mPulse for Salesforce provides Salesforce Health Cloud, Sales Cloud and Service Cloud customers access to mPulse Mobile’s Engagement Console, a cloud-based user interface for managing 1:1 SMS texting interactions. mPulse for Salesforce also allowshealthcare organizations to haveup to date member data directly in Salesforce when messaging and managing their health engagement programs.
mPulse for Salesforce
With mPulse Mobile’s solutions, healthcare organizations can empower their support staff, engage with patients and members through 1:1 texting interactions and live agents. Texting is apreferred approach for consumers to interact with businesses for check-ins and simple requests,and mPulse for Salesforce creates an opportunityfor healthcare organizations to deploy this type of support. Using 1:1 texting, healthcare support staff can reach more patients in less time, which improves efficiencyat a time when healthcare staff resources are stretched.
“Demand is high and ever increasing for powerful tools to improve healthy behaviors among consumers and drive operational efficiencies,” said Bob Farrell, CEO of mPulse Mobile. “Our customers are deploying solutions to address workforce shortages.Now our solutionintegrateswith Salesforce, we can reach more healthcare organizations with our solution and deliver on our mission of helping improve patientoutcomes with innovative technology.”
Plan Navigation, giving members easy access to help and offering additional information
Care Management by targeting high-risk or high-cost consumers with 1:1 outreach
Medication Adherenceto address consumer questions about their prescriptions and complete refills through text interactions
Health Coaching, which streamlines outreach and engagement with program participants and extends coaching conversations via SMS texting
mPulse for Salesforce is a welcome addition to AppExchange, as it accelerates business transformation for customers by helping healthcare organizations engage with patients while increasing internal efficiencies,” said David Lee, Vice President or Product Management, AppExchange. “AppExchange is constantly evolving to connect customers with the right apps and experts for their business needs.”
Specifically, mPulse’s approach combines text messages powered by conversational AI with visual storytelling to address misconceptions, raise awareness, model healthy behaviors, add an element of humor, and build overall health literacy.
A series of bidirectional texts that tailor responses to address individual screening barriers, and
Fotonovelas or illustrated comic strips that tell a story explaining the importance of early detection and encouraging screenings.
An important motivation was to use culturally relevant messaging to engage these groups and to measure whether it could yield improvements in outcomes equitably across populations.
Evaluators at the Center for Community Health and Evaluation (CCHE), part of the Kaiser Permanente Washington Health Research Institute, independently evaluated the intervention. The results, recently published in JMIR Cancer, a peer-reviewed journal focusing on innovation and technology in cancer care and research, were very positive: nearly 40 percent of patients who received texts and fotonovelas responded, and they had significantly higher screening rates than those who did not receive the texts and fotonovelas.
The program was developed by mPulse and combined interactive text messages and fotonovelas to educate and activate patients throughout the four-week outreach. When patients shared their reasons for not completing the screening, the conversational AI platform provided relevant automated responses to address these barriers and to influence their health beliefs and behavior.
A Closer Look at Colorectal Cancer
Colorectal cancer is the second-leading cause of cancer death in the US, accounting for an estimated 151,030 new cases and 52,580 deaths in 2022. With appropriate screening, however, it is mostly preventable and can be treated successfully when localized and diagnosed early. Indeed, the five-year relative survival rate for localized colorectal cancer is more than 90%.
Several screening tests can be used to find polyps or colorectal cancer, including an at-home stool test known as the fecal immunochemical test (FIT) which uses antibodies to detect blood in the stool. Upon completing the test, the patient mails it back to the health plan.
Barriers to Screening
A key step in improving screening rates is understanding why patients don’t get screened.
Studies have identified several potential barriers, including feeling fine and not understanding the need for the test, being busy or forgetful, expressing fear about what the test may indicate, the potential risk of perforation, embarrassment about a fecal collection procedure, concerns about mailing fecal matter, mistrust of the healthcare system, and the cost of follow‐up colonoscopy. Limited health literacy is another stumbling block, particularly when combined with cultural health beliefs and linguistic barriers.
The barriers impacting different populations vary which contributes to differences in screening rates and cancer diagnoses. For example, researchers report that Hispanics have significantly lower rates of screening for colorectal cancer than non-Hispanic Whites, and are more likely to be diagnosed with advanced disease.
AltaMed, the largest federally qualified community health center (FQHC) in California, and one of the largest nonprofit FQHCs in the nation, serves approximately 300,000 patients across Southern California and routinely mails out FIT kits to patients due for colorectal screening.
