Mobile Intervention for Increasing COVID-19 Testing in K-12 Schools Serving Disadvantaged Communities: Randomized Controlled Trial of SCALE-UP Counts

TL;DR

A mobile intervention using automated text messages increased COVID-19 testing among parents in disadvantaged K-12 schools.

Contribution

The study introduces a scalable health IT approach using bidirectional texting to improve testing rates in underserved school communities.

Findings

Bidirectional texting increased self-reported testing by 22.8% compared to 13.5% in the control group.

No significant difference in missed school days was observed between the two groups.

The intervention was successfully implemented in Title 1 schools, showing potential for broader public health use.

Abstract

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.

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.

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.

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).

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.

ClinicalTrials.gov NCT05112900; http://clinicaltrials.gov/ct2/show/NCT05112900

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