Date of Graduation

Spring 2026

Document Type

Dissertation

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

Committee Chairperson

Jacquelyn Owens, DNP

Committee Member

Eric Messner, DNP

Abstract

Pediatric appointment no-show rates lead to fragmented care, missed preventative services, delayed immunizations, and reduced clinic efficiency. Children who miss well-child and follow-up visits are at increased risk for unmanaged chronic conditions and gaps in developmental surveillance. The purpose of this Doctor of Nursing Practice quality improvement project was to evaluate whether bilingual text message reminders would decrease no-show rates in a pediatric primary care clinic. Led by the Plan-Do-Study-Act framework and Bronfenbrenner's Ecological Model, this intervention consisted of two manual text message reminders, delivered in English and Spanish, at 7 days and 2 days before scheduled appointments during a 4-week implementation period. Appointment data were collected from the electronic medical record and compared between a pre-intervention baseline period and the post-intervention period. Outcome data showed a decrease in missed appointments, documenting improved attendance. The intervention was feasible, low-cost, and could be easily integrated into planned EMR and clinic workflow updates. Delivering reminders in families' preferred language facilitated equitable communication and supported health equity by reducing language-related barriers to care. The project addressed social determinants of health that influence attendance by providing families with advance notice of appointments. Findings support the use of culturally responsive, technology-based reminder systems as a useful strategy to improve access to pediatric primary care services.

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