A Tailored SMS Text Message Based Intervention to Facilitate Patient Access to Referred Community-Based Social Needs Resources: Protocol for a Feasibility and Acceptability Pilot (Preprint)
Authors: Lian Tyler , Reid Hadley , Rader Abigail , Dewitt-Feldman Sarah , Hezarkhani Elmira , Gu Elizabeth , Scott Malik , Kutzer Kate , Sandhu Sahil , Crowder Carolyn , Ito Kristin , Eisenson Howard , Bettger Janet Prvu , Shaw Ryan J , Lewinski Allison , Ming David Y , Bosworth Hayden B , Zullig Leah L , Batch Bryan C , Drake Connor 
Published: March 2022

BACKGROUND

Healthcare providers are increasingly screening patients for unmet social needs (e.g., food, housing, transportation, social isolation) and referring patients to relevant community-based resources and social services. Patients’ connection to referred services is often low, however, suggesting the need for additional support to facilitate engagement with resources. Short message service (SMS) text messaging presents an opportunity to address barriers related to contacting resources in an accessible, scalable, and low-cost manner.

OBJECTIVE

In this multi-methods pilot study, we aim to develop an automated SMS-based intervention to promote patient connection to referred social needs resources within two weeks of the initial referral, as well as evaluate its feasibility and patient acceptability. This protocol describes the intervention, conceptual underpinnings, study design, and evaluation plan to provide a detailed illustration of how SMS technology can complement current social needs screening and referral practice patterns without disrupting care.

METHODS

This SMS-based intervention augments an existing social needs screening, referral, and navigation program at a federally qualified health center (FQHC). Patients who received at least one referral for any identified unmet social need are sent two rounds of SMS messages over two weeks. The first round consists of 5-10 messages that deliver descriptions of and contact information for the referred resources. The second round consists of 2 messages that offer a brief reminder to contact the resources. Participants will evaluate the intervention via survey and semi-structured interview, informed by an adapted technology acceptance model. Rapid qualitative and thematic analysis will be used to extract themes from the responses. Primary outcomes are implementation feasibility and patient acceptability. Secondary outcomes relate to intervention effectiveness: reported attempt to connect and successful connection to referred resources two weeks after the initial referral encounter.

RESULTS

The study received regulatory approval in May 2021, and we anticipate enrolling 15-20 participants for this initial pilot.

CONCLUSIONS

This protocol presents detailed implementation methods about a novel automated SMS intervention for social care integration within primary care. By sharing the study protocol early, we intend to facilitate the development and adoption of similar tools across different clinical settings, as more healthcare providers seek to address the unmet social needs of patients. Study findings will provide practical insights into the design and implementation of SMS-based interventions to improve social and medical care coordination.