Accepted for/Published in: JMIR Formative Research
Date Submitted: Jul 8, 2025
Date Accepted: Mar 16, 2026
The Importance of Trust in Text Messaging to Promote Patient Portal Activation Among Low-Income Patients: A Quality Improvement Project
ABSTRACT
Background:
The increasing reliance on patient portals for electronic health records has widened the digital healthcare access gap, particularly among low-income and Medicaid-insured populations. Automated bidirectional text messaging offers a scalable and cost-effective strategy for identifying patients' digital health needs and providing tailored resources; however, its feasibility and impact remain underexplored.
Objective:
To assess the feasibility and acceptability of bidirectional texting messaging for promoting the use of patient portals and informing patients of available digital technology.
Methods:
This quality improvement initiative involved sending automated, bidirectional text messages to 12,381 Medicaid-insured and/or low-income patients from a primary care practice. Messages assessed patients’ digital health needs and provided personalized resources and assistance for enrolling in the patient portal and for accessing digital technology. We assessed Response rates, opt-outs, and follow-up portal enrollment rates. We also surveyed participants regarding the acceptability, appropriateness, and usability of the texting intervention, as well as their subsequent use of the patient portal. We performed descriptive statistics and a binomial probability test.
Results:
Approximately 9% of patients responded to the text messages, with 4% opting out and 5% actively engaging. Among respondents, 72% completed the follow-up survey. Most respondents positively rated the clarity of the message (90%), its usefulness (86%), and the demonstration of care from their health team (76%). Concerns regarding privacy (13%) and trustworthiness (15%) were noted. Notably, 71% of initially unenrolled patients activated their patient portals after the intervention (p = 0.007), exceeding the hypothesized expectations.
Conclusions:
Automated bidirectional text messaging is a feasible and patient-acceptable approach to bridging digital divides among low-income patients that is potentially adoptable nationally when used with trusted phone numbers. Clinical Trial: NA
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.