Acceptability of text messages for safety netting patients with low-risk cancer symptoms: a qualitative study

BackgroundSafety netting is an important diagnostic strategy for patients presenting to primary care with potential (low-risk) cancer symptoms. Typically, this involves asking patients to return if symptoms persist. However, this relies on patients re-appraising their symptoms and making follow-up appointments, which could contribute to delays in diagnosis. Text messaging is increasingly used in primary care to communicate with patients, and could be used to improve safety netting.AimTo explore the acceptability and feasibility of using text messages to safety net patients presenting with low-risk cancer symptoms in GP primary care (txt-netting).Design and settingQualitative focus group and interview study with London-based GPs.MethodParticipants were identified using convenience sampling methods. Five focus groups and two interviews were conducted with 22 GPs between August and December 2016. Sessions were audiorecorded, transcribed verbatim, and analysed using thematic analysis.ResultsGPs were amenable to the concept of using text messages in cancer safety netting, identifying it as an additional tool that could help manage patients and promote symptom awareness. There was wide variation in GP preferences for text message content, and a number of important potential barriers to txt-netting were identified. Concerns were raised about the difficulties of conveying complex safety netting advice within the constraints of a text message, and about confidentiality, widening inequalities, and workload implications.ConclusionText messages were perceived to be an acceptable potential strategy for safety netting patients with low-risk cancer symptoms. Further work is needed to ensure it is cost-effective, user friendly, confidential, and acceptable to patients.

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Assessing the acceptability of a text messaging service and smartphone app to support patient adherence to medications prescribed for high blood pressure: a pilot study.

10.21203/rs.3.rs-24034/v4 ◽

2020 ◽

Author(s):

Aikaterini Kassavou ◽

Charlotte A Court ◽

Jagmohan Chauhan ◽

James Brimicombe ◽

Debbi Bhattacharya ◽

...

Keyword(s):

Primary Care ◽

Text Messaging ◽

Text Message ◽

Text Messages ◽

Controlled Study ◽

Future Research ◽

Smartphone App ◽

Delivery Mode ◽

Log Files ◽

Intervention Content

Abstract Aims and objectives. This paper describes a pilot non-randomised controlled study of a highly tailored 56-days text message and smartphone app prototype intervention to increase adherence to anti-hypertensive medication in primary care. The aim of this study was to evaluate the acceptability of the intervention and obtain patients views about the intervention content, delivery mode, and the mechanisms by which the intervention supported medication adherence. Methods. Patients diagnosed with hypertension were invited to the study via general practice text messages and were recruited face to face by the researcher team. Participants were asked to test the text message intervention for 28 consecutive days and switch to the smartphone app for 28 more days. Participants completed baseline and follow up questionnaires and took part in semi-structured telephone interviews. Digital log files captured patients’ usage of the intervention. Participant transcripts were analysed using thematic analysis. Descriptive statistics were used to summarize data from questionnaires and log files. A mixed methods analysis generated data to respond to the research questions. Results. 79 patients expressed interest to participate in this study, of whom 23 (64% male, 82% above 60 years old) were recruited to take part. With one drop-out, 22 participants tested the text message delivery mode (with 20 being interviewed) and four of them (17%) switched to the app (with 3 being interviewed). All participants engaged and interacted with the text message and app notifications, and most participants found the intervention content and delivery mode acceptable. They also self-reported that the interactive elements of the intervention motivated them to take their medications as prescribed. Conclusion. This study provides evidence that the digital intervention is acceptable by hypertensive patients recruited in primary care. Future research could usefully investigate its feasibility and effectiveness using rigorous research methods.

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Combining Real-Time Ratings With Qualitative Interviews to Develop a Smoking Cessation Text Messaging Program for Primary Care Patients (Preprint)

10.2196/preprints.11498 ◽

2018 ◽

Author(s):

Gina Kruse ◽

Elyse R Park ◽

Naysha N Shahid ◽

Lorien Abroms ◽

Jessica E Haberer ◽

...

