JMIR Publications

ABSTRACT

Background:

Pediatric clinical practice guidelines recommend identifying and addressing Food Insecurity (FI) as part of routine care. However, methods for health systems to connect families experiencing FI to community food resources are lacking. Confidential text messaging may be an equitable and user-friendly approach that is aligned with caregiver preferences and feasible for health systems to implement, but it has not been widely implemented or tested.

Objective:

This paper details 1) the process of developing a novel, mobile health intervention to help families access local food resources; and 2) results on reach, engagement, usability, and acceptability of the intervention following a one-year pilot.

Methods:

We designed and evaluated an automated text messaging system that delivers geographically tailored food resource information to families with FI after hospital discharge at a single U.S. children’s hospital. English- and Spanish-speaking caregivers of hospitalized children with a positive FI screen documented during clinical care were included. Caregivers received a food resource text message 1- and 4-days post-discharge. Two subsequent text messages asked about reach and engagement. We used system-reported (primary) and caregiver-reported (secondary) measures of reach and engagement and caregiver-reported resource connection as a preliminary measure of effectiveness. We assessed usability (System Usability Scale [SUS], >75 indicates good usability), acceptability, and caregiver preferences for resource provision through semi-structured interviews among a subset of caregivers (20 English- and 11 Spanish-speaking).

Results:

Of 194 patients with a positive FI screen during the study period, 187 (96%) spoke English or Spanish and were included in the cohort. Primary, system-reported measures indicated that the food resource message successfully reached 175 (94%) participants; of these, 102 (58%) engaged with the text messages in some way, with 65 (37%) clicking the link and 92 (53%) responding to a text message. Among the subset of text message respondents (n=92), 88 (96%) reported receiving the resource message, 83 (90%) read the message, and 42 (46%) used the information to search for food resources. Among the subset of interviewed caregivers (n=31), the median SUS was 86.1 (interquartile range, 66.7-91.7); 97% of caregivers felt the intervention was acceptable. Caregivers preferred receiving food resource information via text message rather than paper handouts because it felt more accessible.

Conclusions:

Providing automated, geographically tailored food resource information via text message to families with FI after hospital discharge was feasible, the information was usable, and the delivery mode was acceptable to families, with text messaging preferred over paper handouts. Text messaging offers a promising, low-resource approach to social resource provision for health systems. Additional research is needed to assess effectiveness and increase uptake within the context of clinical care.