Using short message (SMS) and multimedia messaging (MMS) to encourage positive parent–child engagement around literacy and language development

Abstract

Research on language development suggests that children from low-income families hear nearly 30 million words less than their higher income counterparts (Hart & Risley, 1999). This paper explores parent perceptions and attitudes toward two mobile interventions (Text4baby and Univision Contigo) designed to support parents’ engagement with their young children as a way of reducing the language gap and improving child outcomes. We conducted eight focus groups with parents who were users of either service. Using general inductive analysis of the transcript data, we found that parents enrolled in the Text4baby service were relatively unaware of the video text messages and almost never clicked the links. Univision Contigo users, on the other hand, more frequently recalled seeing videos encouraging parent–child interaction and particularly liked that these videos came as multimedia messages (MMS). We interpret findings through a social cognitive theory lens and provide recommendations for incorporating video into parent-targeted mobile interventions.

Keywords

language development MMS mobile health SMS Text4baby text messaging

Parenting practices and behavior during children’s early years are known to influence and potentially predict the developmental trajectory of a child, in both positive and negative ways (Shah, Sobotka, Chen, & Msall, 2015). One area of particular importance is the development of language. Research on language development shows a gap in oral language skills between children from lower and higher income families that is related to demonstrable differences in later school readiness and academic achievement (e.g., Hart & Risley, 1999; Hirsh-Pasek et al., 2015; Hoff, 2013). Parents are often seen as both the cause of and potential defense against these differences in language development.

Traditional interventions designed to address the language gap by educating parents are believed to be effective (e.g., Providence Talks, 2014), but are very costly in terms of time and money (e.g., Karoly et al., 1998). We know that text messages are an effective and relatively inexpensive way to communicate with parents (see Evans, Wallace, & Snider, 2012, for an example), but less is known about how messages with video and other multimedia are incorporated and used by parents. Text4baby and Univision Contigo (hereafter Univision) both seek to promote positive parenting practices that support healthy child development generally, and young children’s language development more specifically. Text4baby sends its content using short message service (SMS), which is largely text-based with some links to multimedia content, whereas Univision uses multimedia service (MMS) with embedded media messages. For both services, the video content focuses on supporting parents’ ability to engage their children in language and literacy development activities. The purpose of the current study is to understand how parents with young children utilize digital information received from these two specific text-messaging services, and what their attitudes are toward the language/literacy focused video content, specifically. Based on our findings, we provide recommendations for how best to develop video embedded within text messaging intervention programs for families.

Language development

One of the most crucial developmental milestones children are able to master in the early years is language. Typical language development in the early years is associated with a multitude of positive developmental outcomes in social, emotional, and cognitive domains, while poor language development is associated with an increased risk of negative developmental trajectories like poor school readiness and later grade retention (see Cartmill, 2016, for a review). One factor related to infant language development is parent income (Fernald, Marchman, & Weisleder, 2013). Landmark research by Hart and Risley (1999) on Kansas City families revealed shocking differences in the vocabularies of children from low-, middle-, and high-income families. These differences were largely accounted for by the amount of language spoken by adults in the home. In higher income homes, children heard around 2,000 words an hour, while in lower income homes, they heard an average of anywhere from 600 to 1,200 words per hour. Extrapolating from these findings led the researchers to suggest that there is a nearly “30-million-word gap” in vocabulary between children from the lowest and highest ends of the income spectrum by age 4; a gap that may persist in later language learning (Hart & Risley, 2003). Furthermore, follow-up analyses with these families demonstrated that the amount of adult language in the home at early ages was positively related to third grade language test performance (Walker, Greenwood, Hart, & Carta, 1994).

Hart and Risley’s (1999) groundbreaking work was one of the first to discuss parent factors associated with language development, but more recent research has also revealed other parent variables besides income and word count that also influence child language development. Factors like parent education (Burchinal, Peisner-Feinberg, Pianta, & Howes, 2002; Huttenlocher, Vasilyeva, Waterfall, Vevea, & Hedges, 2007), parental warmth and responsiveness (Tamis-LeMonda, Bornstein, & Baumwell, 2001), and type of language used (quality of language as opposed to mere quantity; Landry, Miller-Loncar, Smith, & Swank, 2002) are also related to children’s language development. Another possibility for differences in child language development is that some parents may lack knowledge about child development. For example, research from Dichtelmiller et al. (1992) found that mothers with more knowledge about infant development had children with higher scores on standard measures of development at 8 months compared to mothers with an average or little knowledge about child development. Taken together, it is clear that parents play an important role in supporting their children’s language, but that certain parents may need more support in this area than others.

Parenting interventions

Because parent behaviors are related to later child language outcomes and because some parents might not know the importance of parent–child talk in the early years or how to interact with a preverbal child, educating parents about how to best support their children’s language development is a possible avenue for intervention. To date, there are several evidence-based, large-scale parenting inventions known to be successful in promoting long-term positive youth outcomes. These interventions have been successful in reducing child neglect and maltreatment (e.g., Jacobs, Easterbrooks, Brady, & Mistry, 2005; Prinz, Sanders, Shapiro, Whitaker, & Lutzker, 2009), preventing child internalizing problems (e.g., Yap et al., 2016), and enhancing parental self-efficacy (e.g., Sanders, 2008). For the most part, interventions with some combination of parent education and social support from professionals or paraprofessionals are most successful (Brooks-Gunn, Berlin, & Fuligni, 2000); however, these sorts of programs are extremely resource intensive for staff to carry out (Karoly et al., 1998; Shonkoff & Phillips, 2000). Additionally, there are often several barriers to enrollment for these types of programs, especially for low-income and/or minority populations. Even when barriers to entry are considered, keeping parents involved and attending regularly is also a challenge (e.g., Baker, Arnold, & Meagher, 2011; Reid, Webster-Stratton, & Baydar, 2004). It is particularly difficult to involve low-income families in these interventions because they may move frequently (see Coulton, Theodos, & Turner, 2012, for an example), have unstable working schedules, or otherwise not be able to afford to attend the intervention (in terms of transportation or procuring childcare).

