Engagement with a Chatbot-based Intervention for the delivery of mailed at-home COVID-19 Testing: a Descriptive Log Analysis Study from the SCALE-UP II Trial
Ordering of COVID-19 test kits among underserved patients who interacted with the chatbot was high, suggesting chatbots may represent a viable approach to reach underserved populations as a part of public health response in a pandemic.
Abstract
Background Promoting at-home tests (e.g., for COVID-19) using chatbots may be a novel and scalable way to improve uptake across underserved populations. Objective The objective of this study was to assess the navigational patterns (i.e., sequence of interactions) of underserved populations when using a chatbot designed to provide education on COVID-19 testing and free order access for at-home COVID-19 test kits. Methods The study was a descriptive analysis of the original data of the chatbot intervention of the SCALE-UP II trial, which compared different digital health modalities (i.e., chatbots versus simple text messages) to deliver free at-home COVID-19 test kits to minority populations in Utah. SCALE-UP II (registration numbers NCT05533918; NCT05533359) was a multisite, pragmatic clinical trial with patients randomized in a 2x2x2 factorial design (smartphone study) to receive (1) chatbot or text messaging, (2) the option to request patient navigation, and (3) intervention frequency every 10 or 30 days. All other participants were randomized in a 2x2 factorial design (nonsmartphone study) to receive the option to request patient navigation and intervention frequency every 10 or 30 days. Eligible patients (1) had an appointment at one of the participating community health centers (CHC) in the last 3 years, (2) were 18 years and older, and (3) had a valid cellphone number recorded in the CHC electronic health record (EHR). The trial enrolled 2117 in the smartphone study and 31,439 in the nonsmartphone study. In the smartphone study, the proportion of participants who requested test kits in the Chatbot arm was lower than in SMS text messaging. In the nonsmartphone study, test kits was higher if they were messaged every 10 days. Sources of funding included the National Institute on Minority Health and Health Disparities (NIMHD) of the US National Institutes of Health (NIH) grant number 5U01MD017421 and by awards from the National Cancer Institute of the NIH (P30CA042014) and the Huntsman Cancer Foundation. Results: Of 1,051 patients randomized to the chatbot intervention, 309 (29%) launched the chatbot, 196 (63%) interacted with it, and 186 (60%) started the COVID-19 test kit ordering process. Among those who launched the chatbot, 170 (55%) completed a test kit order. One patient (0.3%) accessed the chatbot educational content. The median age was 51, with 66% female, 54% Latino/a, 55% uninsured, and 86% located in an urban area. Conclusion: Ordering of COVID-19 test kits among underserved patients who interacted with the chatbot was high. Thus, chatbots may represent a viable approach to reach underserved populations as a part of public health response in a pandemic. All patients except one placed orders without reviewing educational content. Chatbot design should identify and minimize the number of steps for patients to achieve a specific goal.
Equity in digital health is commonly assessed through enrolment and coverage. For interventions requiring sustained participation, enrolment can substantially overstate access. We report a convergent mixed-methods optimisation study of a chatbot-based behaviour change intervention for caregivers (ParentText) delivered via WhatsApp and Facebook Messenger across three low- and middle-income countries: Jamaica, Malaysia, and the Philippines (N = 1293). Using engagement logs, participant and implementer interviews, and a structured consensus process, we examined attrition patterns and explored optimisations. Median engagement was two days and one module; 93.8% of participants completed less than 25% of available content over the five-week intervention. Fewer than one in five participants remained active at Day 7 in two of three sites. Structural barriers included platform policies restricting follow-up after non-response, high message burden, and onboarding design. A consensus panel identified 23 barriers and generated 29 optimisations (69% rated highly feasible within LMIC contexts), currently being tested in a subsequent trial. We introduce effective access as a complementary construct for digital health interventions requiring repeated participation and propose three design principles: 1) test whether users can resume participation under platform constraints; 2) reduce message burden without removing content; and 3) treat re-engagement as a core feature.
Maxwell C. Klapow, P. Zinser, C. Facciolà et al.· npj Digital Public Health· 0 citations
We explored the barriers and facilitators of participating in the patient-initiated follow-up strategy Appointments By Choice (ABC) from the perspectives of participating patients with rheumatoid arthritis (RA).
