Texting vs Community Health Worker Outreach for Missed Routine Check-Ups

Overseen By Taylor J. Arnold, PhD

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: Wake Forest University Health Sciences

Disqualifiers: Rescheduled appointment, Caregiver under 18

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 3

5885 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications.

What data supports the effectiveness of the treatment High-touch: Community health worker outreach, Low-touch: texting for missed routine check-ups?

Research shows that text message reminders can increase clinic attendance and improve communication between patients and healthcare providers. Additionally, community health workers have been effective in bridging communication gaps, especially in rural areas, by using mobile technology to enhance healthcare delivery. ^{1 2 3 4 5}

Is it safe to use texting and community health worker outreach for missed routine check-ups?

The research does not provide specific safety data for using texting and community health worker outreach for missed routine check-ups, but these methods are generally considered safe as they involve communication and reminders rather than medical treatments. ^{2 6 7 8 9}

How does the treatment of texting vs community health worker outreach for missed routine check-ups differ from other treatments?

This treatment is unique because it uses text messaging and community health worker outreach to remind patients about their missed check-ups, which is different from traditional methods that might rely solely on phone calls or letters. Text messaging is a modern, convenient way to reach patients quickly and can be more cost-effective and efficient in improving attendance rates for routine health visits. ^{2 10 11 12 13}

What is the purpose of this trial?

The overall goal of this study is to compare the effectiveness of different follow up protocols for scheduled but not attended ("no-show") Well-Child Visits, relative to care-as-usual (no standardized or typical follow up procedure). The main goals are to: * Demonstrate feasibility of merging a new referral protocol following Well-Child visit no-show into existing health system Community Health Worker resources. * Compare Well-Child Visit attendance following no-show between patients randomized to care-as-usual (comparison), text message only (low-touch intervention), and community health worker outreach (high-touch intervention) groups. * Define the costs and cost-effectiveness of different follow-up protocols.

Research Team

Beata Debinski, PhD

Principal Investigator

Wake Forest University Health Sciences

Eligibility Criteria

This trial is for families who missed a scheduled Well-Child Visit. It's open to those who are part of the health system where the study takes place, but not if they have a standardized follow-up procedure already in place.

Inclusion Criteria

I have a primary caregiver's phone number listed.

I am 17 years old or younger.

No-showed for a well-child visit scheduled at a family medicine or general pediatrics practice in Forsyth County, North Carolina

Exclusion Criteria

Already rescheduled their appointment by the time the sample list was generated

My caregiver is under 18 years old.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1 week

Intervention

Participants receive either care-as-usual, text message reminders, or community health worker outreach following a missed Well-Child visit

6 weeks

Up to 3 contacts (text or phone)

Follow-up

Participants are monitored for Well-Child visit completion and other healthcare encounters

3 months

Treatment Details

Interventions

• High-touch: Community health worker outreach
• Low-touch: texting

Trial Overview The study tests two follow-up methods after a missed Well-Child Visit: text messages (low-touch) and community health worker outreach (high-touch), compared with no standard follow-up (care-as-usual).

Participant Groups

Group I: Low-touch: Text messaging only Experimental Treatment 1 Intervention

The patients' primary caregiver will receive a text message that includes details about the missed appointment, and guidance on rescheduling. Up to three total reminders will be sent, spaced one week apart, if the appointment is not rescheduled in the interim.

Group II: High-touch: Community Health Worker outreach Experimental Treatment 1 Intervention

Regardless of rescheduling status, the Community Health Worker (CHW) will reach out to the primary phone number on file within approximately 1 week of enrollment in the study. Per usual team protocol, up to three phone call attempts will be made to the primary phone number on file, followed by an attempt to the secondary phone number on file. The CHW will screen the families' needs per their usual protocol and inquire about reasons for no-showing for the scheduled appointment; additional questions will include whether they can provide support for rescheduling the no-showed visit and helping to attend it. The CHW will also have a discretionary fund available through this project to help support the family in addressing instrumental needs if existing resources are not available through the hospital, governmental services, or other organizations.