Texting interventions

One promising way to reach today’s parents is through their mobile phones. Over 80% of American adults have cellular phones that can send and receive text messages, otherwise known as short message service (SMS; Duggan, 2013). Not only are cellular phones prevalent among Americans regardless of income, but text messages, specifically, are an ideal form of communication because most people read them. According to Tolentino (2015), text messages have an astounding 98% open rate, compared to just 3–5% for email. Furthermore, Americans read 90% of all text messages within just 3 minutes of delivery (Tolentino, 2015). By harnessing the power of mobile phones in today’s increasingly mobile world, text messaging services are an effective means of communication with parents (see Evans et al., 2012, for an example) and can have a positive effect on young children’s language skills.

One of the earliest studies investigating texting interventions for language learning found that parents/caregivers who received Sesame Street literacy-learning activities via text message reported performing more of these activities with their children after participating in the study (Horowitz et al., 2006). Parents in the intervention group also reported that children improved in their knowledge of letters and the alphabet song from pre- to posttest. More recently, in evaluating Stanford’s READY4K! text messaging program, York and Loeb (2014) suggested that text message reminders are a promising approach to support parent and child engagement in literacy activities. Compared to the control group who received two texts a month about general kindergarten enrollment information, a treatment group that received three texts per week with practical tips about literacy activities did more of these literacy activities in the home and were more involved in the school community. These increases were also modestly related to increases in child learning measures (York & Loeb, 2014).

In their evaluation of a texting service used by largely low-income Head Start families, Hurwitz, Lauricella, Hanson, Raden, and Wartella (2015) found that parents utilizing the service reported engaging in more literacy learning activities in the home than a control group who did not receive these text messages. This difference was particularly compelling for fathers; fathers in the treatment group of this study were significantly more likely to report engaging in activities like pretend play, singing, and storytelling after receiving the text messages (Hurwitz et al., 2015). Considering these three studies together, it is believed that text messaging programs have the potential to enhance parenting skills related to language and literacy development, especially for those from low-income families.

Multimedia messaging

While text messaging has been the primary area of focus for health and parenting mobile interventions, most parents now have smartphones with multimedia message (MMS) capabilities (Smith, 2015). Further, according to the Pew Research Center (Smith, 2015), 64% of U.S. adults have cell phones with data capability, almost 19% of people use their smartphones for Internet access exclusively, and 75% of young adults use their smartphones to watch videos. Accordingly, many organizations are starting to use multimedia messages (MMS) to communicate with parents and families. To date, a few studies have piloted health behavior intervention programs with MMS (e.g., Walsh-Buhi et al., 2016), and the present study seeks to extend this line of work by studying parenting support programs that utilize video messaging. As far as we are aware, this is the first study to focus specifically on this intervention element.

Theoretical framework

Based on social cognitive theory (SCT; Bandura, 2001, 2004), video messaging might be particularly effective at impacting behavior change. SCT posits that humans acquire and maintain behaviors through the process of observation. When people see others in their environment engage in activities that are rewarding, they may be more inclined to perform the same behaviors. This observational learning is not limited to physically proximal models either. SCT also suggests that video modeling is a powerful tool for teaching (Bandura, 2001). Indeed, MMS interventions that utilize videos could be even more effective than traditional text messages for eliciting behavior change by leveraging the power of social modeling. For example, parents may know that they should read and talk with their infants, but if they see a video that models how they could perform this action even during everyday moments like bath time, meal time, and diaper changing, they may think “While I’m changing his diaper, I can sing the ABCs like they showed in the video.” These models may support the larger goal of not only encouraging parents to start reading and talking to their children, but they may also provide them with concrete and contextualized examples of how to consistently engage with their infants and toddlers.

According to Bandura (2001), observational learning rests on four main subfunctions. The first mechanism for eliciting behavior change is attentional processes. People must first pay attention to the model. There are both individual (e.g., cognitive skills, arousal level, personal preferences) and model (e.g., salience, attractiveness, prevalence) factors responsible for whether people attend to the model. The second major mechanism governing learning is retention processes. It would be unlikely for anyone to perform a behavior that they do not remember. Here too, retention is influenced by individual-level and model-level elements. The third mechanism that is crucial to observational learning is production processes, or the (perceived) ability to actually perform the modelled behavior. Finally, the last major subfunction is motivational processes. Behaviors seen as being rewarded are more likely to be modelled than those that are punished, especially when the behaviors are already in line with the individual’s internal standards for behavior and the model who performs them is well-liked or similar.

The present study

Considering the success of prior research on text-based messaging programs designed to improve parenting practices (e.g., Hurwitz et al., 2015; York & Loeb, 2014), the purpose of the current study is to extend that literature and understand how parents respond to and utilize video-based messages that specifically focus on language and literacy development.

This research was driven by four main research questions:

RQ1: Do parents recall video messages encouraging them to support young children’s language development embedded in existing text messaging services?

RQ2: What are parents’ attitudes toward the video content?

RQ3: Do parents report any changes in behavior after viewing the videos?

RQ4: What are parent attitudes and preferences about accessing videos via link or embedded MMS message?

Method

A total of eight focus groups with primary caregivers who subscribed to either Text4baby or Univision services were conducted in Miami, FL and Chicago, IL. These two cities were chosen for their high number of subscribers and higher rates of lower income and Spanish-speaking families. Two focus groups were conducted with parents who subscribed to Univision Contigo in Chicago and two in Miami; all four were conducted in Spanish. The remaining four focus groups were conducted in English with Text4baby subscribers with two in Chicago and two in Miami. Focus groups were used because focus groups allow for “discover[y of] collective perspective, ‘synthesis and validation of ideas and concepts,’ involvement of diverse group of people, and access to a potentially large number of participants” (Gibbs, 2017, pp. 190–191), while also capturing nuanced perceptions of the text messaging services directly from the user. All of these elements were necessary for us to better understand caregivers’ use and evaluation of these services across several dimensions. All study procedures were approved by the sponsoring university’s Institutional Review Board.