Patients enrolled in the ABC pilot were invited via email to participate in semi-structured qualitative interviews. Patients were selected from 2 different time points: mid-study (6 months) and end-of-study (12 months), post-enrollment. Demographic information was collected at study enrollment through an online survey hosted on Qualtrics. Interviews were conducted using Zoom Videoconferencing and were 1 hour in length. Interview transcripts were independently analyzed thematically and in duplicate using the Consolidated Framework for Implementation Research (CFIR) to identify barriers and facilitators to ABC participation.[1] Coders met regularly to address additional themes as they emerged from the transcripts, to discuss and modify codes, and reconcile differences. Interviews ceased once saturation was met. Ten CFIR codes representing key domains (Implementation process, individual, inner setting, innovation, and innovation outcomes) were applied deductively, and 5 additional codes were introduced inductively to capture emergent themes.
Ten participants (5 mid-study, 5 end-of-study) were interviewed. The median age was 61 years (IQR = 13.75), and participants had lived with RA for a median of 11.5 years (IQR = 13). Four out of the 10 participants identified as White/European, and 6 out of the 10 participants identified as female. Reported barriers included uncertainty about whom to contact in the event of a flare or other rheumatologic concern, and challenges maintaining regular lab testing when in-person follow-up reminders were absent. Other barriers included missing the physician/patient relationship and the social visit aspect of the rheumatology clinic appointment. Facilitators included shared decision-making with rheumatologists, the availability of a flare action plan promoting self-management,[2] and the use of a self-reported flare questionnaire,[3] as ongoing “check-ins”. Patients valued the flexibility of the ABC model, particularly those living at a distance, and highlighted the responsiveness of the flare clinic and pharmacist support in medication adjustments. An unexpected facilitator was patients’ altruistic motivation, awareness of clinic workload and willingness to defer appointments to allow others with greater needs to be seen sooner. Select domains and patient quotes are displayed (Table 1).
Table 1.
Selected Barriers and Facilitators to ABC Participation (as Highlighted in Abstract), with Representative Quotes Mapped to CFIR Domains
People with RA described ABC as a feasible and acceptable model of care, with minimal barriers identified. Addressing clarity around flare management and lab testing will improve patient experience and willingness to participate in this patient-initiated follow-up model.
[1.] Damschroder LJ. Implement Sci 2022;17:75. [2.] Ester M. BMC Rheumatol 2025;9:31. [3.] Bartlett SJ. J Rheumatol 2017;44:1536-43.
Supported by a CIORA grant
Kiran Dhiman, M. Ester, Krista White et al.· Journal of Rheumatology· 0 citations
OBJECTIVES
A mixed-methods process evaluation was conducted alongside a randomised controlled trial of iACT4CARERS: an eight-session, online, self-help, Acceptance and Commitment Therapy (ACT) intervention with minimal therapist support for family carers of people with dementia. While the RCT evaluated its effects on anxiety, depression, and psychological flexibility, this study examined intervention implementation (fidelity and dose), contextual factors influencing engagement, and mechanisms of impact, focusing on how participants engaged with intervention content and therapist support to produce expected changes.
METHODS
Data were collected from 249 intervention-group carers, including demographics, between-session ACT skill use, weekly values-based goal completion, and change in psychological flexibility (CompACT) from baseline to post-intervention. Platform analytics captured session completion and therapist interaction. Semi-structured interviews were conducted with a purposive sample of 28 carers (21% ethnic minority).
RESULTS
iACT4CARERS was generally well received, with high completion, particularly among older, unemployed, and spousal carers. Engagement was shaped by carers' perceived need, reflecting subjective experience rather than dementia stage. Changes in psychological flexibility were influenced by carers' resonance with metaphors and case examples, and by their engagement with intervention content (e.g. note-taking) and therapists (e.g. therapeutic relationships).
CONCLUSION
iACT4CARERS largely operated as intended; identified refinements could further enhance engagement and benefits.
Abbey Couchman, T. Katangwe-Chigamba, David Howe et al.· Aging & Mental Health· 0 citations
BACKGROUND/AIMS
To analyze the effectiveness of recruitment methods in the Baby-Feed Online Trial.
METHODS
This randomized clinical trial evaluated an online educational intervention for caregivers to monitor and improve their infants' diets and growth. Caregivers of infants aged <4 months living in the United States were recruited using various sources, including "Traditional" (flyers and snowball) and "Online" (social media and blast emails) methods. All methods led to an online pre-screening survey using Qualtrics, a secure, web-based survey platform, to assess eligibility. We analyzed the number of pre-screenings completed by recruitment method, their socio-demographics, and issues with bots. The Florida International University-Institutional Review Board approved the study.
