Electronic Outreach Research Articles

The effect of mailed outreach on FIT completion among patients aged 45-50 in a safety net healthcare system.

Colorectal cancer screening is recommended starting at age 45, but there has been little research on strategies to promote screening in patients younger than 50. An outreach program quasi-randomly assigned patients aged 45-50 without recent fecal immunochemical test (FIT), colonoscopy or contraindications to screening to two intervention arms: electronic outreach with email and text (electronic outreach only)versus electronic outreach plus mailed outreach with FIT, an instructional letter and a prepaid return envelope (mailed + electronic outreach). In response to known disparities in screening uptake, all Black patients were assigned to receive mailed + electronic outreach. Among patients quasi-randomly assigned to an intervention (non-Black patients), the 180-day FIT completion rate was 18.8% in the electronic outreach only group (n = 1,318) and 25.0% in the mailed + electronic outreach group (n = 1,364) (difference 6.2% [95% CI 3.0, 9.4]). FIT completion was 16.6% among Black patients (n = 469), 8.4% (95% CI 4.1, 12.6) lower than among non-Black patients also assigned to mailed + electronic outreach. Among patients aged 45-50, mailed + electronic outreach had a greater effect on FIT completion than electronic outreach alone. Crossover between intervention groups likely lead to an underestimation of the effect of mailed outreach.

COVID-19 Vaccination Messengers, Communication Channels, and Messages Trusted Among Black Communities in the USA: a Review.

Black and African American adults exhibited higher levels of mistrust and vaccine hesitancy and lower levels of vaccination throughout the COVID-19 pandemic. Vaccination and booster uptake remains disproportionately low among Black adults. We conducted a systematic review of empirical research published between February 2021 and July 2022 from five electronic databases and the grey literature. We screened studies that assessed COVID-19 vaccination information needs and preferences as well as communication strategies among Black adults in the USA. We extracted data, then analyzed and synthesized results narratively. Twenty-two articles were included: 2 interventions, 3 experimental surveys, 7 observational surveys, 8 qualitative inquiries, and 2 mixed methods studies. Studies reported credible and preferred COVID-19 vaccination information sources/messengers, channels, and content. Commonly trusted messengers included personal health care providers, social network connections, and church/faith leaders. Electronic outreach (e.g., email, text messages), community events (e.g., forums, canvassing), and social media were popular. Black communities wanted hopeful, fact-based messages that address racism and mistrust; persuasive messages using collective appeals about protecting others may be more influential in changing behavior. Future communication strategies aiming to increase vaccine confidence and encourage COVID-19 booster vaccination among Black communities should be developed in partnership with community leaders and local health care providers to disseminate trauma-informed messages with transparent facts and collective action appeals across multiple in-person and electronic channels.

Abstract 16149: Recruitment Strategies for a Remote Implementation Study in Diabetes Management - Insights Into Optimizing Enrollment

Background/Objectives: Remote clinical studies offer new outreach opportunities, but recruitment remains challenging. We report our experience in identifying potential participants from diverse sources and adopting various outreach and recruitment methods. Methods: We utilized multiple screening and recruitment methods to identify and enroll patients into an implementation study for guideline-directed care in patients with T2D at high risk of cardio-renal complications within the Mass General Brigham health network. Patients were identified by querying the EHR and invited by emails, individualized, or bulk EHR-portal messages. Traditional outreach included reviewing upcoming clinic visits, accepting provider referrals, and mailing invite letters. All screened-in patients received phone calls following the initial invitation ( Figure ). Results: Of 200 enrolled participants, 190/200 (95%) were identified from the EHR, 2/200 (1%) from upcoming clinic visits, and 8/200 (4%) from provider referrals. Of patients identified through the EHR, 49/3317 (1%) of the total enrolled were invited by an individualized EHR message, 61/3317 (2%) by e-mail, 80/588 (14%) by mailed letter, and 0/3666 (0%) by bulk EHR message. From clinic, 2/102 (2%) of upcoming visits and 8/36 (22%) of provider referrals were enrolled. Overall, 90/200 (45%) of enrolled patients came from letters or clinic while 110/200 (55%) came from electronic outreach. Conclusion: Conducting remote clinical research is feasible, however, enrollment remains labor-intensive. Traditional methods of patient engagement are difficult to scale, although they led to high enrollment rates. While the EHR was the primary method for identification of our enrolled participants, traditional approaches including manual screening, mailed letters, and provider referrals continue to play a role in patient enrollment. Innovative approaches are necessary to improve the process.