Services

Text4baby

Text4baby is a free, national service designed to provide child health and safety information to new parents. Parents receive information via texts sent three times a week (https://www.text4baby.org/; U.S. Department of Health and Human Services, 2015). Texts are available in both English and Spanish. Text4baby focuses primarily on mother and child health. Typical Text4baby topics include: ensuring that the infants’ shots are up to date, reminders to attend well-child appointments, and information about when to expect infants to roll, crawl, walk, and talk. Beyond parent and child health, Text4baby also sends messages about infants’ cognitive, linguistic, and social-emotional development. In partnership with The Clinton Foundation’s Too Small to Fail initiative, parents are sent specific messages to support young children’s language and literacy learning using Sesame Street materials (Too Small to Fail, 2015). These messages include texts with a link to access multimedia information about things like talking with your child, reading to your child, and singing during bath time. These messages are sent once every 2 weeks after the infant’s ninth week of development. Since 2010, Text4baby has reached over 685,000 mothers through its mobile health service and nearly half of those participants come from low-income households (Martinez & Uekusa, 2013).

Univision Contigo

Univision, a Spanish language media company, is also involved in a large-scale text messaging campaign with Too Small to Fail that focuses on promoting rich language and literacy environments for Spanish-speaking families using a mix of text and multimedia methods. Univision Contigo and its associated campaign with Too Small to Fail, Pequeños y Valiosos, includes a mobile messaging service that typically texts caretakers once a week and focuses primarily on supporting parents by encouraging them to engage in language-rich activities with their young children (The Clinton Foundation, 2014). Similar to Text4baby, typical messages include tips, prompts, and other information to help parents talk, read, and sing with their young children from birth. Occasionally, messages will also include information about upcoming Univision television programming relevant to parents or caretakers of young children. Often, prominent Univision network anchors and other on-air talent are present in the videos. Approximately 350,000 families have received information via its text and online services (Univision Communications Inc [UCI] PR team, 2018).

Service differences

Three key differences between the Text4baby and Univision services should be highlighted. First, the overall content of the messages differs widely as the purpose of Text4baby is primarily to support maternal and child health, whereas the purpose of Univision is to support child language and literacy. A second key difference is the frequency with which parents receive messages. Parents receive Text4baby messages three times a week and parents receive Univision messages only once per week. Finally, there are also important differences in the technology used by both services. Text4baby relies on single message service (SMS), whereas Univision utilizes multimedia messages (MMS). This technological difference allows Univision parents to receive media content embedded into the text message, while Text4baby parents must click a link to access the multimedia experiences.

Participants

Users of Text4baby and Univision in Miami, FL and Chicago, IL were texted information about participating in a local focus group. Emails and Facebook posts with the same study information were also sent to Univision and Text4baby partners to distribute and recruit participants in these two cities. All interested participants called in to opt in to focus groups and the moderators selected participants to ensure a mix of demographic characteristics for each group. Participants were compensated $100 in cash for their time.

Focus group participants (N = 69) were mostly female (n = 63, 91%), between the ages of 18 and 61 (M_age = 32.4), had a child or children between the ages of 0 and 5, were predominately low-income (75% of participants reported household incomes below the federal poverty level for a household of their size), and identified mostly as Hispanic/Latino(a) (n = 38, 55%). See Table 1 for information on the demographic makeup of each focus group.

Table 1.

Demographic composition of each focus group.

Group	n	Age		Age ofchild		Race	Education	Gender
		M	SD	M	SD
Text4baby Miami 1	10	27.89	3.48	0.58	0.29	1 Caucasian, 5 Latino, 3 African American, 1 biracial	5 less than college degree, 4 college degree, 1 postcollege degree	10 female, 0 male
Text4baby Miami 2	7	30.00	4.47	0.61	0.23	1 Caucasian, 1 Latino, 5 African American	4 less than college degree, 2 college degree	7 female, 0 male
Text4baby Chicago 1	9	26.00	5.39	0.39	0.29	1 Latino, 8 African American	8 less than college degree, 1 college degree	8 female, 1 male
Text4baby Chicago 2	9	28.78	6.77	1.33	2.09	1 Caucasian, 2 Latino, 6 African American	7 less than college degree, 1 college degree, 1 postcollege degree	9 female, 0 male
Univision Miami 1	9	37.33	10.69	2.16	0.97	9 Latino	4 less than college degree, 2 college degree, 3 postcollege degree	8 female, 1 male
Univision Miami 2	8	37.88	10.95	2.25	2.13	8 Latino	3 less than college degree, 5 college degree	7 female, 1 male
Univision Chicago 1	9	35.63	9.12	3.25	1.39	9 Latino	9 less than college degree	7 female, 2 male
Univision Chicago 2	8	36.63	8.05	3.51	3.61	8 Latino	7 less than college degree, 1 college degree	7 female, 1 male

Note. Means and standard deviations for parent and child age (in years) for each group. Child age is calculated for youngest child in household.

Procedure

Each participant completed an informed consent form and a short survey that asked about demographic information (e.g., age, race, gender, household income, and education) and their experience using the respective text-message-based services. Each focus group lasted for approximately 2 hours and all participants were encouraged to speak openly and honestly about their experiences. They were told that they were participating in a research study and there was no right or wrong answer. They were also told that the moderator and researchers do not work for Text4baby or Univision so participants could be honest with their feedback. For some questions, all individuals in the room volunteered to answer, while for others, only some individuals volunteered to speak. As a result, we use the term “many” to refer to instances when more than half of the room agreed with statements by way of hand raising or head nodding. We use “some” to refer to instances when about half of the group agreed and “few” when less than half agreed.

The moderators conducted semistructured focus groups, following an interview guide created by the research team. The interview guide addressed several broad categories about the videos included in the services, such as participants’ awareness of and experience with the videos, parents’ evaluation of the programs, the potential for messages to stimulate participant behavior change, and their suggestions or recommendations for the programs.

Measures

Recall of language and literacy messages

To understand participant memory and recall of the video messages, the moderators asked questions like, “Can you remember any of the activities that were recently sent to you?” “Have you ever clicked the links to play the videos?” (for Text4baby users) and “Do you remember anything about the videos specifically?”

