Text4baby Research and Evaluation

Text4baby’s power lies in its ability to get the most essential health information to mothers in need quickly and easily using a technology they regularly use and rely on. Over 91% of Americans own a cell phone and 81% of cell users send or receive text messages. Text4baby is a data-driven initiative. Staff routinely monitor and analyze a wide array of data collected by the program, including data on enrollment, completion and cancellation, program dosage, participant-reported reason for cancellation, referral source, and descriptive data from various questions asked through the mobile platform. These data are reviewed to inform and improve program promotional, outreach, and product strategies.  Additionally, Text4baby provides partners with access to real-time enrollment data to support them in understanding the impact of outreach initiatives on enrollment. Below are some key highlights from Text4baby’s ongoing data and evaluation efforts.

Text4baby is Reaching its Target Population
  • Text4baby is reaching individuals early in their pregnancy: Of the participants who signed up to receive pregnancy messages, over 39% enrolled during the first trimester.
  • Text4baby is reaching women in high-poverty areas: At enrollment, a higher percentage of Text4baby participants live in zip codes with the highest levels of poverty compared to the overall U.S. distribution.  Click here to view a graph representing these findings.
  • Text4baby survey respondents from low income households: Nearly half of respondents to a national survey of Text4baby participants implemented by the California State University San Marcos National Latino Research Center (CSUSM) reported their household income was $16,000 or less.1
Text4baby is Well Received by Participants
  • 99% of WIC participants in an Emory University study (baseline n=468) had no concerns about enrolling in Text4baby; 95% reported the enrollment process was easy; 92% regularly read Text4baby messages; and 88% planned to continue to use Text4baby.2
  • 93% of Text4baby participants who responded to a survey since launch (n=46,990) said they would refer Text4baby to a friend and  rated the helpfulness of the service as a 7.7 out of 10 (n=71,312).
  • A short survey conducted with patients at Carilion Clinic in Roanoke, Virginia who enrolled in Text4baby for six months or more found that 92% of women who continued to use the service (49 of 53) were satisfied with the service.3
  • CSUSM national survey participants rated the usefulness of the service 4.4 out of 5.1
Evidence of Knowledge and Behavior Change
  • Health Knowledge and Preparedness: 
    • 82% of CSUSM national survey participants reported Text4baby messages informed them of medical warning signs they did not know.1
    • A George Washington (GW) University-led randomized evaluation found that Text4baby mothers were nearly three times more likely to believe that they were prepared to be new mothers compared to those in the no exposure control group (n=123).4
    • Findings from an RCT funded by the DOD Telemedicine and Advanced Technology Research Center and lead by GW and the Madigan Army Medical found improvements in beliefs targeted by Text4baby, including (1) the importance of prenatal care, (2) the risk of alcohol use, and (3) the importance of prenatal vitamins, among participants with short term (4 week) exposure to Text4baby compared to the control group (n=943).5
  • Appointment Attendance and Behavior Change:
    • 63% of CSUSM national survey participants reported Text4baby helped them remember an appointment.1
    • Preliminary results from a study conducted by researchers from St. Louis University show a significant difference in average glucose values within goal between the Text4baby control group and the no-text control group (73% vs 20%, N=30).6
  • Facilitating Interaction with Health Providers and Improving Access to Health Services:
    • 65% of CSUSM national survey participants reported they talked to their doctor about a topic they read on a text4baby message, 77% reported that they clicked a Text4baby link, and 46% reported they called a number for a service they received from Text4baby.1
    • 47% of CSUSM national survey participants reported Text4baby helped connect them to health services for them and/or their baby, with a higher percentage of uninsured participants (60%) reporting that Text4baby helped them access health services.1
    • 64% of Text4baby survey respondents report having asked a Dr./midwife about information in a text4baby message (n=23,005) and 20% report having called a resource from a Text4baby message (n=19,495).
Ongoing Text4baby Research and Evaluation
  • Funded by the U.S. Department of Health and Human Services, Mathematica Policy Research is conducting a mixed-method process and outcome evaluation of Text4baby. Evaluation methods include national stakeholder interviews, the implementation of a pre-post consumer survey, electronic health record abstraction, key informant interviews, and consumer focus groups in four communities.
  • The University of Maryland School of Public Health, Herschel S. Horowitz Center for Health Literacy is conducting two separate evaluation efforts, including (1) a small pilot to assess receptivity to Text4baby messages and knowledge, awareness and behavioral outcomes among Text4baby participants and non-participants; and (2) an analysis of Text4baby messages based on health communication and health behavior theory in an effort to identify how Text4baby messages align with theories.
  • Researchers from St. Louis University are conducting a study to assess the impact of a text reminder intervention on adherence to a diabetes care regimen and glycemic control. Preliminary results presented at the Society of Maternal and Fetal Medicine’s annual conference show a significant difference in average glucose values within goal between the Text4baby control group and the no-text control group (73% vs 20%, p<0.01). Recruitment for the study is ongoing.6

Text4baby regularly consults and collaborates with experts on research and evaluation efforts. Current research and evaluation efforts include:

