Barriers and facilitators to the implementation of a health–related social needs screening and referral intervention in the Bronx

Background: Text messaging may offer health systems a low-cost, user-friendly method to provide social resource information at hospital discharge.Assessing equitable reach and engagement is paramount prior to wide-scale implementation.Objective: To compare reach and engagement of a novel, text message intervention to address Food Insecurity (FI) between English-and Spanish-speaking caregivers.Methods: We conducted a one-year prospective pilot to evaluate a novel, automated text messaging system designed to deliver geographically-tailored food resource information to families with FI after hospital discharge.English-and Spanish-speaking caregivers of hospitalized children with a positive FI screen documented during routine clinical care were included.Caregivers received a food resource text message 1 day and 4 days after discharge and two interactive text message surveys.Primary outcomes were systemcollected measures of reach and engagement.Among survey respondents, caregiver-reported measures of reach and engagement were also measured.We compared outcomes by language using Chi-Squared tests.We also conducted semistructured interviews with 20 English-and 11 Spanishspeaking caregivers to understand intervention usability and acceptability.Results: Of 190 caregivers, 134 (71%) spoke English and 56 (29%) spoke Spanish.There were no differences in system-or caregiver-reported reach by language.As compared to Englishspeaking caregivers, Spanish-speaking caregivers more frequently engaged by clicking the FindHelp link (49% vs. 32%, p = 0.028) and responding to follow-up surveys (67% vs. 45%, p = 0.009), but less frequently used the information to search for food resources (68 vs. 93%, p = 0.021).In interviews, Spanishspeaking caregivers expressed mistrust in information received from a text message and preference for discussing resources with someone.Conclusion: Our text message intervention for FI equitably reached English-and Spanish-speaking caregivers.Spanishspeaking caregivers may need additional interpersonal contact by phone or in person to use the resources provided.