Behavior change potential

To assess behavior change, moderators asked questions like, “Have you ever tried the activities suggested by [Text4baby/Univision Contigo]?” “Did you engage in any of the activities you saw in the Sesame Street videos?” and “Would you do any of these activities [from the video] with your baby?”

Evaluation of video content

Parents were asked “What do you think about the information you receive from [Text4baby/Univision Contigo]?” and “What did you like about them [videos]? What did you dislike about them [videos]?” The focus group moderators also showed participants several examples of video content that had previously been sent to parents via the texting services and asked them to rate these videos on a 5-point scale (1 = not helpful at all, 2 = somewhat helpful, 3 = helpful, 4 = very helpful, and 5 = extremely helpful). Participants also discussed why they chose a particular rating.

Features

The focus group moderators also solicited participants’ feelings about accessing the videos through questions like, “How often would you like to receive [video] messages from [Text4baby/Univision]?” and “How would you improve the [video] service?”

Analysis

All interviews were transcribed by The Clinton Foundation staff. Univision recordings were transcribed by fluent Spanish speakers who were trained in transcription. In line with Thomas (2006), the authors used general inductive analysis to determine themes throughout the interviews. Data analysis for this project was driven by initial evaluation objectives as a frame of reference. After multiple readings of the focus group transcripts, the authors met to develop a coding frame that best reflected the evaluation aims of the project. After the initial meeting, the first author used the coding frame to code two interviews. Then, the other authors assessed the coding frame as well as the first author’s new codes and any disagreements were discussed and agreed upon by the group. With these categories in mind, the first author coded the remaining interviews. Due to the differences in content, technology, and frequency of messaging, results for Text4baby and Univision participants will be discussed separately.

Results

Text4baby

Message recall

Our first research question asked if parents remembered and could recall specific messages that promoted language development. In our Miami groups, participants did not seem to remember any of the tips about talking, reading, or singing to their child. Indeed, these messages about early language development were almost never recalled until our moderators brought them up. Even when moderators asked about these tips, only 10 participants in total spoke up about receiving these messages. Such lack of recall was most apparent when our moderators asked about the Sesame Street videos specifically. In our Miami focus groups, only one participant indicated that she remembered a video with Sesame Street characters when asked about that specifically. She said, “I remember Big Bird was there . . . it was so long ago I don’t remember [what it was about].” In fact, most of the participants were often surprised to see Sesame Street videos when moderators showed them. On the other hand, our Chicago groups were more optimistic about the tips to facilitate engagement with their infants and several mentioned the videos before being prompted.

Behavior change

Participants who recalled the messages also differed in how useful they found them in terms of prompting positive parenting behaviors. About half of the participants seemed to appreciate the reminders to engage with their child and mentioned examples of trying to incorporate new words when talking to their young children. We heard a few people say things like “I like the activities” and “the reminders [are particular helpful].” Participants that could recall the videos also mentioned doing the activities at a higher rate. One mom said “Yes, I try to dance with my baby . . . I usually try them all, like talking to the baby.” Still, participants were looking for more guidance with these suggestions. One Chicago father said “like, sing [to] your child. Sing what to my child? You want me to sing to my child but why and when. I’ll do it, but to know why would help.”

Other participants were less positive about the topics, particularly if they already “knew to do these things.” Further, participants felt that these reminders were contributing to the anxiety that they felt about parenting. They felt that if they did not or could not do these things when they got the reminder, or if their child did not enjoy these things, they were doing it “wrong.” In one of our Miami focus groups, one parent mentioned that the videos and texts about literacy and language activities were overwhelming:

I think at one point I felt really bad that I was[n’t] doing everything that I was supposed to do, and so I would try to get a lot of information and then I would beat myself up for not reading to him every day. So sometimes I do think that while the information is helpful, you can kind of go overboard and then as a mom you feel really bad that you are not doing everything that you could.

After that, other participants joined her in describing their own anxieties: “My child is not going to go to Harvard because I don’t read two books to him every day or something and then you’re like yeah, start getting overwhelmed.” Considerable amount of discussion was spent around these anxieties.

Video message content

The focus group moderators showed the parents the videos of Sesame Street characters encouraging parents to engage with their child that had been sent via links in the Text4baby program (see Figure 1 for an example of the text and Figure 2 for one of the videos). When they saw these video clips, parents were generally favorable towards them. On average, our focus groups rated the video messages as very helpful (M = 4.1 out of 5). In some cases, participants said that they like the videos even more than the texts that preceded them. In general, participants liked the videos with catchy songs and the inclusion of both live and Muppet characters. Parents were particularly pleased to see Elmo. Video messages that were “short and simple,” “stayed on subject,” and modelled something new were enjoyed most by our participants.

Figure 1.

Image of Text4baby text with link.

Figure 2.

Screenshots of main action in Sesame Street videos.

They did not like everything, however. When video messages were more than 30 seconds long, participants felt they were “just too long.” Parents were also confused about the intended audience for the videos. Because the videos included Sesame Street characters, like Elmo, many parents expressed that they were unclear about whether these were videos they should be watching alone, with their child, or if it was something for their child to watch independently. In each group, we heard comments like “I don’t know if that was more for a child or a parent. I probably would have closed it quicker when I saw Elmo speaking to another puppet” and “Who is it for? [Say that] ‘this is for you and baby,’” from mothers after watching some of the videos.

Technical features of accessing video messages

Because Text4baby delivers content through single message service (SMS), there are limitations to how many characters can be used and additional information is often displayed as links to outside sources (see Figure 1). Most of the participants reported that while they read the texts from Text4baby, they did not always follow the links for the following reasons.

Parents receiving Text4baby messages reported technical problems. Several mentioned receiving the same messages multiple times, links to videos or other resources not working, and occasionally not getting any links at all. Parents stated, “you try to open it and it’s not working” and “some of the links don’t work, even if you click on it, like at least for some of the links do work, and sometimes I’ll click on it and it says error.” Indeed, in every Text4baby focus group, some amount of discussion was devoted to the technical failures and frustrations of using the service.

