JMIR Publications

ABSTRACT

Background:

A key challenge for schools throughout the COVID-19 pandemic was finding ways to monitor and prevent cases of COVID-19. While diagnostic testing and connecting students and their families to appropriate resources to mitigate spread of COVID-19 was recommended, few schools had scalable infrastructure including information technology systems to implement these types of measures.

Objective:

The current study tested a new approach to COVID-19 testing (SCALE-UP Counts) in school settings that employed automated bidirectional text messages provided to the school community that alerted parents of students to COVID-19 testing options and guidance on when to test. The primary outcome was the proportion of parents whose households tested for COVID-19 and the secondary outcome was the number of missed school days.

Methods:

The SCALE-UP Counts trial was designed as a Sequential Multiple Assignment Randomized Trial and final analyses compared results from parents who received intensive, fully automated, bi-directional text messaging about COVID-19 testing or usual care (control; fully automated unidirectional text messaging about COVID-19 testing) unblinded interventions. From the 16 selected schools, all eligible participants who did not opt out of the study were enrolled. Schools from both arms of the trial were provided with free at-home COVID-19 test kits. Parents were asked to respond to self-report measures on testing outcomes and missed school days through online questionnaires.

Results:

The study included 7122 parents of students from 16 schools, half of which were Title 1 schools; 2588 were randomized to usual care and 4534 to bidirectional text messaging. The SCALE-UP Counts intervention led to increased self-reported testing when compared with the control condition (22.8% vs 13.5%, relative testing rate = 1.64, 95% CI 1.31-2.02, P<.001). There was not an observed difference in missed school days between the study arms (0.43/month vs 0.28 in usual care, relative missed days rate = 1.55, 95% CI 0.98 - 2.45, P=.06).

Conclusions:

SCALE-UP Counts worked closely with schools and the state’s public health system to implement and test a scalable health information technology approach that delivered automated text messages to students’ parents around COVID-19 testing and provided access to free at-home test kits. Such an approach can help facilitate COVID-19 testing among school communities including those that provide education and resources to students and their families from racial/ethnic minorities and with low SES. Similar health information technology approaches could be used to increase ease of access to testing, reduce testing burden, and provide tailored information on health measures in school communities for a variety of illnesses or public health concerns. Clinical Trial: ClinicalTrials.gov NCT05112900; http://clinicaltrials.gov/ct2/show/NCT05112900