Treacy-Abarca Sean, Mercado Janisse, Serrano Jorge, Gonzalez Jennifer, Menchine Michael, Arora Sanjay, Wu Shinyi, Burner Elizabeth
David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States.
Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
JMIR Diabetes. 2022 Jun 6;7(2):e23641. doi: 10.2196/23641.
Safety-net emergency departments often serve as the primary entry point for medical care for low income predominantly minority patient populations. Herein, we sought to provide insight into the feasibility, technological proficiencies, engagement characteristics, and practical considerations for a mHealth intervention at a safety-net emergency department.
We aimed to analyze patient technological proficiency to understand the feasibility of and draw practical considerations for mobile phone technology (mHealth) solutions for patients with chronic disease served by safety-net emergency departments.
We analyzed data from a previous diabetes randomized clinical mHealth trial for a diabetes social support intervention. Patients from a safety-net emergency department with preexisting diabetes who used SMS text messages, owned a mobile phone, and with hemoglobin A levels >8.5% were enrolled. A text message-based mHealth program to improve disease self-management was provided to all patients. Supporters of patients were randomized to receive a mailed copy or mHealth-based curriculum designed to improve diabetes support. Among enrolled patients, we surveyed mobile technological capacity and frequency of use. We performed latent class analysis to identify classes of patients by level of technological proficiency and compared demographic characteristics between the latent classes to identify demographic subgroups that may require more training or tailoring of the mHealth approach. Study engagement between classes was assessed by comparing the mean number of text messages exchanged, loss to follow-up, and early termination.
Of 1876 patients who were approached, 44.2% (n=829) of patients had a stable mobile phone and were able to use text messages. Among them 166 met the trial inclusion and enrolled, 90% (149/166) of the cohort were ethnically diverse. Significant variance was found in technology capacity and frequency of use. Our latent class analysis classified 75% (124/166) of patients as highly technologically proficient and 25% (42/166) patients as minimally technologically proficient. Age (P<.001) and level of education (P<.001) were associated with class membership. Highly technologically proficient patients were younger and had higher levels of education (45.74 years old; high school or more: 90%) than minimally technologically proficient patients (53.64 years old; high school or more: 18%). Highly technologically proficient participants exchanged a mean of 40 text messages with the system coordinators compared to a mean of 10 text messages by minimally technologically proficient patients (P<.001).
This study found that nearly half of the patients screened at the safety-net emergency department were equipped for an SMS text message-based mHealth intervention. In the small sample of patients who were enrolled, the majority were classified as highly technologically proficient. These highly proficient patients had greater study engagement. mHealth use in emergency departments may be an opportunity to improve health of ethnically diverse populations by pairing sophisticated chronic disease self-management program with SMS text message-based and traditional in-person interventions to reach patients through the method that is most familiar and comfortable.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1016/j.cct.2019.03.003.
安全网急诊科常常是低收入且主要为少数族裔患者群体获得医疗服务的主要入口。在此，我们试图深入了解在安全网急诊科开展移动健康干预的可行性、技术熟练程度、参与特征及实际考量因素。
我们旨在分析患者的技术熟练程度，以了解为安全网急诊科服务的慢性病患者提供移动电话技术（移动健康）解决方案的可行性并得出实际考量因素。
我们分析了先前一项针对糖尿病社交支持干预的糖尿病随机临床移动健康试验的数据。纳入了来自安全网急诊科、患有糖尿病、使用短信、拥有移动电话且血红蛋白A水平>8.5%的患者。为所有患者提供了一个基于短信的移动健康项目以改善疾病自我管理。患者的支持者被随机分配接受邮寄的副本或基于移动健康的课程，该课程旨在改善糖尿病支持。在纳入的患者中，我们调查了移动技术能力和使用频率。我们进行了潜在类别分析，以按技术熟练程度确定患者类别，并比较潜在类别之间的人口统计学特征，以识别可能需要更多培训或调整移动健康方法的人口统计学亚组。通过比较交换的短信平均数量、失访情况和提前终止情况来评估各类别之间的研究参与度。
在1876名被邀请的患者中，44.2%（n = 829）的患者拥有稳定的移动电话且能够使用短信。其中166名符合试验纳入标准并被招募，该队列中90%（149/166）为不同种族。在技术能力和使用频率方面发现了显著差异。我们的潜在类别分析将75%（124/166）的患者分类为技术熟练程度高，25%（42/166）的患者分类为技术熟练程度低。年龄（P <.001）和教育水平（P <.001）与类别归属相关。技术熟练程度高的患者比技术熟练程度低的患者更年轻且教育水平更高（分别为45.74岁；高中及以上学历：90%）（技术熟练程度低的患者为53.64岁；高中及以上学历：18%）。技术熟练程度高的参与者与系统协调员平均交换40条短信，而技术熟练程度低的患者平均交换10条短信（P <.001）。
本研究发现，在安全网急诊科筛查的患者中，近一半具备接受基于短信的移动健康干预的条件。在纳入的小样本患者中，大多数被分类为技术熟练程度高。这些技术熟练程度高的患者有更高的研究参与度。在急诊科使用移动健康可能是一个机会，通过将复杂的慢性病自我管理项目与基于短信的和传统的面对面干预相结合，以患者最熟悉和舒适的方式接触不同种族人群，从而改善他们的健康状况。
国际注册报告识别码（IRRID）：RR2 - 10.1016/j.cct.2019.03.003 。
