Does a text-messaging program to promote early childhood development reach the highest risk families?

Maureen Cunningham, Sheana Bull, Monica C. McNulty, Kathryn Colborn, Catia Chavez, Stephen Berman, Jean McSpadden, Jared Wigdor, Mandy A. Allison


Background: Bright by Three (BB3), a non-profitorganization that promotes caregiver behaviors to support language developmentin young children was augmented with a text-messaging program, Bright by Text(BBT), in 2015. While some evidence suggests that text-messaging can promoteearly development, it is unknown if these interventions are reaching childrenat increased sociodemographic risk for developmental delay. The purpose of thisstudy is to compare socio-demographic characteristics of caregivers who did anddid not enroll in BBT.
Methods: Retrospective analysis of caregiverswho received BB3 written materials and were eligible to sign up for BBT in2016. Outcomes: (I) provision of a mobile phone number; (II) enrollment in BBT(receipt of 3+ messages). Predictors: education, marital status,race/ethnicity, insurance, language, and urban vs. rural residence. Amultivariable generalized linear model was used to determine characteristics ofcaregivers more likely to sign up for BBT.
Results: A total of 18,145 caregivers receivedBB3 written materials; 10,843 (60%) provided a mobile phone number and 2,314(21%) enrolled in BBT. The relative risk (RR) of enrollment was higher forcaregivers who were non-minority (RR 1.15, 95% CI, 1.04–1.28), had higher education(1.60, 1.35–1.89), had private insurance (1.15, 1.15–1.28) and lived in urbanareas (1.21, 1.06–1.37). Non-English speaking caregivers were less likely toenroll (0.73, 0.59–0.90).
Conclusions: Caregivers withlower incomes and education, minorities and non-English speakers were lesslikely to enroll in BBT. Future research could identify ways to increaseengagement among these populations and determine if BBT is effective inchanging parent behavior and improving children’s development.