摘要：Text4baby is the first free national health text messaging service in the United States that aims to provide timely information to pregnant women and new mothers to help them improve their health and the health of their babies. Here we describe the development of the text messages and the large public–private partnership that led to the national launch of the service in 2010. Promotion at the local, state, and national levels produced rapid uptake across the United States. More than 320 000 people enrolled with text4baby between February 2010 and March 2012. Further evaluations of the effectiveness of the service are ongoing; however, important lessons can be learned from its development and uptake. The US infant mortality rate (6.59/1000 live births) is higher than in most developed countries. 1 In the United States, the infant mortality rate for non-Hispanic African American women is 2.4 times the rate for non-Hispanic White women. 1 Rates are also elevated for Native American Indian and Alaska Native women. In 2008, 12.3% of the 4 251 095 babies born in the United States were born prematurely and 8.2% had a low birth weight. 2 Health-related behaviors in the prenatal and postnatal periods, such as nutrition, tobacco smoking, breastfeeding, safe sleep practices, and vaccination are known to affect maternal and infant outcomes. 3 Women without access to affordable and appropriate care may not be receiving information needed to support prenatal and postnatal pediatric care. Recent studies have also shown limited health literacy in the United States to be related to a lack of prenatal planning, such as taking folic acid, and difficulties with informed parental decision-making. 4,5 Mobile phones may be an appropriate means for addressing the challenges of health literacy 6 and for reaching women from underserved communities. Mobile phone ownership in the United States is similar across racial/ethnic groups (80% of Whites and 87% of African Americans and Hispanics). African Americans (79%) and Hispanic Americans (83%) are more likely than are White Americans (68%) to send text messages. 7 Americans living in or near poverty are more likely to live in cell phone–only households (no fixed phone line), and those living in cell phone–only households are more likely to have experienced numerous barriers to health care. 8 Mobile phone text messaging has been used to support healthy behavior change and health care delivery processes. 9–12 Successful behavior change interventions have used text messaging to support smoking cessation, 13–15 weight management through diet or physical activity, 16–19 and management of anxiety symptoms. 20 Health care process interventions have included appointment reminders 21–24 and reminders to take medications. 25–30 Here we describe the development of text4baby, a free national text messaging service that provides timely information to pregnant women and new mothers to help them improve their health and the health of their babies. More than 320 000 people enrolled with text4baby between its launch in February 2010 and March 2012. Little has been published in peer-reviewed journals on mobile health initiatives of this scale in the United States. Published international examples of national-scale services include a text messaging smoking cessation service in New Zealand, which was established after a randomized trial and registered 3905 clients in the first year, 13,31 and a public health campaign in South Africa, which sent 968 million HIV/AIDS awareness messages embedded in free “Please call me” text messages over two years. 32,33 Lessons from the development of text4baby could guide similar mobile health developments.
