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.
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