Text Message Reminders for the Second Dose of Influenza Vaccine for Children: An RCT

Abstract

BACKGROUND AND OBJECTIVES: Among children requiring 2 influenza doses in a given season, second dose receipt nearly halves the odds of influenza. Nationally, many children do not receive both needed doses. This study sought to compare the effectiveness of text message reminders with embedded interactive educational information versus usual care on receipt and timeliness of the second dose of influenza vaccine. METHODS: This trial took place over the 2017 to 2018 and 2018 to 2019 influenza seasons among 50 pediatric primary care offices across 24 states primarily from the American Academy of Pediatrics’ Pediatric Research in Office Settings practice-based research network. Caregiver-child dyads of children 6 months to 8 years in need of a second influenza vaccination that season were individually randomized 1:1 into intervention versus usual care, stratified by age and language within each practice. Intervention caregivers received automated, personalized text messages, including educational information. Second dose receipt by April 30 (season end) and by day 42 (2 weeks after second dose due date) were assessed using Mantel Haenszel methods by practice and language. Analyses were intention to treat. RESULTS: Among 2086 dyads enrolled, most children were 6 to 23 months and half publicly insured. Intervention children were more likely to receive a second dose by season end (83.8% versus 80.9%; adjusted risk difference (ARD) 3.8%; 95% confidence interval [0.1 to 7.5]) and day 42 (62.4% versus 55.7%; ARD 8.3% [3.6 to 13.0]). CONCLUSIONS: In this large-scale trial of primary care pediatric practices across the United States, text message reminders were effective in promoting increased and timelier second dose influenza vaccine receipt.

Text vs Patient Portal Messaging to Improve Influenza Vaccination Coverage

“…We suspect the UCLA Health population has knowledge about influenza vaccination, has ready access to influenza vaccines from pharmacies and primary care, and has largely decided about vaccination, limiting the impact of low-intensity messaging at the population level. For children needing a second vaccine, reminders are highly beneficial probably because many parents are unaware of the need for 2 vaccinations. Thus, behavioral economic strategies (eg, message framing, personalization, scarcity, urgency, appeal to authority) may not be effective except where knowledge is lacking.…”

Examination of Text Message Plans and Baseline Usage of Families Enrolled in a Text Message Influenza Vaccine Reminder Trial: Survey Study

“…Funded by the National Institute of Health (NIH R01HD086045), the Flu2Text randomized control trial was conducted during the 2017-2018 and 2018-2019 influenza seasons to investigate whether SMS text message reminders can impact the effectiveness and timeliness of receipt of the second dose of influenza vaccine for those who need 2 doses in a season [ 23 ]. Of the 50 practices in this study, 46 were from the Pediatric Research in Office Settings (PROS) Network, the pediatric primary-care practice-based research network of the American Academy of Pediatrics (AAP), and the remaining 4 were affiliated with the Children’s Hospital of Philadelphia (CHOP) and Columbia University, respectively.…”

What Health Systems Can Do Now to Improve Human Papillomavirus Vaccination

“…A reminder/recall system like the one used in the Finney Rutten et al trial is one such intervention shown to effectively increase vaccination. Though Finney Rutten et al used mailed reminders, alternative methods of communication like text messages and automated phone calls have also been shown to be effective in improving vaccination and are scalable at low cost. Centralizing these notification efforts, as has been done by health departments and is also readily done in health systems, could further bolster immunization compared to individual practice–based efforts and may be more efficient …”