As part of usual care, about 11,000 patients who were due for a screening received a text message with a link to an instructional video, a follow-up text reminder, and a call from a patient navigator within a month if they still hadn’t returned the FIT kit.
Three months after the kits were mailed, 5,241 patients, age 50-75 years, had not returned the FIT kit and they were randomized into two groups for the study: the intervention group which received additional outreach (texts and fotonovela over four weeks), and the control group (no additional outreach).
A majority of patients in the intervention group were Hispanic or Latin American. mPulse has developed an index to map social determinants of health (SDOH) impact levels (using several census variables) and over 75% of patients in the study were living in neighborhoods where SDOH might negatively impact health access and health equity, resulting in health disparities.
In the first week, the texts focused on building health literacy about colon cancer and screenings, and the purpose of the FIT kit. Week two texts sought to uncover barriers by asking why the patient hadn’t yet taken the test. The next week gathered feedback on the fotonovela and its impact on health beliefs and behaviors; and the last week was a final reminder to mail back the kit.
If patients replied to the texts, the conversational AI used natural language understanding (NLU) to “listen” for known barriers and other expected replies and provided automated responses to create logical conversation flows.
Patients could text back in their own words, and their responses were handled using rules and conversational AI. This was also an opportunity to build health literacy and raise awareness about the need to get screened regularly. Here is a sample conversation:
“I don’t know why I need the test; I feel fine and have no symptoms.”
“It turns out most people with colon cancer feel healthy and have no symptoms. And most people with colon cancer also have no family history of the disease. This is a quick and easy way to find out if there are any problems.”
Similarly, if a patient replied, “I’m worried about getting COVID-19 if I come into the clinic”, the system was listening for COVID anxiety and would respond immediately by reassuring the patient using conversational AI.
The automated response was: “You don’t need to come into the clinic right now. Just mail back the FIT colon health test kit that we sent you in the mail. If the results are abnormal, somebody from AltaMed will contact you. Don’t let your worries about coronavirus get in the way of completing the test. It’s quick and easy!”
Thus, patients received timely and relevant information as part of a meaningful back-and-forth dialogue in real time.
The fotonovelas were created to address barriers such as procrastination, lack of self-care, lack of time, embarrassment about the process, and fear of results. They were developed in Spanish and English, in collaboration with the AltaMed Institute for Health Equity, and there were separate versions for men and women.
To ensure that the fotonovelas were compelling, the storyline used characters who were 50–75-year-old Hispanic or Latino patients and who looked and talked like they could be the patient’s best friend or neighbor. And the fotonovelas reflected the central role of family in the Latino community by emphasizing that the characters were getting screened not just for their own health, but for the sake of their loved ones as well. All fotonovelas also contained a call to action for patients to use and return the kit. Sample frames are shown below for the English versions (there were 9 frames in each fotonovela). The second fotonovela can be viewed in full in the JMIR Cancer publication.
Approximately 40% of the patients engaged with the text messages (1,026 patients responded to at least one text out of the 2,597 patients in the intervention group). This is considerably higher than the typical engagement rate with screening reminders. Interestingly, patients who did engage were quick to respond and 86.1% of those who engaged did so within an hour of receiving a text. Of the patients who engaged, 31% clicked on the link to view the fotonovela.
Most importantly, there was a statistically significant 7 percentage point difference in screening: 18.8% of patients in the intervention group were screened, compared with 11.6% of those in the control group.
Social Determinants of Health and Health Equity
A central consideration in the study was to understand whether culturally tailored text messages and fotonovelas could drive behavior change in patients experiencing disparities due to sociodemographic and social determinants of health factors such as race, ethnicity, income, cultural linguistic barriers, and geography. The results suggest that layering text and visual modalities was particularly effective, with these subgroups showing higher screening rates than the group average. Spanish speakers in the intervention group had an 8.2 percentage point improvement in screening rates (compared to a 5.7 percentage point improvement among English speakers). Similarly, patients in very high need areas and high need areas based on SDOH had an 8.5 percentage point improvement and 7.2 improvement in screening rates respectively (compared to a 2 percentage point improvement in very low need areas). Finally, among those who had never been screened for colon cancer, there was a 6 percentage point improvement in screening rates.
