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Impacting delayed pediatric influenza vaccination: a randomized controlled trial of text message reminders
Annika M Hofstetter1, Celibell Y Vargas2, Stewin Camargo2
1Department of Pediatrics, Columbia University; NewYork-Presbyterian Hospital, New York, New York.
Insights
Educational and interactive text message reminders modestly increased influenza vaccination rates in urban, low-income children who were unvaccinated by late fall. These findings highlight the potential of targeted text messaging for improving childhood immunization coverage.
Area of Science:
- Public Health
- Pediatrics
- Health Communication
Background:
- Influenza vaccination coverage remains low, particularly in low-income populations.
- Sustained vaccination efforts are essential for optimal public health outcomes.
- Previous studies showed text message reminders can improve vaccination rates in low-income groups.
Purpose of the Study:
- To assess the impact of educational and interactive text message reminders on influenza vaccination.
- To evaluate these interventions in urban, low-income children unvaccinated by late fall.
Main Methods:
- A randomized controlled trial involving 5,462 children aged 6 months to 17 years.
- Participants were randomized to receive educational plus interactive texts, educational texts only, or usual care.
- Text messages were delivered weekly via an immunization registry-linked system.
Main Results:
- The educational plus interactive text message group showed higher vaccination rates (38.5%) compared to educational-only (35.3%) and usual care (34.8%).
- A small but statistically significant increase in influenza vaccination was observed with combined educational and interactive messages.
- The intervention was particularly relevant for a predominantly publicly insured and Spanish-speaking population.
Conclusions:
- Text message reminders incorporating educational content and interactivity offer a small benefit for influenza vaccination.
- These interventions are effective for urban, low-income, minority children with delayed vaccination status.
- Targeted text messaging strategies can support sustained public health vaccination efforts.
Background:
Influenza vaccination coverage is low, especially among low-income populations. Most doses are generally administered early in the influenza season, yet sustained vaccination efforts are crucial for achieving optimal coverage. The impact of text message influenza vaccination reminders was recently demonstrated in a low-income population. Little is known about their effect on children with delayed influenza vaccination or the most effective message type.
Purpose:
To determine the impact of educational plus interactive text message reminders on influenza vaccination of urban low-income children unvaccinated by late fall.
Design:
Randomized controlled trial.
Setting/Participants:
Parents of 5,462 children aged 6 months-17 years from four academically affiliated pediatric clinics who were unvaccinated by mid-November 2011.
Intervention:
Eligible parents were stratified by their child's age and pediatric clinic site and randomized using a 1:1:1 allocation to educational plus interactive text message reminders, educational-only text message reminders, or usual care. Using an immunization registry-linked text messaging system, parents of intervention children received up to seven weekly text message reminders. One of the messages sent to parents in the educational plus interactive text message arm allowed selection of more information about influenza and influenza vaccination.
Main Outcome Measures:
Influenza vaccination by March 31, 2012. Data were collected and analyzed between 2012 and 2014.
Results:
Most children were publicly insured and Spanish speaking. Baseline demographics were similar between groups. More children of parents in the educational plus interactive text message arm were vaccinated (38.5%) versus those in the educational-only text message (35.3%; difference=3.3%, 95% CI=0.02%, 6.5%; relative risk ratio (RRR)=1.09, 95% CI=1.002, 1.19) and usual care (34.8%; difference=3.8%, 95% CI=0.6%, 7.0%; RRR=1.11, 95% CI=1.02-1.21) arms.
Conclusions:
Text message reminders with embedded educational information and options for interactivity have a small positive effect on influenza vaccination of urban, low-income, minority children who remain unvaccinated by late fall.
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