Exploring determinants and strategies for implementing self-management support text messaging interventions in safety net clinics

Lyndsay A. Nelson; McKenzie K. Roddy; Erin M. Bergner; Jesus Gonzalez; Chad Gentry; Lauren M. Lestourgeon; Sunil Kripalani; Pamela C. Hull; Lindsay S. Mayberry

doi:10.1017/cts.2022.503

Exploring determinants and strategies for implementing self-management support text messaging interventions in safety net clinics

Lyndsay A. Nelson, McKenzie K. Roddy, Erin M. Bergner, Jesus Gonzalez, Chad Gentry, Lauren M. Lestourgeon, Sunil Kripalani, Pamela C. Hull, Lindsay S. Mayberry

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

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.

Original language	English
Article number	e126
Journal	Journal of Clinical and Translational Science
Volume	6
Issue number	1
DOIs	https://doi.org/10.1017/cts.2022.503
State	Published - Nov 15 2022

Bibliographical note

Publisher Copyright:
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Association for Clinical and Translational Science.

Funding

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.

Funders	Funder number
Connectus Health
MEMOTEXT
VA Office of Academic Affiliations Advanced Fellowship Program in Mental Illness Research and Treatment
Shade Tree Clinic
National Institutes of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)	K12-HL137943
National Heart, Lung, and Blood Institute (NHLBI)
National Institute of Diabetes and Digestive and Kidney Diseases	R01-DK100694
National Institute of Diabetes and Digestive and Kidney Diseases
U.S. Department of Veterans Affairs

Keywords

Mobile health
behavioral intervention
health disparities
implementation
text messaging
type 2 diabetes

ASJC Scopus subject areas

General Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1017/cts.2022.503

Cite this

Nelson, L. A., Roddy, M. K., Bergner, E. M., Gonzalez, J., Gentry, C., Lestourgeon, L. M., Kripalani, S., Hull, P. C., & Mayberry, L. S. (2022). Exploring determinants and strategies for implementing self-management support text messaging interventions in safety net clinics. Journal of Clinical and Translational Science, 6(1), Article e126. https://doi.org/10.1017/cts.2022.503

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title = "Exploring determinants and strategies for implementing self-management support text messaging interventions in safety net clinics",

abstract = "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.",

keywords = "Mobile health, behavioral intervention, health disparities, implementation, text messaging, type 2 diabetes",

author = "Nelson, {Lyndsay A.} and Roddy, {McKenzie K.} and Bergner, {Erin M.} and Jesus Gonzalez and Chad Gentry and Lestourgeon, {Lauren M.} and Sunil Kripalani and Hull, {Pamela C.} and Mayberry, {Lindsay S.}",

note = "Publisher Copyright: {\textcopyright} The Author(s), 2022. Published by Cambridge University Press on behalf of The Association for Clinical and Translational Science.",

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doi = "10.1017/cts.2022.503",

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AU - Roddy, McKenzie K.

AU - Bergner, Erin M.

AU - Gonzalez, Jesus

AU - Gentry, Chad

AU - Lestourgeon, Lauren M.

AU - Kripalani, Sunil

AU - Hull, Pamela C.

AU - Mayberry, Lindsay S.

PY - 2022/11/15

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N2 - 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.

AB - 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.

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Exploring determinants and strategies for implementing self-management support text messaging interventions in safety net clinics

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

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