Accepted for/Published in: JMIR Formative Research
Date Submitted: Oct 14, 2021
Date Accepted: Mar 31, 2022
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
The OptiMine feasibility study: a novel implementation strategy to electronically screen and signpost patients to health behaviour apps
ABSTRACT
Background:
Behaviour change apps have the potential to provide individual support on a population scale at low cost, but they face numerous barriers to implementation. Electronic health records (EHRs) at acute hospitals provide a valuable resource for identifying at-risk patients who may benefit from behaviour change apps. A novel emerging implementation strategy is to use digital technologies, not only for the provision of support for help-seeking individuals, but for signposting at-risk patients to support services (also called “proactive referral” in the US).
Objective:
This study aims to increase the reach of behaviour change apps by implementing electronic signposting for smoking cessation and alcohol reduction among a large, at-risk population identified through an acute hospital EHR.
Methods:
This 3-phase, mixed-methods implementation study assessed the acceptability, feasibility, and reach of electronic signposting to behaviour change apps using a hospital's EHR system to identify at-risk patients. Phase 1 explored the acceptability of the implementation strategy among patients and staff through focus groups. Phase 2 investigated the feasibility of using the hospital EHR to identify patients with target risk behaviours and contact them via text-message, email or patient portal. Phase 3 assessed the impact of text-messages to patients identified as smokers or risky drinkers that signposted them to behaviour change apps. The primary outcome was the proportion of participants who clicked on the embedded link in the text-message to access information about the apps. The acceptability of the text-messages among those patients who had received them was also explored in an online survey.
Results:
Our electronic signposting strategy that used text-messages to promote health behaviour change apps to at-risk patients was found to be acceptable, feasible and had good reach. The hospital sent 1526 text messages signposting patients to either the NHS Smokefree or Drink Free Days apps, with 14% of patients (207/1526) clicking on the embedded link to the apps, which exceeded our 5% a priori success criteria. Patients and staff contributed to the text-message content and the delivery approach, which was perceived as acceptable before and after the delivery of the text-messages. Feasibility of the text-message format and identification of the target population was determined through mining the EHR.
Conclusions:
Our electronic signposting strategy that used text-messages to promote health behaviour change apps to at-risk patients was found to be acceptable, feasible and had good reach. The hospital sent 1526 text messages signposting patients to either the NHS Smokefree or Drink Free Days apps, with 14% of patients (207/1526) clicking on the embedded link to the apps, which exceeded our 5% a priori success criteria. Patients and staff contributed to the text-message content and the delivery approach, which was perceived as acceptable before and after the delivery of the text-messages. Feasibility of the text-message format and identification of the target population was determined through mining the EHR.
Citation