Outside of the technical problems, a handful of participants never opened the links in Text4baby messages and at least three participants in each group did not recall ever seeing videos or links to videos in the Text4baby text messages. When our moderator showed some examples of texts that parents would have received, the majority of the parents shook their heads when asked if they click on the links. A few parents seemed to think they did not get links saying things like, “Yeah, I don’t know why, I haven’t got any links” and “I don’t get links.” However, after hearing other participants describe them and watching a few sample links as part of our research, most of these parents found the information useful. In fact, after showing some of the videos, the moderator asked the group how many of them were more likely to click on the links, and one participant shared, “I would [click on it now]. The examples are really colorful and are good examples.” She was not alone, as several others nodded as well. Without more information, however, parents would not click on these auxiliary links. Above all, though, parents wanted a rationale for taking the extra step to watch these videos and considerable discussion was spent on this topic.

Text4baby parents also mentioned other barriers to watching the video content. When our moderators asked why they do not click on the links, one or two participants in each group noted that they were concerned about using cellular data for watching the videos. In every group, at least a couple of parents had limited data plans. For these participants, seeing a link denotes that “it’s usually data” and “I don’t want to waste data on the phone.” Other participants felt that they did not have the time to watch the videos when they first receive them. When our moderator asked what prevents participants from watching the videos, one mother put it best when she said, “Because I have a toddler so I’m busy. I don’t even know where my phone is half the time!” Though comical (she even chuckled after she said it), this quote reflects a barrier to video viewing for today’s parents living in our fast-paced and hectic world.

Univision

Message recall

The parents who subscribe to Univision Contigo’s Pequeños y Valiosos service in our focus groups did remember watching the videos encouraging them to talk, read, and sing to their babies. Some remembered a recent video from Sesame Street’s Elmo prompting parents to establish a routine of reading to their child. Other participants recalled videos with Univision star Alejandra Espinoza (see Figure 3 for example). Most Univision participants recognized the videos our moderators screened.

Figure 3.

Image of Univision text with video.

Behavior change

Not only did Univision participants recall the activities encouraging them to talk, read, dance, sing, and play with their children, they also overwhelmingly reported practicing these behaviors at a relatively high rate. Interestingly, some participants also reported that they originally did not think that talking and interacting with their child was important, and watching these videos taught them to see the importance of such interaction. One participant said, “I try to do it every day, something every day.” Another participant said, “I do it [the activities] every day when I get out of my work. Sometimes I look at the texts sometimes I don’t, I just remember old ones and do that instead.” All participants reported practicing these techniques every day or at least every once in a while, although most participants do not try every single one. Reading, talking, and singing to children were listed as activities participants engaged in most after reading the tips, but some participants said they did not practice all of them, particularly “the singing one.”

Video message content

In terms of the video content, parents had mostly positive things to say about the topics covered in the messages. On average, our focus groups rated the video messages as very helpful (M = 4.37 out of 5). Parents liked the inclusion of Sesame Street Muppets and live actors and especially enjoyed videos that incorporated grandparents and other family figures. When the moderator asked specifically about the evaluation of the video with grandparents, the feedback was generally positive. In one group, a father said, “I think that this very nice because grandparents are important” and a grandmother in another group felt strongly that the video with the grandparent was important. She mentioned, “It makes me realize the impact and the importance of my role as a grandparent in my grandchild’s life.”

However, there were some criticisms of the videos too. In one group, participants discussed the class differences between their working-class lives and homes and those portrayed in the videos with well-known Univision talent. The women noted that the richly decorated, luxurious upper middle-class homes in the videos represented a socioeconomic life that did not match their lived experiences. One participant expressed, “It only shows this pretty perfect side . . . plus women have to work a lot. The activities she’s doing in the video then don’t seem as realistic” and another reflected, “when we see Alejandra Espinosa and the other people on the Univision team they have these nice children’s rooms. I don’t think it is a realistic view of the majority of the audience.” They thought portrayals of working-class families would be more appropriate. Specifically, parents requested, “if it could be more reflective of the viewers that watch Univision, more realistic” and “I would like to have normal people. I would like to have people like me so I can relate to them.” On the other hand, some participants in other groups loved seeing the Univision talent modeling language-rich activities with their own children, “it’s showing public figures as role models.” Focus group participants also liked the brevity of the Univision videos, which are 30 seconds or less.

Technical features of accessing video messages

Univision sends content as multimedia messages (MMS). Videos are embedded within the body of the text messages, so subscribers do not need to click on links or navigate away from the text messaging platform to watch the videos. Overall, Univision subscribers really enjoyed this feature and the videos, saying things like “I have the video right there, that is better” and “I would be more interested if I would have a video rather than if it is a link. I just find videos more interesting.” The Univision groups enjoyed the visual component of the videos saying things like “I prefer the videos because you capture more information more easily” and “I really don’t understand much when I read so I like videos better.” However, parents still wanted more information about what they would see before clicking to play the video.

The Univision focus groups reported fewer barriers to opening the videos, but there was still some mention of data usage concern. One parent mentioned that although she did not have unlimited data, it did not stop her from watching the videos. She said that she “just click[s] it at home when I have Wi-Fi.” In another group, one participant spent a significant amount of time talking about how she saves her data usage and finds other ways to play the videos. While not a pressing concern for Univision subscribers, there was still mention of this barrier.

Discussion

This study adds to the literature on mobile interventions designed to promote behavior change by examining the use of video messages. By comparing two different text messaging services, our findings shed insight into best practices for successfully reaching and impacting parents with video messages. This research also supports the importance of interventions designed to facilitate parent–child engagement in order to bolster language development in the very early years (e.g., Hurwitz et al., 2015; Providence Talks, 2014).

MMS video recommendations for intervention designers

Results of this study suggest that embedding video messages within the text directly via MMS technology is a valuable way to increase parent viewing of the content. Univision subscribers who received the messages as MMS messages recalled the video and text messages to talk, read, and sing with children much more than those from Text4baby who received messages as links in SMS messages. If links do continue to be the main method of pushing video content, our participants asked if the texts could somehow “highlight” what would be in the videos so they would be able to decide if they wanted to watch them. Participants recommended prompting users to “click here to see . . .” in the wording of the text. Several participants also recommended “hav[ing] the video there [embedded in the text] so you can just click the button.” Videos embedded into the text messages remove barriers that prevent parents from seeing these images. An added step of clicking on links for more information is burdensome, and streamlining participation in the intervention is necessary to improve adherence (e.g., Baker et al., 2011).

