New study measures the impact of text message reminders on HPV vaccine series completion

Text message reminders led to timely HPV vaccine series completion across a low-income, urban, minority population, according to a new study. Findings from the study will be presented during the Pediatric Academic Societies (PAS) 2019 Meeting, taking place on April 24—May 1 in Baltimore.

"HPV vaccine is a critical cancer-protecting vaccine; yet, only half of adolescents have received their needed doses," said Melissa Stockwell, MD, MPH, FAAP, Associate Professor of Pediatrics and Population and Family Health at Columbia University Irving Medical Center, the lead author of the study. "Even among those who start the series, only three-quarters get all the doses needed for protection. In this study, we found that text message vaccine reminders are a powerful, rapid and scalable way to help encourage families to have adolescents complete their vaccine series."

In this AHRQ-funded study, eligible 9 to 17-year-olds receiving their first HPV vaccine at four affiliated community clinics in Northern Manhattan from December 2014 through December 2016 were randomized 1:1 to receive one of two types of text message vaccine reminders. Conventional messages included next dose due date and site-specific walk-in hours. Enhanced educational reminders included educational information targeted to the parent's stage of vaccine decision-making based on the transtheoretical model. The primary outcome was timely HPV vaccine series completion within 12 months (receipt of two or three doses, based on age and enrollment date, accounting for the 2016 change in CDC guidelines).

Chi-square analyses compared the intervention arms to concurrent non-enrollees who received their first vaccine dose during the study period, but who were not enrolled because they were ineligible, not able to be contacted or refused. Participants were also compared to historical controls (first dose administered 2011-2013); for this analysis adolescents from the intervention arms who only needed two doses to complete the series were removed in order to be more directly comparable. In addition, population coverage for those who received their first dose within the three years prior (2011-2013) and three years (2014-2016) during the intervention were calculated.

Overall, 956 parents of 1,264 eligible families enrolled. Adolescents were half female, and primarily Latino (89%), less than or equal to 14 years (92%), and publicly insured (94%). Two-thirds of parents were primarily Spanish speaking; 60.0% had not finished high school. Both text message arms had similarly high timely series completion rates within 12 months: educational (72.4%) versus conventional (75.7%). Those who were in any text message arm had significantly higher completion rates than non-enrollees (n= 1503)(74.1% vs 45.2%; P<0.0001). In addition, even after removing those who only needed two doses to complete the series, they had higher rates than the historical controls (n= 2823)(71.1% vs. 34.8%; p<0.0001). Finally, a population-wide effect was seen during the years of the study 2014-16, above historical trends.