JMIR Publications

ABSTRACT

Background:

Digital health interventions could be a scalable approach to delivering at-home COVID-19 testing.

Objective:

SCALE-UP II aimed to investigate the effectiveness of three digital health interventions on the delivery of mailed at-home COVID-19 testing: text messaging (TM), automated chatbot (CA), and patient navigation upon request (PN).

Methods:

Pragmatic randomized controlled trial. Participants who self-reported that they had a smartphone were randomized in a 2x2x2 factorial (Smartphone study) to receive (i) chatbot or TM; (ii) option to request PN; and (iii) intervention frequency every 10 or 30 days. All other participants were randomized in a 2x2 factorial (Non-Smartphone study) to receive (i) option to request PN; and (ii) intervention frequency every 10 or 30 days. Study settings were safety net community health centers (CHCs) located across the state of Utah, USA. Eligible patients were >18 years old, with a primary care visit in the last three years, and a valid cellphone in the CHC electronic health record. The primary outcome was proportion of participants requesting at-home COVID-19 tests.

Results:

The trial enrolled 2,117 in the Smartphone study and 31,439 in the Non-Smartphone study. In the Smartphone study, the proportion of participants who requested test kits in the Chatbot arm was lower than in TM (16.6% vs. 52.1%, aRR=0.317 [98.33% CI 0.27-0.38], P<0.0001). In the Non-Smartphone study, the proportion of participants who requested test kits was higher if they were messaged every 10 days rather than every 30 days (5.5% vs 4.8%, aRR=1.144 [97.5% CI 1.03-1.28], P=0.0055) and lower for participants who could request access to PN compared to those in the No PN condition (4.3% vs 5.9%, aRR=0.729 [97.5% CI 0.65-0.81], P<0.0001).

Conclusions:

Text messaging, every 10 days, and without PN were more effective on the uptake of COVID-19 testing than interventions using a chatbot, every 30 days, and with PN respectively. Clinical Trial: Clinicaltrials.gov (NCT05533918 and NCT05533359).