Form CMS-10634 Focus group: Subscribers

APPENDIX C

MATHEMATICA POLICY RESEARCH

Focus group: Subscribers
The reason we’re here today is to learn about the ways that pregnant women and new moms get information
about their health and their baby’s health. One way of getting information that we’re especially interested in is
through programs that send pregnant women and new moms information on their cell phone through text
messages. When you signed up to participate in this focus group, you said that you signed up for Text4baby
during your most recent pregnancy. Just to remind you, Text4baby is a free health text messaging service for
pregnant women and new mothers with an infant up to age one.
Reach: Awareness of Text4baby
Methods of hearing about Text4baby
a. I would like to start by asking how you learned about Text4baby. (Pause and wait for response.)
b. PROBE AS NECESSARY:
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Did you see a poster in a health care facility or health fair? What do you remember about the poster?
Did someone at your health insurance tell you about Text4baby?
Did you learn about Text4baby on the Internet? What kinds of information were you looking for when
you saw something about Text4baby?
Did a friend or relative tell you about Text4baby? What did they say about the service?
Did your doctor tell you about it? What did they say?
Did you learn about it at work? Did a coworker tell you? Was there a presentation? Did you see a
poster where you work?
Did you find out about it on TV, in a magazine, or from a movie?
Did anyone learn about Text4baby in a way that hasn’t been mentioned yet?

Reach: Participation in Text4baby
Method of signing up
Now I would like to ask how you signed up for Text4baby. (Pause and wait for response.)
a. PROBE AS NECESSARY: Did you sign up…
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On the Text4baby website?
By texting BABY or BEBE to Text4baby?
By clicking a link on the Text4baby Facebook page?
Did anyone sign up in some other way?

b. Did you sign up by yourself or did someone help you sign up? (PROBE: Who helped you sign up?)
c.

Does anyone not remember signing up but somehow you started to receive Text4baby messages on
your phone?

Trimester of subscription
d. How many weeks or months pregnant were you when signed up for Text4baby?
PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid
OMB control number. The valid OMB control number for this information collection is 0938-XXXX (Expires: TBD). The time required to
complete this information collection is estimated to average 100 minutes per response, including the time to review instructions, search
existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the
accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports
Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

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Engagement: Satisfaction with Text4baby
Ease of signing up
e. How easy or difficult was it to sign up?
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[IF DIFFICULT]: What made it difficult?
[IF EASY]: What made it easy?
How satisfied are you with the sign up process?

Reach: Participation in Text4baby
Reasons for subscribing
a. Why did you sign up for Text4baby?
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Was there something special about the service you thought you would like? What was it? (Probe as
needed on types of information, messages timed to due date or baby’s age, message length,
message frequency, Spanish availability.)
[IF SOMEONE RECOMMENDED THEY SIGN UP]: Who recommended that you sign up? What about
this person’s recommendation made you sign up?

b. Did you have questions about Text4baby before deciding whether to sign up?
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What kinds of questions did you have?
Did you talk to a specific person or did you find the information yourself online?
Who did you talk to? What websites did you visit?
Were all of your questions answered? Or did you end up signing up but still have questions?

Engagement: Disenrollment
Reasons for disenrolling
c.

Are you still receiving Text4baby messages?
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[IF NO]: Did anyone text STOP to stop receiving messages? Or was there some other reason you
aren’t receiving Text4baby messages?
[ONLY IF TEXTED STOP]: Why did you want to stop receiving messages?
[ONLY IF TEXTED STOP]: Did you stop receiving messages when you were pregnant or after your
baby was born?
- [IF PREGNANT]: About how many weeks or months pregnant were you when you texted STOP?
- [IF POSTPARTUM]: How old was your baby when you texted STOP?

Engagement: Satisfaction with Text4baby
Perception of frequency of messages
a. How often do/did you get text messages from Text4baby? How many times per week? What days of the
week? What time of the day?
b. What do you think about the number of text messages that you get from Text4baby? (PROBE IF NEEDED:
By a show of hands, who thinks Text4baby sends too few messages? Too many messages? The right
amount of messages? [record numbers])
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c.