In light of SCT, video messaging can offer even greater potential for parenting behavior change, especially for those with less education and poor reading ability, since it visually models the desired behavior (Buhi et al., 2012). Our sample of low-income participants, especially the Univision users who had somewhat less education, seemed to agree that the videos were a good way to receive this information.

Our findings reveal that even when video content seemed useful and important to parents, the barriers to watching the videos make them ineffective in eliciting behavior change. Behavior change vis-à-vis SCT is not effective unless the participant attends to and retains the information (Bandura, 2001). Unfortunately, not all parents in this study remembered or even watched the videos included in the interventions, especially if the videos had to be accessed by a link off the text messaging platform—as is the case with Text4baby. Our research suggests that work should be done to better ensure exposure to these videos because parents, especially Text4baby parents, are not seeing them. After addressing the barriers to exposure, further implementation research on the videos for both services could identify other features of the video content that make for successful models (Rossi, Freeman, & Lipsey, 2003). Research considering the mechanisms by which exposure and the specific models support behavior would be wise.

Of Text4baby parents who reported seeing some of the videos, many mentioned barriers to clicking on the links. They mentioned technical issues like data usage or technical difficulties on the part of Text4baby, time concerns, and unawareness of the usefulness of the message. Such concerns are not unheard of, given our lower income sample (e.g., Rideout & Katz, 2016), and services aiming to reach this audience would do well to be sensitive to these concerns in the future. Despite enrolling thousands of new parents, Text4baby still struggles with some of the same challenges as the in-person intervention counterparts, namely in terms of adherence (or attendance in the case of in-person interventions; Baker et al., 2011) and general unawareness that additional material may be helpful (Hurwitz et al., 2015).

Content recommendations

The information in the videos about practicing parent–child engagement to support language development was generally well-received. These behaviors seem relatively easy to demonstrate using video and are liked by our constituents for the most part. Some elements of the video models may be attractive to and salient for participants (e.g., actors, Sesame Street Muppets, etc.), making attending to the videos easy (see Bandura, 2001, for more on attractive and appealing models), but somehow remembering them more difficult. These findings are in line with research on other video-based mHealth interventions with college students and young adults (Walsh-Buhi et al., 2016; Whittaker et al., 2011) in that participants reacted positively to the content, but did not report regularly watching them. Home visiting interventions designed to facilitate child word learning could look to these videos as additional ways to connect to parents. Indeed, incorporating videos as a supplement to in-person interventions might ensure higher levels of viewing (Jabaley, Lutzker, Whitaker, & Self-Brown, 2011).

Finally, our focus groups spent considerable time discussing the importance of the parent–child relationship with respect to fostering language development. Although some parents said that they already knew the importance of interacting with their children, not all of them did, which is consistent with prior literature (e.g., Ertem et al., 2007; Zero to Three, 2000). Even by merely prompting them with questions about the frequency of these activities and showing videos to model these actions, our research sheds light on the value of interventions intended to educate parents about positive parenting practices.

Implications for future research

As these focus groups show, the video links from Too Small to Fail are an exciting way to provide demonstrable, actionable tips for encouraging English- and Spanish-speaking parents to engage with their children in order to support their language and learning development. However, as the Text4baby participants made clear, it is unknown how many more subscribers could be impacted if they chose to click on the links and watch the videos. To the extent that this information is available, future research could utilize analytic data from Text4baby and Univision resources (or from similar content providers) on how many users go to the links, how long they spend at the sources, and at what time of day users most frequently open the links, to better characterize the reach of this novel yet promising form of communication.

In terms of the video content specifically, we can extrapolate that participants are likely interested in newer videos that are shorter, that show more realistic portrayals of the “average” family, and that include fathers, grandparents, and other extended family members. Surely, the use of models more similar to the subscribers could help to promote higher self-efficacy around performing content from the videos (Bandura, 2001). Along with our other recommendations, ideally, videos should be pushed out as embedded, working links with content that is short, diverse, and timely.

Limitations

While our findings are rich in detail, it should be noted that it is impossible to make any generalizable claims about everyone who subscribes to these text messaging services. Our 69 focus group participants may not be representative of the total population of text message service subscribers because they chose to join the focus group in the first place. Often, focus groups tend to attract people who love or hate services rather than being reflective of the “normal” or “average” user (e.g., Krueger, 1997; Morgan, 1997). Furthermore, people who do subscribe may be meaningfully different from the entire population of new parents with young children who do not subscribe to similar services, another reason for the inability to generalize these findings. Although we took great care in developing the semistructured interview questions and in building rapport during the sessions, it is possible that there was some social desirability bias from our focus group participants. Given that participants were not overly positive and that we did not see anyone visibly distressed during the focus groups, we have good reason to believe that participants were not merely appealing to our moderator and/or other group members.

Conclusion

Overall, our focus groups indicate that parents using these services enjoy the video content modeling parent–child engagement, but will only change their behavior if they actually watch the videos. These findings demonstrate that video messaging with appropriate models may indeed promote parent–child engagement by offering something explicit to learn from, in light of social cognitive theory. Future research should be designed to track such behavior change as a result of watching the videos, incorporating observational learning theories as potential explanations for any changes. By addressing parent–child engagement and interaction, presumably these large-scale video messaging interventions have the capacity to change the lives of children and parents for the better.

Footnotes

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by a grant from Pearson Education provided to The Clinton Foundation. The authors thank Patti Miller and Stephen Massey at The Clinton Foundation for their support during this project. Additional thanks to Sahara Byrne for her guidance and input on an earlier version of this manuscript and Zachary Lochmueller for his assistance with data entry.

