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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Developmental Screening.

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Strategy. Text Message-Based Developmental Screening Tools

Approach. Adopt the use of text message-based screening tools in community settings

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Overview. Innovative uses of mobile phones and text messaging have been implemented to expand the availability of validated, parent-reported developmental screening, especially among low-income populations covered by Medicaid. The use of mobile phones and text messages may be a particularly effective way to reach young families at risk, since 100% of adults between the ages of 18 and 29 years and 92% of all adults with incomes below $30,000 surveyed by the Pew Research Center in January 2018 reported that they owned a cell phone of some kind.[1]

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work. They often have a growing body of recent, but limited research that documents effects. However, further study is needed to confirm effects, determine which types of health behaviors and conditions these interventions address, and gauge effectiveness across different population groups. (Clarifying Note: The WWFH database calls this "mixed evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

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

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Timeliness of Care. This strategy promotes delivery of healthcare services in a timely manner to optimize benefits and prevent complications.
  • 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. Policy Development and Enforcement (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 directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

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

PROCESS MEASURES:

  • Number of community settings (e.g., clinics, child care centers, WIC offices) implementing text message-based developmental screening. (Measures the reach and adoption of the innovative approach)
  • Number of families enrolled to receive text message-based developmental screening in participating community settings. (Measures the engagement and participation of the focus population)

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

PROCESS MEASURES:

  • Percent of text message-based developmental screening content and messaging that is adapted for the focus population. (Assesses the relevance and usability of the intervention)
  • Percent of families who complete the full series of text message-based screens per the recommended schedule for their child's age. (Measures adherence to screening periodicity and retention of participants)

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

PROCESS MEASURES:

  • Number of partnerships established between community settings and local early intervention programs to support seamless referrals from text message-based screening. (Assesses the development of cross-sector collaboration and care coordination)
  • Number of text message-based developmental screening tools and protocols adapted for use with different communities. (Measures the customization and tailoring of the approach for various populations)

OUTCOME MEASURES:

  • Number of community settings that report improved rates of early identification and intervention for developmental delays after implementing text message-based screening. (Shows the population-level impact on service linkage and utilization)
  • Number of state for local policies and funding streams that support the use of text message-based developmental screening as an innovative approach. (Assesses the integration of the approach into early childhood systems and priorities)

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

PROCESS MEASURES:

  • Percent of community settings implementing text message-based developmental screening that serve families experiencing socioeconomic challenges. (Assesses the tailoring of the intervention)
  • Percent of text message-based developmental screening enrollment and outreach efforts conducted in partnership with community organizations trusted by families. (Measures the use of responsive, community-based engagement strategies)

OUTCOME MEASURES:

  • Percent increase in developmental screening rates among families participating in text message-based screening initiatives compared to baseline for community norms. (Measures the approach's impact on reducing access challenges)
  • Percent of all children in the community who have access to valid, timely developmental screening through text message-based for other appropriate approaches. (Measures progress toward population-level early detection and intervention)

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 Johnson, P. R., Bushar, J., Dunkle, M., Leyden, S., & Jordan, E. T. (2019). Usability and acceptability of a text message-based developmental screening tool for young children: pilot study. JMIR pediatrics and parenting, 2(1), e10814.

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.