Addressing childcare as a barrier to healthcare access through community partnerships in a large public health system

ObjectiveIn our public health system, a survey of reproductive-aged women identified lack of childcare as the most common reason for missing or delaying healthcare. Community-based organisations (CBOs) in our county...

Botanic gardens: Seizing the moment while imagining the future

Societal Impact StatementThe coronavirus pandemic has reminded us that green spaces provide sanctuary and comfort, as well as opportunities for release and relief, during difficult times. However, to ensure continuing viability, botanical gardens can do more to address important societal concerns, especially around the environment. Sustaining relevance through action, especially local action, while also thinking beyond botanical science, and making creative use of electronic outreach will help botanic gardens to flourish.SummaryThis paper is a personal reflection on high‐level issues relevant to future of botanic gardens and similar organisations, based on the personal experiences of the author at the Field Museum in Chicago, the Royal Botanic Gardens, Kew, in London, the Yale School of Forestry and Environmental Studies (now the Yale School of the Environment) in New Haven, Connecticut, and the Oak Spring Garden Foundation in northern Virginia. Botanic gardens have the inherent advantage that passages of nature, especially in cities, are vital for individual and social well‐being. But this natural advantage needs to be supplemented by actions that take into account a changing world and that respond in meaningful ways to the concerns of supporters and stakeholders. I emphasise five principles that are important now and for the future: (1) Sustaining relevance is key; (2) science is not enough; (3) actions speak louder than words; (4) local action is disproportionately important; and (5) electronic outreach is not optional. Leadership from outstanding individuals is also vital. Finding, encouraging and developing energetic people who are open minded, determined to make a difference and willing to embrace change is vital for institutional success.

Effect of Electronic Portal Messaging With Embedded Asynchronous Care on Physician-Assisted Smoking Cessation Attempts

Despite the substantial health and financial burdens of smoking and the availability of effective, evidence-based interventions in primary care settings, few smokers and physicians use these strategies for smoking cessation. To evaluate whether electronic outreach to smokers with embedded asynchronous care increases the number of quit attempts and explore the roles of the message sender (ie, primary care physician [PCP] vs health care system) and patient-related characteristics. This quality improvement randomized clinical trial was designed to measure 2 factors: (1) electronic outreach messaging with and without a survey link to asynchronous care and (2) messaging by a personal PCP or health system. The study was conducted within the electronic health record and portal messaging platform of a large health system in the South Central US. Participants were adult patients 18 years or older who were designated as smokers in their electronic health records. Data were collected from January 13 to February 24, 2020, with participating PCPs surveyed in July 2020. Portal messages encouraging a quit attempt and offering physician assistance were sent to smokers who were randomly selected and assigned to 1 of 4 conditions (message with or without embedded asynchronous care and PCP or system as sender). Half of the messages contained an invitation to come to clinics and the other half contained a link to access asynchronous care. The primary outcome was electronic health record-documented quit attempts (1 indicates quit attempt; 0, no quit attempt), which were tracked 30 days after the electronic outreach. Secondary outcomes included physician perceptions of the electronic outreach intervention, using a 5-point scale to assess perceptions of workload, comfort with providing medication from survey information, and further interest in the program 6 months after the intervention. A total of 188 participants (99 women [52.4%] and 89 men [47.3%]) with mean (SD) age of 55.2 (13.9) years were randomized to 1 of 4 conditions. Group 1 (n = 46) received a message from the PCP without a link to the survey; group 2 (n = 48) received a message from the PCP with a link to asynchronous care in the form of the survey. Group 3 (n = 47) received a message from the health system without a link to the survey; group 4 (n = 47) received a message from the health system with a link to the survey. No statistically significant difference in documented quite attempts was found among the 4 study groups. There was also no statistically significant difference in quit attempts between the group that received the asynchronous care survey link and the group that did not (odds ratio, 2.50 [95% CI, 0.72-8.72]). However, the quit attempt rate for those with asynchronous care offered (9 of 95 [9.5%]) was more than double the quit attempt rate for those with in-person care offered (4 of 93 [4.3%]). This quality improvement randomized clinical trial did not find a statistically significant difference in physician-assisted quit attempts among patients who received electronic with asynchronous care vs those who received outreach alone, regardless of whether the message source was a PCP or a health system. However, the program engaged patients in difficult-to-reach rural areas as well as younger patients. ClinicalTrials.gov Identifier: NCT05172219.

