Flu vaccination reminder via text messaging improves rate of vaccination among low-income children

April 24, 2012

A text messaging intervention with education-related messages sent to parents increased influenza vaccination coverage compared with usual care in a traditionally hard-to-reach, low-income, urban, minority population of children and adolescents, although coverage overall remained low, according to a study in the April 25 issue of JAMA.

"Timely vaccination is the cornerstone of influenza prevention through vaccination of susceptible populations before illness becomes epidemic in communities. The effectiveness of the in children and adolescents ranges from 66 percent to 95 percent, depending on age, vaccine type, and season," according to background information in the article. Children and adolescents ages 6 months to 18 years are at increased risk for influenza illness and death, and influenza is one of the most common causes of hospitalization in children and adolescents. Influenza nationally remains low; only 51 percent of those ages 6 months to 17 years were vaccinated in the 2010-2011 season according to parental report. "Coverage is lower in low-income populations who are at higher risk of influenza spread due to crowded living conditions," the authors write. "Traditional vaccine reminders have had a limited effect on low-income populations; however, text messaging is a novel, scalable approach to promote influenza vaccination."

Melissa S. Stockwell, M.D., M.P.H., of Columbia University, New York, and colleagues evaluated the effect of targeted text messages for low-income, urban parents to promote influenza vaccine receipt among children and adolescents. The included 9,213 children and adolescents ages 6 months to 18 years who were receiving care at 4 community-based clinics in the United States during the 2010-2011 . Of the 9,213 children and adolescents, 7,574 had not received influenza vaccine prior to the intervention start date and were included in the primary analysis. Parents of children assigned to the intervention received up to 5 weekly immunization registry-linked text messages providing educational information and instructions regarding Saturday clinics. Both the intervention and usual care groups received the usual care, an automated telephone reminder, and access to informational flyers posted at the study sites.

The children and adolescents in the study were primarily minority, 88 percent were publicly insured, and 58 percent were from Spanish-speaking families. As of March 31, 2011, a higher proportion of children and adolescents in the intervention group (43.6 percent) compared with the usual care group (39.9 percent) received the influenza vaccine. Of all children and adolescents vaccinated by this date, 93.9 percent of the intervention group were vaccinated outside of the Saturday clinics compared with 97.2 percent of the usual care group.

At the cohort-based fall review date, 27.1 percent of the intervention group vs. 22.8 percent of the usual care group had received influenza vaccine.

The authors note that the intervention effect was greater in a subgroup analysis accounting for delivery of text messages, lending support to the inference that text messaging was effective in promoting the behavioral changes leading to increased vaccination. "Using text messaging (especially when linked with electronic health records [EHRs] or registries) to identify and notify large patient populations in need of vaccination could be an efficient means for improving influenza vaccination rates in adults as well as and ."

Text messaging to increase vaccination coverage has numerous strengths, the authors write. "It can reach large populations, and for vaccines like recommended for the majority of the population, even small increases in vaccination rates can lead to large numbers of protected individuals. It may also be cost-effective. Once the system is set up, the only variable cost is the sending of the text messages, which, even using commercial platforms, usually cost pennies per message. Therefore, depending on the size of the population, even amortizing upfront and monitoring costs, text messaging is inexpensive on a per individual basis."

"Underlying overall remained low, as they do nationally, and further studies are recommended to identify ways to maximize the potential of text messaging," the researchers conclude.

Peter G. Szilagyi, M.D., M.P.H., of the University of Rochester School of Medicine and Dentistry, Rochester, New York, and William G. Adams, M.D., of the Boston University School of Medicine, Boston, write in an accompanying editorial that the "study by Stockwell et al is a modest step forward in an important area of public health."

"Modest steps are the norm when complex behaviors and systems are targeted such as receipt of preventive services. Nonetheless, these systems have substantial potential, particularly when the technologies are tailored to individual patients and families, delivered in an actionable way, and driven toward important health behaviors. There can be little doubt that in the next decade there will be an increasing use of such systems and their application to additional services. As recently as 10 years ago, e-mailing patients was considered novel and text messaging did not exist. Within the next few years, the novel findings presented in this study will also become a routine component of the complex system of health care delivery."

Explore further: Pediatric flu vaccination: Understanding low acceptance rates could help increase coverage

More information: JAMA. 2012;307[16]:1702-1708.
JAMA. 2012;307[16]:1748-1749.


Related Stories

Pediatric flu vaccination: Understanding low acceptance rates could help increase coverage

April 28, 2011
A study of H1N1 and seasonal influenza vaccination in a sample of black and Hispanic children in Atlanta found a low rate of vaccine acceptance among parents and caregivers. Only 36 percent of parents and caregivers indicated ...

Study evaluates parents' reluctance to vaccinate asthmatic kids

May 16, 2011
Concern over vaccine safety is one of the primary factors preventing parents from having their asthmatic children vaccinated for influenza, or flu, according to Michigan researchers. Parents who do not vaccinate their children ...

Influenza vaccination of pregnant women helps their babies

February 21, 2012
Vaccinating pregnant women against the influenza virus appears to have a significant positive effect on birth weight in babies, according to a study published in CMAJ (Canadian Medical Association Journal).

Recommended for you

To combat teen smoking, health experts recommend R ratings for movies that depict tobacco use

July 21, 2017
Public health experts have an unusual suggestion for reducing teen smoking: Give just about any movie that depicts tobacco use an automatic R rating.

Why sugary drinks and protein-rich meals don't go well together

July 20, 2017
Having a sugar-sweetened drink with a high-protein meal may negatively affect energy balance, alter food preferences and cause the body to store more fat, according to a study published in the open access journal BMC Nutrition.

Opioids and obesity, not 'despair deaths,' raising mortality rates for white Americans

July 20, 2017
Drug-related deaths among middle-aged white men increased more than 25-fold between 1980 and 2014, with the bulk of that spike occurring since the mid-1990s when addictive prescription opioids became broadly available, according ...

Aging Americans enjoy longer life, better health when avoiding three risky behaviors

July 20, 2017
We've heard it before from our doctors and other health experts: Keep your weight down, don't smoke and cut back on the alcohol if you want to live longer.

Parents have critical role in preventing teen drinking

July 20, 2017
Fewer teenagers are drinking alcohol but more needs to be done to curb the drinking habits of Australian school students, based on the findings of the latest study by Adelaide researchers.

Fresh fish oil lowers diabetes risk in rat offspring

July 19, 2017
Fresh fish oil given to overweight pregnant rats prevented their offspring from developing a major diabetes risk factor, Auckland researchers have found.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.