Bringing it All Together: The Impact of Conversational AI and Fotonovelas
Most patients who engaged with the text messages, fotonovelas, and conversational AI had positive or neutral responses and there were very few negative responses. This study underscores how the combination of text, images and tailored responses can help health plans build health literacy and influence health beliefs and behavior in an innovative and culturally relevant way, while achieving positive clinical results. Looking ahead, the mobile health solution in this study provides a robust and replicable model to uncover and address barriers to screening and to improve colorectal screening rates, particularly for disparate and socially vulnerable populations. Increasing the number of screened patients typically leads to more early detection of colorectal cancer, which in turn, can save lives.
The author, Rena Brar Prayaga, is an Impact Tech Advocate and a Behavioral Data Scientist. She is also an Advisor at mPulse Mobile, and a co-author of the study published in JMIR Cancer.
LOS ANGELES–(BUSINESS WIRE)–mPulse Mobile, a leader in conversational AI and digital engagement solutions, partnered with AltaMed Health Services, one of the largest nonprofit federally qualified health centers (FQHC) in the U.S., to publish a research study in JMIR Cancer. The study found that automated, bidirectional texting using Natural Language Understanding (NLU) and fotonovelas can increase screenings for colorectal cancer, particularly among populations facing Social Determinants of Health (SDoH) barriers.
While colorectal cancer is the second most deadly type of cancer in the United States, it is also highly preventable with regular screening, as rates of survival are high when caught early. The California member population served by AltaMed, which is majority Hispanic or Latin American, is less likely to be screened for colorectal cancer and more likely to be diagnosed with advanced disease than non-Hispanic white patients due to a variety of SDoH barriers to care. AltaMed partnered with mPulse Mobile to research ways to address these barriers by delivering culturally-tailored mobile content, in the familiar fotonovela format, aimed at overcoming lack of awareness around CRC screenings and other cultural and behavioral barriers.
Along with mailing at-home fecal immunochemical tests, or FIT kits, to members due for screenings, the randomized controlled trial used an automated texting program for two-way communication to identify barriers to getting screened and to educate members around the importance of screening. Among 5,241 members who had not completed their FIT kit after 12 weeks, an intervention group received an additional 4-week series of automated text messages monitored using a program developed by mPulse Mobile. In combination with the text messages, participants were sent a link to a fotonovela in either English or Spanish, containing a comic about someone encouraging a friend to complete their FIT kit and explaining why the screening is important.
The intervention resulted in a significant quality improvement among participating members:
40% of members in the intervention group engaged with the text messages. Of those, 31% clicked on the link to view the fotonovela.
The intervention group had a screening rate of 18.8%, while the group that did not receive the texts and fotonovela had a screening rate of 11.7%.
Screening rates were higher among members who engaged with the text messages than among those who did not.
“Our program used tailored conversations and personalized stories to engage different segments and drive behavior change. Conversational AI helped us to uncover the reasons why people weren’t completing their screenings and to address these barriers in real time. The results show that we were able to reach and influence some of the most vulnerable populations and this is very encouraging,” said Rena Brar Prayaga, Behavioral Data Scientist and co-author of the study.
AltaMed Health Services, serving primarily Latinx patients in Southern California, has a history of leading innovative, culturally-tailored member engagement programs that improve care outcomes and overcome social determinant barriers among their member population.
mPulse Mobile is transforming digital engagement for healthcare’s leading organizations through proven solutions that combine conversational AI with integrated streaming content. mPulse Mobile’s innovative technology and engagement strategy deliver business efficiencies, improve health outcomes, and inspire a more equitable, healthier world, one person at a time. mPulse Mobile has over 12 years of digital health engagement experience and partners with over 200 leading healthcare organizations to deliver over 1 billion tailored digital touch points with health consumers annually. To learn more visit mpulsemobile.com.
About AltaMed Health Services:
AltaMed understands that when people receive care that considers their individual health needs and respects their cultural preferences; they grow healthy—and help their families do the same. Since 1969, we have delivered complete medical services to communities across Southern California. Our team of qualified multicultural and bilingual professionals—from these same communities— is focused on eliminating barriers to primary care services, senior care programs, and essential community services. With nearly 50 accredited health centers and service facilities, we remain committed and ready to help you grow healthy at any age.
SriVani Ganti brings a unique perspective to member engagement as Director of Health Equity at mPulse and feels that she and her team play a critical role in making people feel seen.
“For me, when I think about health equity, it’s really personal. As the daughter of immigrants, as a woman of color, I have witnessed systemic racism not just in terms of looks but also in terms of all the assumptions that have been made historically,” she says.
