{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:44:05Z","timestamp":1785545045637,"version":"3.56.0"},"reference-count":47,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec sec-type=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hospital-at-home (HaH) care models are increasingly being adopted as a strategy to treat older adults with acute care needs and reduce strain on health care systems. Technological innovations, particularly digital communication platforms, have become essential in enabling care delivery beyond traditional hospital settings. Among these, asynchronous messaging tools have the potential to facilitate safe, timely, and coordinated interactions between health care providers, patients, and caregivers. Despite growing interest, little is known about how the content and relational dynamics of such exchanges influence care experiences in real-world HaH contexts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to examine the content of SMS text messaging exchanged between health care providers and patients or caregivers within a HaH program in Singapore during the COVID-19 pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A descriptive qualitative design was used to analyze retrospective WhatsApp messages exchanged between health care providers and patients or caregivers from August 2022 to October 2022. An inductive qualitative content analysis approach was used to systematically identify and categorize emerging patterns in the data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The analysis of 1218 WhatsApp messages from 354 HaH admissions identified three main categories: (1) clinical checks and advice; (2) administrative and transport arrangements; and (3) quality of interpersonal dynamics, supported by 13 subcategories, reflecting both task-oriented and relational dimensions of communication. The findings highlight how asynchronous messaging enables continuous care coordination while fostering trust and engagement between health care providers, patients, and caregivers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study underscores the multifaceted role of digital communication in HaH care, demonstrating its influence beyond clinical coordination to operational efficiency and the quality of interpersonal relationships. The findings provide insights into how digitally mediated interactions supported care delivery and patient engagement within a Singapore HaH program during the COVID-19 pandemic. While situated within a pandemic-specific context, these findings offer transferable considerations for the design of communication strategies and digital tools to enhance the responsiveness, coordination, and patient-centeredness of HaH programs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/83530","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T15:40:08Z","timestamp":1776786008000},"page":"e83530-e83530","source":"Crossref","is-referenced-by-count":0,"title":["Clinician-Patient Asynchronous Text Messaging Communication in Hospital-at-Home Care: Qualitative Study"],"prefix":"10.2196","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-7706-6339","authenticated-orcid":false,"given":"Jeremy Soon Leong","family":"Seow","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1182-5791","authenticated-orcid":false,"given":"Stephanie","family":"Ko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8554-001X","authenticated-orcid":false,"given":"Shi Yun","family":"Low","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5583-2814","authenticated-orcid":false,"given":"Shefaly","family":"Shorey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"issue":"1","key":"R1","doi-asserted-by":"publisher","DOI":"10.1038\/s41514-024-00148-2","article-title":"Healthcare on the brink: navigating the challenges of an aging society in the United States","volume":"10","author":"Jones","journal-title":"NPJ Aging"},{"issue":"1","key":"R2","doi-asserted-by":"publisher","DOI":"10.1186\/s43162-023-00206-3","article-title":"Hospital at home: emergence of a high-value model of care delivery","volume":"35","author":"Kanagala","journal-title":"Egypt J Intern Med"},{"issue":"3","key":"R3","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD014765.pub2","article-title":"Factors influencing the implementation of early discharge hospital at home and admission avoidance hospital at home: a qualitative evidence synthesis","volume":"3","author":"Wallis","journal-title":"Cochrane Database Syst Rev"},{"issue":"3","key":"R4","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD007491.pub3","article-title":"Admission avoidance hospital at home","volume":"3","author":"Edgar","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"R5","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-043285","article-title":"Comparison of hospital-at-home models: a systematic review of reviews","volume":"11","author":"Leong","journal-title":"BMJ Open"},{"key":"R6","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1196596","article-title":"The promise of digital healthcare technologies","volume":"11","author":"Yeung","journal-title":"Front Public Health"},{"issue":"7","key":"R7","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.63881","article-title":"Revolutionizing healthcare: how telemedicine is improving patient outcomes and expanding access to care","volume":"16","author":"Ezeamii","journal-title":"Cureus"},{"issue":"2","key":"R8","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph20021287","article-title":"Hospitalisation