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Short Message Service Reminder Nudge for Parents and Influenza Vaccination Uptake in Children and Adolescents With
Jane Tuckerman1,2,3, Kelly Harper4,5, Thomas R Sullivan6,7
1Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.
Insights
An SMS reminder nudge significantly increased influenza vaccination rates in children with chronic conditions. This intervention proved more effective than standard clinician recommendations alone for improving vaccine uptake.
Area of Science:
- Pediatric Health
- Public Health Interventions
- Vaccinology
Background:
- Children with chronic medical conditions (SRMCs) face higher risks from severe influenza.
- Influenza vaccination rates in these at-risk children remain suboptimal.
Purpose of the Study:
- To evaluate the effectiveness of a parent short message service (SMS) reminder intervention (Flutext-4U) in boosting influenza immunization among children and adolescents with SRMCs.
Main Methods:
- A randomized clinical trial was conducted in a tertiary pediatric hospital in South Australia.
- Participants (6 months to <18 years) with SRMCs received either standard clinician nudges or clinician nudges plus an SMS reminder.
- Influenza vaccination was confirmed via the Australian Immunisation Register.
Main Results:
- The SMS intervention group showed significantly higher influenza vaccination rates (38.6%) compared to the control group (26.2%).
- SMS intervention led to a reduced time to vaccine receipt.
- Vaccination during the optimal period (April-June) was also higher in the SMS group.
Conclusions:
- An SMS reminder nudge intervention effectively increases influenza vaccine uptake in children and adolescents with SRMCs.
- This digital health strategy offers a valuable addition to traditional clinician-led vaccination promotion efforts.
Importance:
Children with chronic medical conditions are at increased risk of severe influenza. Uptake of influenza vaccination in children and adolescents with these identified special risk medical conditions (SRMCs) is suboptimal.
Objective:
To assess the effectiveness of Flutext-4U, a parent short message service (SMS) reminder nudge intervention, in increasing influenza immunization in children and adolescents with SRMCs.
Design, Setting, And Participants:
This randomized clinical trial was conducted at a tertiary pediatric hospital in Adelaide, South Australia, from April 15 to September 30, 2021. Children and adolescents aged 6 months to younger than 18 years with SRMCs and a subspecialist outpatient appointment over a 5-month period during the Australian seasonal influenza vaccination season (April-August 2021) were eligible to participate. Follow-up was until September 30, 2021.
Interventions:
Participants were randomly assigned (1:1 ratio) to control: clinician nudges (hospital vaccine availability, ease of access, and recommendation from hospital subspecialists) or SMS intervention (control conditions plus an additional SMS reminder nudge to parents), with randomization stratified by age group (<5 years, 5-14 years, or >14 to <18 years).
Main Outcomes And Measures:
The primary outcome was influenza vaccination, as confirmed by the Australian Immunisation Register.
Results:
A total of 600 participants (intervention group: 298 [49.7%]; mean [SD] age, 11.5 [4.6] years; 162 female participants [54.4%]; control group: 302 [50.3%]; mean [SD] age, 11.4 [4.7] years; 155 female participants [51.3%]) were included. Influenza vaccination was 38.6% (113 of 293) in the SMS intervention group compared with 26.2% (79 of 302) in the control group (adjusted odds ratio [aOR], 1.79; 95% CI, 1.27-2.55; P = .001). Time to vaccine receipt was significantly lower among SMS participants (adjusted hazard ratio, 1.67; 95% CI, 1.25-2.22; P < .001). For participants randomly assigned by June 15, a significantly greater proportion receiving the SMS intervention were vaccinated during the optimal delivery period April to June 30 (SMS group: 40.0% [76 of 190] vs 25.4% [50 of 197]; aOR, 1.97; 95% CI, 1.28-3.06; P = .002).
Conclusions And Relevance:
Results of this randomized clinical trial suggest that an additional SMS reminder nudge for parents delivered in the tertiary care hospital setting to children and adolescents with SMRCs resulted in higher influenza vaccine uptake compared with clinician nudges alone.
Trial Registration:
ANZCTR Identifier: ACTRN12621000463875.
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