Evaluation of a Pilot mHealth Intervention to Engage Primary Care Clients at an Urban Clinic Serving Marginalized Populations: Mixed-Methods Cohort Study
Notice bibliographique
Résumé
Background: Many individuals in urban low-income settings face barriers to engaging in primary care and experience systemic challenges such as homelessness and discrimination in the health care system. This study was conducted in the Downtown Eastside of Vancouver, Canada, a low-income neighborhood with intersecting structural vulnerabilities and disproportionate rates of substance use disorders. Advancements in mobile health expand options for facilitating communication between primary care providers and clients. Objective: We conducted a pilot project that provided primary care clients a mobile phone and access to WelTel, a mobile health tool that uses a 2-way texting approach and sends weekly automated check-in messages. Our study measured phone retention, defined as retaining a study-supplied device and being reachable on the study-supplied device over a 6-month period and explored the acceptability and feasibility of WelTel among a cohort of clients with complex health challenges. Methods: Stratified random sampling was used to recruit participants from a larger cohort study of primary care clinic clients in the Downtown Eastside. The sample was stratified to ensure equal participation based on gender and Indigenous and non-Indigenous participants. In this mixed methods research, participants completed 3 surveys over a 6-month period from November 2022 to May 2023. The surveys assessed phone retention and functionality as well as phone use, including use of the WelTel platform. Clients who had access to a functional mobile phone after the follow-up period were invited to complete an in-person interview. The semistructured interviews explored clients' experiences with WelTel, primary care, and engagement with technology. Results: We enrolled 49 participants (median age 48 y; 53% women and 49% Indigenous) and interviewed 16 participants. A total of 44 clients completed the 6-month survey, and of those clients, 26 (59%) had a functional phone. However, only 14 (29%) clients retained the mobile device supplied during the study and completed the 6-month survey. Phone retention or access to a nonstudy phone was lower among those who had used opioids (18% for both) in the past 3 months (P<.01), as well as those who reported not having access to a cellphone at enrollment (25% and 15%, respectively) compared to those who did have phone access at enrollment (P=.05). Both the surveys and semistructured interviews indicated that WelTel was generally well received; 25 (96%) of those with a functional phone reported that they liked receiving the weekly messages. During qualitative interviews, the WelTel intervention was reported to strengthen client-provider relationships and create pathways for receiving care. Conclusions: Overall, the pilot study found this intervention feasible and acceptable to clients; however, barriers to phone retention were an ongoing challenge. Expanded enrollment in the WelTel service will allow us to examine whether it also facilitates engagement in primary care among marginalized urban populations.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,015 | 0,009 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,002 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,005 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,003 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».