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CRAMER et al .
Board and who actively participated in the planning and implemen‐ tation of this community‐based participatory pilot study by assisting with data collection, analysis, and dissemination.
4.2 | Conclusion and recommendations Our feasibility findings help inform implementation science re‐ searchers on rural recruitment, sampling, and fidelity using mobile technology with CHW reinforcement as a clinical intervention in rural populations, where is it essential to promote adoption and integration of evidence‐based practices into provider practices (Thabane et al., 2010). This study provides data for a larger scale research study. Future studies should consider a four‐group de‐ sign (CHW, CHW +PTP, PTP, Control) to separate the effects of the mobile technology from the CHW. We recommend that any future study using the PTP as a clinical intervention be tested using the patient’s smartphone. Most young adults already own a smartphone and have an unlimited text message plan, so testing the PTP on their equipment would not add unnecessary financial burdens and would increase ease of access to the platform and increase engagement. Should participants relocate or change providers midstudy, the PTP would follow them and help reduce study attrition while improving continuity of care. It is advisable that future studies operate within a longer time frame (2–3 years) and that testing be done in a larger population pool with more high‐risk patients who are likely to ben‐ efit from the intervention. For investigators using a community‐based participatory ap‐ proach, it is vital to ensure control over study protocols to avoid bias that can inadvertently be introduced by clinical partners who may be interested in improving patient care by altering professional prac‐ tices. Researchers must assure that community partners understand study bias, and how altering usual medical care during a research study alters study findings. It is also advisable that recruitment and consent occur at the clinic visit where patients are more easily ap‐ proached about study participation as opposed to in‐home visits by the CHW. To mitigate barriers of clinic staff time, we recommend that 1) clinic nurses screen for eligible patients and 2) a clinical CHW, social worker, or staff meet with the patient at the clinic in another office to consent, gather baseline data, orient patients to the tech‐ nology, and provide recruitment incentives. Our findings underscore the need to develop recruitment strat‐ egies including incentives, enroll during clinic visits, negotiate with the IRB on parental consent waivers for minors, and format text messages using multilingual audio services for those who cannot read. Appropriate outcomes measures include birth weight and ges‐ tation; however, a larger sample and study time frame are required to adequately test the intervention’s impact on these outcomes. Finally, further research should focus on the intervention’s effect on patient activation and link to cost‐effectiveness since activated patients have better self‐management, functioning, and use fewer health services over time compared to less activated patients and our intervention especially showed promise in this area. ACKNOWLEDGEMENTS The authors wish to acknowledge Stephen Lazoritz, MD and Kenton Shaffer, MD who co‐chaired the Central Nebraska Prenatal Advisory
CONFLICT OF INTEREST The authors report no conflict of interest.
ORCID Mary E. Cramer
https://orcid.org/0000-0002-1510-9477
http://orcid.org/0000-0003-0221-3459
Elizabeth K. Mollard
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