Author biographies

Sarah Pila, MA, is a doctoral candidate in the Media, Technology, and Society Program at Northwestern University, working in the Center on Media and Human Development with Director Ellen Wartella. She received her Master’s degree in Child Study and Human Development from the Eliot–Pearson Department of Child Study and Human Development at Tufts University. Her research interests focus on the benefits of prosocial and educational media for young children, particularly in early childhood education.

Alexis R. Lauricella, PhD, is an assistant professor at Erikson Institute and Director of the Technology in Early Childhood Center at Erikson Institute. Lauricella earned her PhD in Developmental Psychology and her Master’s degree in Public Policy from Georgetown University. Her research is applied in nature and lies at the intersection of child development, communication, and public policy. Her research focuses on children’s learning from media.

Ellen Wartella, PhD, is the Sheikh Hamad bin Khalifa Al-Thani Professor of Communication Studies at Northwestern University and is the author or editor of 12 books and approximately 200 book chapters, research articles, reports, and papers. She is Editor of Social Policy Reports, a journal of the Society for Research in Child Development, and is a fellow of the American Academy of Arts and Sciences, the American Psychological Society, and the International Communication Association. She is past President of the International Communication Association.

References

Baker

C. N.

Arnold

D. H.

Meagher

(2011). Enrollment and attendance in a parent training prevention program for conduct problems. Prevention Science, 12(2), 126–138.

Bandura

(2001). Social cognitive theory of mass communication. Media Psychology, 3(3), 265–299.

Bandura

(2004). Health promotion by social cognitive means. Health Educucation & Behavior, 31(2), 143–164.

Brooks-Gunn

Berlin

L. J.

Fuligni

A. S.

(2000). Early childhood intervention programs: What about the family? In Shonkoff

J. P.

Meisels

S. J.

(Eds.), Handbook of early childhood intervention (2nd ed., pp. 549–588). New York, NY: Cambridge University Press.

Buhi

E. R.

Trudnak

T. E.

Martinasek

M. P.

Oberne

A. B.

Fuhrmann

H. J.

McDermott

R. J.

(2012). Mobile phone-based behavioural interventions for health: A systematic review. Health Education Journal, 72(5), 564–583.

Burchinal

M. R.

Peisner-Feinberg

Pianta

Howes

(2002). Development of academic skills from preschool through second grade: Family and classroom predictors of developmental trajectories. Journal of School Psychology, 40(5), 415–436.

Cartmill

E. A.

(2016). Mind the gap: Assessing and addressing the word gap in early education. Policy Insights from the Behavioral and Brain Sciences, 3(2), 185–193.

Coulton

Theodos

Turner

M. A.

(2012). Residential mobility and neighborhood change: Real neighborhoods under the microscope. Cityscape, 14(3), 55–89.

Dichtelmiller

Meisels

Plunkett

Bozytnski

Claflin

Mangelsdorf

(1992). The relationship of parental knowledge to the development of extremely low birth weight infants. Journal of Early Intervention, 16(3), 210–220.

10.

Duggan

(2013). Cell phone activities 2013. Retrieved from http://www.pewinternet.org/2013/09/19/cell-phone-activities-2013/

11.

Ertem

I. O.

Atay

Dogan

D. G.

Bayhan

Bingoler

B. E.

Gok

C. G.

. . . Isikli

(2007). Mothersʼ knowledge of young child development in a developing country. Child: Care Health and Development, 33(6), 728–737. doi:10.1111/j.1365-2214.2007.00751.x

12.

Evans

W. D.

Wallace

J. L.

Snider

(2012). Pilot evaluation of the Text4baby mobile health program. BMC Public Health, 12(1), 1031–1048.

13.

Fernald

Marchman

V. A.

Weisleder

(2013). SES differences in language processing skill and vocabulary are evident at 18 months. Developmental Science, 16(2), 234–248. doi:10.1111/desc.12019

14.

Gibbs

(2017). Focus groups and group interviews. In Coe

Waring

Hedges

L. V.

Arthur

(Eds.), Research methods and methodologies in education (2nd ed., pp. 190–196). London, UK: SAGE.

15.

Hart

Risley

T. R.

(1999). The social world of children: Learning to talk. Baltimore, MD: Paul H. Brookes.

16.

Hart

Risley

T. R.

(2003). The early catastrophe: The 30 million word gap by age 3. American Educator, 27(1), 4–9.

17.

Hirsh-Pasek

Adamson

L. B.

Bakeman

Owen

M. T.

Golinkoff

R. M.

Pace

. . . Suma

(2015). The contribution of early communication quality to low-income childrenʼs language success. Psychological Science, 26(7), 1071–1083. doi:10.1177/0956797615581493

18.

Hoff

(2013). Interpreting the early language trajectories of children from low-SES and language minority homes: Implications for closing achievement gaps. Developmental Psychology, 49(1), 4–14.

19.

Horowitz

J. E.

Sosenko

L. D.

Hoffman

J. L. S.

Ziobrowsky

Tafoya

Haagenson

Hahn

(2006). Evaluation of the PBS Ready To Learn cell phone study: Learning letters with Elmo. Los Alamitos, CA: WestEd.

20.

Hurwitz

L. B.

Lauricella

A. R.

Hanson

Raden

Wartella

(2015). Supporting Head Start parents: Impact of a text message intervention on parent–child activity engagement. Early Child Development and Care, 185(9), 1373–1389.

21.

Huttenlocher

Vasilyeva

Waterfall

H. R.

Vevea

J. L.

Hedges

L. V.

(2007). The varieties of speech to young children. Developmental Psychology, 43(5), 1062–1083.

22.

Jabaley

J. J.

Lutzker

J. R.

Whitaker

D. J.

Self-Brown

(2011). Using iPhones™ to enhance and reduce face-to-face home safety sessions within SafeCare®: An evidence-based child maltreatment prevention program. Journal of Family Violence, 26(5), 377–385. doi:10.1007/s10896-011-9372-6

23.

Jacobs

Easterbrooks

Brady

Mistry

(2005). Healthy Families Massachusetts: Final evaluation report. Retrieved from https://www.researchgate.net/publication/242612021_Healthy_Families_Massachusetts_Final_Evaluation_Report

24.

