Implementing Automated Text Messaging for Patient Self-management in the Veterans Health Administration: Qualitative Study Applying the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability Framework

Abstract

Background The Veterans Health Administration (VHA) is deploying an automated texting system (aTS) to support patient self-management. Objective We conducted a qualitative evaluation to examine factors influencing national rollout of the aTS, guided by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework, which is intended to support the evaluation of novel technologies. Methods Semistructured interviews were conducted with 33 staff and 38 patients who were early adopters of the aTS. Data were analyzed following deductive and inductive approaches using a priori codes and emergent coding based on the NASSS. Results We identified themes across NASSS domains: (1) Condition: The aTS was considered relevant for a range of patient needs; however, perceptions of patient suitability were guided by texting experience and clinical complexity rather than potential benefits. (2) Technology: Onboarding of the aTS presented difficulty and the staff had different opinions on incorporating patient-generated data into care planning. (3) Value: Supply-side value relied on the flexibility of the aTS and its impact on staff workload whereas demand-side value was driven by patient perceptions of the psychological and behavioral impacts of the aTS. (4) Adopters: Limited clarity on staff roles and responsibilities presented challenges in incorporating the aTS into clinical processes. (5) Organization: Staff were willing to try the aTS; however, perceptions of leadership support and clinic readiness hindered usage. (6) Wider system: Staff focused on enhancing aTS interoperability with the electronic medical record. (7) Embedding and adaptation over time: The interplay of aTS versatility, patient and staff demands, and broader societal changes in preferences for communicating health information facilitated aTS implementation. Conclusions VHA’s new aTS has the potential to further engage patients and expand the reach of VHA care; however, patients and staff require additional support to adopt, implement, and sustain the aTS. The NASSS highlighted how the aTS can be better embedded into current practices, which patients might benefit most from its functionality, and which aspects of aTS messages are most relevant to self-management. Trial Registration ClinicalTrials.gov NCT03898349; https://clinicaltrials.gov/ct2/show/NCT03898349

Increasing Use of Video Telehealth Among Veterans Experiencing Homelessness with Substance Use Disorder: Design of A Peer-Led Intervention

“…Veterans proposed three intervention candidates: (1) peer-led digital training and support (Abadi et al, 2020 ; Barker et al, 2018 ; Blonigen et al, 2020a , b ; Montena et al, 2021 ); (2) an automated tutoring text from the VA Annie Text Messaging app that allows VA clinicians to text protocols to patients and view individual responses (Yakovchenko et al, 2021 ); and (3) a mobile app to guide video visits log-on (Blonigen et al, 2020a ; Connolly et al, 2021 ; Kuhn & McGee-Vincent, 2020 ). Veterans also suggested that providers familiar with behavioral treatment for SUD might have further intervention ideas.…”

“…Veterans proposed three intervention candidates: (1) peerled digital training and support (Abadi et al, 2020;Barker et al, 2018;Blonigen et al, 2020a, b;Montena et al, 2021); (2) an automated tutoring text from the VA Annie Text Messaging app that allows VA clinicians to text protocols to patients and view individual responses (Yakovchenko et al, 2021); and…”

Text Messages to Support Caregivers in a Health Care System: Development and Pilot and National Rollout Evaluation

“…Part of the success of the Annie caregiver protocols may be because of their cross-diagnosis applicability and the fact that neither caregivers nor clinicians must respond to the messages. The impact on staff workload does influence the uptake [ 36 ]. Research into veteran and staff use of Annie suggests that additional support helps providers adopt, implement, and sustain the program [ 36 , 37 ].…”

“…The impact on staff workload does influence the uptake [ 36 ]. Research into veteran and staff use of Annie suggests that additional support helps providers adopt, implement, and sustain the program [ 36 , 37 ]. The Caregiver Center has provided this support through coordinator to promote the protocols, help providers with the technology, and train them to use the technology.…”

“…Part of the success of the Annie caregiver protocols may be because of their cross-diagnosis applicability and the fact that neither caregivers nor clinicians must respond to the messages. The impact on staff workload does influence the uptake [36].…”