Keyword(s):

Primary Care ◽

Real Time ◽

Text Messaging ◽

Qualitative Interviews ◽

Text Message ◽

Intervention Development ◽

Text Messages ◽

Behavioral Skills ◽

Message Service ◽

Primary Care Patients

BACKGROUND Text messaging (short message service, SMS) interventions show promise as a way to help cigarette smokers quit. Few studies have examined the effectiveness of text messaging (SMS) programs targeting smokers associated with primary care or hospital settings. OBJECTIVE This study aimed to develop a text messaging (SMS) program targeting primary care smokers. METHODS Adult smokers in primary care were recruited from February 2017 to April 2017. We sent patients 10 to 11 draft text messages (SMS) over 2 days and asked them to rate each message in real time. Patients were interviewed daily by telephone to discuss ratings, message preferences, and previous experiences with nicotine replacement therapy (NRT). Content analysis of interviews was directed by a step-wise text messaging (SMS) intervention development process and the Information-Motivation-Behavioral Skills model of medication adherence. RESULTS We sent 149 text messages (SMS) to 15 patients. They replied with ratings for 93% (139/149) of the messages: 134 (96%, 134/139) were rated as clear or useful and 5 (4%, 5/139) as unclear or not useful. Patients’ preferences included the addition of graphics, electronic cigarette (e-cigarette) content, and use of first names. Regarding NRT, patients identified informational gaps around safety and effectiveness, preferred positively framed motivational messages, and needed behavioral skills to dose and dispose of NRT. CONCLUSIONS Patients recommended text message (SMS) personalization, inclusion of e-cigarette information and graphics, and identified barriers to NRT use. Combining real-time ratings with telephone interviews is a feasible method for incorporating primary care patients’ preferences into a behavioral text messaging (SMS) program.

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Supplemental Text Message Support With the National Diabetes Prevention Program: Pragmatic Comparative Effectiveness Trial (Preprint)

10.2196/preprints.15478 ◽

2019 ◽

Author(s):

Natalie D Ritchie ◽

Silvia Gutiérrez-Raghunath ◽

Michael Josh Durfee ◽

Henry Fischer

Keyword(s):

Weight Loss ◽

Prevention Program ◽

Text Messaging ◽

Diabetes Prevention ◽

Text Message ◽

Diabetes Prevention Program ◽

Safety Net ◽

Text Messages ◽

Modest Weight Loss ◽

Weight Loss Outcomes

BACKGROUND The evidence-based National Diabetes Prevention Program (NDPP) is now widely disseminated, yet strategies to increase its effectiveness are needed, especially for underserved populations. The yearlong program promotes lifestyle changes for weight loss and can be offered in-person, online, via distance learning, or a combination of modalities. Less is known about which delivery features are optimal and may help address disparities in outcomes for subgroups. We previously demonstrated the efficacy of a stand-alone text messaging intervention based on the NDPP (SMS4PreDM) in a randomized controlled trial in a safety net health care system. Upon broader dissemination, we then showed that SMS4PreDM demonstrated high retention and modest weight loss at a relatively low cost, suggesting the potential to improve in-person NDPP delivery. OBJECTIVE In this study, we aim to compare the effectiveness of in-person NDPP classes with and without supplementary SMS4PreDM on attendance and weight loss outcomes to determine whether text messaging can enhance in-person NDPP delivery for a safety net patient population. METHODS From 2015 to 2017, patients with diabetes risks were identified primarily from provider referrals and enrolled in NDPP classes, SMS4PreDM, or both per their preference and availability. Participants naturally formed three groups: in-person NDPP with SMS4PreDM (n=236), in-person NDPP alone (n=252), and SMS4PreDM alone (n=285). This analysis compares the first two groups to evaluate whether supplemental text messaging may improve in-person NDPP outcomes. Outcomes for SMS4PreDM-only participants were previously reported. NDPP classes followed standard delivery guidelines, including weekly-to-monthly classes over a year. SMS4PreDM delivery included messages promoting lifestyle change and modest weight loss, sent 6 days per week for 12 months. Differences in characteristics between intervention groups were assessed using chi-square and t tests. Differences in NDPP attendance and weight loss outcomes were analyzed with multivariable linear and logistic regressions. RESULTS The mean age was 50.4 years (SD 13.9). Out of a total of 488 participants, 76.2% (n=372) were female and 59.0% (n=288) were Hispanic. An additional 17.2% (n=84) were non-Hispanic white and 12.9% (n=63) were non-Hispanic black. A total of 48.4% (n=236) of participants elected to receive supplemental text message support in addition to NDPP classes. Participants who chose supplemental text message support were on average 5.7 (SD 1.2) years younger (P<.001) than the 252 participants who preferred in-person classes alone. Relatively more women and Hispanic individuals enrolled in the NDPP with supplemental text messages than in NDPP classes alone, 83.9% (n=198) vs 69.0% (n=174, P<.001) and 68.6% (n=162) vs 50.0% (n=126, P=.001), respectively. Attendance and weight loss outcomes were comparable between groups. CONCLUSIONS Despite its appeal among priority populations, supplemental text messaging did not significantly increase attendance and weight loss for the in-person NDPP. Further research is needed to identify optimal strategies to improve the effectiveness of the NDPP.

