Dataset Information

Text messaging to increase patient engagement in a large health care for the homeless clinic: Results of a randomized pilot study.

ABSTRACT:

Objectives

To assess the feasibility and effectiveness of text messaging to increase outpatient care engagement and medication adherence in an urban homeless population in Boston.

Methods

Between July 2017 and April 2018, 62 patients from a clinic serving a homeless population were sent automated text messages for four months. Messages were either appointment reminders and medication adherence suggestions (intervention group) or general health promotion messages (control group). Medical records were reviewed to evaluate appointment keeping, emergency room (ER) use, and hospitalizations. Pre- and post-surveys were administered to measure self-reported medication adherence.

Results

No significant differences were found in inpatient or outpatient care between the intervention and control groups, though differences in no-show rates and medication adherence approached significance. Appointment no-show rates were 21.0% vs. 30.6% (p = 0.08) for intervention and control, respectively, and rates of completed appointments were 65.8% vs. 56.7% (p = 0.12). Mean ER visits were 3.86 vs 2.33 (p = 0.16) for intervention and control groups, and mean inpatient admissions were 0.6 versus 1.24 (p = 0.42). Self-reported medication adherence increased from 8.27 to 9.84 in intervention participants, compared to an increase from 8.27 to 8.68 in control participants (p = 0.07), on a 1-11 scale.

Conclusions

Text messaging showed the potential to improve patient engagement in care and medication adherence in an urban homeless population (findings approaching but not achieving statistical significance). Work is needed to enhance the effectiveness of text-messaging interventions, which may involve increasing ease of use for mobile phones and texting apps, and addressing high rates of phone theft and loss.

SUBMITTER: Kershaw K

PROVIDER: S-EPMC9551340 | biostudies-literature | 2022 Jan-Dec

REPOSITORIES: biostudies-literature

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Publications

Text messaging to increase patient engagement in a large health care for the homeless clinic: Results of a randomized pilot study.

Kershaw Karyn K Martelly Lisa L Stevens Cassidy C McInnes D Keith DK Silverman Allie A Byrne Thomas T Aycinena Diana D Sabin Lora L LL Garvin Lynn A LA Vimalananda Varsha G VG Hass Robert R

Digital health 20220101

<h4>Objectives</h4>To assess the feasibility and effectiveness of text messaging to increase outpatient care engagement and medication adherence in an urban homeless population in Boston.<h4>Methods</h4>Between July 2017 and April 2018, 62 patients from a clinic serving a homeless population were sent automated text messages for four months. Messages were either appointment reminders and medication adherence suggestions (intervention group) or general health promotion messages (control group). M ...[more]

PMID: 36238754

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Project description:BackgroundAppropriate annual screenings for colorectal cancer (CRC) are an essential preventive measure for the second-leading cause of cancer-related death in the United States. Studies have shown that CRC screening rates are influenced by various social determinants of health (SDOH) factors, including race, ethnicity, and geography. According to 2018 national data, participation in screening is lowest among Hispanic or Latinx individuals (56.1%). At an urban Federally Qualified Health Center, a quality improvement project was conducted to evaluate a texting program with a motivational fotonovela-a short narrative comic. Fotonovelas have previously been used in programs to improve knowledge of cervical cancer and human papillomavirus, vaccinations, and treatments for depression.ObjectiveThis study aimed to encourage compliance with fecal immunochemical test (FIT) screening. Patient engagement involved a texting program with fotonovelas informed by behavior change techniques. This study sought to understand the qualitative characteristics of patient motivation, intention, and barriers to completing their screening.MethodsA total of 5241 English-speaking or Spanish-speaking Federally Qualified Health Center patients aged 50 to 75 years were randomized to either intervention (a 4-week tailored 2-way texting program with a fotonovela comic) or usual care (an SMS text message reminder and patient navigator phone call). The texting vendor used a proprietary algorithm to categorize patients in the intervention group into SDOH bands based on their home addresses (high impact=high social needs and low impact=low social needs). Over 4 weeks, patients were texted questions about receiving and returning their FIT, what barriers they may be experiencing, and their thoughts about the fotonovela.ResultsThe SDOH index analysis showed that most of the patient population was in the SDOH band categories of high impact (555/2597, 21.37%) and very high impact (1416/2597, 54.52%). Patients sent 1969 total responses to the texting system. Thematic analysis identified 3 major themes in these responses: messages as a reminder, where patients reported that they were motivated to return the FIT and had already done so or would do so as soon as possible; increasing patients' understanding of screening importance, where patients expressed an increased knowledge about the purpose and importance of the FIT; and expressing barriers, where patients shared reasons for not completing the FIT.ConclusionsThe texting program and fotonovela engaged a subset of patients in each SDOH band, including the high and very high impact bands. Creating culturally tailored messages can encourage patient engagement for accepting the content of the messaging, confirming intentions to complete their FIT, and sharing insights about barriers to behavior change. To better support all patients across the continuum of care with CRC screening, it is important to continue to develop and assess strategies that engage patients who did not return their home-mailed FIT.

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Dataset Information

Text messaging to increase patient engagement in a large health care for the homeless clinic: Results of a randomized pilot study.

Objectives

Methods

Results

Conclusions

Publications

Text messaging to increase patient engagement in a large health care for the homeless clinic: Results of a randomized pilot study.

Similar Datasets

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