Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA, USA.
Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton RdNE, Atlanta, Georgia.
Arch Public Health. 2014 May 7;72(1):13. doi: 10.1186/2049-3258-72-13. eCollection 2014.
Text4baby provides educational text messages to pregnant and postpartum women and targets underserved women. The primary purpose of this study is to examine the health behaviors and cell phone usage patterns of a text4baby target population and the associations with health literacy.
Pregnant and postpartum women were recruited from two Women, Infant and Children clinics in Atlanta. Women were asked about their demographics, selected pregnancy or postpartum health behaviors, and cell phone usage patterns. Health literacy skills were measured with the English version of the Newest Vital Sign. Multivariable logistic regression was used to examine health behaviors and cell usage patterns by health literacy classification, controlling for commonly accepted confounders.
Four hundred sixty-eight women were recruited, and 445 completed the Newest Vital Sign. Of these, 22% had inadequate health literacy, 50% had intermediate health literacy, and 28% had adequate health literacy skills. Compared to adequate health literacy, limited literacy was independently associated with not taking a daily vitamin during pregnancy (OR 3.6, 95% CI: 1.6, 8.5) and never breastfeeding their infant (OR 1.4, 95% CI: 1.1, 1.8). The majority (69.4%) of respondents received nine or more text messages a day prior to enrollment, one in four participants (24.6%) had changed their number within the last six months, and 7.0% of study participants shared a cell phone. Controlling for potentially confounding factors, those with limited health literacy were more likely to share a cell phone than those with adequate health literacy (OR 2.57, 95% CI: 1.79, 3.69).
Text4baby messages should be appropriate for low health literacy levels, especially as this population may have higher prevalence of targeted unhealthy behaviors. Text4baby and other mhealth programs targetting low health literacy populations should also be aware of the different ways that these populations use their cell phones, including: sharing cell phones, which may mean participants will not receive messages or have special privacy concerns; frequently changing cell phone numbers which could lead to higher drop-off rates; and the penetrance of text messages in a population that receives many messages daily.
Text4baby 向孕妇和产后妇女提供教育性短信，并针对服务不足的妇女。本研究的主要目的是检查 Text4baby 目标人群的健康行为和手机使用模式，以及与健康素养的关联。
从亚特兰大的两家妇女、婴儿和儿童诊所招募了孕妇和产后妇女。妇女被问及人口统计学资料、选择的妊娠或产后健康行为以及手机使用模式。健康素养技能使用最新生命体征的英文版本进行测量。多变量逻辑回归用于检查健康素养分类的健康行为和细胞使用模式，同时控制常见的混杂因素。
招募了 468 名妇女，其中 445 名完成了最新生命体征。其中，22%的人健康素养不足，50%的人健康素养中等，28%的人健康素养良好。与良好的健康素养相比，有限的读写能力与怀孕期间不每天服用维生素（比值比 3.6，95%置信区间：1.6，8.5）和从未母乳喂养婴儿（比值比 1.4，95%置信区间：1.1，1.8）独立相关。大多数（69.4%）受访者在入组前每天收到 9 条或更多短信，四分之一（24.6%）的参与者在过去六个月内更改了号码，7.0%的研究参与者共用一部手机。在控制潜在混杂因素后，与具有良好健康素养的参与者相比，具有有限健康素养的参与者更有可能共用一部手机（比值比 2.57，95%置信区间：1.79，3.69）。
Text4baby 消息应该适合低健康素养水平，尤其是因为该人群可能有更高比例的目标不健康行为。针对低健康素养人群的 Text4baby 和其他移动健康计划也应该意识到这些人群使用手机的不同方式，包括：共用手机，这可能意味着参与者将不会收到消息或有特殊的隐私问题；经常更改手机号码可能会导致更高的流失率；以及在每天接收大量短信的人群中，短信的渗透率。
