“Technological proficiencies, engagement, and practical considerations for mHealth programs at an urban safety-net hospital emergency departments: randomized control trial”
ABSTRACT
Purpose: To understand feasibility and practical considerations for mobile phone technology (mHealth) at safety-net emergency departments (EDs) via analysis of patient technological proficiency and its effect on mHealth engagement.
Methods:
We analyzed the 2017 TExT-MED + FANS social support intervention for diabetes randomized clinical mHealth trial. From a safety-net ED 166 patients who used SMS text messages, owned a mobile phone, and had a Hemoglobin A1C (Hba1c) >8.5% were enrolled. A text message based mHealth platform was provided all patients. Supporters of patients were randomized to receive a mailed copy or a mHealth based curriculum designed to improve diabetes support. We surveyed patient technological capacity and frequency of use at initiation. Latent class analysis (LCA) was used to identify two classes of patients with higher or lower technological proficiency. We compared demographic characteristics between classes to identify predictors of class membership. Study engagement between classes was assessed via comparison of mean text-messages exchanged, loss to follow-up rates, and early termination were used to.
Results:
A 90% minority cohort was recruited. Significant variance was found in technology capacity and frequency of use. LCA 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.
Conclusions:
Technology capacity varies for different communication modalities, but the majority of patients classified as highly technologically proficient; these highly proficient patients had greater engagement. Diverse safety-net ED patients are equipped and ready for text message based mHealth solutions.
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