Rosa Hernandez-Ramos|Adrián Aguilera|Faviola Garcia|Jose Miramontes|Laura Elizabeth Pathak|Caroline A. Figueroa|Courtney R. Lyles
Conducting Internet-Based Visits for Onboarding Populations With Limited Digital Literacy to an mHealth Intervention: Development of a Patient-Centered Approach
background covid19 pandemic propelled patientfacing research shift digital telehealth strategies strategies adapted minority patients lower socioeconomic status health inequality increase patientcentered models care successfully improve access experience minority patients objective study aims present development process preliminary acceptability altering inperson onboarding procedures internetbased remote procedures mobile health mhealth intervention population limited digital literacy methods actively recruited safetynet patients english spanishspeaking adults diabetes depression receiving care public health care delivery system san francisco united states randomized controlled trial text messaging support physical activity covid19 pandemic modified inperson recruitment onboarding procedures internetbased remote processes human support conducted preliminary evaluation composition recruited cohort might changed precovid19 period covid19 enrollment period first analyzed digital profiles patients n32 participated previous inperson onboarding sessions prior covid19 pandemic next documented changes made onboarding processes account remote recruitment especially needed support patients familiar downloading apps onto mobile phones finally used new study procedures recruit patients n11 covid19 social distancing period patients also asked experience enrolling fully digitized mhealth intervention results recruitment across precovid19 covid19 periods n43 demonstrated relatively high rates smartphone ownership lower selfreported digital literacy 326 1443 patients reporting needed help using smartphone installing apps significant changes made onboarding procedures including facilitating app download via zoom video call andor standard phone call implementing brief oneonone staffpatient interactions provide technical assistance personalized patients digital literacy skills comparing recruitment precovid19 covid19 periods proportion patients digital literacy barriers reduced 344 1132 precovid19 cohort 273 311 covid19 cohort differences digital literacy scores cohorts significant p49 conclusions patients lower socioeconomic status high interest using digital platforms manage health may require additional upfront human support gain access oneonone staffpatient partnerships allowed us provide unique technical assistance personalized patients digital literacy skills simple strategies troubleshoot patient barriers upfront additional remote onboarding strategies mitigate eliminate digital barriers patients without extensive technology experience trial registration clinicaltrialsgov nct0349025 httpsclinicaltrialsgovct2shownct03490253