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Published on: August 1, 2019
A Pilot Randomized Controlled Trial of Text Messages to Improve Well-Child Visit Attendance After No-Show
Beata Debinski1, Stephanie S Daniel1, Joseph Rigdon2
1Department of Family and Community Medicine (B Debinski, SS Daniel, and A Mayfield), Wake Forest University School of Medicine, Winston Salem, NC.
Insights
Text message reminders can help caregivers reschedule missed well-child visits (WCVs). While rescheduling rates were similar, text messages significantly increased WCV completion, improving pediatric preventive care access.
Area of Science:
- Pediatric Healthcare
- Health Communication
- Preventive Medicine
Background:
- Well-child visits (WCVs) are crucial for child development and preventive care.
- Missed WCVs (no-shows) disrupt continuity of care and public health.
- Systematic strategies are needed to re-engage caregivers after missed appointments.
Purpose of the Study:
- To evaluate the effectiveness of text messages in engaging caregivers to reschedule missed WCVs.
- To assess if text message interventions increase attendance at rescheduled WCVs.
- To analyze outcomes stratified by language (English/Spanish).
Main Methods:
- Randomized controlled trial involving pediatric and family medicine patients under 18.
- Intervention group received up to three text messages to reschedule missed WCVs; control group received usual care.
- Primary outcomes: WCV rescheduling within 6 weeks and WCV completion within 6 weeks.
Main Results:
- No significant difference in overall WCV rescheduling rates between text message and usual care groups (RD +1.98%).
- Text messages were associated with a significant increase in completed WCVs (RD +2.83%, OR 1.86).
- Higher completion rates observed in the English-speaking subgroup for the text message intervention.
Conclusions:
- Text message follow-up after a missed WCV may improve attendance at rescheduled appointments.
- SMS interventions show promise for increasing adherence to pediatric preventive care schedules.
- Further research can optimize text message strategies for diverse populations.
Objective:
Evaluate the effectiveness of text messages to systematically engage parents/guardians ("caregivers") to reschedule a well-child visit (WCV) that was missed ("no-show") and attend that rescheduled WCV visits.
Methods:
Patients <18 years in one of five pediatrics or family medicine clinics, in one health system in the Southeast US, were eligible. Patients without a rescheduled WCV after a no-show were randomized into intervention (text messages) or care-as-usual comparison, stratified by language (English/Spanish). Enrollment occurred May-July 2022. Up to three text messages were sent to caregivers one week apart via REDCap and Twilio, advising how to reschedule the missed appointment by phone or health portal. Primary outcomes were 1) rescheduling a WCV within 6 weeks of no-show and 2) completing a rescheduled WCV within 6 weeks. Risk differences (RD) and odds ratios (OR) were used to evaluate the effect of text messages.
Results:
Seven hundred and twenty patients were randomized and analyzed (texts: 361, comparison: 359). The proportion rescheduling WCV after text versus usual care was English: 18.85% versus 15.02%, respectively, and Spanish: 5.94% versus 8.14%, with overall RD+ 1.98% (95% CI: -1.85, 5.81) and OR 1.21 (95% CI: 0.79, 1.84; P-value .38). Completed WCV rates in text or usual care were English: 13.08% versus 6.59%, and Spanish: 5.81% versus 5.94% with texts associated with RD+ 2.83% (95% CI: 1.66, 4.00) and OR 1.86 (95% CI: 1.09, 3.19).
Conclusion:
Text message follow-up after a no-show WCV may positively impact attendance at WCVs rescheduled in the subsequent 6 weeks.
Trial Registration:
ClinicalTrials.gov NCT05086237.
