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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Breastfeeding.

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Strategy. Text Message-Based Support

Approach. Provide breastfeeding education and support through two-way text messaging interventions to encourage breastfeeding

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Overview. Despite peer counselors and mothers favorably describing communication via text messaging, there are few trials of interventions to test the effectiveness of text messaging used to provide breastfeeding support. Research indicates that mothers tended to be more likely to meet their breastfeeding goals when texting with peer counselors,[1] that 2-way text messaging enabled peer counselors to shorten the time-to-first-contact with mothers after giving birth,[2] and that text messages could be used to reinforce education on breastfeeding.[3]

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).
  • Environmental Health. This strategy improves the impact of physical, chemical, and biological factors in the environment on health.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Health Teaching (Education and Promotion) (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of text message protocols aligned with evidence-based breastfeeding support guidelines. (Assesses alignment with best practices) Number of text message content and schedules developed with input from community members and breastfeeding supporters. (Evaluates authentic engagement)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of text messages personalized based on individual breastfeeding goals and challenges. (Evaluates adherence to best practices in tailored communication) Percent of text message content reviewed for health literacy. (Assesses use of health literacy principles)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of healthcare providers trained in integrating text message support with in-person breastfeeding care. (Shows provider training and capacity) Number of community health initiatives incorporating text message breastfeeding support into broader maternal-child health programs. (Assesses integration into existing plans) Number of timely breastfeeding interventions facilitated through text message support, preventing early weaning. (Measures clinical impact) Number of healthcare systems adopting text message support as a standard postpartum care service. (Assesses system-level improvements)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of text message support services offered in languages representative of the community served. (Evaluates linguistic competence) Percent of program resources allocated to providing free for subsidized phone services to ensure access to text support. (Assesses strategic deployment) Percent reduction in breastfeeding gaps between text support users and non-users, stratified by key characteristics. (Measures reach and impact) Percent improvement in exclusive breastfeeding rates among populations less likely to breastfeed, attributable to text support interventions. (Assesses population-level health impacts)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

1 Harari, N., Rosenthal, M. S., Bozzi, V., Goeschel, L., Jayewickreme, T., Onyebeke, C., ... & Perez‐Escamilla, R. (2018). Feasibility and acceptability of a text message intervention used as an adjunct tool by WIC breastfeeding peer counsellors: The LATCH pilot. Maternal & child nutrition, 14(1), e12488.

2 Martinez-Brockman, J. L., Harari, N., Segura-Pérez, S., Goeschel, L., Bozzi, V., & Pérez-Escamilla, R. (2018). Impact of the Lactation Advice Through Texting Can Help (LATCH) trial on time to first contact and exclusive breastfeeding among WIC participants. Journal of nutrition education and behavior, 50(1), 33-42.

3 Palacios, C., Campos, M., Gibby, C., Meléndez, M., Lee, J. E., & Banna, J. (2018). Effect of a multi-site trial using short message service (SMS) on infant feeding practices and weight gain in low-income minorities. Journal of the American College of Nutrition, 37(7), 605-613.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.