Reach, Acceptability, and Patient Preferences of a Mobile Health-Based Survey to Assess COVID-19 Vaccine Hesitancy Among Patients Receiving Dialysis

Abstract

Rationale & ObjectiveThe majority of patients with kidney failure receiving dialysis own mobile devices, but the use of mobile health (mHealth) technologies to conduct surveys in this population is limited. We assessed the reach and acceptability of a short message service (SMS) text message-based survey that assessed COVID-19 vaccine hesitancy among patients receiving dialysis. Study DesignCross-sectional SMS-based survey in January 2021. Setting& Participants: Patients receiving in-center hemodialysis, peritoneal dialysis, or home hemodialysis in a non-profit dialysis organization in New York City. Outcomes1) Reach of the SMS survey, 2) Acceptability using the 4-item Acceptability of Intervention Measure (AIM), and 3) Patient preferences for modes of survey administration. Analytical ApproachWe used Fisher’s exact tests and multivariable logistic regression to assess sociodemographic and clinical predictors of SMS survey response. Qualitative methods were used to analyze open-ended responses capturing patient preferences. ResultsAmong 1008 patients, 310 responded to the SMS survey (response rate 31%). In multivariable adjusted analyses, participants who were age 80 and above (aOR 0.49, 95% CI 0.25 – 0.96) were less likely to respond to the SMS survey compared with those aged 18 to 44. Non-Hispanic Black (aOR 0.58, 95% CI 0.39 – 0.86), Hispanic (aOR 0.31, 95% CI 0.19 – 0.51), and Asian or Pacific Islander (aOR 0.46, 95% CI 0.28 – 0.74) individuals were less likely to respond compared with non-Hispanic White participants. Participants residing in census tracts with higher Social Vulnerability Index (SVI), indicating greater neighborhood-level social vulnerability, were less likely to respond to the SMS survey (5th vs. 1st quintile aOR 0.61, 95% CI 0.37 – 0.99). Over 80% of a sample of survey respondents and non-respondents completely agreed or agreed with the Acceptability of Intervention Measure. Qualitative analysis revealed 4 drivers of patient preferences for survey administration: 1) convenience (subtopics: efficiency, multi-tasking, comfort, synchronicity); 2) privacy; 3) interpersonal interaction; and 4) accessibility (subtopics: vision, language, fatigue). LimitationsGeneralizability, length of survey. ConclusionsAn SMS text message-based survey had moderate reach among patients on dialysis and was highly acceptable, but response rates were lower in older (age ≥ 80), non-White individuals, and those with greater neighborhood-level social vulnerability. Future research should examine barriers and facilitators to mHealth among patients on dialysis to ensure equitable implementation of mHealth-based technologies.