Group III: Care as Usual Active Control 1 Intervention

In the comparison group, patients' caregivers will not be subject to any standardized follow-up procedure.

Who Is Running the Clinical Trial?

Wake Forest University Health Sciences

Lead Sponsor

Trials

1,432

Recruited

2,506,000+

National Institute on Minority Health and Health Disparities (NIMHD)

Collaborator

Trials

473

Recruited

1,374,000+

Findings from Research

Community health workers (CHWs) significantly improve population health by connecting individuals to necessary resources, and integrating mobile health (mHealth) tools can enhance their effectiveness, as shown in a review of 64 studies published between 2007 and 2018.

Despite the positive impact of mHealth interventions involving CHWs, challenges remain, including a lack of culturally relevant tools, inconsistent methodologies for assessing outcomes, and the need for better training and communication among health care teams.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Use of Mobile Health (mHealth) Technologies and Interventions Among Community Health Workers Globally: A Scoping Review. Early, J., Gonzalez, C., Gordon-Dseagu, V., et al.[2020]

Text-message reminders for health workers (HWs) were well-received and appreciated as helpful job aids, but did not significantly improve adherence to case management guidelines due to systemic barriers like high workloads and stock-outs.

The study suggests that while SMS reminders can enhance understanding of treatment guidelines, additional support such as targeted supervision and two-way communication may be necessary to overcome structural challenges and improve clinical practice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of mobile phone text message reminders on health workers' adherence to case management guidelines for malaria and other diseases in Malawi: lessons from qualitative data from a cluster-randomized trial. Kaunda-Khangamwa, BN., Steinhardt, LC., Rowe, AK., et al.[2020]

References

1. United States pubmed.ncbi.nlm.nih.gov

How effective are short message service reminders at increasing clinic attendance? A meta-analysis and systematic review. [2022]

2. Pakistan pubmed.ncbi.nlm.nih.gov

Efficacy of Mobile Phone SMS Reminder for Increasing the Patient Follow-Up Consultation Visits in OPD Clinics. [2020]

3. Australia pubmed.ncbi.nlm.nih.gov

mHealth is an Innovative Approach to Address Health Literacy and Improve Patient-Physician Communication - An HIV Testing Exemplar. [2022]

4. Australia pubmed.ncbi.nlm.nih.gov

SMS text messaging improves outpatient attendance. [2019]

5. Netherlands pubmed.ncbi.nlm.nih.gov

A text message-based intervention to bridge the healthcare communication gap in the rural developing world. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

The mCME Project: A Randomized Controlled Trial of an SMS-Based Continuing Medical Education Intervention for Improving Medical Knowledge among Vietnamese Community Based Physicians' Assistants. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Use of Mobile Health (mHealth) Technologies and Interventions Among Community Health Workers Globally: A Scoping Review. [2020]

8. Canada pubmed.ncbi.nlm.nih.gov

The Mobile Solutions for Immunization (M-SIMU) Trial: A Protocol for a Cluster Randomized Controlled Trial That Assesses the Impact of Mobile Phone Delivered Reminders and Travel Subsidies to Improve Childhood Immunization Coverage Rates and Timeliness in Western Kenya. [2022]

9. England pubmed.ncbi.nlm.nih.gov

The effect of mobile phone text message reminders on health workers' adherence to case management guidelines for malaria and other diseases in Malawi: lessons from qualitative data from a cluster-randomized trial. [2020]

10. China pubmed.ncbi.nlm.nih.gov

Comparison of an SMS text messaging and phone reminder to improve attendance at a health promotion center: a randomized controlled trial. [2022]

11. United States pubmed.ncbi.nlm.nih.gov

Effectiveness and Cost of Bidirectional Text Messaging for Adolescent Vaccines and Well Care. [2022]

12. Canada pubmed.ncbi.nlm.nih.gov

Crafting Appealing Text Messages to Encourage Colorectal Cancer Screening Test Completion: A Qualitative Study. [2018]

13. England pubmed.ncbi.nlm.nih.gov

Patient preferences and access to text messaging for health care reminders in a safety-net setting. [2022]