What makes you feel Text4baby sends too few messages?
What makes you feel Text4baby sends too many messages?
What makes you feel Text4baby send the right amount of messages?

Have you read all of the messages you got from Text4baby?
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[IF NO]: Why didn’t you read all of the messages? Did you read most, some, or only a few of the
messages you got?

d. Did you usually read the messages as soon as you noticed the text message on your phone?
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[IF YES]: Why did you read the messages right away?
[IF NO]: Why didn’t you read the messages right away?

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Recall of message receipt
a. Next, I want to ask about the types of messages you may have gotten from Text4baby. What kinds of
messages do you remember getting? What were they about? Any others? (Allow respondents to first
answer for all that they remember. Then probe below for ones that they did not mention.)
POSSIBLE PROBES: Do you remember getting a message about…
- Going for a prenatal checkup?
- Getting a flu shot?
- How to find free or low-cost services?
- How to sign up for health insurance?
- Normal symptoms of pregnancy, such as feeling tired or feeling happy one minute and sad the
next?
- Symptoms of pregnancy that mean you should call your doctor, such as bleeding?
- How your baby is growing and developing?
- Exercising?
- Stopping smoking?
- Taking prenatal vitamins?
- A product recall or disease outbreak?
b. Are there types of messages that you wish you would have gotten but didn’t?
c.

Are there any types of messages that you wish you hadn’t gotten or had gotten less of?

Helpfulness of messages
a. Thinking about all the different messages you have received, which ones have been the most useful to
you? What were the messages about? Why were they particularly useful?
Most/least helpful messages
b. Again, thinking about all the different messages you have received, which ones were the least useful?
What were the messages about? Why were they not particularly useful?
c.

Did you learn new things from any Text4baby messages that you received?
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[IF YES]: What did you learn? What were the messages about? Did you do anything with the
information you learned, or do anything as a result of getting these messages? What did you do?

d. Thinking about all of the different messages you got from Text4baby, did you ever get a message and
think “I already know that” or “I’ve heard that before”?
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[IF YES]: Which messages made you feel this way? What were the messages about How did
receiving these messages make you feel?

e. Do you trust the information that Text4baby sends you?
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[IF YES]: Why do you trust the information?
[IF NO]: Why don’t you trust the information? Who do you trust to get information about your health
and your baby’s health?

Engagement: Use of Text4baby
Use of toll-free numbers
Next, I’m going to ask you more questions about some of the messages you may have received from Text4baby.
Some Text4baby messages include a toll-free number that you can call for more information about a topic.
a. By a show of hands, who has ever called one of these toll-free numbers? [record number]
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[IF YES]: Do you remember why you called? What kind of information were you calling about? Did
anyone call about getting health insurance or for signing up for Medicaid or CHIP?
[IF YES]: Did you get useful information when you called? What did you do with the information you
got?
[IF NO]: Do you remember seeing any of these toll-free numbers in Text4baby messages?
- [IF YES]: Why didn’t you call any of these numbers?

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Use of interactive Text4Baby features
Now I want to ask you about some other features of Text4baby that you may have used.
a. Links. Some messages contain links to web pages, videos, or a toll-free telephone number.
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Has anyone ever clicked on a link in a text message? [Count show of hands]
- [IF YES]: Do you remember a link that you clicked on? What was it about? Did the link take you
to a web page or a video? Did you click on a link for a toll-free telephone number?
- [IF YES]: How often do you click on a link within a message? Do you click on every link, or only
links that you are particularly interested in?
- [IF YES]: Which links were the most useful? Why?
- [IF YES]: Which links were the least useful? Why?
- [F NO]: Do you remember seeing any links in any messages thatyou received from Text4baby?
- [IF YES]: Why didn’t you click on any links?

b. Likes. Some messages can be “liked.” That is, you can reply “LIKE” after you get a message if you think
the message is particularly useful or informative.
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Has anyone ever done that? [count show of hands]
- [IF YES]: What kinds of messages prompted you to reply “Like”? What were the messages about?
- [IF YES]: Why did you reply “LIKE” to these messages?

