{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:55:12Z","timestamp":1782845712036,"version":"3.54.5"},"reference-count":35,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Mhealth Uhealth"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Many individuals in urban low-income settings face barriers to engaging in primary care and experience systemic challenges such as homelessness and discrimination in the health care system. This study was conducted in the Downtown Eastside of Vancouver, Canada, a low-income neighborhood with intersecting structural vulnerabilities and disproportionate rates of substance use disorders. Advancements in mobile health expand options for facilitating communication between primary care providers and clients.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n We conducted a pilot project that provided primary care clients a mobile phone and access to WelTel, a mobile health tool that uses a 2-way texting approach and sends weekly automated check-in messages. Our study measured phone retention, defined as retaining a study-supplied device and being reachable on the study-supplied device over a 6-month period and explored the acceptability and feasibility of WelTel among a cohort of clients with complex health challenges.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Stratified random sampling was used to recruit participants from a larger cohort study of primary care clinic clients in the Downtown Eastside. The sample was stratified to ensure equal participation based on gender and Indigenous and non-Indigenous participants. In this mixed methods research, participants completed 3 surveys over a 6-month period from November 2022 to May 2023. The surveys assessed phone retention and functionality as well as phone use, including use of the WelTel platform. Clients who had access to a functional mobile phone after the follow-up period were invited to complete an in-person interview. The semistructured interviews explored clients\u2019 experiences with WelTel, primary care, and engagement with technology.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n We enrolled 49 participants (median age 48 y; 53% women and 49% Indigenous) and interviewed 16 participants. A total of 44 clients completed the 6-month survey, and of those clients, 26 (59%) had a functional phone. However, only 14 (29%) clients retained the mobile device supplied during the study and completed the 6-month survey. Phone retention or access to a nonstudy phone was lower among those who had used opioids (18% for both) in the past 3 months (\n P<\/jats:italic>\n <.01), as well as those who reported not having access to a cellphone at enrollment (25% and 15%, respectively) compared to those who did have phone access at enrollment (\n P<\/jats:italic>\n =.05). Both the surveys and semistructured interviews indicated that WelTel was generally well received; 25 (96%) of those with a functional phone reported that they liked receiving the weekly messages. During qualitative interviews, the WelTel intervention was reported to strengthen client-provider relationships and create pathways for receiving care.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Overall, the pilot study found this intervention feasible and acceptable to clients; however, barriers to phone retention were an ongoing challenge. Expanded enrollment in the WelTel service will allow us to examine whether it also facilitates engagement in primary care among marginalized urban populations.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/68561","type":"journal-article","created":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T13:41:17Z","timestamp":1764337277000},"page":"e68561-e68561","source":"Crossref","is-referenced-by-count":1,"title":["Evaluation of a Pilot mHealth Intervention to Engage Primary Care Clients at an Urban Clinic Serving Marginalized Populations: Mixed-Methods Cohort Study"],"prefix":"10.2196","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-6010-7658","authenticated-orcid":false,"given":"Lauren","family":"Harrison","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Fulton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Marante Changir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5265-4212","authenticated-orcid":false,"given":"Adedayo","family":"Ajidahun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7283-4082","authenticated-orcid":false,"given":"Cassidy","family":"Tam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tian","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolando","family":"Barrios","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6201-9829","authenticated-orcid":false,"given":"Julio","family":"Montaner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6033-5089","authenticated-orcid":false,"given":"Kate","family":"Salters","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1759-2236","authenticated-orcid":false,"given":"Richard T","family":"Lester","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6857-6231","authenticated-orcid":false,"given":"Surita","family":"Parashar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1078-9247","authenticated-orcid":false,"given":"David