mHealth Congress: Initiatives reap success engaging patients with texts
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Encouraging healthy behavior in New York City adolescents
The Mt. Sinai Adolescent Health Center (MSAHC) provides care to approximately 10,000 patients during 50,000 appointments per year with limited resources, and treating an additional 100 would cost another $1 million annually, according to Chief Administrative Officer Richard Porter. Determined to expand its reach, though, Porter and his colleagues believed technology would allow the clinic to easily expand its ability to help more patients make informed decisions about their health.
While brainstorming a way to connect with the New York City youth that MSAHC serves, the organization considered that the majority of its patient population is low income and unlikely to own a smartphone, which regularly sell for $200 or more. MSAHC also wanted to assuage adolescent fears of parental intrusion. Unlike apps, which are a more permanent presence on smartphones and more likely to be forgotten, texts are easily discarded and checked routinely.
Keeping these factors in mind, MSAHC implemented a pilot program in January 2010 that used texting to engage patients in three different ways. The first component of the program allowed patients to submit health-related questions via text and ensured a response within 24 hours; the second allowed patients to sign up for and receive health-related advice via text; and the third allowed patients to sign up for and receive medication reminders via text.
The premise behind the program was that the organization should use a medium familiar to its patients. “We found with our youth that were mostly low income -- almost all of them had cellphones, but few had smartphones,” Porter said. “That’s why we chose the texting route.”
On teens’ texting habits, a Pew Research Center report published in March lends credence to the MSAHC approach. Approximately three-quarters of adolescents questioned had cellphones while only about one-quarter had smartphones, and teens reported communicating via text with more frequency than email or phone call, according to a survey of 799 teens aged 12 to 17 and their parents.
Past the pilot phase, 2,300 have submitted queries via text and more than 1,200, or about 10 percent of patients, currently subscribe to a newly created appointment reminder service.
MSAHC is now building a database of answers to commonly asked questions, and reminder service subscribers have an attendance rate of 76 percent compared to a non-subscriber rate of 54 percent. Operating costs include the texting platform, a full-time employee and a part-time employee for a total of $146,000 per year, well below the $1 million cost of an additional 100 full-time patients.
Creating a partnership and a call to action in New Orleans
MSAHC’s is not the only public health initiative to engage patients utilizing text. Text4Baby, a text service developed at the University of California San Diego, provides new and expecting mothers with educational information and important reminders. Initially piloted in southern California where its users reported high levels of satisfaction, the campaign now stretches nationwide with corporate sponsorship and reaches more than 380,000 patients, according to a July 27 statement.
Text4Baby’s impact inspired a partnership including the Louisiana Public Health Initiative, the Louisiana Public Health Institute, the Crescent City Beacon Community, Blue Cross Blue Shield of Louisiana, Walmart and mobile health services firm Voxiva to launch a similar program in New Orleans.
The result was Txt4health, a text service targeted toward patients with and at risk for diabetes that helps track health goals, provides health tips and connects users with local resources.
“We looked at the Text4Baby campaign and cellphones,” said Nebeyou Abebe, a project manager at the Louisiana Public Health Initiative. “They are available here. It could not be television, smartphone apps or computers.”
Since launching in January, the service has attracted an average of 200 users per month, the result of a comprehensive marketing campaign that sought an audience through traditional advertising mediums, as well as at community events, in shopping centers and on social media forums. The Louisiana Public Health Institute engaged community leaders, Walmart provided access to patients at its stores and Blue Cross Blue Shield took advantage of its in-house advertising agency.
“It is a concrete, specific service and call to action,” Voxivia President Paul Meyer said. “Not only did we create this, but there’s been a broad community campaign to get people to sign up for it. Hopefully it helps them adopt healthier behaviors and get connected to services.”
Texting toward an end goal
Texting works as a way to engage patients because it allows them to develop personal connections with healthcare providers while maintaining their privacy.
“Texting is a personal way of communicating with someone,” Meyer said. “Txt4health is engaging with people multiple times per week for months. This is a commitment. We text them more than anybody else probably.”
After an adolescent submitted a query through the MSAHC service, “a dialogue would begin to happen with the patient,” Porter explained. “We might see 15 exchanges if the youth got comfortable.”
Barriers still exist even though MSAHC and the Txt4health initiatives are engaging patients and presenting access to healthcare where it didn’t previously exist. MSAHC extended informal care into the virtual space, but “we’ll need more,” to go further, Porter said. Text4health relies on federal funding, and sustainability both in terms of finances and patient engagement are “an important part of this discussion,” according to Anjum Khurshid, PhD, MD, the director of health services at the Louisiana Public Health Initiative.
Neither campaign has definitively shown that it produces positive effects on health outcomes, but MSAHC’s attendance rates and a high rate of interest in Text4health’s weight tracking service are encouraging. In a healthcare system that is trending toward the patient-centered, involving patients is a big first step.
“This is just a tool to engage the population; it’s not the end goal,” Khurshid said. “Engaging those patients and bringing them into healthcare will allow us to start managing them as part of a transformed medical system.”