Comparing Email, SMS, and Concurrent Mixed Modes Approaches to Capture Quality of Recovery in the Perioperative Period: Retrospective Longitudinal Cohort Study

Feasibility of Using Text Messaging to Identify and Assist Patients With Hypertension With Health-Related Social Needs: Cross-Sectional Study

BACKGROUND

Health-related social needs are associated with poor health outcomes, increased acute health care use, and impaired chronic disease management. Given these negative outcomes, an increasing number of national health care organizations have recommended that the health system screen and address unmet health-related social needs as a routine part of clinical care, but there are limited data on how to implement social needs screening in clinical settings to improve the management of chronic diseases such as hypertension. SMS text messaging could be an effective and efficient approach to screen patients; however, there are limited data on the feasibility of using it.

OBJECTIVE

We conducted a cross-sectional study of patients with hypertension to determine the feasibility of using SMS text messaging to screen patients for unmet health-related social needs.

METHODS

We randomly selected 200 patients (≥18 years) from 1 academic health system. Patients were included if they were seen at one of 17 primary care clinics that were part of the academic health system and located in Forsyth County, North Carolina. We limited the sample to patients seen in one of these clinics to provide tailored information about local community-based resources. To ensure that the participants were still patients within the clinic, we only included those who had a visit in the previous 3 months. The SMS text message included a link to 6 questions regarding food, housing, and transportation. Patients who screened positive and were interested received a subsequent message with information about local resources. We assessed the proportion of patients who completed the questions. We also evaluated for the differences in the demographics between patients who completed the questions and those who did not using bivariate analyses.

RESULTS

Of the 200 patients, the majority were female (n=109, 54.5%), non-Hispanic White (n=114, 57.0%), and received commercial insurance (n=105, 52.5%). There were no significant differences in demographics between the 4446 patients who were eligible and the 200 randomly selected patients. Of the 200 patients included, the SMS text message was unable to be delivered to 9 (4.5%) patients and 17 (8.5%) completed the social needs questionnaire. We did not observe a significant difference in the demographic characteristics of patients who did versus did not complete the questionnaire. Of the 17, a total of 5 (29.4%) reported at least 1 unmet need, but only 2 chose to receive resource information.

CONCLUSIONS

We found that only 8.5% (n=17) of patients completed a SMS text message-based health-related social needs questionnaire. SMS text messaging may not be feasible as a single modality to screen patients in this population. Future research should evaluate if SMS text message-based social needs screening is feasible in other populations or effective when paired with other screening modalities.

Survey Response Rates to a Self-Initiated Longitudinal Survey Accessed by a Quick Response Code in Six Different Regions of the United States

Background

A quick response (QR) code allows rapid access to an online survey via a smartphone and may improve response rates for web-based surveys. We report the response rates for a QR code-based, self-initiated, longitudinal survey of opioid use and pain scores following hospital discharge in pediatric surgical patients.

Methodology

All parents of pediatric patients who underwent surgery at one of six pediatric medical facilities were asked to participate in the study from October 5, 2020, until July 15, 2021. Those who chose to participate accessed the initial enrollment survey using a QR code on a handout provided. The next day they received an emailed link to a daily survey until their child was not requiring opioids and had pain scores of less than 4 for the previous 48 hours.

Results

A total of 1,759 families were asked to participate in the study. The parents of 44 patients completed the initial enrollment survey by accessing the QR code (response rate of 2.5%). Of those who completed the initial survey, 67% were lost to follow-up during the survey series.

Conclusions

We found an extremely low response rate for a self-initiated survey accessed by QR code. Additionally, we found a drop in the response rate with each successive daily email-based survey. At the end of the survey series, the majority of the initial participants had dropped out. We recommend using alternative modalities (informed consent, telephone call, weekly surveys) for initiating and delivering surveys to improve response rates for similarly designed studies.