Sending parents text messages with education-related messages and a reminder about influenza vaccination improved coverage among groups that are usually hard to reach, research has shown. But the US study, published today in JAMA, showed that even with the intervention, vaccination uptake remained low among vulnerable children.
Researchers decided to study the effect of sending text messages about flu vaccination to parents from low-income, urban, minority groups because traditional vaccine reminders have had limited effect in improving vaccination uptake among low-income populations – which, they say, are most at risk of influenza spread because of crowded living conditions.
They studied 9213 children 6 months to 18 years old, who were receiving care at one of four community-based health clinics in the US during the 2010-11 flu season. Of these, 7574 had not had influenza vaccine and were randomised to either ‘usual care’ (an automated telephone reminder and posters at the study sites) or to the additional intervention. This meant their parents were sent up to five weekly text messages with educational information, and instructions about Saturday immunisation clinics.
Most children in the study were from minority groups; 88% were publicly insured and 58% were from Spanish-speaking families.
At the time of the first review, in November/December 2010, 27.1% of children in the intervention group had been vaccinated against flu, compared with 22.8% of those in the usual care group. By the end of March 2011, 43.6% of children in the intervention group had had their flu vaccine, compared with 39.9% of those in the usual care group.
When the researchers controlled for delivery of text messages, the intervention had a greater effect on uptake of vaccination compared with usual care. They said: “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 children and adolescents.”
They reported that text messaging “can reach large populations, and for vaccines like influenza 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.”
However, they concluded: “Underlying vaccination coverage overall remained low, as they do [sic] nationally, and further studies are recommended to identify ways to maximize the potential of text messaging.”
The author of an accompanying editorial said: “As recently as 10 years ago, emailing 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 healthcare delivery.”