This document summarizes a text-based health education program that was implemented to send targeted health messages to parents via text. Over 1000 parents across 6 counties participated in receiving 2-3 text messages per week about nutrition and physical activity. The program was evaluated through texted surveys, interviews, and focus groups. Findings showed high participation rates but low initial enrollment, which improved with in-person recruitment efforts. Participants found the messages helpful and personalized. The program provides recommendations for implementing similar text-based health interventions.

1. Implementing a
Text-Based Health
Education Program
Stephanie Grutzmacher, PhD
Department of Family Science
University of Maryland, College Park

2. Workshop Topics
• Why text messages?
• Participants, recruitment
• Messages
• Evaluation design
• Findings
• Challenges and tips

3. 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

4. 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

5. Text “Priester”
to 30644.

6. 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

7. 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

9. 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!

11. Write your own messages!
• ≤160 characters
• Plain language

12. Evaluation Design and Data Sources
Intervention Schools Control Schools
(n=691) (n=361)
Participants Non-participants Non-participants
• Parent pre and post-survey
• Texted evaluation questions
• Dropout interviews
• Focus groups (formative and post)

13. 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

14. 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

15. Pilot Findings - Enrollment
• 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

16. 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

17. Pilot Findings – Text Questions

18. Pilot Findings – Text Questions
• Response Rates:
50
40
30
20
10
0
Message 1 Message 2 Message 3 Message 4
• No increase in opt outs after
sending evaluation message.

19. 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

20. How often did you do something
that was suggested in one of the messages?
50 Always
45 Most of the time
40 Sometimes
35 Rarely
30 Never
25 No answer
20
15
10
5
0

21. Challenges
• Recruitment
• Conducting evaluation
• Determining message timing
• Limited research
– Textisms
– Broad audience or captive audience?

22. 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

23. Next Steps
• Outcome evaluation
• Dissemination of pilot process findings
– Recruitment
– Implementation lessons learned
• SMS program development workshops
• Evaluate reminder/reinforcement uses of SMS

24. 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.

25. Questions?
grutz@umd.edu