A Two-Way Interactive Text Messaging Application for Low-Income Patients with Chronic Medical Conditions: Design-Thinking Development Approach

Background Two-way interactive text messaging between patient and community health workers (CHWs) through mobile phone SMS (short message service) text messaging is a form of digital health that can potentially enhance patient engagement in young adults and families that have a child with chronic medical conditions such as diabetes mellitus, sickle cell disease, and asthma. These patients have complex needs, and a user-centered way can be useful for designing a tool to address their needs. Objective The aim of this study was to utilize the user-centered approach of design thinking to develop a two-way interactive communication SMS text messaging tool for communication between patients or caregivers and CHWs. Methods We applied a design thinking methodology for development of the SMS text messaging tool. We collected qualitative data from 127 patients/caregivers and 13 CHWs, health care professionals, and experts. In total, 4 iterative phases were used to design the final prototype. Results The design thinking process led to the final SMS text messaging tool that was transformed from a one-dimensional, template-driven prototype (phases 1 and 2) into a dynamic, interactive, and individually tailored tool (phases 3 and 4). The individualized components consider social factors that influence patients’ ability to engage such as transportation issues and appointment reminders. SMS text messaging components also include operational factors to support staff such as patient contact lists, SMS text messaging templates, and technology chat support. Conclusions Design thinking can develop a tool to meet the engagement needs of patients with complex health care needs and be user-friendly for health care staff.

[1]  Sagar Rahalkar.  Use Case , 2018, Quick Start Guide to Penetration Testing.

[2]  Jennifer A. Unger,et al.  Text messaging to support a perinatal collaborative care model for depression: A multi-methods inquiry. , 2018, General hospital psychiatry.

[3]  Rena Brar Prayaga,et al.  Improving Refill Adherence in Medicare Patients With Tailored and Interactive Mobile Text Messaging: Pilot Study , 2018, JMIR mHealth and uHealth.

[4]  H. Christensen,et al.  A Mobile Text Message Intervention to Reduce Repeat Suicidal Episodes: Design and Development of Reconnecting After a Suicide Attempt (RAFT) , 2017, JMIR mental health.

[5]  Ming-De Chen,et al.  A pilot comparative study of one-way versus two-way text message program to promote physical activity among people with severe mental illness , 2017 .

[6]  T. Kelechi,et al.  Digital Health for Medication Adherence in Adult Diabetes or Hypertension: An Integrative Review , 2017, JMIR diabetes.

[7]  M. Johnson,et al.  An innovative health-care delivery model for children with medical complexity , 2017, Journal of child health care : for professionals working with children in the hospital and community.

[8]  R. Phillips,et al.  Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review , 2017, Journal of General Internal Medicine.

[9]  Stephen Sutton,et al.  IDEAS (Integrate, Design, Assess, and Share): A Framework and Toolkit of Strategies for the Development of More Effective Digital Interventions to Change Health Behavior , 2016, Journal of medical Internet research.

[10]  J. Gorter,et al.  You never transition alone! Exploring the experiences of youth with chronic health conditions, parents and healthcare providers on self‐management , 2016, Child: care, health and development.

[11]  Lionel Tarassenko,et al.  Mobile Phone Text Messages to Support Treatment Adherence in Adults With High Blood Pressure (SMS-Text Adherence Support [StAR]): A Single-Blind, Randomized Trial , 2016, Circulation.

[12]  Kenneth J. Ruggiero,et al.  Evaluation of an mHealth Medication Regimen Self-Management Program for African American and Hispanic Uncontrolled Hypertensives , 2015, Journal of personalized medicine.

[13]  S. Witter,et al.  Costs and cost-effectiveness of community health workers: evidence from a literature review , 2015, Human Resources for Health.

[14]  Ashley Wennerstrom,et al.  Integrating Community Health Workers Into Primary Care to Support Behavioral Health Service Delivery: A Pilot Study , 2015, The Journal of ambulatory care management.

[15]  Nicola Dell,et al.  Engaging Pregnant Women in Kenya with a Hybrid Computer-Human SMS Communication System , 2015, CHI.

[16]  Judith H Hibbard,et al.  When patient activation levels change, health outcomes and costs change, too. , 2015, Health affairs.

[17]  C. Feudtner,et al.  Children with medical complexity and Medicaid: spending and cost savings. , 2014, Health affairs.

[18]  F. Shebl,et al.  Impact of a Community Health Workers–Led Structured Program on Blood Glucose Control Among Latinos With Type 2 Diabetes: The DIALBEST Trial , 2014, Diabetes Care.

[19]  Margaret M. Thorsen,et al.  Acceptability, language, and structure of text message-based behavioral interventions for high-risk adolescent females: a qualitative study. , 2014, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[20]  S. Vahdat,et al.  Patient Involvement in Health Care Decision Making: A Review , 2014, Iranian Red Crescent medical journal.

[21]  Sebastian K. Fixson,et al.  Adopting Design Thinking in Novice Multidisciplinary Teams: The Application and Limits of Design Methods and Reflexive Practices , 2013 .