Use of appointment reminders
c.

Appointments. Did you ever reply REMIND to a message to set up an appointment reminder? [count
show of hands]
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[IF YES]: What types of appointments did you make reminders for?
[IF YES]: How easy or difficult was it to set up an appointment reminder? What made it [easy or
diffucult]?
[IF YES]: Did the reminder help you to remember the appointment reminder? What made it [easy or
difficult]?
[IF NO]: Do you remember receiving any messages that asked you if you wanted to set up an
appointment reminder?

d. Facebook. Some messages have a link to a Facebook page where you can connect with other
Text4baby moms. Has anyone received a message like that?
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[IF YES]: Did you click on the link and visit the Facebook page?
- [IF YES]: Did you “LIKE” the Facebook page? Did you connect with any other Text4baby moms
through the Facebook page?
[IF NO]: Why didn’t you visit the Facebook page?

e. Surveys. You may have received messages from Text4baby that asked you a question and told you to
text back a response. Did you ever reply to one of these messages?
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[IF YES]: What was the question about?
[IF NO]: Why didn’t you reply?

Forwarding messages to family/friends.
Now let’s talk about some things you may have done with the Text4baby messages that you received.
a. Have you ever talked about or shared any Text4baby messages with other people?
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[IF YES]: Who did you talk about or share the message with? Why did you share the message with
that person? (Allow respondents to answer this first. Then if needed, probe with questions below that
were not mentioned.)
- Did you share any messages with the baby’s father? Why did you share the message with him?
- Did you share any messages with friends or other family members? Why did you share the
message with them?
- Did you share any messages with your doctor, midwife, or other health care provider? Why did
you share the message with them?
[IF YES]: How did you share the message?
- Did you forward the message directly to someone else’s cell phone?

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Did you tell someone else about a message you received?
Did you share the message in some other way?

[IF YES]: Do you remember any of the messages you talked about or shared with other people? What
were they about?

Saving messages for future use
b. Do you usually delete Text4baby messages after you read them or do you keep them on your phone?
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[IF KEEP]: Have you ever gone back and re-read old messages that you kept on your phone?
- [IF YES]: Were you looking for messages about a specific topic?
- [IF YES]: What messages were you looking for? Why did you go back and re-read them?

Engagement: Satisfaction with Text4baby
Recommendations for improving Text4baby
c.

Do you have any suggestions for making Text4baby better?

Engagement: Satisfaction with Text4baby
Recommend to friends/family
a. How many of you have recommended Text4baby to a friend or relative who is pregnant or has a baby?
[show of hands/record count]
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Who did you recommend it to? Why did you recommend it to them?

b. How many of you would recommend Text4baby to a friend or relative who is pregnant or has a baby?
[show of hands/record count]
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[IF WOULD RECOMMEND]: Why would you recommend it?
[IF WOULD NOT RECOMMEND]: Why wouldn’t you recommend it

Sustainability: Institutionalization and dissemination
Potential of mHealth technology in Medicaid population
c.

If there were a program like Text4baby that would send you text messages about a different health topic
or condition, would you sign up?
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[IF YES]: What health topics or conditions would you be interested in receiving text messages about?
[IF NO]: Why wouldn’t you sign up?

Education: Sources of information
Next, I want to find out where you went when you wanted information about your health or your baby’s health
during your most recent pregnancy and after your baby was born.
a. Did you use…
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The Internet?
- [IF YES]: Did you usually go to a specific website? Or did you usually do a search to find websites
with the information you were looking for?
Books or magazines?
- [IF YES]: Were there specific books or magazines that you used?
Newsletters?
- [IF YES]: Were there specific newsletters that you subscribed to (either online or in the mail)?
Facebook or other social media sites?
An app on your cell phone?
- [IF YES]: Which app did you use?

b. Did you go to your doctor, midwife, or nurse for information? Did you ask family or friends for
information?
c.

