William Douglas Evans*, The George Washington University, Washington, United States Track: Research Presentation Topic: Public (e-)health, population health technologies, surveillance Presentation Type: Oral presentation Submission Type: Single Presentation Building: Sol Principe Room: A - Alhambra Date: 2014-10-10 02:50 PM – 03:35 PM Last modified: 2014-09-03

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INTRODUCTION: Investigators from The George Washington University and Madigan Army Medical Center in Tacoma, Washington designed and implemented an RCT to evaluate the text4baby program (text4baby.org). Objectives were to assess text4baby's effectiveness in promoting pre-natal care, reduction of health risks, and promoting healthy behaviors. The investigators posited that text4baby message exposure, and higher dosage levels of exposure, would improve mother's 1) beliefs in behavior change advocated by text4baby, and 2) self-reported pre-natal health behaviors.
METHODS: The study was a randomized prospective design in which pregnant women are randomized to receive text4baby plus usual care or usual care alone. It was powered to detect a 12% increase in the Adequacy of Pre-natal Care Utilization (APNCU) Index and endorsed by the American College of Obstetricians and Gynecologists (Kotelchuk, 1994). At baseline, investigators recruited pregnant women first presenting for pre-natal care at Madigan in two strata: first pregnancy, and having at least one previous live birth. In each stratum, women were randomized to enroll (treatment) or not enroll (control) in text4baby (4 cells). We followed up each of these subgroups through their first post-partum appointment. At the time of this abstract submission, baseline data collection had been completed with 943 participants and folllow up was ongoing.
The evaluation protocol had two main elements: 1) participant self-reported health behaviors targeted by text4baby; and 2) participant self-reported medical outcomes targeted by text4baby messages. The evaluation protocol was based on surveys that consisted of 2 parts: 1) health behaviors, and 2) medical outcomes obtained from patient clinical records.
RESULTS: The presenter reports on final results from the RCT, including the overall sample characteristics. On average, participants were women age 26 who were enlisted or members of military families, 34% of whom were current or former WIC participants. The presenter reviews results of factor analysis of beliefs targeted by text4baby messages, and development of a text4baby belief scale. Bi-variate comparisons revealed statistically significant increases (p < .05) in daily fruit & vegetable consumption and seeking health information online, and reductions in reported smoking in past 30 days among text4baby participants compared to control (treatment effect). General estimating equation (GEE) models to evaluate the full data set from baseline to post-partum interview reveal increases in beliefs about pre-natal prevention and health promoting behaviors, such as avoiding smoking and taking pre-natal vitamins, targeted by text4baby. GEE models for intervention effects on behavior change and clinical outcomes are presented.
CONCLUSIONS: The presenter discusses these findings and the overall preliminary data from the study. The presenter reviews implications of text4baby for other prevention programs and recommend future program strategies and research. The area of weight loss and obesity prevention among postpatrum women is a promising future research direction. The presenter explores this area and potential for eHealth interventions in the future.