Patient Perspectives on a Targeted Text Messaging Campaign to Encourage Screening for Diabetes: A Qualitative Study (Preprint)

BACKGROUND A sizeable proportion of prediabetes and diabetes cases among adults in the United States is undiagnosed. Patient-facing clinical decision support (CDS) tools that leverage electronic health record (EHR) data can positively affect diabetes screening. Given the widespread mobile phone ownership across diverse groups, text messages present a viable mode for delivering alerts directly to patients. The use of unsolicited text messages to offer glycemic screening among patients without diabetes has not yet been studied. It is imperative to gauge perceptions and receptiveness to “cold texts” to ensure that information and language are optimized to promote engagement with text messages and follow-through with health behaviors. OBJECTIVE This study aimed to explore the acceptability of potential text messages for use in text-based mobile health (mHealth) interventions for targeted hemoglobin A1c screening. Messages were intended to invite those not already diagnosed with diabetes to make a decision to engage in and follow through with a free hemoglobin A1c (HbA1c) laboratory test based solely on automated text exchange. METHODS Six focus groups were conducted at Wake Forest Baptist Health between October 2019 and February 2020. The participants were adult patients without diabetes who had completed an in-person visit at the Family and Community Medicine clinic within the previous year. We displayed a series of text messages and asked the participants to react to the message content and suggest improvements. Content was deductively coded with respect to the Health Belief Model and inductively coded to identify other emergent themes that had the potential to impact engagement with text messages and follow-through with an HbA1c test. RESULTS The participants (n=36) responded positively to receiving an alert for HbA1c screening. They preferred plain language, personalization, and content, which highlighted perceived benefits over perceived susceptibility and perceived severity. The patient-physician relationship emerged as a recurring theme in which patients either had a desire or held an assumption that their provider would be working behind the scenes throughout each step in the process, suggesting that participation in this type of intervention would benefit from a strong patient-provider relationship. CONCLUSIONS Our findings suggest that patients accept text messages that alert them to a higher risk for elevated hemoglobin HbA1c but need clarification of the new processes in which they are asked to engage. Future research is necessary to determine whether these text messages lead to meaningful health behaviors in practice and whether this could apply to other health-related opportunities.