{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:45:10Z","timestamp":1785545110199,"version":"3.56.0"},"reference-count":42,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Many patients with unhealthy alcohol use (UAU) access health care in emergency departments (EDs). Scalable supports, such as SMS text messaging interventions, are acceptable and feasible to enhance care delivery for many health issues, including substance use. Further, SMS text messaging interventions have been shown to improve patient outcomes related to alcohol consumption (eg, reduced consumption compared to no intervention, basic health information, or drink tracking), but they are rarely offered in clinical settings.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This paper describes a mixed methods study using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. The goal of this study was to use a stakeholder-engaged mixed methods design to assess barriers and facilitators to the implementation of SMS text messaging interventions for UAU in EDs with a focus on the recipient\u2019s characteristics, the innovation\u2019s degree of fit within the existing practice, and the unique nature of the inner and outer context.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This study was conducted in a large health system in the northeastern United States. We examined electronic health record data on alcohol screening in 17 EDs; surveyed 26 ED physician chairpersons on implementation feasibility, acceptability, and appropriateness; and interviewed 18 ED staff and 21 patients to understand barriers and facilitators to implementation. Interviews were analyzed according to the i-PARIHS framework to assess recipient characteristics, innovation degree of fit, and inner and outer context.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Electronic health record data revealed high variability in alcohol screening completion (mean 73%, range 35%\u201093%), indicating potential issues in identifying patients eligible to offer the intervention. The 26 ED chair surveys revealed a relatively high level of implementation confidence (mean 4, SD 0.81), acceptability (mean 4, SD 0.71), and appropriateness (mean 3.75, SD 0.69) regarding the UAU SMS text messaging intervention; feasibility (mean 3.5, SD 0.55) had the lowest mean, indicating concerns about integrating the text intervention in the busy ED workflow. Staff were concerned about staff buy-in and adding additional discussion points to already overwhelmed patients during their ED visit but saw the need for additional low-threshold services for UAU. Patients were interested in the intervention to address drinking and health-related goals.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n ED visits involving UAU have increased in the United States. The results of this formative study on barriers and facilitators to the implementation of UAU SMS text messaging interventions in EDs indicate both promise and caution. In general, we found that staff viewed offering such interventions as appropriate and acceptable; however, there were concerns with feasibility (eg, low alcohol risk screening rates). Patients also generally viewed the SMS text messaging intervention positively, with limited drawbacks (eg, slight concerns about having time to read messages). The results provide information that can be used to develop implementation strategies that can be tested in future studies.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/65187","type":"journal-article","created":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T11:15:57Z","timestamp":1741000557000},"page":"e65187-e65187","source":"Crossref","is-referenced-by-count":0,"title":["Text Messaging Interventions for Unhealthy Alcohol Use in Emergency Departments: Mixed Methods Assessment of Implementation Barriers and Facilitators"],"prefix":"10.2196","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1121-734X","authenticated-orcid":false,"given":"Megan","family":"O'Grady","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9074-2128","authenticated-orcid":false,"given":"Laura","family":"Harrison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3381-3270","authenticated-orcid":false,"given":"Adekemi","family":"Suleiman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0807-8721","authenticated-orcid":false,"given":"Morica","family":"Hutchison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4658-6815","authenticated-orcid":false,"given":"Nancy","family":"Kwon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2483-9594","authenticated-orcid":false,"given":"Frederick","family":"Muench","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1581-6403","authenticated-orcid":false,"given":"Sandeep","family":"Kapoor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,3,3]]},"reference":[{"issue":"5","key":"R1","doi-asserted-by":"publisher","first-page":"e73","DOI":"10.1016\/j.amepre.2015.05.031","article-title":"2010 national and state costs of excessive alcohol consumption","volume":"49","author":"Sacks","journal-title":"Am J Prev Med"},{"issue":"17","key":"R2","doi-asserted-by":"publisher","first-page":"1704","DOI":"10.1001\/jama.2022.4308","article-title":"Alcohol-related deaths during the COVID-19 pandemic","volume":"327","author":"White","journal-title":"JAMA"},{"issue":"5","key":"R3","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.20m13241","article-title":"Increasing emergency department visits for mental health conditions in the United States","volume":"81","author":"Theriault","journal-title":"J Clin Psychiatry"},{"issue":"2","key":"R4","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1111\/acer.13559","article-title":"Trends in alcohol-related emergency department visits in the United States: results from the nationwide emergency department sample, 2006 to 2014","volume":"42","author":"White","journal-title":"Alcohol Clin Exp Res"},{"issue":"10","key":"R5","doi-asserted-by":"publisher","first-page":"2420","DOI":"10.1007\/s11606-021-07069-w","article-title":"National prevalence of alcohol and other substance use disorders among emergency department visits and hospitalizations: NHAMCS 2014-2018","volume":"37","author":"Suen","journal-title":"J Gen Intern Med"},{"issue":"4","key":"R6","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1016\/j.jemermed.2023.01.010","article-title":"Emergency department management of patients with alcohol intoxication, alcohol withdrawal, and alcohol use disorder: a white paper prepared for the American Academy of Emergency Medicine","volume":"64","author":"Strayer","journal-title":"J Emerg Med"},{"issue":"4","key":"R7","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1016\/j.annemergmed.2022.11.013","article-title":"Time to treat alcohol use disorder in the emergency department","volume":"81","author":"Hawk","journal-title":"Ann Emerg Med"},{"issue":"2","key":"R8","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1007\/s40429-016-0099-6","article-title":"Mobile interventions targeting risky drinking among university students: a review","volume":"3","author":"Berman","journal-title":"Curr Addict Rep"},{"issue":"4","key":"R9","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1111\/dar.12535","article-title":"Mobile phone messaging for illicit drug and alcohol dependence: a systematic review of the literature","volume":"36","author":"Tofighi","journal-title":"Drug Alcohol Rev"},{"key":"R10","doi-asserted-by":"crossref","unstructured":"Ranney ML Pisani AR Chernick LS . 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