Brian Orleans

Background: A key challenge for schools throughout the COVID-19 pandemic was finding ways to monitor and prevent COVID-19 cases. While diagnostic testing and connecting students and their families to appropriate resources to mitigate the spread of COVID-19 were recommended, few schools had scalable infrastructure, including information technology systems, to implement these types of measures. Objective: This study tested a new approach to COVID-19 testing (SCALE-UP Counts) in school settings that used automated bidirectional text messages provided to the school community that alerted parents of students to COVID-19 testing options and guidance on when to test. Methods: The SCALE-UP Counts trial was designed as a Sequential Multiple Assignment Randomized Trial and final analyses compared results from parents who received intensive, fully automated, bidirectional text messaging about COVID-19 testing or usual care (control; fully automated unidirectional text messaging about COVID-19 testing), unblinded interventions. From the 16 selected schools, we enrolled all eligible participants who did not opt out of the study. The study provided schools from both arms of the trial with free at-home COVID-19 test kits. The primary outcome was the proportion of parents whose households tested for COVID-19, and the secondary outcome was the number of missed school days. The study asked parents to respond to self-report measures on testing outcomes and missed school days through web-based questionnaires. Results: The study included 7122 parents of students from 16 schools, half of which were title 1 schools; 2588 were randomized to usual care or control and 4534 to bidirectional text messaging. The SCALE-UP Counts intervention led to increased self-reported testing when compared with the control condition (22.8% vs 13.5%, relative testing rate=1.64, 95% CI 1.31-2.02; P<.001). There was no observed difference in missed school days between the study arms (0.43 per month vs 0.28 in usual care, relative missed days rate=1.55, 95% CI 0.98-2.45; P=.06). Conclusions: SCALE-UP Counts worked closely with schools and the state’s public health system to implement and test a scalable health information technology approach that delivered automated text messages to students’ parents around COVID-19 testing and provided access to free at-home test kits. Such an approach can help facilitate COVID-19 testing among school communities, including those that provide education and resources to students and their families from racial or ethnic minorities and with low socioeconomic status. Similar health information technology approaches could be used to increase ease of access to testing, reduce testing burden, and provide tailored information on health measures in school communities for a variety of illnesses or public health concerns. Trial Registration: ClinicalTrials.gov NCT05112900; http://clinicaltrials.gov/ct2/show/NCT05112900

BACKGROUND A key challenge for schools throughout the COVID-19 pandemic was finding ways to monitor and prevent COVID-19 cases. While diagnostic testing and connecting students and their families to appropriate resources to mitigate the spread of COVID-19 were recommended, few schools had scalable infrastructure, including information technology systems, to implement these types of measures. OBJECTIVE This study tested a new approach to COVID-19 testing (SCALE-UP Counts) in school settings that used automated bidirectional text messages provided to the school community that alerted parents of students to COVID-19 testing options and guidance on when to test. METHODS The SCALE-UP Counts trial was designed as a Sequential Multiple Assignment Randomized Trial and final analyses compared results from parents who received intensive, fully automated, bidirectional text messaging about COVID-19 testing or usual care (control; fully automated unidirectional text messaging about COVID-19 testing), unblinded interventions. From the 16 selected schools, we enrolled all eligible participants who did not opt out of the study. The study provided schools from both arms of the trial with free at-home COVID-19 test kits. The primary outcome was the proportion of parents whose households tested for COVID-19, and the secondary outcome was the number of missed school days. The study asked parents to respond to self-report measures on testing outcomes and missed school days through web-based questionnaires. RESULTS The study included 7122 parents of students from 16 schools, half of which were title 1 schools; 2588 were randomized to usual care or control and 4534 to bidirectional text messaging. The SCALE-UP Counts intervention led to increased self-reported testing when compared with the control condition (22.8% vs 13.5%, relative testing rate=1.64, 95% CI 1.31-2.02; P<.001). There was no observed difference in missed school days between the study arms (0.43 per month vs 0.28 in usual care, relative missed days rate=1.55, 95% CI 0.98-2.45; P=.06). CONCLUSIONS SCALE-UP Counts worked closely with schools and the state’s public health system to implement and test a scalable health information technology approach that delivered automated text messages to students’ parents around COVID-19 testing and provided access to free at-home test kits. Such an approach can help facilitate COVID-19 testing among school communities, including those that provide education and resources to students and their families from racial or ethnic minorities and with low socioeconomic status. Similar health information technology approaches could be used to increase ease of access to testing, reduce testing burden, and provide tailored information on health measures in school communities for a variety of illnesses or public health concerns. CLINICALTRIAL ClinicalTrials.gov NCT05112900; http://clinicaltrials.gov/ct2/show/NCT05112900

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author).