Novel Implementation Strategy to Electronically Screen and Signpost Patients to Health Behavior Apps: Mixed Methods...

Area of Science:

• Digital health implementation science
• Public health interventions
• Health informatics

Background:

• Behavior change apps offer scalable, low-cost support but face implementation barriers.
• Electronic health records (EHRs) in hospitals can identify at-risk patients for targeted interventions.
• Proactive referral, using digital tech to link at-risk individuals to support, is an emerging strategy.

Purpose of the Study:

• To increase behavior change app reach through electronic signposting for smoking cessation and alcohol reduction.
• To identify and engage a large, at-risk population using acute care hospital EHR data.
• To assess the acceptability, feasibility, and reach of this novel implementation strategy.

Main Methods:

• A 3-phase, mixed-methods study using hospital EHRs to identify at-risk patients.
• Phase 1: Focus groups explored patient and staff acceptability.
• Phases 2 & 3: Assessed feasibility of EHR identification and SMS text message signposting, measuring link click-through rates.

Main Results:

• The electronic signposting strategy was acceptable, feasible, and achieved good reach.
• 1526 SMS text messages were sent, with 13.56% of patients clicking links to health behavior change apps (exceeding 5% goal).
• Patient and staff input improved SMS text message content and delivery; EHR mining identified the target population.

Conclusions:

• The OptiMine study proved the concept of using SMS text messages for large-scale, proactive signposting to behavior change apps.
• This novel strategy successfully reached a non-help-seeking population with unsolicited messages.
• The approach demonstrates a viable method for connecting at-risk individuals with digital health tools.