Mining Electronic Health Records to Promote the Reach of Digital Interventions for Cancer Prevention Through Proactive Electronic Outreach: Protocol for the Mixed Methods OptiMine Study.

BackgroundDigital behavior change interventions have demonstrated effectiveness for smoking cessation and reducing alcohol intake, which ultimately reduce cancer risk. Leveraging electronic health records (EHR) to identify at-risk patients and increasing the reach of digital interventions through proactive electronic outreach provide a novel approach that may increase the number of individuals who engage with evidence-based treatment.ObjectiveThis study aims to increase the reach of digital behavior change interventions by implementing a proactive electronic message system for smoking cessation and alcohol reduction among a large, at-risk population identified through an acute hospital EHR.MethodsThis protocol describes a 3-phase, mixed-methods implementation study to assess the acceptability, feasibility, and reach of a proactive electronic message system to digital interventions using a hospital’s EHR system to identify eligible patients. In Phase 1, we will conduct focus group discussions with patients and hospital staff to assess the overall acceptability of the electronic message system. In Phase 2, we will conduct a descriptive analysis of the patient population in the hospital EHR regarding target risk behaviors and other person-level characteristics to determine the project’s feasibility and potential reach. In Phase 3, we will send proactive messages to patients identified as smokers or risky drinkers. Messages will encourage and provide access to behavior change mobile apps via an embedded link; the primary outcome will be the proportion of participants who click on the link to access information about the apps.ResultsAt the time of initial protocol submission, data collection was complete, but analysis had not begun. This study was funded by Cancer Research UK from April 2019 to March 2020. Health Research Authority approval was granted in June 2019.ConclusionsIncreasing the reach of digital behavior change interventions can improve population health by reducing the burden of preventable death and disease.International Registered Report Identifier (IRRID)DERR1-10.2196/23669

Recruiting young women of color into a pilot RCT targeting sexual health: Lessons learned and implications for applied health technology research

Objective To evaluate different recruitment methods to enroll participants into a mHealth pilot RCT: banner ads on Facebook and OkCupid, and targeted electronic outreach (e.g., emails to community-based organizations and to professors at local colleges). Participants: Between October 2015 and May 2016, 114 college-aged Black and Latina women 18 to 24 participated in the study. Methods: Recruitment methods compared online banner ads on social media to targeted electronic outreach. Individual banner ad images were compared by impressions, clicks, and cost by enrolled participants. Results: More targeted electronic recruited participants enrolled than via banner advertisements. Banner ads with images of women yielded a higher click-through-rate and was more cost effective versus the logo alone. Conclusions: Recruiting young women of color may be facilitated through known and trusted adults, such as college professors, rather than through anonymous banner advertisements on social media.

Contraceptive Method Use During the Community-Wide HER Salt Lake Contraceptive Initiative.

To describe a community-wide contraception initiative and assess changes in method use when cost and access barriers are removed in an environment with client-centered counseling. HER Salt Lake is a prospective cohort study occurring during three 6-month periods (September 2015 through March 2017) and nested in a quasiexperimental observational study. The sample was women aged 16 to 45 years receiving new contraceptive services at health centers in Salt Lake County, Utah. Following the control period, intervention 1 removed cost and ensured staffing and pharmacy stocking; intervention 2 introduced targeted electronic outreach. We used logistic regression and interrupted time series regression analyses to assess impact. New contraceptive services were provided to 4107 clients in the control period, 3995 in intervention 1, and 3407 in intervention 2. The odds of getting an intrauterine device or implant increased 1.6 times (95% confidence interval [CI] = 1.5, 1.6) during intervention 1 and 2.5 times (95% CI = 2.2, 2.8) during intervention 2, relative to the control period. Time series analysis demonstrated that participating health centers placed an additional 59 intrauterine devices and implants on average per month (95% CI = 13, 105) after intervention 1. Removing client cost and increasing clinic capacity was associated with shifts in contraceptive method mix in an environment with client-centered counseling; targeted electronic outreach further augmented these results.

