eMCARE: EHealth Mobile Technology Connecting Young Adults to Routine Engagement Young adults (YAs) ages 18-26 have a worse health profile than adolescents or adults in their late twenties and thirties. Most YAs in the US experience no preparation for the transition from pediatric to adult care, often seeking care only through emergency department (ED) visits. The results can be seen across issues such as sexually transmitted infections, unintended pregnancy, depression, anxiety, suicidality, obesity, and management of chronic medical conditions. This formative study will demonstrate the usability and feasibility of an app titled EHealth Mobile Technology Connecting Young Adults to Routine Engagement (eMCARE). eMCARE seeks to connect YAs to care using a system that can be easily integrated into the health care delivery system, and will help address this gap, addressing the huge public cost and gap associated with the lack of established primary care for young adults. eMCARE employs a two-way, adaptive, automated text message- and app-based system to engage YAs in PC follow up after an emergency department or urgent care visit, building upon and moving beyond the one-way, static systems with homogeneous messaging that have been more commonly studied. eMCARE will conduct brief automated dialogue with participants for up to 3 months post-ED discharge, and will tailor dialogue and feedback in real-time to individual risks, profile and motivation level to optimally promote engagement. eMCARE dialogue will be aligned and adaptively adjusted to the Health Belief Model, aimed at increasing perceived susceptibility of important threats, increasing perceived benefits of comprehensive care follow-up, reducing perceived barriers to follow-up, increasing self-efficacy, and providing cues to action. eMCARE builds on a solid foundation of already experienced investigators, and builds upon existing interventions by employing new elements such as an innovative rewards mechanism, gamification, a Health Belief Model feedback loop, and real-time message adaption based on user feedback and behavior. Interdisciplinary collaboration among emergency department and urgent care providers and staff, primary care, behavior health change experts, and interactive technology combined with an innovative incentive plan may serve as a catalyst to involve YAs in routine comprehensive preventative health care. This study will demonstrate the usability of the eMCARE tool among a cohort of young adults ages 18-26 (n=20) using cognitive interviewing and iterative feedback techniques, then assess the feasibility of offering eMCARE to young adults (n=30) in an emergency department (ED) in an open trial using baseline and follow up surveys and interviews to evaluate a) ability to enroll young adults ages 18-26 seeking ED services; b) responses to text message and app cues; c) contact with primary care after ED.
Public Health Relevance Statement: eMCARE Narrative Most young adults ages 18-26 in the US experience no preparation for the transition from pediatric to adult care, evidenced by multiple poor health outcomes such as sexually transmitted infections (STIs), unintended pregnancy, depression, anxiety, obesity, and management of chronic medical conditions. Young adults have a worse health profile than both adolescents and adults in their late twenties and thirties, resulting in staggering public health costs, most of which can be avoided through establishing primary care. We aim to connect young adults presenting in the emergency department to primary care by using an innovative mobile, rewards-based, tailored text messaging application.
NIH Spending Category: Behavioral and Social Science; Clinical Research; Emergency Care; Health Services; Minority Health; Networking and Information Technology R&D; Pediatric; Prevention
Project Terms: Accident and Emergency department; Acute; Address; Administrator; Adolescent; Adult; Age; Anxiety; base; Behavior; behavior change; binge drinking; Brain; care seeking; Caring; catalyst; Childhood; Chronic; Clinical Sciences; Cognitive; cohort; college; commercialization; Companions; Comprehensive Health Care; cost; Cost Savings; Cues; Development; drinking behavior; eHealth; Elements; Emergency Care; Emergency department visit; Enrollment; experience; Feasibility Studies; Feedback; follow-up; Foundations; Friends; Funding; Goals; Health; Health behavior; Health behavior change; health belief; Health Care Costs; health care delivery; health care service utilization; Health Personnel; Healthcare; improved; Incentives; Individual; innovation; Institutes; interdisciplinary collaboration; interest; Intervention; Interview; Medical; Medical center; Mental Depression; mobile computing; Modeling; Motivation; Obesity; obesity management; Organizational Policy; Outcome; Participant; Patient-Focused Outcomes; Patients; peer; Perception; Phase; phase 1 study; Pilot Projects; Population; Predisposition; Preparation; Preventive Health Services; Preventive healthcare; Primary Health Care; Procedures; programs; Provider; Public Health; Randomized Controlled Trials; Research; Research Personnel; response; Rewards; Risk; Self Efficacy; Services; Sexually Transmitted Diseases; Small Business Technology Transfer Research; Social Network; Solid; success; Suicide; Surveys; System; tailored messaging; Techniques; Technology; Testing; Text; Theory of Change; Time; tool; Training; Translational Research; unintended pregnancy; Universities; urgent care; usability; Visit; Vulnerable Populations; young adult; Youth