at home of patients with COVID-19: a qualitative study of user experiences","volume":"20","author":"Cerdan de Las Heras","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"R9","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1055\/s-0039-1678607","article-title":"Evaluation of secure messaging applications for a health care system: a case study","volume":"10","author":"Liu","journal-title":"Appl Clin Inform"},{"issue":"3","key":"R10","doi-asserted-by":"publisher","first-page":"e606","DOI":"10.1097\/PTS.0000000000000890","article-title":"Perceptions of stakeholders toward \u201chospital at home\u201d program in Singapore: a descriptive qualitative study","volume":"18","author":"Chua","journal-title":"J Patient Saf"},{"issue":"3","key":"R11","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1007\/s11606-021-07065-0","article-title":"Perceptions of hospital-at-home among stakeholders: a meta-synthesis","volume":"37","author":"Chua","journal-title":"J Gen Intern Med"},{"issue":"1","key":"R12","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-024-01040-9","article-title":"The hospital at home in the USA: current status and future prospects","volume":"7","author":"Pandit","journal-title":"NPJ Digit Med"},{"issue":"10","key":"R13","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.6456","article-title":"Telemedicine allows for effective communication between a medically complex cancer patient and his virtual hospital medical team","volume":"10","author":"Paulson","journal-title":"Clin Case Rep"},{"issue":"12","key":"R14","doi-asserted-by":"publisher","first-page":"972","DOI":"10.1136\/bmjqs-2013-002339","article-title":"Home care: more than just a visiting nurse","volume":"22","author":"Romagnoli","journal-title":"BMJ Qual Saf"},{"key":"R15","doi-asserted-by":"crossref","unstructured":"Ding J Freeman M Hasija S . Can predictive technology help improve acute care operations? Investigating the impact of virtual triage adoption. SSRN. Preprint posted online on Oct 2, 2023. [doi: 10.2139\/ssrn.3806478]","DOI":"10.2139\/ssrn.3806478"},{"key":"R16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbusres.2020.10.030","article-title":"Digital transformation in healthcare: analyzing the current state-of-research","volume":"123","author":"Kraus","journal-title":"J Bus Res"},{"issue":"1","key":"R17","doi-asserted-by":"publisher","DOI":"10.1093\/bmb\/ldaf017","article-title":"AI chatbots versus human healthcare professionals: a systematic review and meta-analysis of empathy in patient care","volume":"156","author":"Howcroft","journal-title":"Br Med Bull"},{"key":"R18","doi-asserted-by":"publisher","DOI":"10.2196\/72875","article-title":"Patient interaction phenotypes with an automated SMS text message-based program and use of acute health care resources after hospital discharge: observational study","volume":"27","author":"Profka","journal-title":"J Med Internet Res"},{"issue":"4","key":"R19","doi-asserted-by":"publisher","DOI":"10.5688\/ajpe80458","article-title":"The emerging issue of digital empathy","volume":"80","author":"Terry","journal-title":"Am J Pharm Educ"},{"issue":"5","key":"R20","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1177\/1744987119880234","article-title":"An overview of the qualitative descriptive design within nursing research","volume":"25","author":"Doyle","journal-title":"J Res Nurs"},{"issue":"9","key":"R21","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.1097\/ACM.0000000000000388","article-title":"Standards for reporting qualitative research: a synthesis of recommendations","volume":"89","author":"O\u2019Brien","journal-title":"Acad Med"},{"key":"R22","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2021.114523","article-title":"Sample sizes for saturation in qualitative research: a systematic review of empirical tests","volume":"292","author":"Hennink","journal-title":"Soc Sci Med"},{"key":"R23","doi-asserted-by":"crossref","unstructured":"Lincoln YS Guba EG . Naturalistic Inquiry. Sage Publications; 1985. [doi: 10.1177\/144078338702300329]","DOI":"10.1016\/0147-1767(85)90062-8"},{"issue":"4","key":"R24","doi-asserted-by":"publisher","first-page":"520","DOI":"10.1111\/1467-6427.12205","article-title":"Culture and reflexivity: systemic journeys with a British Chinese family","volume":"40","author":"Teh","journal-title":"J Fam Ther"},{"key":"R25","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2018.09.013","article-title":"Apophenia, unconscious bias and reflexivity in nursing qualitative research","volume":"89","author":"Buetow","journal-title":"Int J Nurs Stud"},{"issue":"4","key":"R26","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1109\/TPC.2010.2077450","article-title":"Quantitative content analysis: its use in technical communication","volume":"53","author":"Boettger","journal-title":"IEEE Trans Profess Commun"},{"key":"R27","doi-asserted-by":"crossref","unstructured":"Altheide DL Schneider CJ . Qualitative Media Analysis. 