Cultivating the Next Generation of Psychiatrists

Cultivating the Next Generation of Psychiatrists

Abstract NS 10: eHealth is Necessary in Stroke Education

Introduction: The use of the internet and new technologies to conduct electronic outreach and education (e-Outreach) will help to decrease stroke morbidity and mortality. Due to the near omni-presence of the internet and computers in society today, it is necessary to utilize these electronic resources to truly conduct outreach and educate the public. Background: In 2004, a phone-based survey of 800 households in Alameda County found that only 10% of those surveyed held a basic-level of knowledge about stroke. In that same year, 50% of stroke patients died before reaching the emergency department. Based on these data, a stroke outreach and education committee was created which did not limit its outreach to physical interactions but also incorporated e-Outreach. With at least 60% of the U.S. population owning a computer and 85% owning a mobile device, using the internet and electronic devices for stroke education can eliminate some of the barriers that prevent populations - which are not connected to health care facilities - from being educated about stroke. Purpose: To prevent strokes and educate the community on how to identify and react to the signs and symptoms of stroke. To provide guidelines on how to conduct e-Outreach in the area of stroke. Methods/Results: After an evaluation of the community's needs, different methods to conduct e-Outreach were chosen based on available educational materials and relevant technologies. Three chosen methods include: (1) publish a biannual newsletter through a web-based service (∼300 readers per issue); (2) produce a stroke film and then post it on YouTube (∼140 views per month and over 4000 views in total, worldwide); and (3) develop and pilot a "stand-alone touch-screen computer" (kiosk) program in a church (∼200 users in the first three months) to reach populations that do not regularly use the computer/internet nor attend regular medical appointments. Monthly goals were set at various stages of this process and evaluated to monitor the progress. Conclusion: The use of e-Outreach has been a huge success in conducting outreach and education. e-Outreach has proven to be far more effective in reaching a more broad population than was previously possible and automated tracking systems made the evaluation process more efficient. Leveraging the free resources available through these technologies has proven an excellent addition to our in-person outreach methods. Our plans to expand our e-Outreach efforts include using text messages for stroke education and developing a computer application that will allow users to do a self-examination using the Act F.A.S.T. test. Additionally, we plan to conduct another survey (incorporating e-Outreach methods) in Fall 2011 to gauge the level of stroke literacy and outcome of stroke death prior to reaching the emergency room.

Use of electronic personal health record systems to encourage HIV screening: an exploratory study of patient and provider perspectives

BackgroundWhen detected, HIV can be effectively treated with antiretroviral therapy. Nevertheless in the U.S. approximately 25% of those who are HIV-infected do not know it. Much remains unknown about how to increase HIV testing rates. New Internet outreach methods have the potential to increase disease awareness and screening among patients, especially as electronic personal health records (PHRs) become more widely available. In the US Department of Veterans' Affairs medical care system, 900,000 veterans have indicated an interest in receiving electronic health-related communications through the PHR. Therefore we sought to evaluate the optimal circumstances and conditions for outreach about HIV screening. In an exploratory, qualitative research study we examined patient and provider perceptions of Internet-based outreach to increase HIV screening among veterans who use the Veterans Health Administration (VHA) health care system.FindingsWe conducted two rounds of focus groups with veterans and healthcare providers at VHA medical centers. The study's first phase elicited general perceptions of an electronic outreach program to increase screening for HIV, diabetes, and high cholesterol. Using phase 1 results, outreach message texts were drafted and then presented to participants in the second phase. Analysis followed modified grounded theory.Patients and providers indicated that electronic outreach through a PHR would provide useful information and would motivate patients to be screened for HIV. Patients believed that electronic information would be more convenient and understandable than information provided verbally. Patients saw little difference between messages about HIV versus about diabetes and cholesterol. Providers, however, felt patients would disapprove of HIV-related messages due to stigma. Providers expected increased workload from the electronic outreach, and thus suggested adding primary care resources and devising methods to smooth the flow of patients getting screened. When provided a choice between unsecured emails versus PHRs as the delivery mechanism for disease screening messages, both patients and providers preferred PHRs.ConclusionsThere is considerable potential to use PHR systems for electronic outreach and social marketing to communicate to patients about, and increase rates of, disease screening, including for HIV. Planning for direct-to-patient communications through PHRs should include providers and address provider reservations, especially about workload increases.

