title: For You and Your Baby (4YYB): Adapting the Centers for Disease Control and Prevention's Text4Baby Program for Saudi Arabia.
abstract: BACKGROUND
  Poor birth outcomes in the Kingdom of Saudi Arabia (KSA) have been found to be partially due to missed prenatal appointments as well as lack of knowledge of healthy pregnancy behaviors.
  
  
  OBJECTIVE
  The objectives are to summarize birth outcomes and the antenatal care system in KSA, summarize research related to the US Text4Baby mobile health program, and outline the development of an Arabic version of the Text4baby app, For You and Your Baby (4YYB).
  
  
  METHODS
  First, birth outcomes, health care access, and smartphone usage among Saudi Arabian women are reviewed. Next, the current evidence behind Text4Baby is described. Finally, a plan to develop and test 4YYB is proposed. In the plan, studies will need to be conducted to determine the effectiveness of 4YYB in educating pregnant Saudi women on healthy knowledge and behaviors. This will create an evidence base behind 4YYB before it is launched as a full-scale public health effort in KSA.
  
  
  RESULTS
  The KSA offers public medical services but remaining challenges include poor birth outcomes and health care access barriers. An estimated 73% to 84% of Saudi women of child-bearing age use smartphone social media apps. A total of 13 published articles on Text4Baby were identified and reviewed. Due to design limitations, the studies provide only limited evidence about the effectiveness of the program in increasing healthy pregnancy knowledge and behaviors. To be useful for Saudi women, the educational messages in 4YYB will need to be translated from English to Arabic and tailored for cultural norms.
  
  
  CONCLUSIONS
  Developing the 4YYB Arabic-language app for use by pregnant Saudi Arabian women based on Text4Baby is a viable approach, but a rigorous study design is needed to determine its effectiveness in improving healthy pregnancy knowledge and behaviors.
authors.affiliation: Department of Computer Science, University of Massachusetts Lowell, Lowell, MA, United States.
authors.forename: Soha
authors.identifier: http://orcid.org/0000-0002-6108-4020
authors.initials: S
authors.lastname: Bahanshal
authors.affiliation: Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA, United States.
authors.forename: Steven
authors.identifier: http://orcid.org/0000-0003-1704-0466
authors.initials: S
authors.lastname: Coughlin
authors.affiliation: Department of Computer Science, University of Massachusetts Lowell, Lowell, MA, United States.
authors.forename: Benyuan
authors.identifier: http://orcid.org/0000-0002-7543-1054
authors.initials: B
authors.lastname: Liu
keywords: Saudi Arabia; health knowledge, attitudes, practice; pregnant women; telemedicine; text messaging