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© 2016 Garg et al. Background: Text messaging is an affordable, ubiquitous, and expanding mobile communication technology. However, safety net health systems in the United States that provide more care to uninsured and low-income patients may face additional financial and infrastructural challenges in utilizing this technology. Formative evaluations of texting implementation experiences are limited. We interviewed safety net health systems piloting texting initiatives to study facilitators and barriers to real-world implementation. Methods: We conducted telephone interviews with various stakeholders who volunteered from each of the eight California-based safety net systems that received external funding to pilot a texting-based program of their choosing to serve a primary care need. We developed a semi-structured interview guide based partly on the Consolidated Framework for Implementation Research (CFIR), which encompasses several domains: The intervention, individuals involved, contextual factors, and implementation process. We inductively and deductively (using CFIR) coded transcripts, and categorized themes into facilitators and barriers. Results: We performed eight interviews (one interview per pilot site). Five sites had no prior texting experience. Sites applied texting for programs related to medication adherence and monitoring, appointment reminders, care coordination, and health education and promotion. No site texted patient-identifying health information, and most sites manually obtained informed consent from each participating patient. Facilitators of implementation included perceived enthusiasm from patients, staff and management belief that texting is patient-centered, and the early identification of potential barriers through peer collaboration among grantees. Navigating government regulations that protect patient privacy and guide the handling of protected health information emerged as a crucial barrier. A related technical challenge in five sites was the labor-intensive tracking and documenting of texting communications due to an inability to integrate texting platforms with electronic health records. Conclusions: Despite enthusiasm for the texting programs from the involved individuals and organizations, inadequate data management capabilities and unclear privacy and security regulations for mobile health technology slowed the initial implementation and limited the clinical use of texting in the safety net and scope of pilots. Future implementation work and research should investigate how different texting platform and intervention designs affect efficacy, as well as explore issues that may affect sustainability and the scalability.

Reproduced as a reference document. ; "A report submitted to the President's Commission on Law Enforcement and the Administration of Justice." ; Includes bibliographical references. ; Chap. 18. The problems of morale in police management -- Chap. 19. The behavioral sciences and police management -- Chap. 20. Coordination and control -- V. 4. Chap. 21. Research and planning -- Chap. 22. Budgeting as a management device -- Chap. 23. Operations research and management science -- Chap. 24. Legislative barriers -- Chap. 25. Proposed methods of project implementation -- Chap. 26. Texas Commission on Law Enforcement Standards. ; Appendix E. Suggestions in organizing a block parent program, Oakland Police Department, Oakland, California -- Appendix F. Oakland Police Department citizenship program -- Appendix G. Police complaint procedure, Oakland Police Department, Oakland, California -- Appendix H. Tentative proposals to combat crime and violence -- Appendix I. Security bulletins and training outlines distributed by insurance companies -- Appendix J. Departmental general order 63-2, Oakland Police Department -- Appendix K. City of Oakland ordinance no. 6899 C.M.S. to require security devices in certain buildings used for business purposes as a burglary prevention measure -- Appendix L. Examples of forms used in implementing the activities of the Security Section, Oakland Police Department -- V. 3. Chap. 13. Police reports and records -- Chap. 14. The report review concept -- Chap. 15. The inspection concept -- Chap. 16. The internal investigation concept -- Chap. 17. Implementation of policies --^ ; Forward / G.D. Gourley -- V. 1. Chap. 1. Introduction -- Chap. 2. Public information -- Chap. 3. County police systems -- Chap. 4. State police systems -- V. 2. Chap. Patrol specialization vs. generalization -- Chap. 6. Chronological and geographical distribution of the patrol force -- Chap. 7. Use of police reserves -- Chap. 8. Police cadet programs -- Chap. 9. Releasing police officers for field services -- Chap. 10. Specialization of investigation duties -- Chap. 11. The custody function -- Chap. 12. Organizing for crime prevention -- Appendix A. British police principles -- Appendix B. The St. Louis Council on Police-Community Relations and the district committees -- Appendix C. Functions and activities of the Community Relations Section, Oakland Police Department, Oakland, California -- Appendix D. Recommendations adopted by the Clergy-Police Committee, Oakland, California, October 20, 1965 --^ ; Mode of access: Internet.