DESCRIPTION (provided by applicant): Appointment non-attendance - or, "no shows" - is common across health institutions, hindering efficient functioning of healthcare systems and contributing to over $150 billion in annual costs. Further, appointment non-attendance is associated with poorer health outcomes, as patients forgo critical preventative care and fail to receive necessary treatment. Certain populations are more likely to engage in non-attendant behavior, including individuals with low socio-economic status and limited English proficiency. As these populations already experience health disparities, they have the greatest need for tools that can effectively help them address the environmental and personal barriers that hinder their ability to keep healthcare appointments. In light of these challenges, the current proposal outlines the development and evaluation of a comprehensive solution to address the numerous personal and environmental factors contributing to no-show behavior. By embedding evidence-based behavior change techniques within a social support structure, the system will deliver targeted, culturally appropriate message campaigns across interactive voice response (IVR), SMS/text message, and email modalities. The messages will offer educational information specific to the nature of the appointment, connection to relevant resources such as affordable local transportation services, and reminders for scheduled visit date, time, and location. Importantly, this system will also be rooted in a peer support network, providing additional personalized assistance to promote adherence and overcome attendance barriers. The resultant system will provide comprehensive support for the range of factors contributing to appointment non-adherence, leveraging external resources and known internal cognitive processes to facilitate patients' increased participation and understanding of their own health care needs.

PUBLIC HEALTH RELEVANCE: Appointment attendance is both a pre-requisite to quality health outcomes and a persistent challenge across the healthcare system, with `no-shows' and cancellations accounting for almost one-third of scheduled time for many institutions. Patient populations that already face significant health disparities, such as those with low socioeconomic status and limited English proficiency, are particularly prone to non-adherence, which is influenced by a wide range of environmental and personal factors. A tool with the capacity to help individuals overcome these diverse barriers via peer support, connection to local resources, and customizable educational information will bring existing appointment reminder solutions to the next level, helping to overcome barriers that prevent vulnerable populations from receiving the quality care they deserve.