Table 3.

Summary of iterations and prototype outcomes.

Iteration	Ideation	Prototype (patients)	Prototype (staff)	Example
Prototype 1	A two-way SMSa app, non–Health Insurance Portability and Accountability Act (HIPAA) secure, low to no cost, no data or Wi-Fi required, live communication through preset logic to gather insight into patients’ common health-related needs and language that would encourage engagement with their health and care	Explore patients’ language of engagement using 3 methods of engagement: Informative SMS using encouraging and self-motivating text; informative SMS using direct text; generic SMS using neutral text. Explore patients’ needs through 5 common preidentified themes: (1) General information (2) Goal tracking (3) General support (4) Social reinforcement (5) Humor/religious	—b	Goal tracking: Do you think you get enough sleep at night? Reply 1=Yes or 2=No; Preset logic for No choice: Sleep is important. It is recommended that the average adult gets 7 to 9 hours of sleep each night. Try to make sleep a priority! Preset logic for Yes choice: Great! It is recommended that the average adult gets 7 to 9 hours of sleep each night. Keep it up.
Prototype 2	A two-way SMS non–HIPAA secure, low to no cost, no data or Wi-Fi required, live communication through preset logic on 3 themes identified as the patients’ top needs and delayed interactive support by CHWc staff	Explore patients’ level of engagement using text (English and Spanish) to meet their 3 top needs in a delayed two-way interaction with staff: (1) Transportation coordination (2) Social support service delivery (3) Appointment scheduling and reminders	Explore CHWs’ operational needs in addressing and meeting their patients’ top 3 needs in a timely fashion and executed per protocol	Transportation Scheduling: Dear Ms. Doe, the transportation service for your appointment has been scheduled. Your transportation provider is [Fake Transport]. It will pick you up at the address we have on file, on 01/01/01 at 01:00 AM/PM. Please reply 1 or Y to confirm and keep this service; please reply 2 or N to cancel it. Thank you, Your CHW; Preset logic for Yes: Thank you Ms. Doe; you are all set! We will send you a reminder closer to the date. Your CHW; Preset logic for No: Thank you, I will call you shortly to reschedule. Your CHW
Prototype 3	A two-way SMS HIPAA secure, low to no cost, no data or Wi-Fi required, real live communication, and interactive support by CHW staff	To meet patients’ 3 top needs using a live, two-way interaction with staff: (1) Transportation coordination (2) Social support service delivery (3) Appointment scheduling and reminders	To meet on-the-field staff operational needs for live two-way interaction (English and Spanish) with patients, using an editable and smart library of SMS templates to address patients’ top 3 needs; A self-maintaining secure password reset system for staff	See Figure 2
Prototype 4	A two-way SMS HIPAA secure, low to no cost, no data or Wi-Fi required, real live communication, and interactive support by CHW staff	To meet patients’ 3 top needs using a live, two-way interaction with staff: (1) Transportation coordination (2) Social support service delivery (3) Appointment scheduling and reminders; An opt-out and HIPAA disclaimer feature for patients; A self-managed stop and start enrollment feature for patients	To meet patient-centered care support operational needs for live two-way interaction (English and Spanish): CHWs to patients (1:1 and 1:many) and vice versa; staff-to-staff and global texting. An automated grouping feature (based on any combination of patients’ chronic condition, assigned risk, and zip code); An automated scheduling and reminder feature; A tech-support group chat feature triaging staff issues in real time; A self-learning training manual with 24-hour Web access	See Figures 3 and 4

^aSMS: short message service.

^b—Not applicable.

^cCHWs: community health workers.