools

(n=691)

Control Schools

(n=361)

Participants Non-participants Non-participants

Evaluation Content PROCESS

• Recruitment and retention strategies

• Message content, timing, usefulness

• Feasibility of texted evaluation questions

• Cell/texting behavior – Texting frequency, preferences

– Number and type of devices, plans

MAIN OUTCOMES – Parent and child FV consumption

– Parent and child physical activity

Pilot Findings – Barriers to Enrollment

• Did not know they could enroll

• Concerned about cost of texting

• Apprehensive about program content

• Had disabled short codes

• Did not know how to send a message to someone not in their address book

• Low enrollment (203 parents) during the pilot led to a focus on recruitment

• Enrollment increased with:

– FSNE staff and principals talking to parents in person

– School goals (minimums) for recruitment

– Collecting phone numbers

Pilot Findings - Enrollment

Dropouts

• Most “accidentally” dropped out

– Revised STOP message did not reduce rates

• Re-enrolled participants stayed in

• A few parents cited limited time to read messages

Pilot Findings – Text Questions

Pilot Findings – Text Questions

• Response Rates:

• No increase in opt outs after sending evaluation message.

0

10

20

30

40

50

Message 1 Message 2 Message 3 Message 4

Pilot Findings - Participant Satisfaction

• 94% of participants read all texts • 71% said texts were “very helpful” • 84% said they would enroll again next year • Messages perceived as personalized, caring

How often did you do something that was suggested in one of the messages?

0

5

10

15

20

25

30

35

40

45

50 Always

Most of the time

Sometimes

Rarely

Never

No answer

Challenges

• Recruitment

• Conducting evaluation

• Determining message timing

• Limited research

– Textisms

– Broad audience or captive audience?

Recommendations for Implementation

• Seek substantial buy-in from partners – Can help reach audience

– Promote and incentivize enrollment

– Connect program to other activities

• In-person enrollment promotion

• Offer to collect mobile phone numbers and manage enrollment for parents; have alternatives

• Focus group test materials, messages

Next Steps

• Outcome evaluation

• Dissemination of pilot process findings

– Recruitment

– Implementation lessons learned

• SMS program development workshops

• Evaluate reminder/reinforcement uses of SMS

Acknowledgements • Maryland FSNE: Erin Braunscheidel, Laryessa Worthington, Kate

Speirs, Sally Ann Kamen, Lisa Lachenmayr

• UMD SPH: Ashley Munger, Lauren Messina, Jessica DiBari, Kat Downes, Lindsey Zemeir, FSNE-SPH Undergraduate Research Team

• Participating FSNE educators, schools, and families

This project was funded by USDA's Supplemental Nutrition Assistance Program in cooperation with the Maryland Department of Human Resources

and the University of Maryland.

Questions?

grutz@umd.edu