Working hard to address that imbalance and treat people with the dignity and respect they deserve, SriVani feels that mPulse’s solutions are changing the landscape of member engagement. “We have this really cool technology that lets everyone’s experience be bespoke to them, and we can do it in a scalable way. Everyone comes with different perspectives, backgrounds, and narratives, and that means we need different approaches to achieve the same outcomes for each of them.”
Bridging the gap
Having done her Bachelor of Science in Biology through Northeastern University thinking she might become a doctor or a researcher, SriVani realized that neither were for her and went on to achieve her Masters in Health Communication through Boston University.
Having always been her family’s ‘translator’, demystifying what was presented to them when it came to ‘doctor speak’, today, SriVani continues to do just that for millions of people around the country.
With considerable experience in digital engagement, member experience, and health communications through text messaging, interactive voice response, emails and nanosites, SriVani has been focused on these modalities since she joined HealthCrowd in 2016 which later merged with mPulse in 2021. Prior to her time at HealthCrowd, SriVani worked in a few different industries including as a counterintelligence government contractor and Membership Director at a non-profit.
As a result, SriVani understands that delivering the right content to the right people at the right time, and through the right channels is critical when it comes to health equity, and she challenges her team to find new and innovative ways to reach diverse member population groups all the time.
“My philosophy, when it comes to health equity, is to design for everyone on the margin. Because when we design for them, we include everyone in the middle,” she says. “This inevitably benefits society as a whole,” she adds, citing closed captioning subtitles as an example.
Dedicated to creating the ideal member experience, SriVani describes the Engagement Team as a small but mighty group of individuals, who each bring valuable experience from their different backgrounds, such as public health, behavioral science, health equity, and learning experience to create engaging moments of education that motivate people to take action. This not only helps health plans close important healthcare gaps, but it also educates and empowers members in a more sustainable way.
In fact, during her time at mPulse, the team has worked on a number of fascinating projects including surveys that uncover social needs such as housing, food insecurity, and financial and job instability. Based on these and other insights, they’ve developed a range of solutions focused on improving health equity, such as pregnancy solutions that target and educate Black mothers who experience some of the highest mortality rates in the country, or diabetes management campaigns for Latino populations that provide culturally relevant dietary tips and acknowledge cultural beliefs on how to treat the condition. Additionally, they have created programs in over 13 languages to help improve individual health literacy, which have seen extremely positive results with members seeking out important social services and closing healthcare gaps.
As a result, SriVani says she’s proud that, as a team, they’ve become more than a vendor to their customers, they’ve become trusted advisors.
In fact, having attended and chaired the BRI Network SDOH (Social Determinants of Health) Summit earlier this year, SriVani used the opportunity to connect with the industry and really dig into what our customers and their members are struggling with.
“A big part of what drives your personal health outcomes is actually what’s happening around you. It’s not just your access to primary care providers or urgent care, it’s things like financial stability, access to quality education, even the quality of the neighborhood you live in,” explains SriVani, who went on to add that conversations she had sparked all sorts of ideas for what we can do and how can we do it better.
“The benefit of the mPulse Mobile technology is that we can get messages out there at a wide scale, but more than that, we can make them super personalized to the individual receiving them,” says SriVani, who explains that she and her team are working on a health equity playbook and how to be more inclusive in their marketing.
“The thing with health equity is that you always have to be considering different perspectives. No one should receive the exact same message. Every message should be tweaked based on the person’s background, health, cultural background and more,” says SriVani.
It’s clear that a different perspective is exactly what SriVani brings to the table, as she works to create genuine moments of connection in everything she turns her hand to. Fortunate to enjoy a natural synergy day between her personal passion projects and her day job, SriVani is doing what she loves every day.
Born and raised in Massachusetts, SriVani is now based in Maryland, and credits her parents for shaping the way she sees the world. Growing up watching them give back to those around them, she’s inspired to make a difference in her own way. “I like giving back. I think it goes back to kindness, and if we have more kindness in this world things can only be better,” she says with humility.
A veritable powerhouse, SriVani is proof that dynamite comes in small packages. Aside from volunteering with a local spiritual organization, she co-founded a Hindu environmental organization, is the Director of Communications for a nonprofit dedicated to eradicating maternal and infant mortality rates in India, and is also the co-founder of a South Asian Publishing house, focused on putting out children’s literature featuring children of color.
“Every child deserves to be the hero of a story because if you don’t see yourself, then you don’t believe you can do it,” explains SriVani, eloquently summing up her beliefs when it comes to health equity too.