Randomized controlled trials (RCTs) have been the core of level 1 data in medical and surgical science for at least the last three decades. However, frequently patient selection is very narrow, anatomic criteria do not match real-world experience, and much of the work is done in selected academic centers. We use RCTs to help explain the rational for intervention and then rely on longitudinal registries and single center data to give the patients a real-world expectation concerning outcomes and complications in our hands.

BackgroundIncomplete vaccination in Australia is greatly due to vaccine hesitancy, which is driven by multiple factors. Studies analysing the effect of behavioural ‘nudges’ on vaccine uptake have shown promising results. Although there is some evidence for positively framed SMS vaccine messages, evidence is lacking for loss-based framed messages which may be highly effective but may paradoxically risk increasing vaccine hesitancy. This pilot study aimed to evaluate the effect of loss-based framed SMS messages on vaccine hesitancy.MethodsThis single-blinded randomised controlled trial enrolled pregnant women from antenatal clinics in King Edward Memorial Hospital, Perth, WA which delivers approximately 6000 higher-risk infants per year. Participants were randomised to receive either a loss-based framed SMS message warning of the risks of failure to vaccinate, or a sham SMS message unrelated to vaccination, and were asked to complete the short-scale vaccine hesitancy questionnaire before and after the intervention.DiscussionThe application of behavioural sciences through SMS-reminders has the potential to improve vaccination rates. There are difficulties in engaging with parents of newborns about vaccine hesitancy. Further research is warranted using other approaches to recruitment.HighlightsPilot randomised controlled trial on the use of SMS reminders to influence vaccine hesitancyApplication of behavioural economics, nudge techniques and mobile healthVaccine hesitancy measured using the short-scale PACV questionnaireThere are difficulties in engaging with parents of newborns about vaccine hesitancyFurther research needed to optimise message framing, timing and reduce vaccine hesitancyTrial RegistrationThe trial is registered with the Australia and New Zealand Clinical Trials Register (ACTRN12618001510235).