Parenting Resource

The Evolution of Text4baby Influenza Vaccine Messaging

Download Files Aug 8, 2016

During the 2011–2012 flu season, Text4baby piloted an annual flu module—a series of interactive text messages addressing flu shot barriers and urging moms to get the vaccine. Learn more about how the module has evolved over the past four years.

Maternal flu vaccination was identified as a critical issue to target at the inception of Text4baby. When the service launched in 2010, all participants were sent a text encouraging receipt of the flu vaccine during their first week of enrollment and in 2011-2012, Text4baby piloted an annual module of flu messages. Below is an overview of the module’s 4-year evolution, highlighting yearly content, features, and key findings used to inform module enhancements.

The Timeline (Click to enlarge)


Text4baby’s interactive flu module has allowed for rapid data collection and analysis to inform and improve the module over the past 4 years. In particular, the evaluation of the 2012-2013 module found:

  • Among Text4baby mothers planning to get the vaccine, those who received a text reminder were 2X more likely to report getting the vaccine.
  • Among Text4baby mothers who weren’t planning to get the vaccine due to cost, those who received text-based tailored education on free/low cost flu shots were nearly 2X more likely to report getting the vaccine.

These and other findings were critical in shaping the overarching framework for the 2014–2015 module which will be used moving forward. Additional efforts—such as the partnership with RiteAid to provide text-based coupons for free flu shots— provide ideas for future opportunities for module enhancements and research to learn how to further improve flu vaccine rates for pregnant and postpartum mothers and infants ≥6 months old.
The Text4baby flu module also shows promise as a surveillance tool as flu vaccine rates for pregnant women are consistent with those reported by the CDC. Text4baby will continue to monitor flu vaccine coverage among participants and explore additional opportunities to use Text4baby for timely surveillance of flu vaccination and other health behaviors and outcomes.

Learn More About Text4baby as a Surveillance Tool for Influenza Vaccination

Text4baby has collected data from pregnant women on reported receipt of the flu shot, barriers to getting the flu shot, and requests for text-based flu shot reminders among pregnant women.

Learn More


  • Jessica Bushar, MPH, ZERO TO THREE: National Center for Infants, Toddlers, and Families, Washington, DC
  • Danielle Garfinkel, MSPH, ZERO TO THREE: National Center for Infants, Toddlers, and Families, Washington, DC
  • Juliette Kendrick, MD, Consultant, Decatur, GA
  • Caroline Anderson, MSPH, Voxiva, Arlington, VA
  • Pamela Johnson, PhD, Voxiva, Arlington, VA


The authors would like to acknowledge and thank Lalida Thaweethai, former Senior Product Manager for Voxiva, and Amy Pirretti, Text4baby Director for ZERO TO THREE, for their leadership in developing and implementing the Text4baby flu module. Text4baby would also like to thank RiteAid for providing Text4baby participants with coupons for free flu shots in 2013–2014 and 2014–2015, as well as all partners and supporters for their efforts to share Text4baby with pregnant women and mothers across the country.