Accepted for/Published in: JMIR Formative Research
Date Submitted: Jul 8, 2025
Date Accepted: Mar 16, 2026
Warning: This is an author submission that is not peer-reviewed or edited.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.
Quality Improvement: Feasibility of Automated, Bidirectional Text Messaging to Assist Patients with Bridging the Digital Health Divide
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
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