HCM 440 Module 2 Research Question Short Paper Example

Do Two-Way Texts Keep Patients Coming? Framing the Question and Reviewing the Evidence

[Student Name]

Southern New Hampshire University

HCM 440: Healthcare Research and Evaluation Methodologies

Module Two Short Paper

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Do Two-Way Texts Keep Patients Coming? Framing the Question and Reviewing the Evidence

Fairhaven Medical Group's leaders asked a practical question: should we pay for text reminders in every clinic? That is a decision, not yet a research question. Before any data are pulled, the question has to be framed so that a study could answer it, and the existing research has to be searched so the study builds on what is known. This paper states the problem, frames and tests the question, documents a literature search, appraises the studies found and refines the question around the gaps.

The Problem

About 17.6% of Fairhaven's scheduled appointments, more than 54,000 a year, end as no-shows. Rates are highest in behavioral health, at about 24%, and lowest in orthopedics, at about 11%. Each missed visit leaves clinician time unused and delays care for patients waiting for an opening. Since March, six clinics have sent two-way text reminders 72 and 24 hours before each visit, allowing patients to confirm, cancel or ask to reschedule by reply. The other eight clinics continue automated phone calls 48 hours ahead.

Framing the Question

PICOT asks the writer to pin down who is studied, what is tried, what it is measured against, which result counts and over what period. Writing each element forces precision. The population is adult patients with scheduled visits at Fairhaven's clinics, excluding same-day appointments, where reminders make little sense. The intervention is two-way text reminders; the comparison is automated phone calls. The primary outcome is the no-show rate, defined as scheduled visits the patient neither attended nor canceled at least two hours ahead. The time frame is six months after the change.

Table 1. PICOT Elements of the Research Question

Note. Definitions set by the author with the clinic operations team.

The Draft Question

Among adult patients with scheduled visits at Fairhaven clinics, do two-way text reminders, compared with automated phone reminders, reduce the no-show rate over six months? Two secondary questions follow. Do text reminders increase the share of canceled slots that are refilled, since earlier cancellations give schedulers time to book another patient? And does the effect differ by age group, preferred language or specialty?

Testing the Question

Hulley et al. (2013) propose that good research questions be feasible, interesting, novel, ethical and relevant, often abbreviated FINER. The question is feasible because scheduling data already record every appointment and its outcome, and no new data collection is required for the primary outcome. It interests leaders who must decide on a contract. It is modestly novel, since most published trials test one-way reminders. It is ethical because both groups receive a reminder. And it is relevant because the answer changes a spending decision this year.

Search Strategy

The search covered PubMed, CINAHL and the Cochrane Library for studies published in English from 2005 through mid-2026. Terms combined three concepts with Boolean operators: ("text message" OR SMS OR "short message service" OR "mobile phone") AND (reminder*) AND ("no-show" OR attendance OR "missed appointment" OR nonattendance). Only studies that compared attendance for texted patients against an unreminded group, or against another type of reminder, were kept. Reference lists of included reviews were also checked.

Screening the Results

The search returned 412 records. After 96 duplicates were removed, titles and abstracts of 316 records were screened, and 278 were excluded, mostly because they studied medication adherence or vaccination reminders rather than appointments. Thirty-eight full texts were read, and 27 were excluded for lacking a comparison group or reporting no attendance outcome. Eleven studies were included: two systematic reviews, five randomized trials and four observational studies, one of them conducted in a US multispecialty group.

Table 2. Search and Screening Results

Note. Counts from the author's search log.

How the Studies Were Appraised

Greenhalgh (1997) recommends that an appraisal open by identifying the purpose and research question behind a study, naming its design and judging whether that design suits the question. These questions were applied to each included study, followed by checks on sample size, how attendance was measured, whether groups were comparable and how long follow-up lasted. Observational studies were weighted less heavily because other differences between groups could explain their results.

