Improving Intervention Engagement, Usability, and Acceptability Toward Integrating a Mobile Health Substance Use Prevention Program into Federally Qualified Health Clinics

Background and Purpose: Integrating digital health prevention interventions into Federally Qualified Health Centers (FQHCs) offers a promising strategy to expand access to evidence-based prevention services for underserved parents and youth, particularly in low-resource and rural communities. FQHCs are uniquely positioned to serve as implementation settings due to their reach, continuity of care, and trusted relationships with patients. However, integrating digital interventions into routine workflows presents challenges related to feasibility, staff burden, technology infrastructure, and patient engagement. From an implementation science perspective, successful integration requires attention to determinants such as acceptability, appropriateness, and feasibility, as well as strategies that enhance reach and sustained engagement. This study aims to identify best practices for integrating digital prevention interventions into FQHC settings and to examine strategies for recruiting and engaging parents and youth.

Methods: Interviews were conducted with clinical, administrative, and leadership staff of a large FQHC in the southeastern U.S., as well as adolescent patients (ages 13–18) and their parents. The lead investigator and trained research assistants completed semi-structured interviews in person and via web conference. Prior to interviews, participants were provided an overview of a prior pilot randomized controlled trial of a parent- and youth-focused text message–delivered substance use prevention intervention. Participants reviewed and provided feedback on proposed recruitment and engagement strategies derived from prior trial experience and the literature. Interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis. A codebook was developed a priori and iteratively refined to capture emergent themes. Coding discrepancies were resolved through consensus among analysts.

Results: Sixteen FQHC staff and twelve parent-adolescent dyads were interviewed. Among FQHC staff, the most frequently endorsed strategies included educating clinic staff about the study (86%) and embedding dedicated research staff to support recruitment (79%). Additional commonly endorsed themes included implementing electronic health record alerts to identify eligible patients, identifying clinic champions to support recruitment efforts, and fostering family trust by integrating recruitment within existing patient-provider relationships (each endorsed by 64% of staff). Preliminary findings from youth and parent interviews suggest divergent preferences in recruitment approaches. Parents emphasized the importance of receiving information from trusted healthcare providers, highlighting the role of provider endorsement in building credibility and trust. In contrast, adolescents expressed a preference for direct, technology-based outreach, including text messages and digital advertisements, reflecting their communication norms and preferences.

Conclusions & Implications: Findings highlight the importance of multi-level implementation strategies to support integration of digital prevention interventions within FQHC settings. Strategies that combine clinic-level infrastructure (e.g., staff training, EHR prompts, and clinic champions) with patient-centered outreach approaches (e.g., provider endorsement for parents and technology-based recruitment for youth) may optimize reach and engagement. Results underscore the value of tailoring recruitment and engagement strategies to distinct stakeholder groups and leveraging trusted relationships within healthcare settings to enhance acceptability and uptake. From an implementation science perspective, these findings inform strategies to improve key determinants of implementation, including acceptability, appropriateness, and feasibility, and ultimately support greater reach of preventive interventions. Implications of this work for future research will be discussed.