Date of Award

Spring 2014

Degree Type

Final Project

Degree Name

DNP Doctor of Nursing Practice




Dr. Mary Ellen Roberts

Committee Member

Dr. Judith Lothian

Committee Member

Meghan Leigh, MS, LSW


Purpose: Despite major medical advancements and education, more than 500,000 babies are born prematurely and an estimated 28,000 infants die before their first birthday annually ( New Jersey’s infant mortality rate appears exemplary when compared to the United States overall infant mortality rate. Yet, New Jersey’s infant mortality rate, preterm birth rate and low birth rate by mother’s race reveal a far greater risk for infants born to a mother who is African American ( The need for innovative approaches to improving New Jersey’s maternal-infant health is paramount. Mobile phones may provide an appropriate means of addressing maternal-infant health challenges for women from underserved communities. The overall aim of this implementation project is to enroll young homeless pregnant and parenting mothers, accessing services within two urban settings of Covenant House-New Jersey, in the Text4baby mHealth program.

Methods: After consultation, young homeless 18-21 year old pregnant and new mothers who presented for residential or day services at Covenant House, if agreeable, were given the Text4baby program “How to Enroll” tear-off sheet, that is in use nationwide. Mothers were offered assistance with enrolling via cell phone as well as being offered the option of enrolling online. Staff education and weekly follow-up clinical site visits with staff and homeless resident mothers occurred at each clinical site. Weekly follow-up discussions focused on: reception of Text4baby messages, enrollment concerns or difficulty, if texts were read, if texts were perceived as interesting and helpful to the enrolled mother, and if texts resulted in a change of healthcare behaviors of enrolled mothers.

Findings: Homeless, pregnant 18 to 21 year old mothers residing in Covenant House transitional housing, that were offered assistance with enrolling via cell phone, enrolled in the free nationwide maternal-infant mHealth program, Text4baby, at a rate of 83.33%.

Enrolled homeless mothers had a 0% un-enrollment rate, in addition to joining TEAM Text4baby at a rate of 90%. There were no enrollment or technical difficulties reported. Text messages were read and saved by homeless mothers; perceived as interesting and helpful; and were acted upon by both pregnant and new mothers in this project. Pregnant and new mothers presenting for day-services at Covenant House-Crisis Shelter were offered information and enrollment assistance regarding Text4baby, as appropriate.

Conclusions: The Text4baby mHealth program provided important health information to 18-21 year old homeless pregnant and new mothers residing within transitional housing at Covenant House. Enrollment rates and TEAM Text4baby rates were excellent and exemplify the mission and social capital within Covenant House-New Jersey. The Text4baby Process Policies developed for both clinical sites support sustainability of this innovative approach to improve maternal-infant healthcare outcomes, effecting this especially vulnerable population of homeless, young mothers and infants.