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GPs’ understanding and practice of safety netting for potential cancer presentations: a qualitative study in primary care

British Journal of General Practice ◽

10.3399/bjgp18x696233 ◽

2018 ◽

Vol 68 (672) ◽

pp. e505-e511 ◽

Cited By ~ 12

Author(s):

Julie Evans ◽

Sue Ziebland ◽

John I MacArtney ◽

Clare R Bankhead ◽

Peter W Rose ◽

...

Keyword(s):

Primary Care ◽

Clinical Practice ◽

Qualitative Study ◽

Cancer Diagnosis ◽

Perceived Risk ◽

Low Risk ◽

Diagnostic Strategy ◽

Risk Of Cancer ◽

Safety Netting

BackgroundSafety netting is a diagnostic strategy used in UK primary care to ensure patients are monitored until their symptoms or signs are explained. Despite being recommended in cancer diagnosis guidelines, little evidence exists about which components are effective and feasible in modern-day primary care.AimTo understand the reality of safety netting for cancer in contemporary primary care.Design and settingA qualitative study of GPs in Oxfordshire primary care.MethodIn-depth interviews with a purposive sample of 25 qualified GPs were undertaken. Interviews were recorded and transcribed verbatim, and analysed thematically using constant comparison.ResultsGPs revealed uncertainty about which aspects of clinical practice are considered safety netting. They use bespoke personal strategies, often developed from past mistakes, without knowledge of their colleagues’ practice. Safety netting varied according to the perceived risk of cancer, the perceived reliability of each patient to follow advice, GP working patterns, and time pressures. Increasing workload, short appointments, and a reluctance to overburden hospital systems or create unnecessary patient anxiety have together led to a strategy of selective active follow-up of patients perceived to be at higher risk of cancer or less able to act autonomously. This left patients with low-risk-but-not-no-risk symptoms of cancer with less robust or absent safety netting.ConclusionGPs would benefit from clearer guidance on which aspects of clinical practice contribute to effective safety netting for cancer. Practice systems that enable active follow-up of patients with low-risk-but-not-no-risk symptoms, which could represent malignancy, could reduce delays in cancer diagnosis without increasing GP workload.

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Supplemental Text Message Support With the National Diabetes Prevention Program: Pragmatic Comparative Effectiveness Trial

JMIR mhealth and uhealth ◽

10.2196/15478 ◽

2020 ◽

Vol 8 (6) ◽

pp. e15478 ◽

Cited By ~ 1

Author(s):

Natalie D Ritchie ◽

Silvia Gutiérrez-Raghunath ◽

Michael Josh Durfee ◽

Henry Fischer

Keyword(s):

