JMIR Publications

ABSTRACT

Background:

The Veterans Health Administration (VHA) is deploying an automated texting system (aTS) to support patient self-management.

Objective:

We conducted a qualitative evaluation to examine factors influencing national rollout of the aTS, guided by the Non-adoption, Abandonment, Scale-Up, Spread, and Sustainability Framework (NASSS) which is intended to support the evaluation of novel technologies.

Methods:

Semi-structured interviews with 33 staff and 38 patient aTS early adopters. Data were analyzed following deductive and inductive approaches using a priori codes and emergent coding based on the NASSS.

Results:

We identified themes across NASSS domains: 1) Condition: aTS was considered relevant for a range of patient needs; however, perceptions of patient suitability were guided by texting experience and clinical complexity rather than potential benefit; 2) Technology: aTS onboarding presented difficulty and staff wavered on how to incorporate patient generated data into care planning; 3) Value: supply-side value relied on the flexibility of the aTS and its impact on staff workload while demand-side value was driven by patient perceptions of the psychological/behavioral impacts of the aTS; 4) Adopters: limited clarity on staff roles and responsibilities presented challenges to incorporating the aTS into clinic processes; 5) Organization: staff were willing to try the aTS; however, perceptions of leadership support and clinic readiness hindered spread; 6) Wider System: staff focused on enhancing aTS interoperability with the electronic medical record, and 7) Embedding and Adaptation Over Time: the interplay of aTS versatility, patient and staff demand, and broader societal changes in preferences for communicating health information facilitated aTS implementation.

Conclusions:

VHA’s new aTS has potential to further engage patients and expand the reach of VHA care; however, patients and staff require additional support to adopt, implement, and sustain use. The NASSS highlighted how the aTS can be better embedded into current practices, which patients might benefit most from its functionality, and which aspects of aTS messages are potentially most relevant to self-management. Clinical Trial: ClinicalTrials.gov, NCT03898349. Registered April 2, 2019 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03898349