A Two-Way Text-Messaging System Answering Health Questions for Low-Income Pregnant Women

song_hayeonDr. Hayeon Song is an Assistant Professor at the Department of Communication at University of Wisconsin – Milwaukee. Dr. Song received her doctorate in Communication from the Annenberg School for Communication at University of Southern California. Her recent paper (co-authored with Dr. Susan McRoy), titled “A two-way text-messaging system answering health questions for low-income pregnant women” was published in the journal Patient Education and Counseling.

Research interests

My primary research interest is to study interactive media for health promotion and health education. I am particularly interested in using mobile phones as effective vehicle for health information distribution and using digital games as persuasive media for health promotion. My broader research area is the social and psychological effect of communication technology. My background is health communication and media psychology.

Background of the study

Previously, I was involved in a social media & mobile phone intervention project targeting young adult cancer survivors, affiliated with the LIFE program at the Childrens Hospital Los Angeles. I saw the impact of new media on various health outcomes such as social support and psychological health.

When I arrived at Milwaukee, I learned that the city had notoriously high health disparity in infant mortality, meaning that a lot of babies in low income communities die before they turn a year old. Moreover, many of these deaths are considered preventable. I wanted to do something by using my previous research experiences.

I was so lucky to meet Dr. McRoy, a professor at Medical Informatics at UWM, who had similar interests. She developed a question-answering system using text messaging on mobile phones and we collaborated to test the effectiveness of the system targeting low-income pregnant women.


Individuals who do not have access to the Web may be disadvantaged when they need to find answers to health-related questions. Even if they have access to the web, they lack the skills to find and/or understand the information. One solution to bridge this digital divide is to provide access to health information using a question-answering service.

This study is introducing a new application of technology: a low-cost, automated, two-way text messaging system to communicate locale-specific, pregnancy- and health-related information to low-income, expectant women. Our system allowed users to ask questions and receive responses in comprehensible ‘‘chunks’’ targeted to the unique demographics and needs of the population.

This study explored the benefits and challenges of using this system to communicate pregnancy and health-related information to low-income, expectant women. Twenty expectant moms living in underserved communities in Milwaukee were recruited and asked to use the system for a month.

As expected, we found that the text messaging system could promote health communication by delivering health information and facilitating patient-provider communication, while offering psychological benefits as well. That is, participants reported that they learned a lot about how to have a healthy baby as well as they came up with more questions to ask to doctors. It means that this system served as a catalyst for communication between participants and healthcare professionals which can impact healthcare delivery in positive ways. These results are important because the current intervention was not aimed to replace patient-provider communication, but to help women to get better prepared for conversations with healthcare providers.

In addition, using this system reduced the level of depression, perceived stress, and overall mental health, which can be critical in fetus health as well.


A lot of effort has been focused on helping low-income individuals get health information more efficiently. What our findings suggest is that a mobile phone is both practical and effective medium especially for this population. Our survey results found that mobile phone penetration was much higher than that of Internet and high confidence in mobile phone use skills was observed.

Thus, I strongly believe that our text-messaging system can be actually used by the people in these communities and help them get health information efficiently.

Next steps

We have already extended this project to gauge whether men living in underserved communities would desire and/or benefit from using a two-way messaging system that can provide information about prostate cancer and help inform decision making. These studies were part of the Public Health Impact Initiative of the University of Wisconsin-Milwaukee Zilber School of Public Health, funded by the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, and National Center for Chronic Disease Prevention and Health Promotion.

We recently launched another project by collaborating with Text4Baby, focusing on the information needs, seeking behavior, and technology use of fathers. We are currently working with them to develop text messages targeting expected fathers.

Reaching out to the community

As it is community outreach project, we have closely worked with community. Because of the nature of the project, we had a lot of entities to work with such as Milwaukee Health Department, hospital, and community leaders, Men’s referral health network as well as target population. We are trying hard to build relationship with community so that we understand the community better and provide more tailored help.