Weight Loss ◽

Prevention Program ◽

Text Messaging ◽

Diabetes Prevention ◽

Text Message ◽

Diabetes Prevention Program ◽

Safety Net ◽

Text Messages ◽

Modest Weight Loss ◽

Weight Loss Outcomes

Background The evidence-based National Diabetes Prevention Program (NDPP) is now widely disseminated, yet strategies to increase its effectiveness are needed, especially for underserved populations. The yearlong program promotes lifestyle changes for weight loss and can be offered in-person, online, via distance learning, or a combination of modalities. Less is known about which delivery features are optimal and may help address disparities in outcomes for subgroups. We previously demonstrated the efficacy of a stand-alone text messaging intervention based on the NDPP (SMS4PreDM) in a randomized controlled trial in a safety net health care system. Upon broader dissemination, we then showed that SMS4PreDM demonstrated high retention and modest weight loss at a relatively low cost, suggesting the potential to improve in-person NDPP delivery. Objective In this study, we aim to compare the effectiveness of in-person NDPP classes with and without supplementary SMS4PreDM on attendance and weight loss outcomes to determine whether text messaging can enhance in-person NDPP delivery for a safety net patient population. Methods From 2015 to 2017, patients with diabetes risks were identified primarily from provider referrals and enrolled in NDPP classes, SMS4PreDM, or both per their preference and availability. Participants naturally formed three groups: in-person NDPP with SMS4PreDM (n=236), in-person NDPP alone (n=252), and SMS4PreDM alone (n=285). This analysis compares the first two groups to evaluate whether supplemental text messaging may improve in-person NDPP outcomes. Outcomes for SMS4PreDM-only participants were previously reported. NDPP classes followed standard delivery guidelines, including weekly-to-monthly classes over a year. SMS4PreDM delivery included messages promoting lifestyle change and modest weight loss, sent 6 days per week for 12 months. Differences in characteristics between intervention groups were assessed using chi-square and t tests. Differences in NDPP attendance and weight loss outcomes were analyzed with multivariable linear and logistic regressions. Results The mean age was 50.4 years (SD 13.9). Out of a total of 488 participants, 76.2% (n=372) were female and 59.0% (n=288) were Hispanic. An additional 17.2% (n=84) were non-Hispanic white and 12.9% (n=63) were non-Hispanic black. A total of 48.4% (n=236) of participants elected to receive supplemental text message support in addition to NDPP classes. Participants who chose supplemental text message support were on average 5.7 (SD 1.2) years younger (P<.001) than the 252 participants who preferred in-person classes alone. Relatively more women and Hispanic individuals enrolled in the NDPP with supplemental text messages than in NDPP classes alone, 83.9% (n=198) vs 69.0% (n=174, P<.001) and 68.6% (n=162) vs 50.0% (n=126, P=.001), respectively. Attendance and weight loss outcomes were comparable between groups. Conclusions Despite its appeal among priority populations, supplemental text messaging did not significantly increase attendance and weight loss for the in-person NDPP. Further research is needed to identify optimal strategies to improve the effectiveness of the NDPP.

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Assessing the acceptability of a text messaging service and smartphone app to support patient adherence to medications prescribed for high blood pressure: a pilot study.

10.21203/rs.3.rs-24034/v2 ◽

2020 ◽

Author(s):

Aikaterini Kassavou ◽

Charlotte A Court ◽

Jagmohan Chauhan ◽

James Brimicombe ◽

Debbi Bhattacharya ◽

...

Keyword(s):

Primary Care ◽

Text Messaging ◽

Text Message ◽

Text Messages ◽

Controlled Study ◽

Future Research ◽

Smartphone App ◽

Delivery Mode ◽

Log Files ◽

Intervention Content

Abstract Aims and objectives. This paper describes the a pilot non-randomised controlled study of a highly tailored 56-days text message and smartphone app prototype intervention to increase adherence to anti-hypertensive medication in primary care. The aim of this study was to evaluate the acceptability of the intervention and obtain patients views about the intervention content, the delivery mode, and the mechanisms by which the intervention supported medication adherence. Methods. Patients diagnosed with hypertension were invited to the study via general practice text messages invitation and were recruited face to face by the researcher team. Participants were asked to tested the text message intervention for 28 consecutive days and switch to or the text message followed by the smartphone app for 56 28 more days. Participants completed baseline and follow up questionnaires and took part in a semi-structured weekly or end of intervention telephone interviews. Digital log files captured patients’ usage of the intervention. Participant transcripts were analysed using thematic analysis. Descriptive statistics were used to summarize data from questionnaires and log files. A mixed methods analysis generated data to respond to the research questions. Results. 79 patients expressed their interest to participate in this study, of whom and 23 (64% male, 82% above 60 years old) of these patients were recruited to take part. With one drop-out, 22 participants tested the text message delivery mode (with 20 being interviewed) and four of them (17%) requested to switched to the app (with 3 being interviewed). All participants used and engaged and interacted with the text message and app notifications, and most participants found the intervention content and delivery mode acceptable. They also self-reported that the interactive elements of the intervention supported motivated them to take their medications as prescribed. Conclusion. This study provides evidence that the digital intervention is acceptable by hypertensive patients recruited in primary care. Future research could usefully, thus it should investigatebe its tested for its feasibility and effectiveness using rigorous research methods.

