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Implementation of a Referral Scheme to Text Messaging Programs for Physical Activity and Healthy Eating in Underserved Hispanics

ABSTRACT Hispanics share a disproportionate burden of several of the nation’s leading chronic diseases caused by poor lifestyle habits, such as a lack of physical activity and unhealthy eating. Interventions that include text messaging have shown the ability to positively affect health behaviors. This study examined the implementation of a referral scheme connecting Hispanic patients attending a community health clinic to text messaging programs encouraging health behavior change. A mixed methods approach was used to evaluate the implementation of the referral scheme. Assessments included tracking referral rates patient enrollment, as well as semistructured interviews conducted to identify barriers and facilitators experienced by health care providers. During the 2-month referral period, five health care providers referred 26 (8.9%) of the 291 eligible patients. Of these patients, only one self-enrolled in the text messaging program (3.9% of referred patients), with an additional 11 patients (42.3% of referred patients) enrolling after follow-up from an intern at the clinic. In-depth interviews with clinic administrators and providers, conducted at the end of the referral period, revealed four overarching barriers to the text messaging referral scheme: a lack of time during patient visit, limited resources and personnel, a lack of communication between administrators and health care providers, and an inefficient technology system. Addressing these barriers using alternative implementation strategies may lead to increased levels of health care provider adoption and patient enrollment in text messaging programs. Information from this study can inform areas of improvement in better linking underserved Hispanic patients to available resources for lifestyle modification.