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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine the best way to encourage parents to reschedule missed well-child visits for their children. Researchers are comparing three approaches: no follow-up, sending text reminders (low-touch), and having a community health worker reach out personally (high-touch). They seek to identify which method most effectively increases attendance at these important check-ups and to assess the associated costs. Families with children who have missed a well-child visit in Forsyth County, North Carolina, and have a contactable caregiver qualify as candidates for this study. As an unphased trial, this study offers families the opportunity to contribute to improving healthcare practices for children.

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 prior data suggests that these follow-up protocols are safe?

Studies have shown that text message reminders can help people remember their appointments and improve their health. A review found that 86% of studies reported positive results from using text messages for appointment reminders, indicating that many people find these reminders helpful and safe to use.

Research on community health worker (CHW) outreach has demonstrated its effectiveness in reducing missed appointments and hospital readmissions. CHWs provide support and connect people to resources, aiding them in attending medical visits. Although specific safety data for CHW outreach is lacking, it is generally considered safe because it involves supportive phone calls and assistance. Since these methods do not involve medication or medical procedures, there are no known safety risks. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores innovative ways to ensure patients don't miss their routine check-ups. Unlike the typical approach of relying on patients to remember and schedule their own appointments, this trial tests two proactive methods: texting reminders and outreach by community health workers (CHWs). Text messaging offers a low-cost, direct way to prompt caregivers to reschedule missed appointments with up to three reminders. On the other hand, the high-touch method involves CHWs personally reaching out to families, offering not just reminders but also support in overcoming barriers to attending appointments, such as financial or logistical challenges. These methods aim to improve healthcare access and adherence, potentially leading to better health outcomes.

What evidence suggests that this trial's follow-up protocols could be effective for improving Well-Child Visit attendance?

This trial will compare two methods to reduce missed medical appointments: text message reminders and community health worker outreach. Studies have shown that text message reminders can significantly reduce missed appointments. They provide an easy and affordable way to help people remember their appointments, and research indicates that these reminders can increase attendance by simplifying rescheduling if needed.

Community health workers have also proven effective in helping people keep their appointments. These workers connect directly with patients to offer support and resources, addressing specific challenges that might prevent attendance. Both methods have shown promising results in reducing missed visits, and this trial will evaluate their effectiveness in separate treatment arms. ^{3 5 6 7 8}

Who Is on the Research Team?

Beata Debinski, PhD

Principal Investigator

Wake Forest University Health Sciences

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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).

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8138690/

Effect of Community Health Workers on 30-Day Hospital ... Intervention participants also were less likely to miss clinic appointments, but no significant reductions in ED visits were noted. These ...

2. ahrq.gov ahrq.gov/downloads/pub/evidence/pdf/comhealthwork/comhwork.pdf

Outcomes of Community Health Worker Interventions To conduct a systematic review of the evidence on characteristics of community health workers (CHWs) and CHW interventions, outcomes of such interventions, ...

3. chwcentral.org chwcentral.org/wp-content/uploads/Community-Health-Worker-Integration-with-and-Effectiveness-in-Health-Care-and-Public-Health-in-the-United-States.pdf

Community-Health-Worker-Integration-with-and- ... Several studies have demonstrated that CHWs can improve the management of chronic conditions, increase access to preventive care, improve patients' experience ...

4. refugeehealthta.org refugeehealthta.org/wp-content/uploads/2012/07/comhwork-1.pdf

Outcomes of Community Health Worker Interventions The literature showed mixed results of effectiveness when analyzed by clinical context: CHW interventions had the greatest effectiveness relative to ...

5. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8622376/

Mechanisms for Community Health Worker action on patient ... CHW interventions have been found to reduce costs, improve high-value care preventing emergency department (ED) visits, and increase primary care utilization ( ...

6. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2780265

Effect of Community Health Workers on 30-Day Hospital ... This randomized clinical trial found that pairing ACO-insured inpatient adults with CHWs reduced readmissions and missed outpatient visits 30 days ...

7. withpower.com withpower.com/trial/texting-vs-community-health-worker-outreach-for-missed-routine-check-ups-3bdc3

Texting vs Community Health Worker Outreach for Missed ... 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 ...

8. researchgate.net researchgate.net/publication/361435127_Decreasing_Missed_Appointments_at_a_Community_Health_Center_A_Community_Collaborative_Project

(PDF) Decreasing Missed Appointments at a Community ... Results: Within one quarter, missed appointment rates at the clinic dropped by 6%-17% for different appointment types. Conclusion: While the project was ...