“Technological proficiencies, engagement, and practical considerations for mHealth programs at an urban safety-net hospital emergency departments: randomized control trial” (Preprint)

Abstract

Safety-net emergency departments often serve as the primary entry point for medical care for low income predominantly minority patient populations. Here we sought to provide insight to the feasibility, technological proficiencies, engagement characteristics, and practical considerations for a mHealth intervention at a safety-net emergency department.

An analysis of patient technological proficiency to understand feasibility and draw practical considerations for mobile phone technology (mHealth) solutions for patients with chronic disease served by safety-net emergency departments (EDs).

We analyzed data from the 2017-2019 TExT-MED + FANS social support intervention for diabetes randomized clinical mHealth trial. From a safety-net ED, patients with pre-existing diabetes who used SMS text messages, owned a mobile phone, and had a Hemoglobin A1C (Hba1c) >8.5% were enrolled. A text message based mHealth program to improve disease self-management was provided to all patients. Supporters of patients were randomized to receive a mailed copy or a mHealth based curriculum designed to improve diabetes support. Among enrolled patients, we surveyed mobile technological capacity and frequency of use, and then performed a latent class analysis to identify classes of patients by technological proficiency. We compared demographic characteristics between the latent classes to identify demographic subgroups which may require more training or tailoring to the mHealth approach. Study engagement between classes was assessed via comparison of mean text-messages exchanged, loss to follow-up rates, and early termination.

Of approached patients, 44% (n=829) of patients had a stable mobile phone and were able to use text messages. Among them 166 met the trial inclusion and enrolled, 90% of the cohort were ethnically diverse. Significant variance was found in technology capacity and frequency of use. Our latent class analysis classified 75% of patients as “highly technologically proficient” and 25% as “minimally technologically proficient”. Age (p<0.0001) and educational attainment (p<0.05) correlated with class membership. Highly technologically proficient patients were younger and had higher educational attainment than the minimally technologically proficient patients (45.74 years old with 90% high school or more compared to 53.64 years old and 18% high school or more for minimally technologically proficient patients). Highly technologically proficient participants exchanged a mean of 40 text-messages compared to 10 text-messages by minimally technologically proficient patients (p<.0001) with the system coordinators.

This study contributes a rare statistic in mHealth literature that, nearly half of screened safety-net ED’s patients are equipped for SMS-text message-based mHealth interventions. Of the small sample enrolled, the majority were classified as highly technologically proficient. These highly proficient patients had greater study engagement. mHealth use in EDs may be an opportunity to improve health of ethnically diverse populations by pairing sophisticated chronic disease self-management program with SMS text-message and traditional in-person intervention to reach patients through each patient’s most familiar and comfortable method.

RR2-10.1016/j.cct.2019.03.003