Where did you usually go first when you wanted information?

d. Where did you go most often?

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MATHEMATICA POLICY RESEARCH

e. Where did you go least often?
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Are there any places you can think of where you could go but didn’t? Why didn’t you go there?

g. How important is Text4baby to you? Is it more, less, or equally important to you than the other sources
you mentioned? Why do you say that?
Education: Health education receipt
Next I’m going to read from a list of topics. If you remember getting information about any of the following topics
during your pregnancy or after your baby was born, please raise your hand for each one you learned about.
[Read through list. For each topic, ask, “Please raise your hand if you learned about [subject]?” For each topic
with raised hands, ask, “Please tell me where you learned about [subject]. Anywhere else?”]
• Signs of preterm labor such as cramping or bleeding
• Well child visits
• Vaccines or shots for your baby
• How your baby grows and develops
• Dental health (that is, your own dental health and your baby’s dental health)
• Breastfeeding
• Taking a prenatal vitamin
• Eating healthy foods during pregnancy
• Postpartum depression
• How to lay your new baby down to sleep
• Infant car seat use
• Birth control or family planning after your child’s birth
• Stopping smoking
• Avoiding alcohol and drugs
• Domestic violence
Is there any information you felt you needed during your pregnancy or after your baby was born, but you did not
get?
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What information did you need?
Why didn’t you get it? Did you not look for the information or ask anyone about it? Or did you look for
the information but couldn’t find it? Or did you ask someone but they didn’t know?

Connection: Community-based resources used.
I’m going to read a list of different things you may have done during your recent pregnancy or after your baby was
born. After I read each thing, I will ask you to raise your hand if you did this. It’s okay if you don’t want to raise
your hand about some of these.
a. At any time during your recent pregnancy or after your baby was born did you…
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Call a smoking quit line or get help with quitting smoking?
Get information about where you could get free or low-cost health services?
Get help signing up for Medicaid or CHIP?
Talk to a counselor or social worker for mental health help or treatment, or for help with domestic
violence?
Get information about family planning or birth control?
Get help with child care?
Get information to help with parenting?
Get information about home visiting?
Get help from Poison Control if you thought your baby ate or drank something dangerous?
Have your baby’s blood tested for lead?
Have your baby’s eyes checked?
Use WIC services?

Connection: Postpartum care.
Now I’d like to ask you about doctor visits for yourself after your baby was born.

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a. Please raise your hand if you have had a postpartum checkup after your baby was born. A postpartum
checkup is the regular checkup a woman has about 6 weeks after she gives birth.
If you got a postpartum checkup, did you see the doctor you saw when you were pregnant, your
regular doctor, or someone else?
o Is the doctor you saw an OBGYN? An OBGYN is an obstetrician-gynecologist. This is a
special kind of doctor who treats women during pregnancy and delivers babies.
OBGYNs also help women who aren’t pregnant with birth control and family planning.
They also treat sexually transmitted diseases.
o Is the doctor you saw a primary care provider or PCP? Your regular doctor is usually a
PCP. A doctor who is a PCP treats people with common medical problems such as a
cold or the flu.
• If you got a postpartum checkup, how easy or difficult was it to get a checkup?
o What made it easy?
o What made it difficult? How did you deal with that difficulty?
b. If you got a postpartum checkup, I’d like to ask you about what you and your doctor talked about during
the checkup.
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Please raise your hand if…
o You talked about ways to get back to your prepregnancy weight by eating healthy foods
or by being physically active
o You talked about your thoughts and feelings after giving birth, or about postpartum
depression or “baby blues”
o You talked about birth control or family planning
o The doctor examined you to make sure your body was healing from child birth
• Did anyone talk with their doctor about anything else?
Was there anything you wanted talk to the doctor about during the checkup, but didn’t?
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Why didn’t you talk to the doctor about that?

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