The Impact of an Electronic Outreach Program on AHEC Physicians' Patient Care

The Impact of an Electronic Outreach Program on AHEC Physicians' Patient Care

Nuclear knowledge management initiatives of the Regional Cooperative Agreement undertaken by the Electronic Networking and Outreach project

The Regional Cooperative Agreement (RCA) in the Asia Pacific region is one of the cooperative agreements under the aegis of the International Atomic Energy Agency and currently consists of 17 member states. Since the region covered by the RCA is undergoing a rapid expansion in nuclear power development, many activities have been carried out under the RCA. The Electronic Networking and Outreach (ENO) Project under the RCA was used as a vehicle for the RCA programme for the dissemination of valuable information to end-users. This paper will describe the initiatives undertaken by the ENO project to initially establish an information and knowledge-sharing environment as an initiative towards a nuclear knowledge management system within the RCA community. It will also discuss the challenges and issues peculiar to the region that have been encountered during the project cycle. Then it will try to offer a conceptual framework of a nuclear knowledge management system for the RCA region.

The terrestrial ecosystem monitoring sites: a utility assessment

Ecological research sites generate data which are potentially useful at the national, regional and global scales. However, most of the data remain embedded in local, project-specific research programmes. The primary role of the Global Terrestrial Observing System (GTOS) is to act as a data broker and bring researchers and modellers together in order to better understand global change processes in areas such as climate change and biodiversity. The Terrestrial Ecosystem Monitoring Sites (TEMS) database is a GTOS-led effort to enhance the ability of sites to collaborate and provide a framework for researchers, resource managers and decision makers who seek data to support their efforts at the regional and global levels. Early in 2002, a user survey was carried out to assess the use of the TEMS database, the adequacy of geographic coverage and identify future user requirements. The survey also assessed the utility of specific features within the website such as the environmental variables methodology sheets, the search engines and the dynamic map interface. The results confirmed that TEMS contains useful information which can be easily accessed. The registered sites are under-represented, on both an eco-regional and continental basis, in all geographic areas except for Europe and Northern America. Data sharing, including satellite imagery, was indicated to be of high priority; however, free access to data remains a constraint in some regions. Finally, a focus on electronic solicitation and outreach should be continued.

Rethinking Project Selection at the Monterey Bay Aquarium

In 1995, the Monterey Bay Aquarium started an experimental business unit called Electronic Outreach. Electronic Outreach's mission was to employ emerging technologies to deliver the aquarium's messages of ocean stewardship to diverse and scattered audiences. Faced with many projects from which to choose, the Electronic Outreach team wanted to determine which projects were most likely to succeed before they actually had to dedicate resources to development. We constructed two models to help them accomplish this: a multiattribute-value model to quantify a project's alignment with the aquarium's mission and a discounted-cash-flow model to quantify a project's viability as a business venture. We then combined the outputs of these two models into a two-dimensional framework to allow the Electronic Outreach team members to focus on monetary-nonmonetary trade-offs when evaluating potential projects.

Art, Electronic Outreach and American Democracy

Art, Electronic Outreach and American Democracy

Sharing the Resources: Electronic Outreach Programs

Rural schools struggle with limited resources including an inadequate curriculum, lack of qualified teachers and little access to programming usually available to larger metropolitan schools. Such inequities have prevented many rural students from pursuing scholarship opportunities and entrance to institutions with restricted admissions. The Louisiana School for Math, Science and the Arts attempts to remediate the problem by serving rural students throughout the state with a distance learning network, Project Outreach, which delivers special classes that otherwise would be unavailable. The system uses interactive computer technology to teach advanced content courses in math, foreign language, science, and survey of the arts. The effectiveness of the outreach program was evaluated as to its potential to provide courses at a distance to rural students in Louisiana. Results of the study included a significant gain in scores between pre-test and posttest scores on a national calculus exam, and open-ended responses revealed favorable comments toward the system from its participants. The distance learning network is seen as one method for connecting rural students to the superior programs offered by special schools.