Clinician-Patient Asynchronous Text Messaging Communication in Hospital-at-Home Care: Qualitative Study

Abstract Background Hospital-at-home (HaH) care models are increasingly being adopted as a strategy to treat older adults with acute care needs and reduce strain on health care systems. Technological innovations, particularly digital communication platforms, have become essential in enabling care delivery beyond traditional hospital settings. Among these, asynchronous messaging tools have the potential to facilitate safe, timely, and coordinated interactions between health care providers, patients, and caregivers. Despite growing interest, little is known about how the content and relational dynamics of such exchanges influence care experiences in real-world HaH contexts. Objective This study aimed to examine the content of SMS text messaging exchanged between health care providers and patients or caregivers within a HaH program in Singapore during the COVID-19 pandemic. Methods A descriptive qualitative design was used to analyze retrospective WhatsApp messages exchanged between health care providers and patients or caregivers from August 2022 to October 2022. An inductive qualitative content analysis approach was used to systematically identify and categorize emerging patterns in the data. Results The analysis of 1218 WhatsApp messages from 354 HaH admissions identified three main categories: (1) clinical checks and advice; (2) administrative and transport arrangements; and (3) quality of interpersonal dynamics, supported by 13 subcategories, reflecting both task-oriented and relational dimensions of communication. The findings highlight how asynchronous messaging enables continuous care coordination while fostering trust and engagement between health care providers, patients, and caregivers. Conclusions This study underscores the multifaceted role of digital communication in HaH care, demonstrating its influence beyond clinical coordination to operational efficiency and the quality of interpersonal relationships. The findings provide insights into how digitally mediated interactions supported care delivery and patient engagement within a Singapore HaH program during the COVID-19 pandemic. While situated within a pandemic-specific context, these findings offer transferable considerations for the design of communication strategies and digital tools to enhance the responsiveness, coordination, and patient-centeredness of HaH programs.