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Text messages helped to reach vulnerable population for flu vaccine reminders
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WASHINGTON — Sending text message reminders to parents of urban children appeared to be effective at increasing vaccine delivery in this at-risk population, according to study results presented this week during the 45th Annual National Immunization Conference.
The objective of the study by Melissa Stockwell, MD, MPH, assistant professor of clinical pediatrics at Columbia University, New York Presbyterian Hospital, and colleagues was to determine the efficacy of text message reminders for increasing timely influenza vaccination in urban, minority, low-income children — a population with especially low coverage rates. Primary outcome of the study was receipt of at least one influenza vaccine dose by Nov. 30 and February 28, assessed using Pearson’s chi-square test. Traditional immunization reminders have had limited effectiveness in low-income populations, according to Stockwell, and text messaging is a novel, measureable approach to promote influenza vaccination that has not been studied.
“Cell phone penetration is 96% of the US population and is high in low-income population,” Stockwell said during her presentation.
Using intention-to-treat analyses, 38.9% of intervention children aged 6-23 months vs. 32% (P<.01) of controls received a dose of influenza vaccine by Nov. 30, and 40.9% using per protocol analyses (P<.001). Rates were 57.4% for intervention children vs. 50.4% for control children as of February 28, using per protocol analyses (P<.01). There were no baseline differences between intervention and control children.
The researchers randomly assigned 9,213 children aged 6 months to 18 years intervention and control groups for the 2010-2011 influenza season. Children were patients in four community clinics associated with an academic medical center in an underserved community in New York City.
“They were primarily a minority population and spoke Spanish,” Stockwell said.
Through a text messaging system linked to the hospital’s immunization registry, parents of children in the intervention group received five weekly text messages that included education about vaccine importance and information about location and timing of influenza vaccine clinics. Messages were sent from October to mid-November, and were sent in English or Spanish.
All children, intervention and control, received standard of care that included an automated telephone reminder and fliers posted in the community clinics.
“It seems that text messaging is efficacious for young children. While the difference was 7 to 9 percentage points, even that change could make a real difference in coverage if used in a large population,” Stockwell said. “There need to be more studies looking at this.”
This study was funded by the Health Resources and Services Administration.
Disclosure: Dr. Stockwell reported no relevant financial disclosures.
In our own community- based public health immunization work through the years, which is closely linked to an immunization registry, we have found that a telephone-based reminder-recall system is very effective in maintaining fairly impressive levels of age-appropriate compliance with the vaccine schedule across all age groups, but especially with the younger infants and children. Our experience has been primarily with land lines since this is what was available when the system was first set up. The prior, now outdated, pager technology was effective to a certain extent, but not as effective as what seems to be occurring with cellular phones.
However, given the increasing availability and popularity of cell phones, and the frequent use of text messaging for communicating, this certainly makes sense, and I believe it could easily be incorporated into registry reminder-recall systems.
Considering that text messaging is being used for promoting any number of public health messages, or reminders about appointments, pending meetings, and other activities, there is great potential and benefit for using with immunization programs. Perhaps in the future, it might even serve the purpose of obtaining individual immunization records.
—Fernando A. Guerra, MD, MPH
Infectious Diseases in Children Editorial Board
member
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