RESULTS
Of the 1213 pre-screenings received, 84% were identified as bots or spam, prompting the implementation of additional security tools in the online pre-screener and a verification call. Within 6 months, 155 individuals were enrolled; 51% came from "Traditional" strategies and 49% from "Online" strategies. The most effective methods were incentivized snowball referrals from enrolled participants, other strategies from the Florida International University research team (referrals, emails, social media posts), and posts in Facebook groups. Participants were recruited from 24 states, with the largest proportion coming from Florida (N = 50; 32.3%). From enrolled participants, 95.5% were mothers aged 34.2 (5.0) years, 16% were participants of the Women, Infant, and Children Program, 65.2% were White, 25.2% were Hispanics, 83.2% had a bachelor's degree or higher, and the mean parental body mass index was 27.3 (4.6) kg/m2. The infant's age at enrollment was 2.2 (1.1) months. No significant differences were observed between the "Traditional" and "Online" recruitment methods in any socio-demographic characteristics.
CONCLUSION
Both recruitment strategies were crucial in recruiting the required sample within a short period with no socio-demographic differences. The incentivized snowball referrals proved to be the most successful strategy. Although a critical challenge was the substantial number of bots, our recruitment plan was effective in recruiting caregivers. However, these strategies were effective in recruiting a highly educated group.
PURPOSE
To evaluate feasibility, death-anchored timeliness, and acceptability of a messaging-based electronic patient reported outcomes (ALVA) for after-death Quality of Dying and Death (QODD) collection from bereaved caregivers in Chile.
METHODS
We conducted a single-arm, mixed-methods pilot study. After consent, caregivers completed the Spanish QODD via ALVA on common messaging apps (no installation). The primary end point was completion among registered participants; on-time was prespecified as 14-84 days after death. Proportions include 95% CIs.
RESULTS
Of 36 invited, 21 registered; pre-registration losses were dominated by hospital-based consent logistics (11/36). Among registered, QODD completion was 100% (21/21) and postquestionnaire interview completion was 95.2% (20/21; 95% CI, 77.4 to 99.2); all QODD completions occurred via chat. Median time to completion was 15 minutes (IQR, 10-22; range, 0:05-23:34); 50% finished ≤15 minutes, 75% ≤20 minutes, 85% ≤60 minutes, and 100% within 24 hours (three pause/resume sessions ≥12 hours). Among those with death-anchored timing data (n = 20), on-time completion was 65.0% (13/20; 95% CI, 43.3 to 81.9); median death to completion was 74 days (IQR, 50-85; range, 7-93). Participants' mean age was 49.1 years (standard deviation, 14.2), and relationships were predominantly children (70%) and spouses (15%).
CONCLUSION
ALVA achieved near-universal completion among registered caregivers (100% QODD; 95% including postinterview) with rapid, same-day questionnaire completion and feasible death-anchored timeliness, supporting scale-up and a comparative trial to optimize implementation and equity.
J. Retamales, Claudio Aracena, Laura Aguilera Beovides et al.· JCO Global Oncology· 0 citations
ABSTRACT Objectives To investigate the efficacy of electronic screening, brief intervention, and referral to treatment (e‐SBIRT) at improving gambling outcomes and increasing help‐seeking. Methods We conducted a two‐arm, randomised online pilot trial (n = 83) comparing an e‐SBIRT intervention with an active control over 12 weeks. The brief intervention was informed by motivational interviewing and incorporated personalised normative feedback, information provision, and relapse‐prevention components. Eligible participants were aged 18 or older, resided in the UK and had scores indicating at least moderate severity gambling. Results Participants (54 [65.1%] male; mean [SD] age = 40.58 [12.75] years, mean [SD] PGSI = 7.16 [5.58]) in the e‐SBIRT and control conditions showed improvements in gambling harms (p = 0.033) and perceived ability to control gambling (p = 0.029). No significant effects of condition assignment or condition x time interactions were observed. However, exploratory analyses of individual model coefficients suggested greater improvement in perceived ability to control gambling among participants receiving e‐SBIRT at 12 weeks (p = 0.043). Exploratory analyses also suggested higher rates of help‐seeking at 12‐week follow‐up among participants receiving e‐SBIRT. Conclusion Overall, e‐SBIRT did not demonstrate clear advantages over assessment and information provision alone. Further research should prioritise refining intervention components and evaluating SBIRT approaches in settings that better reflect its opportunistic delivery model.
Simon Wright, Martyn Quigley, Simon Dymond· Journal of Clinical Psycholo...· 0 citations
We use cookies to run the site and, with your consent, for analytics and to show ads.
See our Cookie Policy.
