Parent Opinions About Use of Text Messaging for Immunization Reminders

Abstract

BackgroundAdherence to childhood immunization schedules is a function of various factors. Given the increased use of technology as a strategy to increase immunization coverage, it is important to investigate how parents perceive different forms of communication, including traditional means and text-message reminders.ObjectiveTo examine current forms of communication about immunization information, parents’ satisfaction levels with these communication modes, perceived barriers and benefits to using text messaging, and the ideal content of text messages for immunization reminders.MethodsStructured interviews were developed and approved by two Institutional Review Boards. A convenience sample of 50 parents was recruited from two local pediatric clinics. The study included a demographics questionnaire, the shortened form of the Test of Functional Health Literacy for Adults (S-TOFHLA), questions regarding benefits and barriers of text communication from immunization providers, and preferred content for immunization reminders. Content analyses were performed on responses to barriers, benefits, and preferred content (all Cohen’s kappas > 0.70).ResultsRespondents were mostly female (45/50, 90%), white non-Hispanic (31/50, 62%), between 20–41 years (mean = 29, SD 5), with one or two children (range 1–9). Nearly all (48/50, 96%) had an S-TOFHLA score in the “adequate” range. All parents (50/50, 100%) engaged in face-to-face contact with their child’s physician at appointments, 74% (37/50) had contact via telephone, and none of the parents (0/50, 0%) used email or text messages. Most parents were satisfied with the face-to-face (48/50, 96%) and telephone (28/50, 75%) communication. Forty-nine of the 50 participants (98%) were interested in receiving immunization reminders by text message, and all parents (50/50, 100%) were willing to receive general appointment reminders by text message. Parents made 200 comments regarding text-message reminders. Benefits accounted for 63.5% of comments (127/200). The remaining 37.5% (73/200) regarded barriers; however, no barriers could be identified by 26% of participants (13/50). Parents made 172 comments regarding preferred content of text-message immunization reminders. The most frequently discussed topics were date due (50/172, 29%), general reminder (26/172, 26%), and child’s name (21/172, 12%).ConclusionsMost parents were satisfied with traditional communication; however, few had experienced any alternative forms of communication regarding immunizations. Benefits of receiving text messages for immunization reminders far outweighed the barriers identified by parents. Few barriers identified were text specific. Those that were, centered on cost if parents did not have unlimited texting plans.

Effectiveness of interventions that apply new media to improve vaccine uptake and vaccine coverage

“…29,30 Of the studies, 68% (n = 13) had an experimental study design, the rest were observational studies. In particular, we considered seven randomized controlled trials, 26,[31][32][33][34][35][36] five non-randomized trials, 27,30,37-39 three cross-sectional studies, 29,40,41 one case-control study, 42 and three studies that we considered to have an operational research approach. 37,43,44 Studies' sample size ranged from 50 to 9213 subjects (median = 341).…”

“…35 Five studies focused on childhood-recommended vaccines without listing specific vaccines. 31,[40][41][42]44 Nine studies considered influenza vaccine, 26 Due to high degree of heterogeneity between studies no quantitative assessment could be performed.…”

“…31,33,35,36,38,40,41 Text messaging can be applied to the following interventions: patients remind/ recall 31,35,36,38,40,41 and multicomponent interventions including education. 33,36 Retrieved studies were published between 2011 and 2013, all in the US.…”

“…Study populations Study populations included parents of children 31,35,36,40,41 and adolescents, 35,38 pregnant women, 33 providers and medical staff. 41 In two studies the predominant ethnicity was white, 31,40 in others the percentage of latino ethnicity ranged from 42% to 85%. 35,36,41 In one study almost 70% of enrolled subjects were African American.…”

Effect of Mobile Phone Text Message Reminders on Routine Immunization Uptake in Pakistan: Randomized Controlled Trial (Preprint)

“…Qualitative studies conducted in the US have also shown parents acceptability for text message immunization reminders, factors affecting mothers/caregivers' decision to vaccinate their child and benefits of receiving text for immunizations [34,35]. Further SMS text messages content were explored with parents/caregivers in order to prompt them to schedule their child's immunization appointment [36].…”