Development, Implementation, and Results from a COVID-19 Messaging Campaign to Promote Health Care Seeking Behaviors Among Community Clinic Patients

Abstract

Care-delays can further exacerbate racial and ethnic health disparities in novel coronavirus disease 2019 (COVID-19) related complications. The purpose of our study was to describe and evaluate a Patient Engagement Messaging campaign (PEM campaign) promoting health care seeking behaviors among community and rural clinic patients in North Carolina. Text and voice messages were delivered over 3-weeks. Messages encouraged patients to call a regional operation call center (ROC) line for information related to health care appointments and testing. A cross-sectional evaluation was conducted on the total population (n = 48,063) and a sample without recent health care contact (n = 29,214). Among the sample, logistic regression was used to model determinants of calls to the ROC-line and associations between calling the ROC-line and health care seeking behaviors (scheduling any health care appointment or receiving a COVID-19 test). 69.9% of text messages and 89% of voice messages were delivered. Overall, 95.4% of the total population received at least 1 message. Successful delivery was lower among Black patients and higher among patients with moderate health-risk comorbidities. Among the sample, 7.4% called the ROC-line, with higher odds of calling among minority patients (vs. White) and among Medicaid and uninsured (vs. private insurance). Calling the ROC-line was associated with higher odds of scheduling any health care appointment (OR: 4.14; 95% CI 2.93-5.80) and receiving a COVID-19 test (OR: 2.39; 95% CI 1.64-3.39). Messaging campaigns may help disconnected patients access health care resources and reduce disparities, but are likely still limited by existing barriers.

Keywords: COVID-19; Health care; Health disparities; Insurance; Telephone campaign.

Fig. 1

Patient selection flow diagram. Note: All samples represent those who received a message and did not have recent contact with Atrium Health; ^*Combined Analytic Sample was used in regression analysis to estimate outcomes: calling the ROC-line, scheduling a health care appointment, and receiving a COVID-19 test during the campaign

Fig. 2

Total outcome counts by campaign day among combined analytic sample (n = 29,214). ROC regional operation call center. Note: Analytic Sample represents a subset of the campaign population defined as those meeting the exclusion criteria including those without Healthcare System contact (ROC-line call, health care appointment, or COVID-19 test) prior to the start of the campaign, therefore outcomes counts were zero prior to 4/21/202