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Does Safety Netting for Lung Cancer Symptoms Help Patients to Reconsult Appropriately? A Qualitative Study

10.21203/rs.3.rs-908030/v1 ◽

2021 ◽

Author(s):

Georgia Black ◽

Sandra van Os ◽

Christina Renzi ◽

Fiona Walter ◽

Willie Hamilton ◽

...

Keyword(s):

Lung Cancer ◽

Primary Care ◽

Thematic Analysis ◽

Low Risk ◽

Passive Safety ◽

Active Safety ◽

Cancer Symptoms ◽

Diagnostic Uncertainty ◽

Face To Face ◽

Safety Netting

Abstract Background Safety netting in primary care is considered an important intervention for managing diagnostic uncertainty. This is the first study to examine how patients understand and interpret safety netting advice around low-risk potential lung cancer symptoms, and how this affects reconsultation behaviours. Methods Qualitative dyadic interview study in UK primary care. Pre-covid-19, five patients were interviewed face-to-face twice (shortly after a primary care consultation for potential lung cancer symptom(s) and 2–5 months later). The general practitioner (GP) they last saw was interviewed face-to-face once. During the covid-19 pandemic, an additional 15 patients were interviewed once via telephone. Audio-recorded interviews were transcribed verbatim and analysed using a mix of inductive and deductive thematic analysis. Results The findings from our thematic analysis suggest that patients prefer active safety, as part of thorough and logical diagnostic uncertainty management. Passive safety netting may be perceived as dismissive and cause delayed reconsultation. GP safety netting strategies are not always understood, potentially causing patient worry and dissatisfaction. Telephone consultations and the diagnostic overshadowing of COVID-19 on respiratory symptoms impacted GPs’ safety netting strategies and patients’ appetite for active follow up measures. Conclusions Safety netting guidelines do not yet offer solutions that have been proven to promote symptom vigilance and timely reconsultation for low-risk lung cancer symptoms. Patients prefer active safety netting coupled with thorough consultation techniques and a comprehensible diagnostic strategy, and may respond adversely to passive safety netting advice.

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Assessing the acceptability of a text messaging service and smartphone app to support patient adherence to medications prescribed for high blood pressure: a pilot study.

10.21203/rs.3.rs-24034/v3 ◽

2020 ◽

Author(s):

Aikaterini Kassavou ◽

Charlotte A Court ◽

Jagmohan Chauhan ◽

James Brimicombe ◽

Debbi Bhattacharya ◽

...

Keyword(s):

Primary Care ◽

Text Messaging ◽

Text Message ◽

Text Messages ◽

Controlled Study ◽

Future Research ◽

Smartphone App ◽

Delivery Mode ◽

Log Files ◽

Intervention Content

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Screening Depression and Related Conditions via Text Messaging Versus Interview Assessment: Protocol for a Randomized Study (Preprint)

10.2196/preprints.12392 ◽

2018 ◽

Author(s):

Haomiao Jin ◽

Shinyi Wu

Keyword(s):