Karoly

L. A.

Greenwood

P. W.

Everingham

S. S.

Hoube

Kilburn

M. R.

Rydell

C. P.

. . . Chiesa

(1998). Investing in our children: What we know and donʼt know about the costs and benefits of early childhood interventions. Santa Monica, CA: RAND Corporation.

25.

Krueger

R. A.

(1997). Analyzing and reporting focus group results. Thousand Oaks, CA: SAGE.

26.

Landry

S. H.

Miller-Loncar

C. L.

Smith

K. E.

Swank

P. R.

(2002). The role of early parenting in childrenʼs development of executive processes. Developmental Neuropsychology, 21(1), 15–41. doi:10.1207/S15326942DN2101_2

27.

Martinez

K. M.

Uekusa

(2013). 2013 national survey of Text4baby participants. Retrieved from http://www.csusm.edu/anthropology/docsandfiles/Text4baby.pdf

28.

Morgan

D. L.

(1997). Focus groups as qualitative research (2nd ed.). Thousand Oaks, CA: SAGE.

29.

Prinz

R. J.

Sanders

M. R.

Shapiro

C. J.

Whitaker

D. J.

Lutzker

J. R.

(2009). Population-based prevention of child maltreatment: The U.S. Triple P system population trial. Prevention Science, 10(1), 1–12.

30.

Providence Talks. (2014). Providence Talks: Pilot findings & next steps. Retrieved from http://www.providencetalks.org/wp-content/uploads/2015/10/Providence-Talks-Pilot-Findings-Next-Steps.pdf

31.

Reid

M. J.

Webster-Stratton

Baydar

(2004). Halting the development of conduct problems in Head Start children: The effects of parent training. Journal of Clinical Child and Adolescent Psychology, 33(2), 279–291.

32.

Rideout

V. J.

Katz

V. S.

(2016). Opportunity for all? Technology and learning in lower-income families. A report of the Families and Media Project. New York, NY: The Joan Ganz Cooney Center at Sesame Workshop.

33.

Rossi

P. H.

Freeman

H. E.

Lipsey

M. W.

(2003). Evaluation: A systematic approach (7th ed.). Thousand Oaks, CA: SAGE.

34.

Sanders

M. R.

(2008). Triple P-Positive Parenting Program as a public health approach to strengthening parenting. Journal of Family Psychology, 22(4), 506–517.

35.

Shah

Sobotka

S. A.

Chen

Y. F.

Msall

M. E.

(2015). Positive parenting practices, health disparities, and developmental progress. Pediatrics, 136(2), 318–326.

36.

Shonkoff

J. P.

Phillips

D. A.

(2000). From neurons to neighborhoods: The science of early childhood development. Washington, DC: National Academies Press.

37.

Smith

(2015). U.S. smartphone use in 2015. Retrieved from http://www.pewinternet.org/2015/04/01/us-smartphone-use-in-2015/

38.

Tamis-LeMonda

C. S.

Bornstein

M. H.

Baumwell

(2001). Maternal responsiveness and childrenʼs achievement of language milestones. Child Development, 72(3), 748–767.

39.

The Clinton Foundation. (2014). Too Small To Fail joins with Univision to launch “Pequeños y Valiosos” (Young and Valuable). Retrieved from https://www.clintonfoundation.org/press-releases/too-small-fail-joins-univision-launch-pequenos-y-valiosos-young-and-valuable

40.

Thomas

D. R.

(2006). A general inductive approach for analyzing qualitative evaluation data. American Journal of Evaluation, 27(2), 237–246.

41.

Tolentino

(2015). SMS vs. push notification vs. email: When should your app use what? Retrieved from https://thenextweb.com/future-of-communications/2015/02/09/sms-vs-push-vs-email/

42.

Too Small to Fail. (2015). Too Small to Fail, Text4baby and Sesame Street launch first national text-to-parents program to support young childrenʼs early language development. Retrieved from http://toosmall.org/news/press-releases/too-small-to-fail-text4baby-and-sesame-street-launch-first-national-text-to-parents-program-to-support-young-childrens-early-language-development

43.

Univision Communications Inc. (UCI) PR team. (2018). The 2018 Pequeños y Valiosos campaign kicks off this Sunday. Retrieved from https://corporate.univision.com/press/2018/02/23/2018-pequenos-y-valiosos-campaign-kicks-off-sunday/

44.

U.S. Department of Health and Human Services. (2015). Promoting maternal and child health through health text messaging: An evaluation of the Text4baby program— Summary of key findings. Rockville, MD: Author.

45.

Walker

Greenwood

Hart

Carta

(1994). Prediction of school outcomes based on early language production and socioeconomic factors. Child Development, 65(2), 606–621.

46.

Walsh-Buhi

E. R.

Helmy

Harsch

Rella

Godcharles

Ogunrunde

Lopez Castillo

(2016). Pregnancy prevention at her fingertips: A text- and mobile video-based pilot intervention to promote contraceptive methods among college women. Health Education Journal, 75(5), 621–636.

47.

Whittaker

Dorey

Bramley

Bullen

Denny

Elley

C. R.

. . . Rodgers

(2011). A theory-based video messaging mobile phone intervention for smoking cessation: Randomized controlled trial. Journal of Medical Internet Research, 13(1), e10. doi:10.2196/jmir.1553

48.

Yap

M. B. H.

Morgan

A. J.

Cairns

Jorm

A. F.

Hetrick

S. E.

Merry

(2016). Parents in prevention: A meta-analysis of randomized controlled trials of parenting interventions to prevent internalizing problems in children from birth to age 18. Clinical Psychology Review, 50, 138–158.

49.

York

B. N.

Loeb

(2014). One step at a time: The effects of an early literacy text messaging program for parents of preschoolers (Center for Education Policy Analysis at Stanford University [CEPA] working paper). Retrieved from https://cepa.stanford.edu/sites/default/files/York%20&%20Loeb%20(October%202014).pdf

50.

Zero to Three. (2000). What grown-ups understand about child development: A national benchmark survey. Retrieved from https://static.virtuallabschool.org/atmt/physical/IT.Phys_2.Milestones_A2.GrwnupsUnderstandChildDev.pdf