Background: Text message-delivered interventions for chronic disease self-management have potential to reduce health disparities, yet limited research has explored implementing these interventions into clinical care. We partnered with safety net clinics to evaluate a texting intervention for type 2 diabetes called REACH (Rapid Encouragement/Education And Communications for Health) in a randomized controlled trial. Following evaluation, we explored potential implementation determinants and recommended implementation strategies. Methods: We interviewed clinic staff (n = 14) and a subset of intervention participants (n = 36) to ask about REACH's implementation potential. Using the Consolidated Framework for Implementation Research (CFIR) as an organizing framework, we coded transcripts and used thematic analysis to derive implementation barriers and facilitators. We integrated the CFIR-ERIC (Expert Recommendations for Implementing Change) Matching Tool, interview feedback, and the literature to recommend implementation strategies. Results: Implementation facilitators included low complexity, strong evidence and quality, available clinic resources, the need for a program to support diabetes self-management, and strong fit between REACH and both the clinics' existing workflows and patients' needs and resources. The barriers included REACH only being available in English, a lack of interoperability with electronic health record systems, patients' concerns about diabetes stigma, limited funding, and high staff turnover. Categories of recommended implementation strategies included training and education, offering flexibility and adaptation, evaluating key processes, and securing funding. Conclusion: Text message-delivered interventions have strong potential for integration in low-resource settings as a supplement to care. Pursuing implementation can ensure patients benefit from these innovations and help close the research to practice gap.
|Journal||Journal of Clinical and Translational Science|
|State||Published - Nov 15 2022|
Bibliographical noteFunding Information:
Acknowledgements. The authors thank our partnering clinics - Faith Family Medical Center, The Clinic at Mercury Courts, Connectus Health, Shade Tree Clinic, Neighborhood Health, Vanderbilt Adult Primary Care - and the participants for their contributions to this research. We thank MEMOTEXT, our technology partner for the REACH study. We also thank the Qualitative Research Core at Vanderbilt University Medical Center for their assistance with the qualitative analyses. This research is funded by the National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) through R01-DK100694 (LSM, principal investigator). LAN was supported by a career development award from NIH/National Heart, Lung, and Blood Institute (K12-HL137943). MKR is supported by the Office of Academic Affiliations, Department of Veteran Affairs, and the VA National Quality Scholars Program with the use of facilities at VA Tennessee Valley Healthcare System, Nashville, Tennessee. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Association for Clinical and Translational Science.
- Mobile health
- behavioral intervention
- health disparities
- text messaging
- type 2 diabetes
ASJC Scopus subject areas
- Medicine (all)