Engagement With and Acceptability of Digital Media Platforms for Use in Improving Health Behaviors Among Vulnerable Families: Systematic Review.

BACKGROUND: The use of digital communication platforms to improve health behaviors has increased dramatically over the last decade. Public health practitioners have adopted digital communication technologies such as text messages, mobile apps, and social media to reach diverse populations. However, the effectiveness of digital communication platforms used by community-serving agencies remains unclear, and patterns of engagement and acceptability of different platforms have not been studied. OBJECTIVE: This review aimed to identify the types of digital communication strategies used by community-serving organizations to promote healthy behaviors, assess the strength of evidence for health behavioral change, and describe the degree of consumer engagement with and acceptability of these strategies. The study population included low-income pregnant women, parents of young children, and adolescents. METHODS: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed, Scopus, Web of Science, CINAHL, and APA PsycInfo, covering research conducted from 2009 to 2022. Studies were included if they examined the use of digital communication (ie, texting, mobile apps, or social media) to promote healthy behaviors in the target population. Risk of bias and strength of evidence were assessed using the Effective Public Health Practice Project Risk of Bias tool and criteria from Agency for Healthcare Research and Quality, respectively. RESULTS: Twenty-three peer-reviewed research studies published between 2012 and 2022, conducted in the United States, the United Kingdom, and Australia, were included in the review. The sample comprised studies exploring the use of texting (n=12), apps (n=6), social media (n=3), and multiple platforms (n=2; eg, texting and mobile apps). Targeted health behaviors included healthy diet, physical activity, obesity prevention, healthy pregnancy, breastfeeding, vaccine use, smoking cessation, and nutrition benefit redemption. The sample included 8 randomized controlled trials, 6 pretest-posttest design, 3 mixed methods studies, 2 pilot studies, 1 feasibility study, 1 prospective cohort study, 1 descriptive study, and 1 cross-sectional study. The median sample size was 77.5. There was no strong evidence to suggest the effectiveness of digital media campaigns in improving health behaviors; however, there were moderate to high levels of engagement and high levels of acceptability across digital platforms. CONCLUSIONS: Low-income pregnant women, parents of young children, and adolescents demonstrated moderate levels of engagement with and high levels of acceptability of digital media health campaigns conducted by community-serving agencies. The effectiveness of these strategies in improving health behaviors was inconclusive. Additional rigorous studies with larger sample sizes are required. In addition, more research is required to consistently measure and report participants' engagement with each platform. Digital communication platforms are critical tools for public health practitioners, and future investigations of the effectiveness of these platforms in engaging clients and improving health behaviors will maximize client services.

A WIC Agency Drip Marketing Campaign Is Well Received and Improves Program Participation and Retention: A Quasi-Experimental Study.

BACKGROUND: Little is known about text messaging's influence on child retention in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). OBJECTIVE: This study aimed to evaluate the influence of WICBuzz, a WIC agency drip marketing texting campaign, on retention and participation compared with a comparison WIC agency and to assess WIC participants' perceptions of the campaign's added value. DESIGN: A quasi-experimental design, with pre- and postimplementation measurement, was used to compare innovation and comparison groups' outcomes. Outcome evaluation integrated quantitative analysis of WIC management information system data and survey data of WICBuzz recipients' perceptions. PARTICIPANTS/SETTING: Data obtained for baseline (2019 calendar year) and implementation periods (March 1, 2020, to February 28, 2021), included WIC participation for children who were WIC active at the beginning of each period. WIC agency sample sizes were 6780 to 7452 children from 5189 to 5832 households (baseline) and 4599 to 5004 children from 3186 to 4297 households (implementation). INTERVENTION: WICBuzz, a drip marketing text message campaign with targeted nutrition education and WIC brand awareness messages was the intervention. The comparison agency received standard WIC care. MAIN OUTCOME MEASURES: Main outcome measures included recertification (re-enrollment during the implementation period), timely recertification (within 60 days of prior certification's termination), retention (WIC active at the study period's end), household WIC participation (continuous benefit issuance), and WICBuzz recipients' WIC perceptions. STATISTICAL ANALYSES PERFORMED: Statistical analysis included propensity score weighting and difference-in-difference modeling. Thematic analysis using a deductive approach was used to analyze the process evaluation findings. RESULTS: The influence of WICBuzz on outcomes included 6.7% (95% CI 3.8% to 9.5%) higher recertification, 7.4% (95% CI 4.5% to 10.3%) higher retention, and 10.9% (95% CI 8.0% to 13.8%) higher participation compared with the comparison agency. Most WICBuzz recipients reported added value regarding WIC knowledge and perceptions. CONCLUSIONS: WIC text message campaigns can improve participation and retention and improve participant perceptions of WIC's value.