Evaluating the impact of stable cellphone access and digital navigation on 6-month health outcomes and service connection in emergency care: Protocol for a randomised controlled trial

INTRODUCTION: Healthcare systems increasingly screen for social needs, yet referrals often fail to connect patients with services-particularly in emergency department (ED) settings where unmet social needs are common. Our research highlights critical barriers to service connection, including unstable access to cellphones, limited internet and low digital literacy. These challenges disproportionately affect socio-economically disadvantaged groups and are associated with poorer health outcomes and more frequent ED visits. With the recognition of information and communication technology (ICT) access as a 'super social determinant of health', we have a timely opportunity to test solutions that address these disparities. 

METHODS AND ANALYSIS: We will conduct a three-arm randomised controlled trial enrolling 600 ED patients across three ED sites. Participants are eligible if they self-report at least one unmet social need using the validated Screener for Intensifying Community Referrals for Health (SINCERE) screening instrument, identify barriers to ICT access and want to be referred to community services. Arm 1 will receive community service referrals using email or alternate phone numbers (211 service navigator outreach, usual care). Arm 2 will receive stable cellphone access and community service referrals (cellphone with data+211 service navigator outreach). Arm 3 will receive cellphone access, community service referrals and tailored digital navigation support (Cellphone with data+211 service navigator outreach+digital navigation). Primary outcomes will include community service use and health-related outcomes such as depression, anxiety, social support, loneliness, self-reported global health and healthcare utilisation over 6 months. Using a mixed methods design, we will explore contextual and individual factors influencing engagement and outcomes. 

ETHICS AND DISSEMINATION: This study has been approved by the University of Utah Institutional Review Board (IRB). Findings will be shared with clinical and policy stakeholders, community organisations and published in open-access journals.