M","family":"Moore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,11,27]]},"reference":[{"issue":"15","key":"R1","doi-asserted-by":"publisher","first-page":"E463","DOI":"10.1503\/cmaj.170784","article-title":"Why strengthening primary health care is essential to achieving universal health coverage","volume":"190","author":"van Weel","journal-title":"CMAJ"},{"key":"R2","unstructured":"Government of Canada. About Canada\u2019s health care system. Jun 25, 2025. URL: https:\/\/www.canada.ca\/en\/health-canada\/services\/canada-health-care-system.html [Accessed 16-07-2025]"},{"issue":"5","key":"R3","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1177\/08404704231183599","article-title":"Disparities in access to primary care are growing wider in Canada","volume":"36","author":"Lavergne","journal-title":"Healthc Manage Forum"},{"issue":"1","key":"R4","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-022-01679-4","article-title":"Do changes in primary care service use over time differ by neighbourhood income? Population-based longitudinal study in British Columbia, Canada","volume":"21","author":"Lavergne","journal-title":"Int J Equity Health"},{"issue":"12","key":"R5","doi-asserted-by":"publisher","first-page":"e348","DOI":"10.46747\/cfp.6712e348","article-title":"Inability to access primary care clinics among people who inject drugs in a Canadian health care setting","volume":"67","author":"Brar","journal-title":"Can Fam Physician"},{"issue":"1","key":"R6","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-020-05670-z","article-title":"Engagement in primary health care among marginalized people who use drugs in Ottawa, Canada","volume":"20","author":"Kendall","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"R7","doi-asserted-by":"publisher","DOI":"10.1186\/s12954-017-0143-4","article-title":"A cohort study examining emergency department visits and hospital admissions among people who use drugs in Ottawa, Canada","volume":"14","author":"Kendall","journal-title":"Harm Reduct J"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2007.9984","article-title":"The provider role in client engagement in HIV care","volume":"21 Suppl 1","author":"Mallinson","journal-title":"AIDS Patient Care STDS"},{"issue":"3","key":"R9","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1016\/j.pec.2017.08.019","article-title":"Contingent engagement: what we learn from patients with complex health problems and low socioeconomic status","volume":"101","author":"Komaromy","journal-title":"Patient Educ Couns"},{"issue":"5","key":"R10","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1177\/08404704221110084","article-title":"Virtual care and the influence of a pandemic: necessary policy shifts to drive digital innovation in healthcare","volume":"35","author":"Patterson","journal-title":"Healthc Manage Forum"},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-publhealth-031914-122855","article-title":"Mobile text messaging for health: a systematic review of reviews","volume":"36","author":"Hall","journal-title":"Annu Rev Public Health"},{"issue":"5","key":"R12","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.120.007015","article-title":"Text message medication adherence reminders automated and delivered at scale across two institutions: testing the nudge system: pilot study","volume":"14","author":"Luong","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"R13","unstructured":"WelTel Health, a secure saasvirtual care platform. WelTel Health. URL: https:\/\/www.weltelhealth.com\/platform [Accessed 14-07-2024]"},{"issue":"7","key":"R14","doi-asserted-by":"publisher","DOI":"10.2196\/mhealth.9493","article-title":"Health care provider utilization and cost of an mHealth intervention in vulnerable people living with HIV in Vancouver, Canada: prospective study","volume":"6","author":"Campbell","journal-title":"JMIR Mhealth Uhealth"},{"issue":"4","key":"R15","doi-asserted-by":"publisher","DOI":"10.2196\/mhealth.9187","article-title":"Interactive two-way mHealth interventions for improving medication adherence: an evaluation using the behaviour change wheel framework","volume":"6","author":"Chiang","journal-title":"JMIR Mhealth Uhealth"},{"issue":"9755","key":"R16","doi-asserted-by":"publisher","first-page":"1838","DOI":"10.1016\/S0140-6736(10)61997-6","article-title":"Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial","volume":"376","author":"Lester","journal-title":"Lancet"},{"key":"R17","unstructured":"Memetovic J van der M . A pilot study of text-message support for HIV-positive patients at the oak tree clinic in Vancouver: WelTel HAART BC1. 2013. URL: https:\/\/smartsexresource.com\/for-health-providers\/sti-updates\/2013\/04\/pilot-study-text-message-support-hiv-positive-patients-oak-tree-clinic\/ [Accessed 14-07-2024]"},{"issue":"3","key":"R18","doi-asserted-by":"publisher","first-page":"7","DOI":"10.7309\/jmtm.2.3.3","article-title":"Use of the WelTel mobile health intervention at a tuberculosis clinic in British Columbia: a pilot study","volume":"2","author":"van der Kop","journal-title":"JournalMTM"},{"issue":"8","key":"R19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/02770903.2018.1500583","article-title":"A pilot randomized controlled trial on the impact of text messaging check-ins and a web-based asthma action plan versus a written action plan on asthma exacerbations","volume":"56","author":"Poureslami","journal-title":"J Asthma"},{"issue":"5","key":"R20","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1002\/acr2.11652","article-title":"\u201cHow are you?