mHealth Evaluation & Text4Baby

Doug Evans

September 20, 2010

Evaluation Overview

● Text4baby is a brand● Based on behavior change theory● Short-term effects on brand equity, KAB● Intermediate effects on behavior● Long-term impact on maternal and newborn

health

Theory of Behavior Change

● T4B messages are a cue to action for low-income mothers (Glanz, Lewis and Rimer, 2002)

● Role of social influence and diffusion of information in text messages within the target population

● Social Cognitive Theory: Psychosocial factors (self-efficacy, social modeling) mediate effects of messaging on behavior (Bandura,

2004)

Evaluation conceptual model

Evaluation at 30K Feet● What is the level of exposure to the text4baby brand

among the target audience? ● What is exposure among selected population groups?● Does it work to change health behaviors?● How does it work (what processes)?

Subscribers – late July 2010

Process evaluation questions

● Who subscribes?– What are their demographic & health profiles?

● What are mothers reactions/receptivity to messages? – Are they perceived useful, credible?

– Are there differences in perceptions between messages or categories?

– What are health care provider (HCP) reactions?

– Are text4baby messages consistent with HCP provided information?

Process evaluation methods

● Mobile surveys– Interviewer administered by mobile phone– IVR (automated)

● In-depth interviews● Focus groups

– Qualitatively assess how messages received, used, intended/unintended effects

Outcome evaluation questions

● Do text4baby subscribers also use the www.text4baby.org Website?

● Are subscribers more likely than non-subscribers to use other health information sources (helplines, etc.)?

● Are subscribers more likely to form positive pre-natal care and health promoting attitudes/beliefs?

● Are subscribers more likely to engage in behaviors targeted by messages?– Campaign has behavioral objectives embodied in the

messages – are they achieved?

Outcome evaluation methods

● Randomized experiments

● Comparison of sites (hospitals, clinics) promoting text4baby v. those not

● Control for mothers who visit non-promoting sites but still subscribe

● Mobile surveys, typically interviewer administered

● Electronic Health Record abstraction

Conclusions

● Build an mHealth evidence base

● Develop a theoretical framework for mHealth

● Imagine in 5 years someone wanted to do a meta-analysis of mHealth

● What would need to be in place to do that analysis coherently?

● Text4baby is a big step in building the evidence base and future mHealth theory

Thank you!

● Doug Evans

● The George Washington University

● wdevans@gwu.edu