JMIR Publications

ABSTRACT

Background:

Only 30% of parents of children 9-35 months old report that their child had a developmental screening in the previous year – despite American Academy of Pediatrics’ recommendations for early screening, when interventions can be most beneficial. Seeking to build on the dramatic growth of text messaging to increase access to screening, the founders of Text4baby, a national perinatal texting program, created an interactive text message-based version of PEDS:DM (Parents’ Evaluation of Developmental Status: Developmental Milestones) – a validated screening tool. The study team worked with the Maryland Department of Health and Mental Hygiene (MDHMH) and Prince George’s County Women, Infants and Children (WIC) Program and Infant and Toddlers Program (ITP) to pilot the tool.

Objective:

This study assesses the usability and acceptability of a text message-based developmental screening tool among low-income mothers.

Methods:

Low-income mothers of infants 8-10 months old were recruited in WIC clinics. After a background survey, participants used their mobile phones to trigger and respond to six developmental screening questions. After confirming their responses, they received results. Project staff called and surveyed participants about their experience and invited a subset to attend focus groups. Data were collected between August 2014 and April 2015. Descriptive and thematic analyses were conducted on system, survey and focus group data.

Results:

Eighty-one mothers enrolled in the study and most reported that their infants received Medicaid. Forty-nine percent were classified as Hispanic/Latina (40/81) and 42% were Black (34/81). Eighty percent participated in follow-up surveys (65/81); 14 mothers attended focus groups. All participants initiated the screening and responded to all questions. Seventy-nine percent immediately confirmed their responses (64/81); 21% wanted to make one or more changes (27/81). Mothers completing the screening on their first attempt averaged 4:44 minutes total time compared to 9:23 minutes for those who made two attempts. Based on final responses, 63% received a text that baby was “doing well” in all six developmental domains (51/81); 37% received texts listing domains where “baby was doing well” and one or more domains where “baby may be behind (30/81).” All mothers received a text with resources for follow-up. All participants surveyed post screening said they wanted to answer screening questions again when their baby was older (65/65); all but one would recommend the tool to a friend; and 98% (64/65) rated the experience of answering questions and getting feedback by text as “very good” or “good.”

Conclusions:

Low-income mothers were able to use a mobile text version of a validated developmental screening tool. Mothers could enroll, respond to screening questions, and receive results and resources via text messages. Results may inform future research and options for scalable, mobile text-based developmental screening, such as an offering within Text4baby.