Exploring the Use of Theory in a National Text Message Campaign: Addressing Problem Recognition and Constraint Recognition for Publics of Pregnant Women

Infant mortality is associated with access to healthcare, knowledge, and health literacy. Text4baby, the largest national texting health initiative, seeks to address these factors. However, no research has examined the program’s theoretical framework, an aspect that may impact its success. To address this gap, Text4baby’s use of theory was evaluated through a content analysis of Text4baby messages and interviews with Text4baby content developers. We compared the main variables of health behavior theories framing Text4baby messages with the situational theory of publics and its factors of problem recognition and constraint recognition. The situational theory of publics provides an understanding of the types of publics that might emerge from Text4baby’s audiences of pregnant women. Aware, latent, and active publics are defined by the situational theory and are created out of problem recognition and constraint recognition along with a level of personal involvement in the issue of prenatal health. We used content analysis and interviewing to explore how Text4baby prenatal messages were constructed using theory and to offer lessons learned for prenatal health campaigns. The multi-methodological approach to understanding meaning construction in the production of these text messages and how meaning played out in the messages is a useful framework for text message campaigns.