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. 2017 Mar 21;5(3):e36.
doi: 10.2196/mhealth.5892.

Investigating the Perceptions of Care Coordinators on Using Behavior Theory-Based Mobile Health Technology With Medicaid Populations: A Grounded Theory Study

Brittany Erika Sigler  1   2
Affiliations

Investigating the Perceptions of Care Coordinators on Using Behavior Theory-Based Mobile Health Technology With Medicaid Populations: A Grounded Theory Study

Brittany Erika Sigler. JMIR Mhealth Uhealth. .

Abstract

Background: Medicaid populations are less engaged in their health care than the rest of the population, translating to worse health outcomes and increased health care costs. Since theory-based mobile health (mHealth) interventions have been shown to increase patient engagement, mobile phones may be an optimal strategy to reach this population. With increased development of theory-based mHealth technology, these interventions must now be evaluated with these medically underserved populations in a real-world setting.

Objective: The aim of our study was to investigate care coordinators' perceived value of using a health behavior theory-based mHealth platform with Medicaid clients. In particular, attention was paid to the perceived impact on patient engagement. This research was conducted using the patient-provider text messaging (short message service, SMS) platform, Sense Health (now Wellpass), which integrates the transtheoretical model (TTM), also called the stages of change model; social cognitive theory (SCT); supportive accountability; and motivational interviewing (MI).

Methods: Interviews based in grounded theory methodology were conducted with 10 care managers to understand perceptions of the relationship between mHealth and patient engagement.

Results: The interviews with care managers yielded a foundation for a grounded theory model, presenting themes that suggested 4 intertwined correlative relationships revolving around patient engagement: (1) A text messaging (short message service, SMS) platform supplements the client-care manager dynamic, which is grounded in high quality, reciprocal-communication to increase patient engagement; (2) Texting enhances the relationship between literacy and access to care for Medicaid patients, increasing low-literacy patients' agency to access services; (3) Texting enhances communication, providing care managers with a new means to support their clients; and (4) Reminders augment client accountability, leading to both increased motivation and readiness to change behaviors, as well as an improved client-care manager relationship.

Conclusions: Messaging platform features tied to health behavior theory appear to be effective in improving patient engagement. Two-way communication (supportive accountability), trusted relationships (supportive accountability, SCT), personalized messages (TTM), and patient input (TTM, SCT, MI) appeared as the most relevant components in achieving desired outcomes. Additionally, reminder messages were noted as especially useful in making Medicaid patients accountable and in turn engaging them in their health and health care. These findings convey suggested elements for inclusion in other mHealth interventions aiming to improve patient engagement in Medicaid populations.

Keywords: Medicaid; communication; health behavior; mHealth; patient engagement; safety-net providers; text messaging.

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Conflict of interest statement

Conflicts of Interest: Brittany Sigler was provided access to Sense Health data after completing her practicum at the company, as part of her degree requirements for her Master of Public Health at Columbia University. During the period of study design, Sense Health did not employ Ms Sigler. During the course of data collection, she was hired as an employee. Sense Health had no control over the study design, or presentation of the published findings. Dr Rachel Shelton at Columbia University acted as thesis supervisor, providing feedback on design, content, and analysis. Dr Shelton had access to all data but did not have any ties to Sense Health.

Figures

Figure 1
Figure 1
Conceptual model reflecting aims and study design.
Figure 2
Figure 2
Grounded theory model resulting from interviews.
See this image and copyright information in PMC

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References

    1. Hibbard JH, Greene J. What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health Aff (Millwood) 2013 Feb;32(2):207–14. doi: 10.1377/hlthaff.2012.1061.32/2/207 - DOI - PubMed
    1. Hibbard JH, Cunningham PJ. How engaged are consumers in their health and health care, and why does it matter? Res Brief. 2008 Oct;(8):1–9. - PubMed
    1. Smith A. Pew Research Center. 2013. Smartphone ownership — 2013 update http://www.pewinternet.org/files/old-media//Files/Reports/2013/PIP_Smart... .
    1. Kvedar JC, Fogel AL, Elenko E, Zohar D. Digital medicine's march on chronic disease. Nat Biotechnol. 2016 Mar 10;34(3):239–46. doi: 10.1038/nbt.3495.nbt.3495 - DOI - PubMed
    1. Broderick A, Haque F. Mobile health and patient engagement in the safety net: a survey of community health centers and clinics. Issue Brief (Commonw Fund) 2015 May;9:1–9. - PubMed