What the Reviews Show

The review by Guy et al. (2012) combined results from eight randomized trials plus ten controlled observational studies. The trials produced a consistent effect, with text reminders making attendance about 1.48 times as likely, regardless of clinic type or whether the message went 24, 48 or 72 hours ahead. The observational studies varied so much that no overall estimate could be calculated. Gurol-Urganci et al. (2013), in a Cochrane review, found low- to moderate-quality evidence that text reminders improved attendance compared with no reminder and worked about as well as phone call reminders, at lower cost.

What the Primary Studies Add

The five trials, conducted mostly in single hospital outpatient departments outside the United States, supported the reviews' conclusions but followed patients for three months or less. Dantas et al. (2018), a review of no-show research rather than reminders, adds useful context: patients who missed before, who are younger or who booked far in advance miss more often, so an evaluation should account for these factors when comparing clinics. Kheirkhah et al. (2016) show why the outcome matters financially, describing the cost of missed visits at a large Veterans Affairs center.

Grading the Evidence

Table 3 summarizes the most important sources, their designs and what each contributes. Taken together, the evidence supports text reminders over no reminder with reasonable confidence, but it is weaker on the comparison that matters most to Fairhaven, text versus automated phone calls, and nearly silent on two-way messages.

Table 3. Key Evidence and Its Strength

Note. Strength judgments by the author using Greenhalgh's appraisal questions.

Gaps in the Literature

Four gaps stand out. Few studies compare text reminders with automated phone calls in the same setting. Almost none test two-way messages that let patients cancel or reschedule by reply. Most follow patients for only a few months, leaving open whether effects fade. And few report results by age, language or specialty, even though Fairhaven's no-show rates vary widely across those groups. Each gap is a reason Fairhaven's own evaluation could add something useful rather than repeat known findings.

The Refined Question

The literature sharpens the question in two ways. The comparison with phone reminders becomes central, and the time frame lengthens to capture fading effects. The refined question reads: among adult patients with scheduled visits at Fairhaven clinics, do two-way text reminders, compared with automated phone reminders, reduce the no-show rate over twelve months, and does the effect differ by age, preferred language and specialty?

Conclusion

A clear PICOT question, tested against the FINER criteria and informed by a documented search, turns leadership's spending decision into something a study can answer. The evidence suggests text reminders help, but it leaves real uncertainty about the comparison and features Fairhaven cares about. The next module will choose a design that can answer the refined question despite the fact that the clinics were not randomly assigned.

References

Dantas, L. F., Fleck, J. L., Cyrino Oliveira, F. L., & Hamacher, S. (2018). No-shows in appointment scheduling: A systematic literature review. Health Policy, 122(4), 412-421. https://doi.org/10.1016/j.healthpol.2018.02.002

Greenhalgh, T. (1997). How to read a paper: Getting your bearings (deciding what the paper is about). BMJ, 315(7102), 243-246. https://doi.org/10.1136/bmj.315.7102.243

Gurol-Urganci, I., de Jongh, T., Vodopivec-Jamsek, V., Atun, R., & Car, J. (2013). Mobile phone messaging reminders for attendance at healthcare appointments. Cochrane Database of Systematic Reviews, 2013(12), Article CD007458. https://doi.org/10.1002/14651858.CD007458.pub3

Guy, R., Hocking, J., Wand, H., Stott, S., Ali, H., & Kaldor, J. (2012). How effective are short message service reminders at increasing clinic attendance? A meta-analysis and systematic review. Health Services Research, 47(2), 614-632. https://doi.org/10.1111/j.1475-6773.2011.01342.x

Hulley, S. B., Cummings, S. R., Browner, W. S., Grady, D. G., & Newman, T. B. (2013). Designing clinical research (4th ed.). Lippincott Williams & Wilkins.

Kheirkhah, P., Feng, Q., Travis, L. M., Tavakoli-Tabasi, S., & Sharafkhaneh, A. (2016). Prevalence, predictors and economic consequences of no-shows. BMC Health Services Research, 16, Article 13. https://doi.org/10.1186/s12913-015-1243-z