[22]  Ken Kitayama,et al.  Parental and provider preferences and concerns regarding text message reminder/recall for early childhood vaccinations. , 2013, Preventive medicine.

[23]  Constance M. Johnson,et al.  Development of a Theoretically Driven mHealth Text Messaging Application for Sustaining Recent Weight Loss , 2013, JMIR mHealth and uHealth.

[24]  Judith H Hibbard,et al.  Patients with lower activation associated with higher costs; delivery systems should know their patients' 'scores'. , 2013, Health affairs.

[25]  J. Hibbard,et al.  What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. , 2013, Health affairs.

[26]  Judith A. Long,et al.  Community health workers combat readmission. , 2012, Archives of internal medicine.

[27]  Eyal Cohen,et al.  Patterns and Costs of Health Care Use of Children With Medical Complexity , 2012, Pediatrics.

[28]  W. Evans,et al.  Pilot evaluation of the text4baby mobile health program , 2012, BMC Public Health.

[29]  K. Spalding,et al.  Integrated complex care coordination for children with medical complexity: A mixed-methods evaluation of tertiary care-community collaboration , 2012, BMC Health Services Research.

[30]  Thomas Martin,et al.  Assessing mHealth: Opportunities and Barriers to Patient Engagement , 2012, Journal of health care for the poor and underserved.

[31]  M. Hellard,et al.  Increasing chlamydia test of re-infection rates using SMS reminders and incentives , 2012, Sexually Transmitted Infections.

[32]  J. Hibbard,et al.  Why Does Patient Activation Matter? An Examination of the Relationships Between Patient Activation and Health-Related Outcomes , 2012, Journal of General Internal Medicine.

[33]  R. Muñoz,et al.  Text Messaging as an Adjunct to CBT in Low-Income Populations: A Usability and Feasibility Pilot Study. , 2011, Professional psychology, research and practice.

[34]  C. Bell,et al.  Randomized controlled trial of primary care physician motivational interviewing versus brief advice to engage adolescents with an Internet-based depression prevention intervention: 6-month outcomes and predictors of improvement. , 2011, Translational research : the journal of laboratory and clinical medicine.

[35]  Eyal Cohen,et al.  A national profile of caregiver challenges among more medically complex children with special health care needs. , 2011, Archives of pediatrics & adolescent medicine.

[36]  Jakob E. Bardram,et al.  A framework for overcoming challenges in designing persuasive monitoring and feedback systems for mental illness , 2011, 2011 5th International Conference on Pervasive Computing Technologies for Healthcare (PervasiveHealth) and Workshops.

[37]  Christoph Meinel,et al.  Design Thinking: Understand - Improve - Apply , 2010 .

[38]  Daniel L. Schwartz,et al.  Parallel prototyping leads to better design results, more divergence, and increased self-efficacy , 2010, TCHI.

[39]  Jennifer Mason,et al.  What is Creative Interviewing , 2010 .

[40]  C. Ahlers-Schmidt,et al.  Text messaging immunization reminders: feasibility of implementation with low-income parents. , 2010, Preventive medicine.

[41]  Joshua Fogel,et al.  From Prototype to Product: Development of a Primary Care/Internet Based Depression Prevention Intervention for Adolescents (CATCH-IT) , 2009, Community Mental Health Journal.

[42]  Johnny Saldaña,et al.  The Coding Manual for Qualitative Researchers , 2009 .

[43]  Ben S. Gerber,et al.  Mobile phone text messaging to promote healthy behaviors and weight loss maintenance: a feasibility study , 2009, Health Informatics J..

[44]  David R Williams,et al.  Moving upstream: how interventions that address the social determinants of health can improve health and reduce disparities. , 2008, Journal of public health management and practice : JPHMP.

[45]  J. Car,et al.  Effectiveness of mobile-phone short message service (SMS) reminders for ophthalmology outpatient appointments: Observational study , 2008, BMC Ophthalmology.

[46]  S. Schroeder.  Shattuck Lecture. We can do better--improving the health of the American people. , 2007, The New England journal of medicine.

[47]  Kristin Myers,et al.  Profile of medical charges for children by health status group and severity level in a Washington State Health Plan. , 2004, Health services research.

[48]  L. Shortridge‐Baggett,et al.  The Theory and Measurement of the Self-Efficacy Construct , 2001, Scholarly Inquiry for Nursing Practice.

[49]  A. Bandura.  The Explanatory and Predictive Scope of Self-Efficacy Theory , 1986 .

[50]  A. Bandura.  Self-efficacy: toward a unifying theory of behavioral change. , 1977, Psychological review.

[51]  J. Kruse.  Fragmentation in US medical education, research, and practice: the need for system wide defrag. , 2013, Family medicine.

[52]  R. Otero-Sabogal,et al.  Physician-community health worker partnering to support diabetes self-management in primary care. , 2010, Quality in primary care.

[53]  Columbia University in the City of New York , 2007 .

[54]  H. Bernard.  Research Methods in Anthropology: Qualitative and Quantitative Approaches , 1988 .