Primary Care ◽

Low Income ◽

Text Messaging ◽

Culturally Diverse ◽

Text Message ◽

Safety Net ◽

Depression Screening ◽

Retest Reliability ◽

Test Retest Reliability ◽

Sms Text Messaging

BACKGROUND Depression is an often underdiagnosed and, therefore, untreated comorbidity for low-income, racially or ethnically diverse patients with a chronic illness such as diabetes. Recent updates from the US Preventive Services Task Force guidelines in 2016 recommend depression screening for every adult but does not suggest the mode of assessment. Short message service (SMS) text messaging is an inexpensive, private, and scalable approach to provide depression screening and monitoring; it can also alleviate many barriers, such as transportation, childcare, and clinical visit time faced by the low-income population, in receiving a diagnosis of depression. Current evidence is inconsistent in comparing technology-mediated assessment versus interviewer (INTW) assessment in collecting sensitive health information, as some studies suggest that technology encourages self-disclosure while the other studies show the opposite effect. OBJECTIVE The proposed study will test the use of SMS text messaging to assess depression and its related conditions, including functional disability, pain, and anxiety, in low-income, culturally diverse, safety-net primary care populations with diabetes. The study will examine the concordance between SMS text message and interviewer assessments and evaluate test-retest reliability. METHODS The proposed study will adopt a randomized design with 200 patients assigned to four study groups: SMS/INTW, INTW/SMS, SMS/SMS, and INTW/INTW. The first two groups will be used to examine the concordance between SMS text message and interviewer assessments. The third and fourth groups will be used to evaluate test-retest reliability. Participants of the study will be recruited from the participants of the prior Diabetes-Depression Care-management Adoption Trial, a large comparative effectiveness research trial in collaboration with the Los Angeles County Department of Health Services. Test-retest reliability and concordance between SMS text message and interviewer assessments will be evaluated by the interclass correlation coefficient and the kappa statistic. Missing data patterns will be explored to understand whether participants are willing to self-disclose information related to depression in SMS text message assessments. RESULTS Recruitment of participants was conducted from June 2017 to November 2017. A total of 206 participants were enrolled: 52 (25.2%) in SMS/INTW, 53 (25.7%) in SMS/SMS, 49 (23.8%) in INTW/SMS, and 52 (25.2%) in INTW/INTW. The average age of the participants was 57.1 years (SD 9.2). A total of 57.8% (119/206) of participants were female, 93.2% (192/206) were Latino, and 77.7% (160/206) chose Spanish as their preferred language. Analysis of the SMS text message assessment shows the cost of distributing the 16 questions is about US $0.50 per person per assessment. Full results of the study will be reported elsewhere. CONCLUSIONS This study is anticipated to establish the feasibility of using SMS text messaging to assess depression and its related conditions in low-income, culturally diverse, safety-net primary care populations with diabetes. We also expect to generate knowledge about whether patients in the targeted population are willing to reply and self-disclose sensitive information about depression and its related conditions through SMS text message assessments. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/12392

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Text Messaging as a Mental Health Treatment Intervention: A Corpus-Based Study

10.31234/osf.io/gt73p ◽

2019 ◽

Author(s):

Megan Partch ◽

Cass Dykeman

Keyword(s):

Mental Health ◽

Mental Health Treatment ◽

Text Messaging ◽

Low Cost ◽

Statistical Significance ◽

Text Message ◽

Treatment Session ◽

Text Messages ◽

Health Treatment ◽

Emotional Tone

Mental health treatment providers seek high-impact and low-cost means of engaging clients in care. As such, text messaging is becoming more frequently utilized as a means of communication between provider and client. Research demonstrates that text message interventions increase treatment session attendance, decrease symptomology, and improve overall functioning. However, research is lacking related to the linguistic make up of provider communications. Text messages were collected from previously published articles related to the treatment of mental health disorders. A corpus of 39 mental health treatment text message interventions was composed totaling 286 words. Using Linguistic Inquiry and Word Count (LIWC) software, messages were analyzed for prevalence of terminology thought to enhance client engagement. Clout, demonstrating the writer’s confidence and expertise, and positive Emotional Tone were found to be at a high level within the corpus. Results demonstrated statistical significance for five linguistic variables. When compared with national blog norms derived from Twitter, Clout, Emotional Tone, and use of Biological terminology were found to be at higher rates than expected. Authenticity and Informal terminology were found at significantly lesser rates.

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