{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T19:06:39Z","timestamp":1782846399282,"version":"3.54.5"},"reference-count":36,"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 The increasing reliance on patient portals for electronic health records has widened the digital health care access gap, particularly among low-income and Medicaid-insured populations. However, resources exist to assist low-income patients with portal enrollment; in obtaining a free smartphone; and, in New York, in obtaining low-cost internet. Automated bidirectional SMS text messaging offers a scalable and cost-effective strategy for identifying low-income patients\u2019 digital health needs and eligibility for resources by using screening questions and providing tailored information on how to access available resources.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to increase portal access among low-income patients using automated bidirectional SMS text messaging and assess its feasibility and acceptability.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This quality improvement initiative involved sending automated, bidirectional SMS text messages in English to 12,381 Medicaid-insured and\/or low-income patients from a primary care practice. Messages assessed patients\u2019 digital health needs and provided adaptive, personalized resources and assistance for enrolling in the patient portal and for accessing digital technology. We assessed response rates and follow-up portal enrollment rates. We surveyed participants regarding the acceptability, appropriateness, and usability of the SMS text messaging intervention, as well as their subsequent use of the patient portal. We performed descriptive statistics and a binomial probability test.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n In total, 9.2% (1140\/12,381) of patients responded to the SMS text messages, with 3.9% (481\/12,381) opting out and 5.3% (659\/12,381) actively engaging. Among respondents, 71.1% (469\/659) completed the follow-up survey. Respondents were predominantly female (336\/469, 71.6%), with ages ranging from 18 to 65 years or older. Most respondents rated the message\u2019s clarity (420\/469, 89.6%), its usefulness (400\/469, 85.2%), and the demonstration of care by their health team (350\/469, 74.6%) favorably. Concerns regarding privacy (469, 13%) and trustworthiness (469, 15%) were noted. Notably, 71% of initially unenrolled patients activated their patient portals after the intervention (\n P<\/jats:italic>\n =.007), exceeding the hypothesized expectations.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Automated bidirectional SMS text messaging had mixed effects on promoting patient portal use among low-income patients. Response rates to SMS text messages were low when delivered from an unknown phone number. Among responders, most reported that these messages were useful and that they would recommend them to others. Research is needed to determine optimal strategies for introducing the program and vendor phone numbers to patients to improve engagement.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/80255","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T16:50:05Z","timestamp":1773679805000},"page":"e80255-e80255","source":"Crossref","is-referenced-by-count":1,"title":["The Role of Trust in Text Messaging for Promoting Patient Portal Activation Among Low-Income Patients: Quality Improvement Project"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3613-8012","authenticated-orcid":false,"given":"Kevin","family":"Fiscella","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0340-0179","authenticated-orcid":false,"given":"Mechelle","family":"Sanders","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,5,4]]},"reference":[{"issue":"7","key":"R1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001852","article-title":"Connecting the dots: health information technology expansion and health disparities","volume":"12","author":"Lyles","journal-title":"PLoS Med"},{"issue":"5","key":"R2","doi-asserted-by":"publisher","first-page":"1053","DOI":"10.1055\/a-1951-3153","article-title":"Characteristics of adult primary care patients who use the patient portal: a cross-sectional analysis","volume":"13","author":"Casacchia","journal-title":"Appl Clin Inform"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.2196\/68091","article-title":"Sociodemographic and socioeconomic determinants for the usage of digital patient portals in hospitals: systematic review and meta-analysis on the digital divide","volume":"27","author":"Goldberg","journal-title":"J Med Internet Res"},{"issue":"10","key":"R4","doi-asserted-by":"publisher","first-page":"2233","DOI":"10.1007\/s11606-025-09359-z","article-title":"Disparities in access and utilization of electronic health record patient portals","volume":"40","author":"Shah","journal-title":"J Gen Intern Med"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-publhealth-071521-023913","article-title":"Multilevel determinants of digital health equity: a literature synthesis to advance the field","volume":"44","author":"Lyles","journal-title":"Annu Rev Public Health"},{"issue":"5","key":"R6","doi-asserted-by":"publisher","first-page":"965","DOI":"10.1093\/jamia\/ocad015","article-title":"Digital healthcare equity in primary care: implementing an integrated digital health navigator","volume":"30","author":"Rodriguez","journal-title":"J Am Med Inform Assoc"},{"issue":"3","key":"R7","doi-asserted-by":"publisher","DOI":"10.1093\/jamiaopen\/ooad077","article-title":"Patient portal interventions: a scoping review of functionality, automation used, and therapeutic elements of patient portal interventions","volume":"6","author":"Gleason","journal-title":"JAMIA Open"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.2196\/69253","article-title":"Feasibility and effectiveness of an urgent care-community partnership to reduce disparities in patient portal uptake: quality improvement project","volume":"17","author":"Sanders","journal-title":"J Particip Med"},{"key":"R9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2019.103984","article-title":"Features, outcomes, and challenges in mobile health interventions for patients living with chronic diseases: a review of systematic reviews","volume":"132","author":"Triantafyllidis","journal-title":"Int J Med Inform"},{"key":"R10","doi-asserted-by":"publisher","DOI":"10.2196\/58726","article-title":"Deceptively simple yet profoundly impactful: text messaging interventions to support health","volume":"26","author":"Suffoletto","journal-title":"J Med Internet Res"},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.1016\/j.evalprogplan.2017.04.001","article-title":"Feasibility of bidirectional text messages in evaluating a text-based nutrition education program for low-income parents: results from the Text2BHealthy program","volume":"64","author":"Grutzmacher","journal-title":"Eval Program Plann"},{"issue":"5","key":"R12","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1007\/s10995-014-1595-8","article-title":"Use of text messaging for maternal and infant health: a systematic review of the literature","volume":"19","author":"Poorman","journal-title":"Matern Child Health J"},{"key":"R13","doi-asserted-by":"publisher","DOI":"10.1108\/s1474-8231(2011)0000011013","article-title":"Text messaging in health care: a systematic review of impact studies","volume":"11","author":"Yeager","journal-title":"Adv Health Care Manag"},{"key":"R14","unstructured":"Consumer resources. 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