2 nd ed. Sage Publications; 2012. [doi: 10.4135\/9781452270043]","DOI":"10.4135\/9781452270043"},{"issue":"1","key":"R28","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1111\/j.1365-2648.2007.04569.x","article-title":"The qualitative content analysis process","volume":"62","author":"Elo","journal-title":"J Adv Nurs"},{"issue":"1","key":"R29","doi-asserted-by":"publisher","DOI":"10.2196\/17273","article-title":"Characterizing patient-clinician communication in secure medical messages: retrospective study","volume":"24","author":"Huang","journal-title":"J Med Internet Res"},{"issue":"1","key":"R30","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1089\/tmj.2013.0359","article-title":"Patient-clinician mobile communication: analyzing text messaging between adolescents with asthma and nurse case managers","volume":"21","author":"Yoo","journal-title":"Telemed J E Health"},{"issue":"5","key":"R31","doi-asserted-by":"publisher","DOI":"10.2196\/16019","article-title":"Efficacy of text messaging and personal consultation by pharmacy students among adults with hypertension: randomized controlled trial","volume":"22","author":"Zhai","journal-title":"J Med Internet Res"},{"key":"R32","doi-asserted-by":"publisher","DOI":"10.2196\/64753","article-title":"The value of remote vital signs monitoring in detecting clinical deterioration in patients in hospital at home programs or postacute medical patients in the community: systematic review","volume":"27","author":"Cheng","journal-title":"J Med Internet Res"},{"issue":"1","key":"R33","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-019-0948-1","article-title":"Patient portal messaging for care coordination: a qualitative study of perspectives of experienced users with chronic conditions","volume":"20","author":"Hefner","journal-title":"BMC Fam Pract"},{"issue":"5","key":"R34","doi-asserted-by":"publisher","first-page":"2429","DOI":"10.1111\/jocn.17758","article-title":"Continuity and coordination of care during hospital-to-home transitions: healthcare professionals\u2019 perspectives","volume":"35","author":"van Grootel","journal-title":"J Clin Nurs"},{"issue":"1","key":"R35","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-018-2855-x","article-title":"Operation and challenges of home-based medical practices in the US: findings from six aggregated case studies","volume":"18","author":"Norman","journal-title":"BMC Health Serv Res"},{"key":"R36","doi-asserted-by":"publisher","DOI":"10.2196\/66107","article-title":"Hybrid hospital-at-home program in Singapore: ethnographic study","volume":"27","author":"Ko","journal-title":"J Med Internet Res"},{"key":"R37","doi-asserted-by":"publisher","DOI":"10.1177\/20101058231209200","article-title":"Enhancing the hospital at home experience","volume":"32","author":"Towle","journal-title":"Proc Singap Healthc"},{"issue":"6","key":"R38","doi-asserted-by":"publisher","DOI":"10.2196\/13470","article-title":"Impact of age on patients\u2019 communication and technology preferences in the era of meaningful use: mixed methods study","volume":"22","author":"Clarke","journal-title":"J Med Internet Res"},{"issue":"4","key":"R39","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1093\/jamiaopen\/ooaa051","article-title":"Insecure messaging: how clinicians approach potentially problematic messages from patients","volume":"3","author":"Lee","journal-title":"JAMIA Open"},{"issue":"1","key":"R40","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-024-10785-8","article-title":"Digital clinical empathy in a live chat: multiple findings from a formative qualitative study and usability tests","volume":"24","author":"Luetke Lanfer","journal-title":"BMC Health Serv Res"},{"key":"R41","doi-asserted-by":"publisher","DOI":"10.1177\/20552076231225889","article-title":"Digital empathy in behaviour change interventions: a survey study on health coach responses to patient cues","volume":"10","author":"Rey Velasco","journal-title":"Digit Health"},{"key":"R42","doi-asserted-by":"publisher","DOI":"10.22454\/PRiMER.2024.644242","article-title":"Empathetic communication in telemedicine: a pilot study","volume":"8","author":"Subramanya","journal-title":"PRiMER"},{"issue":"1","key":"R43","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1177\/10464964231200015","article-title":"Teams in the digital workplace: technology\u2019s role for communication, collaboration, and performance","volume":"55","author":"Lane","journal-title":"Small Group Res"},{"key":"R44","doi-asserted-by":"publisher","DOI":"10.2196\/39089","article-title":"Online physician-patient interaction and patient satisfaction: empirical study of the internet hospital service","volume":"25","author":"Wu","journal-title":"J Med Internet Res"},{"issue":"5","key":"R45","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":"R46","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.1089\/tmj.2021.0316","article-title":"Secure messaging and COVID-19: a content analysis of patient-clinician communication during the pandemic","volume":"28","author":"Alpert","journal-title":"Telemed J E Health"},{"issue":"3","key":"R47","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.8801","article-title":"Patient centeredness in electronic communication: evaluation of patient-to-health care team secure messaging","volume":"20","author":"Hogan","journal-title":"J Med Internet Res"}],"container-title":["Journal of Medical Internet Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.jmir.org\/2026\/1\/e83530","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:26:10Z","timestamp":1785536770000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.jmir.org\/2026\/1\/e83530"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,8]]},"references-count":47,"URL":"https:\/\/doi.org\/10.2196\/83530","relation":{},"ISSN":["1438-8871"],"issn-type":[{"value":"1438-8871","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,8]]},"article-number":"v28i1e83530"}}