  • Text4baby partnered with George Washington University in 2014 to assess the feasibility and acceptability of using text messages for smoking-cessation among 20 women enrolled in Text4baby.  Participants who received the Quit4baby messages reported that the program was helpful in quitting and that they would recommend it to a friend.  Participants particularly appreciated the skills-based content of the program and the social support that the program fostered.  In addition, the number of cigarettes smoked per day fell from 7.6 at baseline to 2.4 at 4 weeks program follow-up.  Click here to read the study.
  • Text4baby worked with the California Department of Health and Immunize Nevada to implement a childhood vaccination module pilot project in March 2013. The goal of the project was to gain insight on self-reported childhood vaccination status and well baby visit attendance among Text4baby participants.  Preliminary results show higher self-reported appointment attendance among participants who received educational and appointment reminder messages compared to those who did not receive them, and high rates of self-reported hepatitis B vaccination in the pilot project sample.  Click here to learn more about the results of the immunization module.
  • In October 2012, Text4baby implemented a flu module designed to gain insight around whether providing appointment reminders and tailored educational messaging via text improves self-reported vaccination coverage among Text4baby participants.  The results were recently presented at the 2013 mHealth Summit.  Click here to read the abstract of the presentation.7
  • In partnership with the Centers for Medicare and Medicaid Services, Text4baby implemented a Medicaid module. The goal of the module was to identify the health insurance status of Text4baby participants and provide information on Medicaid/CHIP to participants who indicated they were uninsured.  Preliminary results suggest messaging sent to uninsured women may encourage Medicaid/CHIP application among pregnant and new mother Text4baby participants.  Click here to learn more about the results of the Medicaid module.  Additionally, the Kaiser Family Foundation (KFF) recently conducted interviews with Text4baby participants to better understand the impact of the Medicaid Module.  Findings are highlighted in their February 2014 Issue Brief.8


Click here for a factsheet summarizing Text4baby's impact.

Click here for a factsheet summarizing Text4baby's impact among Spanish Language Participants.

Click here to view national and state-level Text4baby enrollment data.

Access to Data for Text4baby Outreach Partners

The National Healthy Mothers, Healthy Babies Coalition (HMHB) and Voxiva are pleased to support access to data for organizations who have signed a Memorandum of Understanding as Outreach Partners for Text4baby. The process for partners to access data is as follows:

1. Complete MOU found here.

2. During your intake call with HMHB staff, you will be informed about next steps for data access, which will include completing a Data Use Agreement.

3. Once the DUA is completed, HMHB staff will work with Voxiva to create log-in credentials to give you access to real-time, zip-based enrollment data in your state.

4. HMHB hosts regular webinars to train you on how to access and use the enrollment database. A staff member will contact you regarding training.

Conducting Research and/or Publishing on Text4baby

If you are interested in conducting research on Text4baby, please email jbushar@hmhb.org with details about your request.


1. Martinez, K. and Uekusa, S. 2013 National Survey of Text4baby Participants. California State University San Marcos (CSUSM). Available from: http://www.csusm.edu/anthropology/docsandfiles/Text4baby.pdf.

2. Gazmararian, J., Elon, L., Yang, B., Graham, M., Parker, R. (2013). Text4baby Program: An Opportunity to Reach Underserved Pregnant and Postpartum Women? Maternal Child Health Journal.  Abstract available: http://www.ncbi.nlm.nih.gov/pubmed/23494485.

3. Kaleka, A., Olsen, R., & Sweet, M. (2012, April 26). Utilization of Text4baby to Improve Maternal and Infant Outcomes with an Interdisciplinary Team. Presented at STFM Annual Conference, Seattle, Washington. Available from: http://www.fmdrl.org/index.cfm?event=c.getAttachment&riid=6110.

4. Evans, W., Wallace, J., and Snider, J. Pilot Evaluation of the text4baby Mobile Health Program, BMC Public Health, 12. Available at: http://www.biomedcentral.com/1471-2458/12/1031/abstract.

5. Evans, W., Wallace, J., Szekely, D., et al. (2014). Initial Outcomes From a 4-Week Follow-Up Study of the Text4baby Program in the Military Women's Population: Randomized Controlled Trial.  Journal of Medical Internet Research, 16. Available at: http://www.jmir.org/2014/5/e131/

6. Grabosch, S., Gavard, J., and Mostello, D. Text4baby improves glycemic control in pregnant women with diabetes. St. Louis University, Obstectrics, Gynecology, & Women's Health.  American Journal of Obstectrics & Gynecology: Supplement to Jan. 2014, 151. Available at: http://www.ajog.org/article/S0002-9378(13)01249-0/pdf.

7. Abstract from Research Symposium at Dec 2013 mHealth Summit.  “Findings from an Interactive Module Encouraging Influenza Vaccination among Text4baby Participants.”  Available at: http://mhealth.blackfly.com/program-details/findings-interactive-module

8. Kaiser Family Foundation. Feb 2014. “Profiles of Medicaid Outreach and Enrollment Strategies: Using Text Messaging to Reach and Enroll Uninsured Individuals into Medicaid and CHIP” Available at: http://kff.org/medicaid/issue-brief/profiles-of-medicaid-outreach-and-enrollment-strategies-using-text-messaging-to-reach-and-enroll-uninsured-individuals-into-medicaid-and-chip/