Novel implementation strategy to electronically screen and signpost patients to health behavior apps: Mixed methods implementation study (OptiMine study)

Khadjesari, Zarnie ORCID:, Brown, Tracey J., Ramsey, Alex T., Goodfellow, Henry, El-Toukhy, Sherine, Abroms, Lorien C., Jopling, Helena, Viik, Arden Dierker and Amato, Michael S. (2022) Novel implementation strategy to electronically screen and signpost patients to health behavior apps: Mixed methods implementation study (OptiMine study). JMIR Formative Research, 6 (7). ISSN 2561-326X

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Background: Behavior change apps have the potential to provide individual support on a population scale at low cost, but they face numerous barriers to implementation. Electronic health records (EHRs) in acute care hospitals provide a valuable resource for identifying patients at risk, who may benefit from behavior change apps. A novel, emerging implementation strategy is to use digital technologies not only for providing support to help-seeking individuals but also for signposting patients at risk to support services (also called proactive referral in the United States). Objective: The OptiMine study aimed to increase the reach of behavior change apps by implementing electronic signposting for smoking cessation and alcohol reduction in a large, at-risk population that was identified through an acute care hospital EHR. Methods: This 3-phase, mixed methods implementation study assessed the acceptability, feasibility, and reach of electronic signposting to behavior change apps by using a hospital’s EHR system to identify patients who are at risk. Phase 1 explored the acceptability of the implementation strategy among the patients and staff through focus groups. Phase 2 investigated the feasibility of using the hospital EHR to identify patients with target risk behaviors and contact them via SMS text message, email, or patient portal. Phase 3 assessed the impact of SMS text messages sent to patients who were identified as smokers or risky drinkers, which signposted them to behavior change apps. The primary outcome was the proportion of participants who clicked on the embedded link in the SMS text message to access information about the apps. The acceptability of the SMS text messages among the patients who had received them was also explored in a web-based survey. Results: Our electronic signposting strategy—using SMS text messages to promote health behavior change apps to patients at risk—was found to be acceptable and feasible and had good reach. The hospital sent 1526 SMS text messages, signposting patients to either the National Health Service Smokefree or Drink Free Days apps. A total of 13.56% (207/1526) of the patients clicked on the embedded link to the apps, which exceeded our 5% a priori success criterion. Patients and staff contributed to the SMS text message content and delivery approach, which were perceived as acceptable before and after the delivery of the SMS text messages. The feasibility of the SMS text message format was determined and the target population was identified by mining the EHR. Conclusions: The OptiMine study demonstrated the proof of concept for this novel implementation strategy, which used SMS text messages to signpost at-risk individuals to behavior change apps at scale. The level of reach exceeded our a priori success criterion in a non–help-seeking population of patients receiving unsolicited SMS text messages, disconnected from hospital visits.

Item Type: Article
Additional Information: Acknowledgements: The authors are grateful to the patients and staff at the West Suffolk Foundation Trust, who participated in this study, and the team that facilitated the study on-site, namely, Adam Jull, Cassia Nice, Josh Wigley, Liam McLaughlin, Simon Reeve, Anna Hollis, Penny Molkenthin, and Paul Oats. This study was funded by a Cancer Research UK Cancer Policy Research Centre innovation grant (C69129/A28665). The authors acknowledge the support from the National Institute for Health Research (NIHR) Clinical Research Network. The effort of SE was supported by the Division of Intramural Research of the National Institute on Minority Health and Health Disparities, National Institutes of Health. ATR was supported by the National Institute on Drug Abuse grant (K12DA041449). This is a summary of the study supported by the NIHR Applied Research Collaboration East of England. The views expressed are those of the authors and not necessarily those of the National Health Service, NIHR, UK Department of Health and Social Care, US National Institutes of Health, US Department of Health and Human Services, or West Suffolk Foundation Trust.
Uncontrolled Keywords: ehr,alcohol,alcohol reduction,alcohol use,electronic health record,electronic messages,mhealth,mobile app,mobile health,proactive messages,proactive outreach,smoking,smoking cessation,tobacco use,medicine (miscellaneous),health informatics ,/dk/atira/pure/subjectarea/asjc/2700/2701
Faculty \ School: Faculty of Medicine and Health Sciences > School of Health Sciences
Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Centres > Norwich Institute for Healthy Aging
Faculty of Medicine and Health Sciences > Research Groups > Behavioural and Implementation Science
Faculty of Medicine and Health Sciences > Research Groups > Health Promotion
Faculty of Medicine and Health Sciences > Research Centres > Lifespan Health
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Depositing User: LivePure Connector
Date Deposited: 15 Jul 2022 10:30
Last Modified: 20 Jul 2024 22:31
DOI: 10.2196/34271


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