TY - JOUR AU - Sturgiss, Elizabeth AU - Advocat, Jenny AU - Barton, Christopher AU - Walker, Emma N AU - Nielsen, Suzanne AU - Wright, Annemarie AU - Lam, Tina AU - Gunatillaka, Nilakshi AU - Oad, Symrin AU - Wood, Christopher PY - 2024 DA - 2024/9/5 TI - Using Text Messaging Surveys in General Practice Research to Engage With People From Low-Income Groups: Multi-Methods Study JO - JMIR Mhealth Uhealth SP - e55354 VL - 12 KW - SMS KW - data collection KW - research methods KW - disadvantaged population KW - priority populations KW - message KW - messages KW - messaging KW - disadvantaged KW - underserved KW - survey KW - surveys KW - digital divide KW - marginalized KW - access KW - accessibility KW - barrier KW - barriers KW - smartphone KW - smartphones KW - digital health KW - underrepresented KW - mobile phone KW - short message service AB - Background: SMS text messages through mobile phones are a common means of interpersonal communication. SMS text message surveys are gaining traction in health care and research due to their feasibility and patient acceptability. However, challenges arise in implementing SMS text message surveys, especially when targeting marginalized populations, because of barriers to accessing phones and data as well as communication difficulties. In primary care, traditional surveys (paper-based and online) often face low response rates that are particularly pronounced among disadvantaged groups due to financial limitations, language barriers, and time constraints. Objective: This study aimed to investigate the potential of SMS text message–based patient recruitment and surveys within general practices situated in lower socioeconomic areas. This study was nested within the Reducing Alcohol-Harm in General Practice project that aimed to reduce alcohol-related harm through screening in Australian general practice. Methods: This study follows a 2-step SMS text message data collection process. An initial SMS text message with an online survey link was sent to patients, followed by subsequent surveys every 3 months for consenting participants. Interviews were conducted with the local primary health network organization staff, the participating practice staff, and the clinicians. The qualitative data were analyzed using constructs from the Consolidated Framework for Implementation Research. Results: Out of 6 general practices, 4 were able to send SMS text messages to their patients. The initial SMS text message was sent to 8333 patients and 702 responses (8.2%) were received, most of which were not from a low-income group. This low initial response was in contrast to the improved response rate to the ongoing 3-month SMS text message surveys (55/107, 51.4% at 3 months; 29/67, 43.3% at 6 months; and 44/102, 43.1% at 9 months). We interviewed 4 general practitioners, 4 nurses, and 4 administrative staff from 5 of the different practices. Qualitative data uncovered barriers to engaging marginalized groups including limited smartphone access, limited financial capacity (telephone, internet, and Wi-Fi credit), language barriers, literacy issues, mental health conditions, and physical limitations such as manual dexterity and vision issues. Practice managers and clinicians suggested strategies to overcome these barriers, including using paper-based surveys in trusted spaces, offering assistance during survey completion, and offering honoraria to support participation. Conclusions: While SMS text message surveys for primary care research may be useful for the broader population, additional efforts are required to ensure the representation and involvement of marginalized groups. More intensive methods such as in-person data collection may be more appropriate to capture the voice of low-income groups in primary care research. International Registered Report Identifier (IRRID): RR2-10.3399/BJGPO.2021.0037 SN - 2291-5222 UR - https://mhealth.jmir.org/2024/1/e55354 UR - https://doi.org/10.2196/55354 UR - http://www.ncbi.nlm.nih.gov/pubmed/39235843 DO - 10.2196/55354 ID - info:doi/10.2196/55354 ER -