\u201d Perspectives from patients and health care providers of text messaging to support rheumatoid arthritis care: a thematic analysis","volume":"6","author":"Zafar","journal-title":"ACR Open Rheumatol"},{"issue":"7","key":"R21","doi-asserted-by":"publisher","DOI":"10.2196\/16783","article-title":"The Cedar Project - mobile phone use and acceptability of mobile health among young Indigenous people who have used drugs in British Columbia, Canada: mixed methods exploratory study","volume":"8","author":"Jongbloed","journal-title":"JMIR Mhealth Uhealth"},{"issue":"3","key":"R22","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1007\/s11524-012-9771-x","article-title":"Research on a vulnerable neighborhood-the vancouver downtown eastside from 2001 to 2011","volume":"90","author":"Linden","journal-title":"J Urban Health"},{"key":"R23","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2021.102692","article-title":"A spatiotemporal analysis of inequalities in life expectancy and 20 causes of mortality in sub-neighbourhoods of Metro Vancouver, British Columbia, Canada, 1990-2016","volume":"72","author":"Yu","journal-title":"Health Place"},{"key":"R24","unstructured":"City of Vancouver. Jobs and economy snapshot for the Downtown Eastside. 2019. URL: https:\/\/vancouver.ca\/files\/cov\/jobs-and-economy-snapshot-dtes.pdf [Accessed 14-07-2024]"},{"key":"R25","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2019.102164","article-title":"From risky places to safe spaces: re-assembling spaces and places in Vancouver\u2019s Downtown Eastside","volume":"59","author":"Ivsins","journal-title":"Health Place"},{"issue":"8-9","key":"R26","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1177\/10497323231167829","article-title":"Exploring primary healthcare experiences and interest in mobile technology engagement amongst an urban population experiencing barriers to care","volume":"33","author":"Pakhomova","journal-title":"Qual Health Res"},{"key":"R27","unstructured":"City of Vancouver. Downtown Eastside plan three year summary of implementation (2017-2019). 2020. URL: https:\/\/vancouver.ca\/files\/cov\/dtes-plan-implementation-summary-2017-2019.pdf [Accessed 14-07-2024]"},{"key":"R28","unstructured":"BC Center for Excellence in HIV\/AIDS. Improving patient engagement and retention in healthcare at Hope to Health. URL: https:\/\/bccfe.ca\/news\/forecast\/improving-patient-engagement-and-retention-healthcare-hope-health [Accessed 14-07-2024]"},{"key":"R29","unstructured":"Primary care clinic. BC Centre for Excellence in HIV\/AIDS. URL: https:\/\/bccfe.ca\/primary-care-clinic [Accessed 25-10-2024]"},{"issue":"2","key":"R30","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","journal-title":"Qual Res Psychol"},{"issue":"3","key":"R31","doi-asserted-by":"publisher","first-page":"1391","DOI":"10.1007\/s11135-021-01182-y","article-title":"A worked example of Braun and Clarke\u2019s approach to reflexive thematic analysis","volume":"56","author":"Byrne","journal-title":"Qual Quant"},{"issue":"6","key":"R32","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1016\/j.jana.2014.01.008","article-title":"A qualitative study investigating the use of a mobile phone short message service designed to improve HIV adherence and retention in care in Canada (WelTel BC1)","volume":"25","author":"Smillie","journal-title":"J Assoc Nurses AIDS Care"},{"issue":"19","key":"R33","doi-asserted-by":"publisher","first-page":"1867","DOI":"10.1056\/NEJMc1310509","article-title":"Ask, don\u2019t tell - mobile phones to improve HIV care","volume":"369","author":"Lester","journal-title":"N Engl J Med"},{"key":"R34","doi-asserted-by":"publisher","DOI":"10.1177\/2325958219870166","article-title":"Implementation of a text message to improve adherence to clinic and social service appointments","volume":"18","author":"Anthony","journal-title":"J Int Assoc Provid AIDS Care"},{"key":"R35","doi-asserted-by":"publisher","DOI":"10.1016\/j.invent.2018.06.002","article-title":"Using text message reminders in health care services: a narrative literature review","volume":"13","author":"Schwebel","journal-title":"Internet Interv"}],"container-title":["JMIR mHealth and uHealth"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/mhealth.jmir.org\/2025\/1\/e68561","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:55:28Z","timestamp":1782842128000},"score":1,"resource":{"primary":{"URL":"https:\/\/mhealth.jmir.org\/2025\/1\/e68561"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,27]]},"references-count":35,"URL":"https:\/\/doi.org\/10.2196\/68561","relation":{},"ISSN":["2291-5222"],"issn-type":[{"value":"2291-5222","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,27]]},"article-number":"v13i15e68561"}}