Evaluating the use of text message communication in a postpartum patient navigation program for publicly insured women

Objective: To compare communication between navigators and women according to follow-up status in a postpartum patient navigation program (“Navigating New Motherhood” [NNM]). Methods: This is a mixed methods secondary analysis of text message and email transcripts from NNM. Transcripts were analyzed by number of messages sent, received, and unanswered. Message themes were qualitatively analyzed using constant comparative technique. Bivariable and multivariable tests were conducted. Results: Most women (98.2%) communicated with navigators via text message. Women who completed postpartum follow-up sent and received more texts than women who did not (7.8 vs. 3.7, p < 0.001 and 11.5 vs. 8.0, p < 0.05, respectively); exchange of ≥6 messages was associated with greater odds of follow-up (adjusted odds ratio 2.89, 95% CI1.13–7.41). Lack of patient response was also associated with lack of follow-up (p < 0.001). Four categories of message themes were identified: Rapport-building, Postpartum Care Coordination, Maternal Health, and Motherhood. Message threads with more Rapport-building or Maternal Health messages were associated with more frequent patient follow-up (p < 0.01 and p < 0.05, respectively), as was average number of emoticons per message thread (2.1 vs. 1.2, p = 0.01). Conclusion: More frequent and multidimensional communication was associated with follow-up in a postpartum patient navigation program. Practice Implications: Text messaging can serve as a favorable communication platform within patient navigation.