In a recently released issue of Pediatrics, Dr. Lisa Ross DeCamp and colleagues (10.1542/peds.2019-1405) describe a randomized controlled trial examining the effect of Spanish-translated text messages and reminders on health care utilization by Spanish speaking families. The authors focused on Latino children in immigrant families and collaborated in every aspect of study design with their Latino Family Advisory Board (LFAB), a patient family advisory council for the clinic in which the trial was conducted. LFAB members were Latino women with mainly US-born children, who had emigrated from diverse regions of Latin America, and meetings were conducted in Spanish. This key aspect of study design and implementation is a meaningful asset to the trial because its main stakeholders were thus fully represented throughout.
The study team developed a series of interactive text messages for the child’s first year of life, with an introductory 9 minutes-long educational video that was viewed at the 2 month visit; the video focused on healthcare navigation topics chosen by the LFAB. The text messages, sent throughout the first year of life, included directed “push reminders” regarding flu vaccination, parent support programming and public benefit programs, but also included interactive reminders that enabled staff assistance regarding appointments, referrals and illness management. The main study outcomes were Emergency Room utilization, immunization status and well child care visit attendance. A total of 79 parent-infant pairs were randomized to receive the intervention and 78 served as controls for the study. Intervention parents surveyed subjective responses were highly positive about the program – for example, 96% agreed or strongly agreed that the messages made them feel “more connected” to the clinic.
Key positive outcomes of the trial included significantly reduced Emergency Room use (1.23 vs 1.82 visits, p=0.04) for intervention compared to control participants, and a higher rate of receipt of two flu vaccine doses in the intervention versus the control group (again, p=0.04). I was surprised that there was not a significant difference in either immunization status or well care attendance, but the authors make note that the clinic in which the trial was being conducted implemented text reminders for all patient appointments during the study period, which could have diluted the effect of the research intervention. Many questions remain for future study, including precisely how the intervention worked to influence Emergency Room visiting. But overall, this thoughtful study can serve as an inspiration to each of us – by working locally with the families of the patients we serve, we can make a global difference in health care utilization.
